Sputum Negative Pulmonary Tuberculosis Research Articles

Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis.

Tuberculosis (TB) is a major global cause of ill health. Sputum microscopy for confirmation of presumptive pulmonary TB (PTB) has a reportedly low sensitivity of 22-43 per cent for single smear and up to 60 per cent under optimal conditions. National TB Elimination Programme in India recommends the use of cartridge-based nucleic acid amplification test (CBNAAT) and culture for microbiological confirmation in presumptive PTB individuals with sputum smear negative test. The use of lateral flow urine lipoarabinomannan (LF-LAM) is usually recommended for the diagnosis of TB in HIV-positive individuals with low CD4 counts or those who are seriously ill. The objective of this study was to detect urinary LAM using cage nanotechnology that does not require a physiologic or immunologic consequence of HIV infection for LAM quantification in human urine in 50 HIV-seronegative sputum smear-negative PTB individuals. To study the diagnostic value of urinary LAM in sputum smear negative PTB individuals, a cage based nanotechnology ELISA technique was used for urinary LAM in three different groups of participants. Fifty smears negative PTB clinically diagnosed, 15 smear positive PTB and 15 post TB sequel individuals. Sputum was tested by smear, CBNAAT, and culture along with urine LAM before treatment. The results were interpreted by ROC curve in comparison to the standard tests like CBNAAT and culture. The mean urinary LAM value was 0.84 ng/ml in 37 culture-positive [Mycobacterium tuberculosis (M.tb)] and 0.49 ng/ml in 13 culture-negative (M.tb) smear-negative individuals with PTB, respectively. In 47 smear-negative PTB cases with microbiologically confirmed TB by CBNAAT, the mean urinary LAM was 0.76 ng/ml. The mean urinary LAM in post-TB sequel individuals was 0.47 ng/ml. As per the receiver operating characteristic curve, cut-off value of urinary LAM in individuals with smear-negative PTB microbiologically confirmed by: (i) CBNAAT was 0.695 ng/ml and (ii) culture was 0.615 ng/ml. The findings of this study suggest that individuals with smear-negative PTB and a urinary LAM value of >0.615 ng/ml were most likely to have microbiological confirmed TB while those with a LAM value <0.615 ng/ml >0.478 ng/ml are less likely and those with a value <0.478 ng/ml are unlikely to have microbiological confirmed TB.

DIAGNOSTIC ROLE OF GASTRIC ASPIRATION IN SMEAR NEGATIVE PULMONARY TUBERCULOSIS IN ADULT

To study the diagnostic utility of gastric aspiration in sputum negative pulmonary tuberculosis by identifying gastric smear for AFB and culture.To compare the outcome among HIV positive and negative individuals. To study how many were false negative due to improper techniques in sputum sample submission. To compare the radiological patterns with yield in gastric aspiration.To investigate the role of bronchoscopy in smears negative pulmonary tuberculosis.From this study, gastric aspirate for smear positivity among sputum smear negative pulmonary tuberculosis was 24% and gastric culture positivity was 22%. Gastric aspirate for AFB smear and culture can be used as a tool in diagnosis of pulmonary tuberculosis in patients who cannot submit sputum and patients who are smear negative as suggested by the study.Gastric aspirate performed on 2 consecutive days may improve the diagnostic yield.Gastric aspirate performed among HIV positive patients was only 10%.Gastric aspirate positivity in culture had a high yield among chest xray with suspected pulmonary tuberculosis with consolidation pattern(38%).There is practice of prescribing fluoroquinolone for community acquired pneumonia in private. The patients seeking treatment in a tertiary care centre are not naïve population .Many of them would have had treatment and exposed to fluoroqunilones before presenting to us and hence these patients are at the risk of developing fluroquinolone resistant pulmonary tuberculosis. DOTS program in India is functioning at the level of primary health centre where sophisticated techniques like bronchoscopy are not available, patient presenting with no sputum under suspicion of tuberculosis, gastric aspirate can be performed as a diagnostic technique which is a simple outpatient procedure.

Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

Tuberculosis (TB) is one of the common infections in the world, especially in developing countries like India. Therefore, early diagnosis is important. This study was undertaken to compare the yield of sputum, induction with bronchoalveolar lavage (BAL) in smear-negative suspected pulmonary TB patients in a tertiary care hospital in Agra. Fifty patients were included in the study. In all patients, induced sputum, fibreoptic bronchoscopy and BAL fluid were subjected to diagnostic testing. On acid-fast smear examination, induced sputum and BAL fluid tested positive in 27/50 and 25/50 patients, respectively with a sensitivity of 83.3% and 90% respectively (p<0.0001). On comparing sputum induction versus BAL on culture, 30 patients were positive by sputum induction and 27 patients were positive on BAL fluid, with the sensitivity of 85.7% and 77.1%, respectively. The results showed that the sputum induction showed a significantly higher yield than that of BAL fluid (p=0.0013). Sputum induction offers an alternative approach in the diagnosis of smear-negative suspected pulmonary TB patients and would enhance sensitivity for the diagnosis of TB.

Screening and preliminary validation of biomarkers in sputum-negative pulmonary tuberculosis based on positron emission tomography/computed tomography and transcriptomics

Objective: To screen and perform preliminary clinical validation of biomarkers of activity based on positron emission tomography/computed tomography (PET-CT) and transcriptomics in sputum-negative pulmonary tuberculosis lesion tissue. Methods: Nine patients with sputum-negative pulmonary tuberculosis treated surgically at the Shanghai Public Health Clinical Center for Thoracic Surgery from January 1, 2017 to December 31, 2019 were retrospectively collected as the discovery group, including four males and five females, aged 20-57 years (mean 36 years). All of the patients underwent PET-CT scanning before surgery, and the resected specimens were postoperatively classified according to preoperative PET-CT. The resected specimens were divided into areas with increased fluorodeoxyglucose (FDG) metabolism (SUVmax>3) and areas with normal FDG metabolism (SUVmax ≤ 3) according to the preoperative PET-CT performance. After sample processing, total RNA was extracted from the tissues of different regions, and then whole gene transcriptome sequencing was performed. Bioinformatics analysis of the two sets of data was performed to discover the expression profiles of the differences in whole gene transcriptome data between the two regions and to screen for candidate biomarkers. Eighty patients with sputum-negative pulmonary tuberculosis admitted to Shanghai Public Health Clinical Center from January 1, 2019 to January 1, 2021 were retrospectively collected as the validation group, including 37 males and 43 females, aged 20-62 years, with an average age of 39 years. The validation group was divided into a group with increased SUV (n=40) and a group without lesions on CT imaging (n=40). Enzyme-linked immunosorbent assay (ELISA) was used to determine the protein levels of candidate biomarkers in the peripheral plasma of patients. The effect of biomarkers was assessed using subject operating characteristic (ROC) curves. Student's t-test was used to determine whether the difference in protein levels between the two groups was statistically significant. Results: Bioinformatics analysis revealed that the expression levels of C1QB, CCL19, CCL5 and HLA-DMB correlated with the metabolic activity of sputum-negative tuberculosis lesion tissue. Further screening and validation by the validation group confirmed that the difference in C1QB protein levels in the peripheral plasma of patients was statistically significant between the group with increased SUV and the group without lesions on CT imaging [(3.55±0.34) mg/L vs. (2.75±0.21) mg/L, t=4.12, P<0.001]. And the ROC curve showed that the area under the curve for C1QB protein levels was 0.731, which had potential clinical value. Conclusion: The C1QB protein level can be used to assess the activity of lesions in patients with sputum-negative tuberculosis and is a potential biomarker.

Non-response in a child with pulmonary tuberculosis: a story of strange partners

This case report is about a 13 years old boy who was diagnosed to have sputum negative pulmonary tuberculosis. Anti-tuberculosis treatment (ATT) was continued for it and he initially showed improvement but later transitioned into a slowly progressive persistent pneumonia. In this scenario, most appropriate approach is to work the patient up for persistent tuberculosis (TB)/multidrug-resistant TB (MDR-TB) due to poor compliance to treatment or emergence of resistant tubercular strains. This patient was treated on the same lines but did not improve. The initial tubercular disease process was joined by a strange forgotten partner whose diagnosis was tough. Many times, in clinical practise such dilemmas are encountered wherein secondary disease pathology gets masked by primary disease process. We present one such case and how we managed it.

Diagnostic value of bronchoscopy in sputum-negative pulmonary tuberculosis patients and its correlation with clinicoradiological features.

CONTEXT:Tuberculosis (TB) remains endemic in Saudi Arabia. Little local data have been reported on bronchoscopic evaluation of sputum-negative pulmonary TB patients, which poses a significant diagnostic and therapeutic challenge.AIMS:To determine the diagnostic value of bronchoscopy and bronchoalveolar lavage (BAL) and its correlation with clinical and radiological features in sputum-negative, culture-confirmed pulmonary TB patients.METHODS:We performed a retrospective analysis of patients with definite or probable pulmonary TB with overall negative (smear and/or polymerase chain reaction [PCR]) or scanty sputum that had undergone bronchoscopy with BAL over a period of 5 years. Patients’ symptoms, radiological features, lung lobe lavaged, BAL acid-fast bacilli (AFB) stain, Mycobacterium TB (MTB)-PCR, and mycobacterial cultures were analyzed. Mycobacterial cultures (either sputum or BAL) were used as a reference standard.RESULTS:Out of 154 patients, 49 (32%) were overall sputum negative and underwent a diagnostic bronchoscopy. Dry cough and fever were the most common symptoms. Uncontrolled diabetes mellitus was the most frequent comorbidity identified in 15 (31%) patients. Fifty-nine percent of the patients had diffuse lung infiltrates, with consolidation being the most common abnormality (41%), followed by cavitation (39%). Right upper lobe was the most frequent lung lobe lavaged (31%), while transbronchial lung biopsies (TBLB) were obtained in 21 (43%). BAL mycobacterial culture and MTB PCR were positive in 35 (71%) and 23 (47%) patients, respectively. Combined BAL MTB PCR and TBLB provided rapid diagnosis in 28 (57%) patients.CONCLUSIONS:An overall diagnostic yield of 90% was achieved with combined use of BAL MTB PCR, culture, and histopathology. Upper lobe lavage and presence of cavities on chest imaging had a higher diagnostic yield.

Diagnostic accuracy of BAL Gene Xpert compared to BAL AFB staining in Sputum negative Pulmonary Tuberculosis Suspects

Tuberculosis has stood the test of time over the millennia and still wreaks havoc on human life all over the world. We have studied the role of bronchoscopy in smear negative PTB suspects and have compared the results of BAL Gene Xpert with BAL AFB staining among the study population. We have also determined the microbiological profile in cases who are MTB negative. We retrospectively reviewed the respiratory samples (sputum and BAL) of 82 sputum negative PTB suspects from july 2018 – july 2019 for ZN stain and Gene Xpert. 25 cases were detected by Gene Xpert additionally to the 11 cases detected by BAL afb staining alone. Out of the 36 cases detected on gene Xpert 3(8%) were RIF resistant. These 5 samples which were positive on BAL AFB and negative on Gene Xpert,are suspected to be NON TB mycobacteria. Out of the remaining 41 samples, non TB culture results showed 8 Acinetobacter, 10 pseudomonas, 12 klebsiella, 2 e.coli,2 candida, 7 no growth on culture. According to our study, the bronchoscopic samples when subjected to Gene Xpert detect a higher number of cases which would go undetected otherwise compared to BAL AFB staining. Hence, bronchoscopy must be performed on such smear negative suspects and Gene Xpert could replace smear microscopy as initial diagnostic testing. It also helps in detecting first line drug resistance in addition.

A CLINICO-PATHOLOGICAL STUDY ON CYTOLOGICAL SCREENING OF BRONCHOALVEOLAR LAVAGE AND SUBSEQUENT CORRELATION WITH ADENOSINE DEAMINASE, GENEXPERT MTB IN SUSPECTED SPUTUM NEGATIVE PULMONARY TUBERCULOSIS

BACKGROUND: Sputum negative pulmonary tuberculosis is a world-wide burden on health budget. Clinico- radiologically suspected sputum negative pulmonary tuberculosis needs to be diagnosed using cytopathology along with ADA levels and GeneXpert MTB tests of BAL fluid obtained through bronchoscopy. AIM: To interpret the cytological screening of bronchoalveolar lavage and subsequent correlation with adenosine deaminase, genexpert mtb in suspected sputum negative pulmonary tuberculosis. METHODS: Patients visiting Pulmonary Medicine outdoor of R.GKAR Medical College Hospital, who are clinico radiologically being suspected as pulmonary tuberculosis but are sputum smear AFB negative on two consecutive samples. The study group includes these patients who are willing to undergo bronchoscopy, in whom there are neither any medical contraindications nor other miscellaneous restraints i.e. the study group contains cases of pulmonary TB as well as other infectious malignant non-infectious lung diseases. RESULT: Of the 61 patients, 41(67.2%) patients were male and 20(32.8%) patients were female. The average age of male patients was 51.71years and the average age of female patients was 39.35years.The mean ADA level of BAL fluid in patients with Pulmonary Tuberculosis was 22.54 U/L (Normal level – less than 30 U/L) and mean ADA level of BAL fluid in patients without Pulmonary Tuberculosis was 4.76 U/L (Normal level – less than 30 U/L). CONCLUSION: Cytology of bronchoalveolar lavage along with adenosine deaminase and GeneXpert MTB are important diagnostic and screening tools in suspected sputum negative pulmonary tuberculosis. As it can detect different kinds of inflammatory and other types of cells, it can also help in choosing the appropriate therapeutic procedure / modality for a disease.

Diagnostic accuracy of metagenomic next-generation sequencing for active tuberculosis in clinical practice at a tertiary general hospital.

BackgroundTo evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) for active tuberculosis (TB).MethodsWe retrospectively collected 820 samples at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 April 2017 and 31 March 2018. They were classified into TB cases (125, 15.2%) and NOT TB cases (695, 84.8%) according to the clinical diagnosis. Specimens were evaluated by a regular clinical microbiological assay and mNGS performed in parallel.ResultsSixty-one confirmed TB cases and 64 clinical TB cases were included. The overall sensitivity of mNGS was 49.6% [95% confidence interval (95% CI), 40.6–58.6%], and the specificity was 98.3% (95% CI, 96.9–99.1%), with peak sensitivities of 88.9% (95% CI, 50.7–99.4%) for lung tissue, 55.0% (95% CI, 32.0–76.2%) for bronchoalveolar lavage fluid (BALF), and 50.0% (95% CI, 32.8–67.2%) for serous fluids. The overall sensitivity of mNGS was superior to that of the culture assay (35.2%, 95% CI, 27.0–44.3), but no superior sensitivity for sputum was observed in mNGS compared with the culture assay (mNGS: 52.3%, 95% CI, 31.1–72.6%; culture: 60.9%, 95% CI, 38.8–79.5%). In clinical TB cases, mNGS detected additional positive results (40.6%, 26/64). mNGS reduced the turnaround time from 2–6 weeks to 32–36 hours.ConclusionsmNGS may be a promising technology for the early auxiliary diagnosis of active TB, especially sputum-negative pulmonary TB (PTB) and tuberculous serous effusion.

Utility of Bronchoalveolar Lavage in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

INTRODUCTION: Sputum smear examination for acid fast bacilli (AFB) by Ziehl-Neelsen stain (ZN stain) is the initial approach to the diagnosis of pulmonary tuberculosis (PTB). But 50% of the cases are reported to be sputum smear negative. This study was aimed to investigate the diagnostic yield of fibreoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. The sample was tested for Mycobacterium tuberculosis using the XpertMTB/RIF assay, which is a new test that detects Mycobacterium tuberculosis complex and resistance to rifampin in less than two hours.&#x0D; MATERIAL AND METHODS: This is a prospective cross sectional study carried out on 58 sputum smear negative patients who were clinically suspected to have pulmonary tuberculosis from April 2017 to January 2019. All patients are subjected to FOB, BAL and BAL specimens were stained for AFB and also sent for Xpert (MTB)/RIF.&#x0D; RESULTS: Among 58 patients enrolled for the study 26 patients were positive for acid fast bacilli (AFB) through BAL stain and Xpert (MTB)/RIF combined.&#x0D; CONCLUSION: FOB guided BAL is a reliable, alternative and rapid method for diagnosing smear negative pulmonary tuberculosis with minimal complications.

Comparison of LJ Medium and BACTEC MGIT 960 Culture System for the Diagnosis of Tuberculosis

Introduction: Sputum negative pulmonary Tuberculosis (TB) is a major public health problem. So, the emergence of new techniques for a more precise and rapid microbiological identification of Mycobacterium tuberculosis in clinical samples is of great importance to improve the management of TB. Aim: To determine and compare the sensitivity and turnaround time for Mycobacterium tuberculosis detection by the BACTEC Mycobacteria Growth Indicator Tube (MGIT) 960 system, Lowenstein Jensen (LJ) medium and Ziehl-Neelsen (ZN) staining. Materials and Methods: An Institution based, observational, cross-sectional study was conducted at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, from July 2013-March 2016. Sputum, pericardial fluid, pleural fluid, peritoneal fluid, pus and endometrial tissue samples were collected from 80 patients of suspected TB cases. All were Acid-Fast stained by ZN staining method and cultured on solid culture LJ medium and on liquid medium (MGIT). Data was analysed using Statistical Package for the Social Sciences (SPSS) software, Version 20.0 (SPSS Inc, Chicago, IL, USA). Fisher’s-Exact test was used to show association of categorical variables. Non-parametric Mann-Whitney U test was used to show median difference of non-normally distributed continuous variables of two groups. Results: Out of the 80 samples, 41 cases were positive by either of the all methods. The positive specimen for ZN staining, LJ media and MGIT were 21, 29 and 41 cases respectively. The mean Time To Detection (TTD) was shorter for MGIT system than LJ media. Both LJ medium and MGIT 960 detected all cases of sputum smear positive cases and in addition significantly higher number than ZN stain in sputum smear negative cases. MGIT 960 detected significantly higher number of cases of sputum negative cases than LJ Media. The mean TTD was also significantly shorter in case of smear positive cases than the smear negative cases by both the solid and liquid culture mediums. Conclusion: The use of liquid media (MGIT) is more accurate and rapid method for the diagnosis of TB. The combination of more than one method is also highly recommended for rapid detection and early treatment of TB.

Clinico-demographic characteristic of multidrug-resistant pulmonary tuberculosis presenting to tertiary care hospital of India

Introduction: Multidrug-resistant tuberculosis (MDR-TB) is emerging as major problem due to poor management of drug-sensitive as well as drug-resistant TB. This study designs to assess clinical-demographic and radiological characteristic of MDR pulmonary tuberculosis. Material and method: This was a retrospective record-based study of 85 MDR pulmonary tuberculosis patients diagnosed in pulmonary medicine department AIIMS Patna between 1st Jan 2016 and 31st Dec 2017. All the socio-demographic and clinical-radiological features of MDR tuberculosis were entered in Microsoft Excel and compared. Results: Total 85 patients were diagnosed with MDR tuberculosis in 2016–2017 period. Seventy four patients fulfil inclusion criteria with mean age of 26.78±15.75. There were 56 (75.67%) males and 18 (24.32%) females. Out of 74 study patients, 19 (25.67%) occur in new cases. The most commonly present symptom in study patients was cough (100%) followed by fever, breathlessness, anorexia, and haemoptysis in decreasing order. On radiological examination, 56.75% patients had bilateral disease. The extent of chest X-ray involvement showed far advanced disease in 18.91% of the patients, moderately advanced disease in 67.56%, and 13.51% of the patients had minimal disease. HIV test result was performed in 58 patients in which 2 patients showed positive result (3.4%). Sputum for AFB was negative in 25 (34.72%) patients. Conclusion: High degree of suspicion was required even in sputum negative pulmonary tuberculosis as almost one-third of patients have sputum negative for acid base bacilli at the time of diagnosis.

Diagnostic Accuracy of Interleukin-27 in Bronchoalveolar Lavage Fluids for Pulmonary Tuberculosis.

BackgroundThe World Health Organization states that China had 0.9 million cases of tuberculosis in 2017, accounting for 9% of cases globally. Despite a decrease in the incidence and mortality of tuberculosis in China over time, development in choosing the appropriate prevention and control of TB is required.PurposeThe aim of this study was to evaluate the diagnostic significance of interleukin-27 in bronchoalveolar lavage fluids for pulmonary tuberculosis.Materials and methodsEventually, 107 bronchoalveolar lavage fluids from patients were included in this study. The concentrations of interleukin-27 and adenosine deaminase were determined in bronchoalveolar lavage fluids using enzyme-linked immunosorbent assay.ResultsIt was found that the concentrations of interleukin-27 in bronchoalveolar lavage fluids of sputum-positive pulmonary tuberculosis group were significantly higher than those in sputum-negative pulmonary tuberculosis, lung cancer, and previous pulmonary tuberculosis groups, respectively (all P<0.001). Interleukin-27 levels in bronchoalveolar lavage fluids could be used for diagnostic purpose for pulmonary tuberculosis, with the cutoff value of 7.867 pg/mL; interleukin-27 had a sensitivity of 68.8% and specificity of 100% for the differential diagnosis of pulmonary tuberculosis (sputum-negative and sputum-positive PTB) from lung cancer. And with the cutoff value of 6.012 pg/mL, IL-27 had sensitivity and specificity of both 100% for the differential diagnosis of PTB from previous PTB. The risk of pulmonary tuberculosis was positively associated with the concentrations of interleukin-27 and adenosine deaminase in bronchoalveolar lavage fluids.ConclusionInterleukin-27 in bronchoalveolar lavage fluids is a sensitive and specific biomarker for the differential diagnosis of pulmonary tuberculosis from lung cancer and previous pulmonary tuberculosis.

Diagnostic role of gastric aspiration in sputum negative pulmonary tuberculosis

Diagnostic role of gastric aspiration in sputum negative pulmonary tuberculosis

Radiological difference between new sputum-positive and sputum-negative pulmonary tuberculosis.

Introduction:The current guidelines for the diagnosis of pulmonary tuberculosis (PTB) are based primarily on the demonstration of acid-fast bacilli (AFB) on sputum microscopy and chest radiograph. Knowing various radiological manifestations and their association with sputum microscopy findings can allow for early diagnosis and early initiation of treatment.Aims:This study was performed to compare the chest radiograph features seen in sputum-positive and sputum-negative tuberculosis patients, respectively.Materials and Methods:It was a prospective observational study, which included 147 consecutive patients newly diagnosed and treated as PTB between Jan 2018 and July 2018. Chest X-ray was reviewed by 2 independent radiologists and the findings were compared between sputum-positive and sputum-negative PTB cases. The obtained data were analyzed by statistics using SPSS version 15 for Windows (SPSS Inc., Chicago, IL) and χ2 test and Student t test were used for statistical analysis. P values < 0.05 were considered statistically significant.Results:Out of a total of 147 patients, 38 (25 males and 13 females, mean age 35.23 ± 18.40) were sputum positive and 109 (77 males and 32 females, mean age 36.07 ± 18.15) were sputum negative. The frequency of patchy consolidation (78.94% vs 49.54%) and cavitation (36.84% vs 15.59%) was significantly higher in sputum-positive PTB (P < 0.05). Radiological lesions like nodular shadow (10.09% vs 2.63%), cystic lesion (13.76% vs 5.26%), fibrosis (12.84% vs 7.89%), miliary shadows (2.75% vs 2.63%), and pleural effusion (1.83% vs 0%) were seen more commonly with sputum-negative PTB but the difference was not statistically significant for any of these features. Sputum-positive PTB tends to occur more commonly on the left side (47.36%) compared with sputum-negative PTB (27.52%) (P < 0.05). 34.21% and 35.77% of the chest X-ray lesions were bilateral in sputum-positive and sputum-negative PTB, respectively.Conclusion:Patchy infiltration and cavitation on chest X-ray are seen more frequently in sputum-positive cases of PTB compared with sputum-negative cases.

Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India.

Introduction:Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert.Materials and Methods:Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program).Results:The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016–2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy–negative patients for Xpert, and incompletely filled referral forms.Conclusion:Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing.

Chest X ray score (Timika score): an useful adjunct to predict treatment outcome in tuberculosis.

Chest X-ray (CXR) has been used since long as an aid in the diagnosis of pulmonary tuberculosis (PTB) and also to determine the extent of the disease. The present study was conducted to evaluate the correlation of disease extent on CXR basing on the Timika CXR score with clinical and microbiological parameters at baseline, in sputum positive cases of pulmonary tuberculosis. The study was conducted at a tertiary referral centre for chest diseases in Bangalore, Karnataka from January 2017 to January 2018. This is a prospective study of new sputum smear positive pulmonary tuberculosis cases diagnosed in the department of Pulmonary Medicine. At baseline, patients' symptoms and signs on chest auscultation were recorded. The clinical scoring was done by the Karfosky performance score (KPS) and TB score I (Bandim TB score) and II. Baseline CXR- PA view of each patient was assessed independently by two chest physicians and evaluated by the Timika CXR scoring method. Routine blood investigations and sputum smear for acid fast bacilli were done. The correlation between the CXR score and other disease severity parameters was analysed. Clinical scores such as the KPS and TB score I (Bandim TB score) and II, did not correlate with the presence of cavitary disease on CXR (p > 0.05). 48.6% of patients with cavitary disease had higher baseline AFB density in sputum (i.e. sputum smear microscopy grade 3+) as compared to 40% of patients with non cavitary disease, which was not statistically significant. CXR score > 71 was significantly associated with longer duration of symptoms, higher clinical scores (KPS and TB score I, II) and lower Body Mass Index (BMI) at diagnosis of PTB (p < 0.05). 65.2% of the patients with CXR score ≤ 71 had significantly higher baseline AFB density as compared to only 32.4% with CXR result > 71 (p 0.04). CXR score > 71 also had significant association with higher ESR. Cavitary disease on CXR is associated with a higher mycobacterial load at baseline. The Timika CXR score is a simple, standard scoring system which can be used by a chest physician in a clinical setting. The CXR score significantly correlates with a broad range of clinical and microbiological measures of disease severity in PTB patients. Thus, it has a role in risk stratification, especially in patients not producing sputum or sputum negative PTB at diagnosis.

A Case Study of Rifampicin Resistance in Newly Detected Sputum Negative Pulmonary Tuberculosis Patients by CBNAAT

A Case Study of Rifampicin Resistance in Newly Detected Sputum Negative Pulmonary Tuberculosis Patients by CBNAAT

The role of genexpert in diagnosis of sputum-negative pulmonary tuberculosis

Background The GeneXpert MTB/RIF assay is a new diagnostic test that depends on a real-time PCR analysis of the sample for diagnosis of tuberculosis (TB) and detection of rifampicin resistance. Aim The aim was to evaluate the role of role of GeneXpert in the diagnosis of sputum-negative pulmonary TB. Patients and methods This study included 30 patients suspected to have TB, with mean age being 45.5±17.7 years. All patients had clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Patients having no or incomplete data were excluded from the study. Results This study included 30 patients suspected to be have TB, comprising 24 (80%) males and six (20%) females. Their age ranged from 18 to 70 years, with a mean age of 45.5±17.7 years. They were selected from the Chest Departments of Bab El-Sha’eria, Al-Hussein University, and El-Abbasia Chest Hospitals in the period from February 2017 to December 2017. All patients have clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Our study showed that GeneXpert was positive in 11 (36.7%) patients and negative in 19 (63.3%) patients. Conclusion The GeneXpert assay can be used as a gold standard to diagnose TB. As it is sensitive and specific for diagnosing smear-negative pulmonary TB, the assay is faster than culture.

Role of Cartridge based nucleic acid amplification test (CBNAAT) in new sputum negative pulmonary tuberculosis

Role of Cartridge based nucleic acid amplification test (CBNAAT) in new sputum negative pulmonary tuberculosis