Sputum Smear Examination Research Articles

Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis.

Introduction Vitamin D has a significant role in host immune defense against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was therefore undertaken to identify the association between vitamin D deficiency and pulmonary tuberculosis. Methods A case-control study was conducted in a tertiary care hospital from 2014 to 2016, including 50 adult newly diagnosed sputum positive pulmonary tuberculosis patients as cases and 50 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D, calcium, and sputum for AFB. The clinical characteristics, X-ray findings, sputum AFB, and vitamin D levels were analyzed and compared with data obtained from healthy controls. Results In both groups, the majority were men (88%). BMI was significantly (<0.0001∗) lower in the tuberculosis group (19.40 (17.20, 22.0) vs. 24.00 (22.50, 25.47)). Serum vitamin D levels were significantly lower (P = 0.012) in the tuberculosis group (19 (7.75, 27.25) ng/dl) as compared to the control group (25 (19.75, 32.00) ng/dl). Out of 50 TB patients, 27 (54%) had vitamin D deficiency, while among healthy controls, only 13 (26%) had vitamin D deficiency. Among vitamin D deficient PTB patients, 44% had 3+/hpf AFB in sputum smear examination. Conclusion The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high. Hypovitaminosis D was associated with more severe clinical symptoms, higher sputum smear positivity, and extensive lesions in chest radiograph among pulmonary tuberculosis patients.

Evaluation of the Xpert MTB/RIF test accuracy for rapid diagnosis of pulmonary tuberculosis in a tuberculosis endemic area

Aim and objectives: Mycobacterium tuberculosis (MTB) is a causative agent of tuberculosis (TB) which remains as an endemic disease in Iran. One of the most significant steps for control of TB is the fast and accurate diagnosis of patients. Examination of sputum smears is the primary method for TB diagnosis, and the culture method remains as the gold standard. Recently, a molecular assay that named Xpert MTB/RIF assay (Xpert), was introduced for rapid diagnosis of TB. The aim of this study was to evaluate the performance of the Xpert assay for diagnosis of TB in Golestan province. Methods: The TB suspected cases which referred to Tuberculosis Reference laboratory, Gorgan, Iran, from March 2018 to February 2019 were included to this study. The sputum specimens were examined using smear microscopy after Ziehl–Neelsen staining and graded according to the International Union Against Tuberculosis and Lung Disease scale (scanty, 1+, 2+, 3+ and 4+). The Xpert analysis was performed according to the manufacturer's instructions and the provided semi-quantitative results for positive specimens (very low, low, medium and high) were documented. The specimens were cultured into Lowenstein-Jensen (LJ) culture media after decontamination by Petroff's method. Sensitivity and specificity of Xpert and smear microscopy were calculated using a culture as reference standard. Results: Of 102 presumptive TB cases, 17 (16.7%) had culture proven TB. The set of 16 (94·1%) culture-confirmed TB cases were equivalently detected using smear microscopy and Xpert. Compared to the culture method, specificity of Xpert and smear microscopy was 100% (85/85) and 97.6% (83/85), respectively. Both tests had a sensitivity of 94.1% (16/17). When the semi-quantitative results of Xpert were compared with smear microscopy, there was 92.3% agreement for specimens with medium/high results, with those that had 1+ to 3+ scales. Conclusion: The rapid and accurate laboratory diagnosis of TB is one of the most important steps for TB control programs. In this study, the Xpert was effectively used to early and accurate diagnosis of TB in the study area. In the other hand, correlation between the Xpert semi-quantitative results and smear microscopy showed that Xpert could help in evaluation of patient's transmission potential.

Demographic and clinical factors affecting health-related quality of life in patients with pulmonary tuberculosis in Jazan, Saudi Arabia

Introduction Despite the abundant literature about health-related quality of life (HRQOL) in patients with active pulmonary tuberculosis (PTB) and the scarcity of published literature in KSA, this is the first study to assess the 6-min walk test, sputum examination, and tuberculin test for patients with PTB in correlation with HRQOL domains. Patients and methods The study aimed to measure HRQOL among patients with PTB and to identify the demographic and the clinical factors that may affect HRQOL. A cross-sectional study using the WHO-BREF 26-item questionnaire was carried out on 114 patients with PTB at a secondary hospital in Jazan from September 2018 to September 2019. Results There was a significant association between the overall perception of health and health status of patients. The social domain had the lowest scores, followed by the environmental, psychological, and lastly, the physical domains. The influence of comorbidities has a significant correlation with the environmental and social domains for HRQOL in patients with PTB. A significant correlation was found between the 6-min walk test and physical and psychological domains. However, sputum smear examination and tuberculin test did not significantly relate to HRQOL domains. Conclusion A decrease of the four domains in the assessment of the HRQOL in PTB has been noted in relation to some demographic and clinical factors.

FIRST LINE ANTI-TUBERCULOSIS DRUG RESISTANCE PATTERN IN MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS PATIENTS CORRELATE WITH ACID FAST BACILLI MICROSCOPY GRADING

Multidrug-resistant tuberculosis (MDR-TB) is a global public health crisis. Acid-fast bacilli (AFB) gradation in sputum examination is an important component in Pulmonary Tuberculosis (PTB) diagnosis and treatment outcome monitoring. Previously treated pulmonary TB patients with a higher AFB smear gradation may have higher rates of acquired resistance. Patients with a higher AFB grade indicate a higher bacillary load and had higher rates of acquired resistance. This study aims to evaluate the correlation between AFB gradation and first-line anti-TB drug resistance patterns in MDR pulmonary TB patients. This was a retrospective study conducted from August 2009 to April 2018 in Dr. Soetomo Hospital. Sputum samples were taken from MDR PTB patients. Sputum smear examination was done using Ziehl–Neelsen staining and gradation was measured according to IUATLD criteria. Samples with positive smear were evaluated for resistance patterns based on culture and resistance tests using the MGIT 960 BACTEC System. There were 433 sputum samples with AFB positive collected from MDR PTB patients. Resistance to RHES was found in 22 (14%) AFB +1, 19 (15%) AFB +2, and 29 (20%) AFB +3. Resistance to RHS was found in 22 (14%) AFB +1, 12 (9%) AFB +2, and 13 (9%) AFB +3. Resistance to RHE was found in 39 (25%) AFB +1, 38 (29%) AFB +2, and 35 (24%) AFB +3. Resistance to RH was found in 74 (47%) AFB +1, 61 (47%) AFB +2, and 69 (47%) AFB +3. Statistic analysis by Spearman test showed that there was no significant correlation between AFB gradation and first-line anti-TB drug resistance patterns. Acquired resistance to RHES can also found in lower bacillary load AFB +1.

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.

Procalcitonin (PCT) levels in pulmonary tuberculosis patients with acid fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which enters the droplet nuclei into the mouth or nasal passages to reach the pulmonary alveoli. The sputum smear examination for smear-positive and negative smear pulmonary tuberculosis is challenging due to requiring a longer time to get the results. Therefore, a specific marker is needed that is able to detect bacterial infections immediately, such as procalcitonin (PCT). This study aims to determine the levels of PCT in pulmonary tuberculosis patients with acid-fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia.Method: A cross sectional was conducted among 40 pulmonary tuberculosis patients who met the inclusion and exclusion criteria at Haji Adam Malik General Hospital, Medan, Indonesia. The subjects were 20 positive smears and 20 negative smears. PCT examination with mini VIDAS BRAHMS was carried out using the Sandwich principle using the ELFA method (Enzyme-Linked Fluorescent Assay). Sputum examination was carried out by smear of Zhiel Neelsen smear, which was analyzed by the Mann-Whitney (Non-Parametric) test using SPSS version 17 for Windows. Results: Most of the respondents were males in both positive and negative smears group (65.0% and 70.0%, respectively) and not significantly different (P&gt;0.05). The age of subjects was slightly older in positive smear (49.75 ± 17.993 years) compare with negative smear group (42.50 ± 14.816 years) but not statistically significant (P=0.172). The PCT levels in pulmonary tuberculosis patients with positive smear (0.1550; 21.65 ng/mL) differ significantly from the PCT levels in pulmonary tuberculosis patients with negative smear (0.05; 3.14 ng/mL) (p=0.0001). The cut off value using ROC found 0.06 ng/mL (AUC: 0.842) with a sensitivity of 80% and a specificity of 80%.Conclusion: There was a significant difference in the level of procalcitonin in patients with pulmonary tuberculosis who smear-positive and smear-negative.

Tuberculosis, an old disease, still present in Romania

Tuberculosis is a chronic infection, most often affecting the lungs, which usually manifests after a latency period from primary infection with Mycobacterium tuberculosis. Symptoms are generally nonspecific, with fever, cough, weight loss and malaise. The diagnosis is based on microscopic examination of sputum smear and rapid diagnostic molecular tests, which are increasingly used today. Genotypic tests for establishing the strain involved and phenotypic antibiograms for early detection of drug resistance should guide the initiation of treatment but are still expensive. Treatment of active tuberculosis is done with combination of antimycobacterial drugs, administered for at least 6 months. The antituberculosis treatment has several purposes: to cure the patient, to reduce the risk of recurrence, to prevent the installation of chemo-resistance, to prevent complications and to reduce mortality, as well as to limit the spread of the infection. Drug combinations are used to prevent the development of resistance. The administration is long-lasting in order to achieve the sterilization of foci that are difficult to access by medicines, ensuring healing and relapse prevention. Generally, standard pharmacological protocols are used. In order to increase the adherence to the treatment and its completion, often the anti-tuberculosis treatment is done under direct observation, in what is called directly observed therapy. Undesirable effects of anti-tuberculosis drugs should be detected early and managed appropriately. Recently, many cases of tuberculosis are resistant to the first-line drugs isoniazid and rifampicin (multidrug-resistant tuberculosis), or to these drugs, fluoroquinolones and at least one injectable antimycobacterial drugs (extensively drug-resistant tuberculosis). Especially the treatment of the latter is difficult to do, because there are not currently too many therapeutic options. That is why it is important to detect the resistance early and to establish the appropriate treatment. Treatment of latent tuberculosis usually involves the administration of isoniazid for 9 months. BCG vaccination is an active immunization method used in countries with high incidence of tuberculosis (Romania being the country of the European Union with the highest incidence of tuberculosis), protecting mainly against miliary tuberculosis, a spread form of tuberculosis, severe especially in children.

TO ASSESS THE RESPONSE AND OUTCOME OF THE TB PATIENTS REGISTERED AT DTC REWA OF CENTRAL INDIA

Background-Tuberculosis is a highly infectious disease caused by Mycobacterium tuberculosis. The disease primarily affects lungs so it known as Pulmonary TB and other tissues of the body which is known as Extra-pulmonary TB. The vast majority of TB deaths are in the developing world left untreated, Tuberculosis is treatable with a course of antibiotics. The most successful strategy to treat TB patients is DOTS.&#x0D; Material and Method: This is a Prospective Longitudinal study conducted among the patients attending DOTS center of DTC located at S.G.M.H. campus Rewa for the Treatment provided under of a definitive time period ( as per RNTCP, last quarter of 2014) from 1st Oct to 31st Dec 2014.&#x0D; Aim &amp; Objective: 1. To observe the sputum conversion rate of study population. 2. To find out the outcome of treatment. Result: 69.92%were pulmonary tuberculosis and 30.07% was Extra-pulmonary tuberculosis and sputum conversion rate of Pulmonary TB cases at the end of IP in new sputum smear positive cases was 96.66% but at the end of 5 month it was 100%. In retreatment cases Sputum Conversion rate at the end of IP was 89.28% and at the end of 5 month 92.85%.and overall treatment success rate were 90.97%. &#x0D; Conclusion: At the end of treatment as per DOTS schedules sputum smear examination is mandatory to know the exact treatment cure rate.&#x0D; Key words: Pulmonary, Extra-Pulmonary, Sputum Conversion, cured, Treatment completed, Defaulter etc.

Chest Radiography and Xpert MTB/RIF® Testing in Persons with Presumptive Pulmonary TB: Gaps and Challenges from a District in Karnataka, India.

Background In India, as per the latest diagnostic algorithm, all persons with presumptive pulmonary TB (PPTB) are required to undergo sputum smear examination and chest radiography (CXR) upfront. Those with sputum smear positive, sputum smear negative, but CXR lesions suggestive of TB or those with strong clinical suspicion of TB are expected to undergo Xpert MTB/RIF® assay test (also known as CB-NAAT (cartridge-based nucleic acid amplification test)). Objective To assess what proportion of PPTB who are undergoing sputum smear examination at microscopy centers of public health facilities have undergone CXR and CB-NAAT. To explore the barriers for uptake of CXR and CB-NAAT from the public health care provider's perspective. Methods We conducted a sequential explanatory mixed-methods study in Chikkaballapur district of Karnataka State, South India. The quantitative component involved a review of records of PPTB who had undergone sputum smear examination in a representative sample of seven microscopy centers. The qualitative component involved key informant interviews with four medical officers and group interviews with 9 paramedical staff. Results In February and March 2019, about 732 PPTB had undergone smear examination. Of these, 301 (41%) had undergone CXR and 49 (7%) had undergone CB-NAAT. The proportion of PPTB who had undergone CXR varied across the seven microscopy centers (0% to 89%). CB-NAAT was higher in PPTB from urban areas when compared to rural areas (8% vs. 3%) and in those who were smear positive when compared to smear negative (65% vs. 2%). The major barriers for CXR and CB-NAAT were nonavailability of these tests at all microscopy centers and patients' reluctance to travel to the facilities where CXR and CB-NAAT services are available. Conclusions CXR and CB-NAAT of PPTB are suboptimal. RNTCP should undertake measures to address these gaps in implementing its latest diagnostic algorithm.

Light emitting diode (LED) based fluorescence microscopy for tuberculosis detection: a review.

Since time immemorial, tuberculosis (TB) has intimidated the human race owing to its severity. Its socio-economic burden has led to it being a major cause of concern. It is one of the world's major causes of death from a single agent. Since most of the middle- and low-income countries are burdened with TB, sputum smear examination using conventional light microscopy is often the only resort for diagnosing TB. However, fluorescence microscopy is used as standard in most high-income countries, owing to its increased sensitivity. Light-emitting diodes (LEDs), being inexpensive, are increasingly gaining popularity as an alternative light source for fluorescence microscopy. It has been found to be highly efficient and has a lot of advantages over the conventional Ziehl-Neelsen-based bright field microscopy. In this review, we discuss about the usefulness of LED-based fluorescence microscopy in diagnosing TB and how it is superior to the other sources of light used.

Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study

Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.

Yield of direct sputum smear examination in pulmonary tuberculosis suspect cases with hemoptysis

Introduction: Hemoptysis is one of the cardinal symptoms of pulmonary tuberculosis (PTB) as per the Revised National Tuberculosis Control Programme 2016 guidelines. Hemoptysis in tuberculosis patients usually occurs in those who have a large bacillary load like that in a cavity. Direct smear done from the sputum of a PTB suspect with hemoptysis should have a higher diagnostic yield due to the greater bacillary load in such patients. Keeping this intention in mind, our study was conducted to systematically inquire into the efficacy of a cheap and easily available test like direct sputum smear examination in PTB suspect cases of hemoptysis. Materials and Methods: This was a prospective, hospital-based, analytical study, conducted on 100 PTB suspects with hemoptysis, who were attending the Outpatient and Emergency Department of National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Patients were enrolled over a period of 8 months. All patients underwent routine clinical and radiological evaluation and sputum examination in the form of direct smear by Ziehl–Neelsen (ZN) staining and mycobacterium growth indicator tube (MGIT) culture. Results: Most of the patients (25%) belonged to the age bracket 16–25 years followed by 24% of patients who belonged to the age group of 26–35 years. Fifty-two percent of patients had the cavity in their chest X-ray findings in which mostly were the unilateral cavity (39%). Direct sputum microscopy was found to be positive in 56% of patients. In comparison to MGIT, it had a sensitivity of 79% and a positive predictive value of 92%. Conclusion: Direct smear examination in hemoptysis patients should be a first line essential investigation as it is a good, cheap, easily available, and quick test. The yield of the test increases if the patient is young, male, with a previous history of antitubercular therapy intake and cavitary lesions on the radiological findings.

Viable Mycobacterium tuberculosis in sputum after pulmonary tuberculosis cure

BackgroundPulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it.MethodsNew sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for 6 months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured.ResultsAmong 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of 6 months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase.ConclusionViable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.

National Control of Tuberculosis: Does Primary Health Care System Play a Crucial Role in the Fight Against Tuberculosis?

To analyze the tuberculosis control studies in a primary health care center and to observe the changes throughout the years. Data of patients followed up between 2005 and 2014 in the Elazığ Dispensary were investigated retrospectively. Of the total 1,251 patients, 51.6% were male. Majority of patients were aged between 15 and 24 (19.9%), 25 and 35 (18.5%), and over 65 (14.4%). While the rate of a sputum smear examination was 71.6%, the positivity rate for Acid-Fast bacilli was 55.5%. It was detected that the drug sensitivity test was applied in only 25.8% of all patients. The treatment success of all patients was 85.8%. The cure rate of smear-positive cases was found to be 26.35%. The rate of the relapsing patients was 9.1%. An overall treatment response rate was found to be 87.4%. The control of tuberculosis in primary health care is partially successful and insufficient. The rate of smear-positive defaulters was found to be high in young adult individuals, which indicates that the contamination is probably still going on at a dangerous rate. Furthermore, the overall rate of microscopic examination, sputum culture, and drug sensitivity tests performed in patients in the primary health care system is low and should be improved immediately.

Sputum Negative Tubercular Adults Spread Infection and Disease to Their Household Children

To examine whether tuberculosis sputum negative adults can spread disease to their household children. A patient based study was conducted over a time period of one year, on children of those adults who were suspected case of “sputum smear positive” as well as “sputum smear negative” diagnosed with pulmonary tuberculosis at JNMCH, India. Various investigations like tuberculin test, chest X-ray, fine needle aspiration cytology (FNAC) of lymph nodes, gastric aspirate, acid-fast bacilli (AFB) sputum smear examination and others were done to attain the goal of this study. Out of 129 children, 69 were in household contact of sputum smear positive and 60 in contact of sputum smear negative adults. Forty children were found to be Mantoux positive; of which the ratio of children that were in contact of sputum positive adult to those in contact of sputum negative adult was 2:1 (27 vs 13). A small percentage (6%) of asymptomatic children was found to be diseased. Sputum positivity, low socio-economic status as well as less than 3 years of age exhibited strong association with infection as well as disease; nonetheless the number of infected and diseased children in sputum smear negative group is not negligible. A considerable number of screened children that were in contact with sputum negative tubercular adult were found to be infected as well as diseased; hence this group should not be ignored. A portion of Mantoux positive children were found to be asymptomatic and one-third of diseased children were Mantoux negative, so Mantoux cannot be taken as a gold standard for diagnosis of tuberculosis.

Tuberculosis Patient Adherence to Treatment and Transmission to Home Contact Family Members

Tuberculosis is a contagious disease that remains a health problem worldwide. Treatment of tuberculosis is one of the main strategies in controlling tuberculosis because it can break the transmission chain, especially in families of household contacts where transmission is twice as risky as casual or unfamiliar contact. The purpose of this study was to analyze secondary data on patient adherence to pulmonary tuberculosis treatment sessions and transmission to household contact families in 2016-2017 at a private hospital in Indonesia. This research used a correlative descriptive design with Secondary Data Analysis (ADS) approach using existing data as primary data that is TB 06 and TB 09 data, TB 01 (medical card TB PKM). The population in this research was based on the report of patient data of TB DOTS year 2016-2017 with 60 TB patients. The statistical analysis used was Pearson’s r. The result of the research showed that the patient’s adherence of pulmonary tuberculosis to treatment sessions. [D1] The value of adherence was seen from all respondents of tuberculosis patients which coming to the referral clinic according to the TB 06, and TB 09. As well as the patient’s record card at the referral clinic showed all the respondents routinely took the anti tuberculosis medication and completed the treatment as recommended by the doctor. Investigation based on 60 respondents, there is 23.3% or 14 people diagnosed based on sputums, while remaining 46 people or 76.7% [D2] based on radiology results. Identification of household contact families members found positive sputum smear examination of 5 people (8.3%) and found to be undergoing tuberculosis treatment as many as 4 people (6.7%).The results of this study found a relationship between tuberculosis patient adherence to treatment sessions and transmission to household contact family with P value 0.001 (&lt;0.05) with a moderate correlation (r) = 0.378%. For further [D3] treatment, the nurse includes TB 06 and TB 09 sheets for follow up treatment at the public health service center. [D1]Edit the sentence [D2]Please use the correct sentence to explains this data [D3]Are tb patients hospitalized? Did you mean nursing care at home&gt;

Automated identification of mycobacterium bacillus from sputum images for tuberculosis diagnosis

Tuberculosis is a terrible, transferrable disease instigated by infection with Mycobacterium tuberculosis bacillus. A common diagnosis of this infection is the microscopic examination of sputum smears of affected persons. This paper presents an automatic system for detecting the bacillus present in the stained microscopic images of sputum which eases the job of laboratory technician with manual detection. In this work, the Channel Area Thresholding algorithm is proposed for segmentation of the bacterial image. The intensity-based local bacilli features are extracted using location-oriented histogram and speeded up robust feature algorithm. The exact classification of the bacilli objects after segmentation is carried out using deep learning neural networks. Experimental results show that the proposed work had the classification accuracy of about 97.55 on sputum image dataset.

Karakteristik Penderita Tuberculosis Multidrug Resistant (TB MDR) di Sulawesi Tenggara Tahun 2014-2017

ABSTRACTBackground:MDR TB is one type of bacterial tuberculosis resistance to first-line anti-TB drugs, Isoniazid and Rifampicin. Data from the Provincial Health Office of Southeast Sulawesi cases of MDR TB increase every year that is in 2014 there are 7 patients with MDR TB, 2015 there are 8 patients with MDR TB, 2016 there are 23 patients with MDR TB, and in 2017 there are 28 patients with MDR TB. The purpose of this study is to explain the characteristics of patients with MDR TB in Southeast Sulawesi in 2014-2017. Research Purpose: This study is to explain the characteristics of patients with MDR TB in Southeast Sulawesi in 2014-2017. Research Method: The location of this study was in the Provincial Health Office of Southeast Sulawesi and Bahteramas General Hospital of Southeast Sulawesi Province with study population included all patients diagnosed with MDR TB in Southeast Sulawesi Province 2014-2017. The research data is processed to know the number and percentage of each characteristic of MDR TB patients in Southeast Sulawesi 2014-2017. Research result: The conclusion of the result of the study is characteristic of MDR TB patient in Southeast Sulawesi 2014-2017 dominated by age 15-55 years old, male gender, entrepreneur job, case of drop out treatment, examination of chest X-ray in the form of infiltrate and cavity, sputum smear examination (+1), the type of Rifampicin resistance, and is still temporarily treated.Keyword: MDR TB, age, sex, occupation, medical history, investigation, type of resistance and treatment outcome.

Erectile dysfunction in pulmonary tuberculosis: is it a common association?

BackgroundGenital tuberculosis (TB) has negative influences on the reproductive function, and pulmonary TB causes disruption of the sexual function as well. The purpose of this study was to estimate the influence of pulmonary TB on male sexual function and sex hormones.Patients and methodsOf the 55 newly diagnosed male patients with pulmonary TB (40 pulmonary and 15 extrapulmonary: six with TB lymphadenitis and nine with TB pleuritis), 20 healthy volunteers served as control. All patients were evaluated: full clinical data, sputum smear examination, chest radiography, serum testosterone levels, and The International Index of Erectile Function (IIEF-5) questionnaires.ResultsOf the studied TB cases 78.1% had erectile dysfunction, with a higher prevalence in pulmonary TB (67.2%) when compared with the 10.9% in extrapulmonary TB. As regards radiographic patterns, the patients presented with consolidation/cavitary lesion had the highest prevalence (60%). According to the IIEF questionnaires, the total score in the pulmonary group was significantly lower than that in the extrapulmonary group (10.8±2.05 vs. 20.2±3.09) (P=0.000*). The mean testosterone level was significantly decreased in pulmonary TB cases. Sputum grading of acid-fast bacilli in patients with pulmonary TB showed that the testosterone level was significantly decreased among patients with ‘3+’ (>10 acid-fast bacilli/field) sputum smears (3.23±2.88 ng/ml) when compared with sputum negative. A significant correlation was found between bacillary load and the total score of IIEF and serum testosterone levels (r=−0.323, P=0.000*).ConclusionPulmonary TB has a negative impact on male sexual function. Thus, sexual problems should be in mind during the assessment and evaluation of patients with TB.

Comparison of tuberculin skin test and interferon-gamma release assay in the diagnosis of latent tuberculosis infection among indonesian health-care workers

Background: Health-care workers are groups that are close contact with tuberculosis (TB) patients. As an alternative to the tuberculin skin test (TST), there is interferon-gamma release assay (IGRA) for the diagnosis of latent TB infection (LTBI). The objective of this study is to compare TST and IGRA in the diagnosis of LTBI among Indonesian health-care workers. Methods: This study design was a cross-sectional study. TST results are consistent for LTBI if there is induration ≥10 mm in individuals without previous TST, or ≥15 mm in participants with a history of previous TST. Medical history interview, physical examination, chest X-ray, and sputum smear examination were performed to exclude active TB infection. Results: Among 84 healthcare workers, the prevalence of LTBI was 51.2% by IGRA and 29.8% by TST with sufficient agreement (κ = 0.34). Age and low education were significantly correlated with the positive results of IGRA (P