AFB Sputum Smear Research Articles

Glycemic Control Effect on Acid-Fast Bacteria Conversion in Diabetic Patients with Tuberculosis

Background Diabetic people have a 2-3 times higher risk of tuberculosis than non-diabetic people. Immunocompromised conditions due to diabetes increase the risk of therapeutic failure and delayed sputum conversion, which may cause by poor glycemic control. This study was conducted to determine the glycemic control effect on AFB conversion in diabetic patients with tuberculosis. Methods A cross-sectional study has been conducted on 100 diabetic patients with the new emergence of pulmonary tuberculosis. All patients were in intensive phase treatment of tuberculosis for two months at Bhayangkara R. Said Sukanto's Hospital. Data collected from medical records were random blood glucose level, percentage of random blood glucose decrement, HbA1C, and the microscopic AFB sputum smear. Fisher exact test analysis was conducted to determine the effect of random blood glucose level, percentage of blood glucose decrement and HbA1C to AFB smear results using SPSS V25.0 software for Windows with a significance level of 0.05. Results The analysis between glycemic control and AFB sputum smear conversion using random blood glucose, percentage of random blood glucose decrement and HbA1C showed a p-value of 0.000, indicating a significant relationship (p<0.05), so it showed that glycemic control affects AFB sputum smear conversion. Conclusions A significant relationship exists between glycemic control and AFB-negative conversion in patients with DM and TB. RBG showed the best sensitivity and specificity as a glycemic control parameter compared to others.

Active case finding of pulmonary tuberculosis and HIV infection among prisoners of South Gujarat: A cross sectional study

BackgroundIn a close knit congregation such as prison, Tuberculosis (TB) and HIV can be major health problems. However, their prevalence in Indian prisons is under reported. This study aimed at adopting a camp based, active case finding approach to identify cases of TB, HIV and at risk prisoners in a central prison of South Gujarat. MethodsA multidisciplinary team of public health experts, pulmonologists, social workers and lab technicians conducted a week-long camp to screen 1665 prisoners for TB using clinical examination, sputum smear for AFB, CBNAAT and Chest X-Ray and for HIV through Rapid Antigen Testing. ResultsMajority of participants (1392, 84%) were under trail prisoners, having spent an average of 1.4 years in prison. About 2.9% of participants had previous history of TB, of whom only 59% had completed treatment. About 14% of participants were underweight. Weight reduction was found to be significant in first five years of imprisonment. Of all participants, 3.6% were found to have diabetic range of blood sugar. Seven new active, drug sensitive pulmonary TB cases and three new cases of HIV infection were identified. All new cases of TB, HIV and increased blood sugar levels were linked to treatment. ConclusionCamp based approach is effective in active case finding of pulmonary TB and predisposing factors such as malnourishment, Diabetes and HIV among prisoners. Routine screening of all prisoners at the time of entry and monthly thereafter in a camp based approach should be adopted to identify TB and at risk prisoners.

Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

BackgroundPeople successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care.MethodsWe enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion.ResultsOf 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44–7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86–4.48).ConclusionOur results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.

Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana.

Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. We performed a retrospective study of adults presenting with CAP from April 2010-October 2011 to the Emergency Department (ED); we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. We identified 1305 individuals presenting with CAP; TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive and 87% were identified as being HIV-positive. Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana.

Association between level of interferon gamma and acid-fast bacillipositivity in pulmonary tuberculosis

Tuberculosis is an infectious disease which caused by Mycobacterium tuberculosis (M. tuberculosis) that infected numerous organ especially the lung. A person’s immunity is very affecting for a person exposed to pulmonary tuberculosis. T-helper-1 cell (Th1) is very influential in the immune system especially in interfering intracellular bacterial infection. One of the cytokines known produced by Th1 cell is interferon gamma (IFN-γ) which is in eliminating M. tuberculosis. The study aims to identify the association between level of IFN-γ and AFB positivity in pulmonary tuberculosis patients in Medan. It is a case-control study. The subjects of the study were 60 new cases of pulmonary tuberculosis with AFB sputum smear- positive that never received ATT consisting 20 cases AFB (+1), 20 cases AFB (+2) and 20 cases AFB (+3).Samples were plasma collected from the venous blood of pulmonary tuberculosis patients. The plasma then underwent laboratory assay with ELISA techniques. Independent t-test was p<0.05 considered significant. Level of IFN-γ in TB AFB (+1) is higher than TB AFB (+2) and (+3), with thesignificant statistical result (p=0.001).

The role of FokI polymorphism of vitamin D receptor gene and vitamin D level in multidrug-resistant tuberculosis occurrence in Medan city, Indonesia

IntroductionMultidrug-resistant tuberculosis (MDR-TB) has become a new problem in the world. Many factors have been associated with MDR-TB occurrence. Some studies have demonstrated a role of vitamin D level and vitamin D receptor (VDR) gene polymorphism in MDR-TB. The aim of this study is to explore the role of FokI polymorphisms of the VDR gene and vitamin D level in MDR-TB occurrence in Medan city, Indonesia.Material and methodsThis is a case-control study. Cases were 43 MDR-TB patients from the MDR-TB polyclinic Adam Malik Hospital in Medan, Indonesia. The control group comprised 56 new pulmonary TB cases with positive AFB sputum smear. Patients who were HIV positive, known to have diabetes mellitus or other severe disease, taking immunosuppressive drugs and vitamin D were excluded for both groups. Genetic polymorphisms of the VDR gene were analyzed using PCR-RFLP. Vitamin D level was analyzed using the ELISA procedure.ResultsThe frequencies of FokI genotypes were FF 39.5%, Ff 53.5%, ff 7.0% for MDR-TB patients and FF 39.3%, Ff 46.4.% and ff 14.3% for controls. There was no significant association between FokI genotype of the VDR gene and MDR-TB. Vitamin D level in MDR-TB was 53.5% sufficient, 39.5% insufficient and 7.0% deficient. Vitamin D level was 41.1% sufficient, 46.4% insufficient and 12.5% deficient in TB non-MDR. There was no significant association between vitamin D level and MDR-TB.ConclusionsNo role of FokI polymorphism of the VDR gene and vitamin D level in MDR-TB occurrence was found.

A Study on the Clinical Presentation of Hiv-Tb Coinfection and Its Correlation with Cd4 Count

INTRODUCTION: The burden of TB and HIV /AIDS poses unprecedented challenges on the public health system in India. TB and HIV are overlapping epidemics. They are closely interlinked. Untreated HIV infection leads to progressive immuno deficiency and increased susceptibility to infections including TB. TB is the leading cause of HIV related morbidity and mortality. HIV is the most important factor fuelling the TB epidemic in populations with a high HIV prevalence in many countries especially in sub-Saharan Africa and increasingly in Asia and South America. Studies have shown that there is close association between HIV and TB. Evidence of this interaction included several observations repeatedly made by WHO, National governments and funding partners. These observations are • The areas that have been mostly affected by HIV epidemic also report the greatest increase in the incidence and prevalence of the TB. • The largest increase in TB cases has occurred among people aged 25-40 years. The very same age group mostly affected by HIV/AIDS. • TB is the most common opportunistic infection among AIDS patients(Between 60-75% of AIDS patients will develop TB). • HIV prevalence among TB patients is higher than in the general population. (It is estimated a prevalence of 5.2% of HIV in adult TB in India). AIM OF THE STUDY: 1. To study the clinical presentation of tuberculosis in HIV positive patients. 2. To study the correlation of CD4 count with the radiological findings of Pulmonary tuberculosis. MATERIALS AND METHODS: Place of Study : Department of Medicine, KMCH Type of Study : Cross sectional Study Collaborating Department : Chest Clinic, ART Clinic. Duration of Study : January 2006 to July 2007 Case Selection: INCLUSION CRITERIA: • Patients who have been diagnosed as HIV positive either by Rapid Test or ELISA and who have clinical and investigatory evidence of pulmonary TB or Extra pulmonary TB are enrolled in the study. These patients are picked up from ART Clinic. • Those patients who sought medical attention for any form of Tuberculosis at chest clinic OP, who are HIV negative, are chosen as controls. • Patients between the age group of 15 to 55 are enrolled in the study. EXCLUSION CRITERIA: • Patients below the age of 15 and above the age of 55 are excluded in the study. • HIV positive individuals who did not have clinical or investigatory evidence of any form of TB were excluded. • Patients who had other causes of immuno suppression such as Diabetes, Lymphoma, Leukemea, visceral malignancy, malnutrition, on immuno suppressive drugs were excluded. METHODOLOGY: All HIV positive patients were meticulously examined for the presence of Pulmonary and Extra pulmonary Tuberculosis. Their symptoms were analyzed in a detailed manner. Complete general examinations for presence of opportunistic infection and respiratory system and other system examination were done. All of them were subjected to the following investigations. Basic blood investigation, sputum smear for AFB, chest x-ray PA view, PPD reactivity by mantaoux test and CD4 count. Special investigations were done in patients with extra pulmonary TB like FNAC of lymphnode, biopsy, and CSF analysis. RESULTS: A total number of 60 patients of HIV +ve TB and 30 patients HIV -ve TB were enrolled in this study. All the data were fed into a computer and the results were collected using an epidemiology incorporated software. The following test statistics were used 1) two sample t test, 2) wilcoxon Rank Sum test/Mann -Whitney test, 3) Chi-square test, 4) Fisher -exact. CONCLUSION: 1. As TB is the most common opportunistic infection in all HIV positive individuals, hence all HIV patients should be screened for TB and all TB patients should be screened for HIV status. 2. Tuberculosis has multiple clinical presentations in patients with HIV infection. 3. Atypical chest x-ray findings are common in HIV-TB co infection. 4. The most common atypical presentations are mediastinal adenopathy, lower zone infiltration and miliary mottling. 5. Cavitation is rare in HIV-TB co infection. 6. When the CD4 count is more than 200, upper zone infiltration is more common. When the CD4 count less than 200 atypical xray findings are common. 7. Sputum smear negativity is more common,hence sputum culture is essential as a screening procedure . 8. Mantoux test often is false negative in HIV-TB co infection. 9. Lymphnodes, meninges and pleura are the common sites of extra pulmonary TB involvement. 10.Tuberculosis can occur at any level of depletions of CD4 count but when the CD4 count level is grossly low extra pulmonary TB is more common. Since TB-HIV fuel each other, early diagnosis and proper effective management are essential to reduce the morbidity and mortality.

The profile of tuberculosis infection at the Babcock University Teaching Hospital

Background: Tuberculosis is the leading cause of death from any single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries. Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital. Methods: This was a retrospective cross sectional study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital. Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers – P = 0.05, χ 2 = 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ 2 = 24.74, df = 2. Conclusion: The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment. Keywords: Tuberculosis, HIV, Primary Healthcare Centre, Ziehl Neelson stain, Directly Observed Treatment Short Course, pathogen

Empirical treatment for TB in HIV: lessons from a cohort study of people living with HIV treated in Recife, Brazil

BackgroundTuberculosis (TB) is the leading cause of death related to HIV worldwide. This study analyzes the survival of People Living with HIV (PLHIV) reporting cough without bacteriological confirmation of TB and identify factors associated with death.MethodsProspective cohort with a consecutive sample of PLHIV, aged ≥ 18 years. Patient inclusion criteria were complaint of current cough of any duration at the time of the first study interview or during their subsequent routine visits to health services and for whom AFB sputum smear was either negative or not performed during the whole follow-up period. Kaplan-Meier method was used to calculate the probability of survival. We estimated the Hazard Ratio (HR) in bivariate and multivariate Cox regression analyses.ResultsMortality was 4.6 per 100 py; 73% were receiving HAART at recruitment. Average time from the first recorded date of cough until empirical treatment for tuberculosis was six months. Mortality was higher when the CD4 count was low (HR = 5.3; CI 95%: 3.2-9.0; p = 0.000), in those with anemia (HR = 3.0; CI 95%: 1.6-5.6; p = 0.001) and with abnormal chest X-rays (HR = 2.4; CI 95%: 1.4-4.0; p = 0.001). Mortality was higher in those receiving empirical TB treatment (HR = 2.4; CI 95%: 1.4-4.0; p = 0.002), but only in those with normal X-rays, no history of tuberculosis and no bacteriology requests. Empirical treatment for TB was more frequent in PLHIV with low CD4 counts, anemia, history of opportunistic infections, weight loss, previous tuberculosis, negative bacteriology test (as opposed to not having a test) and abnormal chest X-ray.ConclusionsHigher mortality in PLHIV reporting a current cough without bacteriological confirmation of tuberculosis was identified for those with a CD4 cell count <200, abnormal chest X-ray, anemia and empirical treatment for tuberculosis. Mortality was not significantly higher in those empirically treated for TB, who had three characteristics suggestive of the disease (abnormal chest X-ray, history of TB treatment, AFB sputum smear or M.tb culture testing). Routine cohorts are not an adequate setting to evaluate the impact of empirical treatment for TB on the mortality of PLHIV.

The utility of the interferon gamma-inducible protein-10 (IP-10) level in bronchoalveolar lavage and blood in the diagnosis of tuberculosis

IntroductionControl of TB depends on early detection and treatment of active cases. Aim of the workInvestigating the utility, sensitivity and specificity of interferon gamma inducible protein IP-10 in both blood and bronchoalveolar lavage (BAL) in the diagnosis of TB infection in clinically suspected patients. MethodsThirty patients with clinical and/or radiological suspicion of pulmonary tuberculosis and negative sputum smear for AFB with Z–N stain were included in the study. BAL and blood samples were sent for the estimation of the level of interferon gamma inducible protein IP-10. ResultsIP-10 levels in both blood and BAL were significantly higher in TB patients (P=0.005 and 0.007 respectively). Sensitivity of IP-10 in blood was 100% and specificity was 60%. Positive predictive value was 56%, negative predictive value was 100% and accuracy was 73%. Sensitivity of IP-10 in BAL was 100% and specificity was 35%. Positive predictive value was 44%, negative predictive value was 100% and accuracy was 57%. Sensitivity of IP-10 in blood and BAL were similar (100%) and both were more sensitive than tuberculin skin test (TST) (sensitivity 67%). Detection of IP-10 in blood (specificity=60%) was more specific than its detection in BAL (specificity=35%). On the other hand, specificity of detection of IP-10 in blood (60%) was comparable to the tuberculin test (specificity=62%). ConclusionInterferon gamma inducible protein IP-10 may help in detecting M. tuberculosis infection and monitoring disease activity and efficacy of therapy.

Role of Common Investigations in Aetiological Evaluation of Exudative Pleural Effusions

Pleural effusion is a common problem encountered in daily practice. To Establish aetiology of exudative effusions is a diagnostic challenge to general practitioners and even to pulmonologists especially in resource poor government hospitals with lack of investigations like thoracoscopy. Some recent studies had shown that around 2% of patients remained undiagnosed even after these investigations. To evaluate the role of the commonly available investigations such as pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopy in the aetiological evaluation of exudative effusions and to ascertain the proportion of cases which remain undiagnosed after all the above investigations. This was a prospective single-centred cross-sectional study carried out at the NRS Medical College, Kolkata, India from February 2008 to February 2013 which included 568 patients of exudative pleural effusions. We performed commonly available procedures like pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopic procedures to the diagnosis. Total number of patients studied were 568. Tuberculosis was the most common cause (54.57%) followed by malignancy (28.17%), empyema (10.56%), parapneumonic effusion (5.28%) and others. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy was given the highest yield of histological diagnosis (84.6%) followed by CT guided FNAC (77.6%) and pleural fluid cytology (55%). Highest yield to diagnose tubercular effusion was found in lymph node FNAC (81.5%) followed by pleural biopsy (62%). Sputum smear for AFB was positive in only 27.4% cases. Bleeding followed by pneumothorax were the most common complications. Complications are very less (1.3% and 0.9% respectively). 2 patients (0.34%) remained undiagnosed even after these all above said investigations. Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures.

Predictive Role of ADA in Bronchoalveolar Lavage Fluid in Making the Diagnosis of Pulmonary Tuberculosis

Current diagnostic tests for tuberculosis (TB) are time-consuming. The aim of this study was to evaluate the diagnostic usefulness of ADA in bronchoalveolar lavage fluid in patients with pulmonary TB. A cross-sectional study was performed in Yazd, Iran, between 2009 and 2010. Patients suspected of pulmonary TB with negative sputum smear for AFB were included in the study. Mean ADA levels in BAL fluids were measured and compared between study groups. Sixty-three patients were enrolled in the study among which 15 cases had pulmonary TB, 33 had pulmonary diseases other than TB, and 15 subjects with normal bronchoscopy results were considered as controls. Mean ADA levels in BAL fluid were 4.13 ± 2.55, 2.42 ± 1.06, and 1.93 ± 0.88, respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups (P = 0.001). Using ROC curve with a cut-off value of 3.5 IU/L, the highest sensitivity (57%) and specificity (84%) were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB.

Pulmonary Tuberculosis Involving the Right Middle Lobe of the Lung: CT and Clinical Characteristics

Purpose: To describe the CT and clinical features of tuberculosis involving the right middle lobe of the lung. Materials and Methods: Among patients diagnosed with pulmonary tuberculosis at our hospital during the past three years, 16 cases (mean age of patients: 72 years) were reviewed for radiological and clinical presentation of patients that underwent CT and chest radiography and showed mainly right middle lobe involvement. Results: Middle lobe collapse or consolidation (n=16) and bronchial stenosis or obstruction without the presence of soft tissue masses (n=15) were the main findings. Enlarged mediastinal or hilar lymph nodes (n=15), cavities within consolidated tissue (n=2), ill-defined centrilobular nodules (n=12), a tree-in-bud appearance (n=10), focal consolidations (n=7) and small nodules (n=4) were found. All patients were older than 64 years and most complained of non-specific symptoms. A sputum smear for AFB was positive in four cases. Conclusion: A diagnosis of tuberculosis in the right middle lobe is suggested in older patients with following CT findings: 1) middle lobe collapse or consolidation; 2) middle lobe bronchus stenosis or obstruction without the presence of soft tissue masses; 3) mediastinal or hilar lymphadenopathy; 4) cavities within consolidation, and centrilobular nodules with branching linear structure in the adjacent lungs. Further evaluation such as bronchoscopy is recommended for confirmation even when the sputum smear for AFB is negative.

HIGH RATES OF MULTIDRUG-RESISTANT TUBERCULOSIS IN THE COUNTRY OF GEORGIA: A POPULATION-BASED STUDY.

Background Multidrug-resistant TB (MDR-TB, defined as resistance to at least isoniazid and rifampin) has emerged as a serious global public health problem, especially in former Soviet republics. The extent of the problem in Georgia has been incompletely defined because there have been no representative or population-based studies on the rates of drug-resistant TB in Georgia. Purpose The purpose of this study was to determine the prevalence and risk factors for MDR-TB in the country of Georgia. Methods/Study Design A prospective population-based study was carried out in the country of Georgia between July 2005 and May 2006. All patients diagnosed with AFB sputum smear positive (ss+) pulmonary TB in Georgia were enrolled and sputum specimens processed for culture, and subsequently, first-line drug susceptibility testing (DST) on one M. tuberculosis isolate recovered from each patient with a positive culture was performed. Specimens were collected from patients receiving care at 74 civilian TB facilities and 8 TB facilities within the penitentiary system located throughout Georgia. Demographic data, laboratory data, and data abstracted from medical records and patient interviews were entered into an Epi Info database and analyzed using SAS software (9.1). Results A total of 2,200 ss+ patients were enrolled, and 1,451 were culture positive for M. tuberculosis. DST was available for 1,426 patients (98%). Overall, 810 (57%) patients had resistance to at least one anti-TB drug, and 220 (15%) of 1,426 patients had MDR-TB; 794 (56%) were newly diagnosed patients with TB, 511 (36%) were previously treated for TB for > 1 month, and prior treatment status was not known for 121 (8%) who were excluded from further analyses. In univariate analysis, patients who had previously been treated for TB were significantly more likely to have MDR-TB (140/511 [27%]) than patients who were newly diagnosed and never previously treated (53/794 [7%]) (OR = 5.27, 95% CI 3.75-7.41, p Conclusions Drug-resistant TB, including MDR-TB, has emerged as a major public health problem in Georgia. Further TB control efforts being implemented to prevent the development of new cases of MDR-TB and to treat existing patients with MDR-TB are urgently needed.

Lower Lung Field Tuberculosis

Sixty-five patients with lower lung field tuberculosis were found, representing 5.1 percent of the total admissions with pulmonary tuberculosis over a period of five years. Unlike previous reports, the disease affects more within the old age and female groups. The most common symptoms were cough, followed by chills, fever and hemoptysis. Bilateral or bilobar involvement was infrequent. Common basal segments and middle lobe were the most commonly affected locations. Chest x-ray film showed consolidation in most cases. Sputum smear for AFB was positive in 37 patients. Endobronchial involvement was proved by bronchoscopy in 32 of 42 patients who received the diagnostic procedure. The major bronchoscopic findings were ulcerative granuloma, fibrostenosis, and submucosal infiltration. In rare instances, final diagnosis could be made only after exploratory thoracotomy. Besides its diagnostic merit in lower lung field tuberculosis, bronchoscopy can assess the severity of the endobronchial lesion and provide a guide to early surgical intervention in patients with severe fibrostenosis.