Positive Sputum Smear Research Articles

Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Eastern Sudan.

Background In Sudan, tuberculosis diagnosis largely relies on clinical symptoms and smear microscopy as in many other low- and middle-income countries. The aim of this study was to investigate the positive predictive value of a positive sputum smear in patients investigated for pulmonary tuberculosis in Eastern Sudan. Methods Two sputum samples from patients presenting with symptoms suggestive of tuberculosis were investigated using direct Ziehl-Neelsen (ZN) staining and light microscopy between June to October 2014 and January to July 2016. If one of the samples was smear positive, both samples were pooled, stored at −20°C, and sent to the National Reference Laboratory (NRL), Germany. Following decontamination, samples underwent repeat microscopy and culture. Culture negative/contaminated samples were investigated using polymerase chain reaction (PCR). Results A total of 383 samples were investigated. Repeat microscopy categorized 123 (32.1%) as negative, among which 31 were culture positive. This increased to 80 when PCR and culture results were considered together. A total of 196 samples were culture positive, of which 171 (87.3%), 14 (7.1%), and 11 (5.6%) were M. tuberculosis, M. intracellulare, and mixed species. Overall, 15.6% (57/365) of the samples had no evidence of M. tuberculosis, resulting in a positive predictive value of 84.4%. Conclusions There was a discordance between the results of smear microscopy performed at local laboratories in the Sudan and at the NRL, Germany; besides, a considerable number of samples had no evidence of M. tuberculosis. Improved quality control for smear microscopy and more specific diagnostics are crucial to avoid possible overtreatment.

Detection of Mycobacterium tuberculosis bacilli in bio-aerosols from untreated TB patients.

Background:Tuberculosis (TB) is predominantly an airborne disease. However, quantitative and qualitative analysis of bio-aerosols containing the aetiological agent, Mycobacterium tuberculosis (Mtb), has proven very challenging. Our objective is to sample bio-aerosols from newly diagnosed TB patients for detection and enumeration of Mtb bacilli. Methods:We monitored each of 35 newly diagnosed, GeneXpert sputum-positive, TB patients during 1 hour confinement in a custom-built Respiratory Aerosol Sampling Chamber (RASC). The RASC (a small clean-room of 1.4m ) incorporates aerodynamic particle size detection, viable and non-viable sampling devices, real-time CO 2 monitoring, and cough sound-recording. Microbiological culture and droplet digital polymerase chain reaction (ddPCR) were used to detect Mtb in each of the bio-aerosol collection devices. Results: Mtb was detected in 27/35 (77.1%) of aerosol samples; 15/35 (42.8%) samples were positive by mycobacterial culture and 25/27 (92.96%) were positive by ddPCR. Culturability of collected bacilli was not predicted by radiographic evidence of pulmonary cavitation, sputum smear positivity. A correlation was found between cough rate and culturable bioaerosol. Mtb was detected on all viable cascade impactor stages with a peak at aerosol sizes 2.0-3.5μm. This suggests a median of 0.09 CFU/litre of exhaled air (IQR: 0.07 to 0.3 CFU/l) for the aerosol culture positives and an estimated median concentration of 4.5x10 CFU/ml (IQR: 2.9x10 -5.6x10 ) of exhaled particulate bio-aerosol. Conclusions: Mtb was identified in bio-aerosols exhaled by the majority of untreated TB patients using the RASC. Molecular detection was more sensitive than mycobacterial culture on solid media, suggesting that further studies are required to determine whether this reflects a significant proportion of differentially detectablebacilli in these samples.

Detection of Mycobacterium tuberculosis bacilli in bio-aerosols from untreated TB patients

Background: Tuberculosis (TB) is predominantly an airborne disease. However, quantitative and qualitative analysis of bio-aerosols containing the aetiological agent, Mycobacterium tuberculosis (Mtb), has proven very challenging. Our objective is to sample bio-aerosols from newly diagnosed TB patients for detection and enumeration of Mtb bacilli. Methods: We monitored each of 35 newly diagnosed, GeneXpert sputum-positive, TB patients during 1 hour confinement in a custom-built Respiratory Aerosol Sampling Chamber (RASC). The RASC (a small clean-room of 1.4m ) incorporates aerodynamic particle size detection, viable and non-viable sampling devices, real-time CO 2 monitoring, and cough sound-recording. Microbiological culture and droplet digital polymerase chain reaction (ddPCR) were used to detect Mtb in each of the bio-aerosol collection devices. Results: Mtb was detected in 27/35 (77.1%) of aerosol samples; 15/35 (42.8%) samples were positive by mycobacterial culture and 25/27 (92.96%) were positive by ddPCR. Culturability of collected bacilli was not predicted by radiographic evidence of pulmonary cavitation, sputum smear positivity. A correlation was found between cough rate and culturable bioaerosol. Mtb was detected on all viable cascade impactor stages with a peak at aerosol sizes 2.0-3.5μm. This suggests a median of 0.09 CFU/litre of exhaled air (IQR: 0.07 to 0.3 CFU/l) for the aerosol culture positives and an estimated median concentration of 4.5x10 CFU/ml (IQR: 2.9x10 -5.6x10 ) of exhaled particulate bio-aerosol. Conclusions: Mtb was identified in bio-aerosols exhaled by the majority of untreated TB patients using the RASC. Molecular detection was more sensitive than mycobacterial culture on solid media, suggesting that further studies are required to determine whether this reflects a significant proportion of differentially detectable bacilli in these samples.

Increasing likelihood of advanced pulmonary tuberculosis at initial diagnosis in a low-incidence US state.

Arkansas, USA. To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states. We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation. From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation. Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.

Health-related QOL of elderly patients with pulmonary M. avium complex disease in a university hospital.

Little is known about the clinical characteristics and health-related quality of life (HQOL) of elderly patients with pulmonary Mycobacterium avium complex (pMAC) disease. To evaluate HQOL using the 36-Item Short-Form Health Survey and St George's Respiratory Questionnaire (SGRQ) and to investigate the predictors of HQOL changes among elderly patients with pMAC disease. This prospective cohort registry was conducted at Keio University Hospital, Tokyo, Japan, between May 2012 and July 2015 and included 84 patients with pMAC disease aged 75 years who had completed the HQOL questionnaire and 48 patients with pMAC disease who had been followed up and completed the HQOL questionnaire in cross-sectional and longitudinal analyses, respectively. In cross-sectional analyses, elderly patients with pMAC disease had significantly lower role-physical, general health, vitality, social functioning, role-emotional and role/social component scores than the general Japanese elderly population. Analysis of covariance revealed that patients with cavitary lesions had significantly worse physical functioning and SGRQ scores (P < 0.05). Longitudinal analysis showed that under-treatment, short duration of disease and positive sputum smear at baseline were predictors of worse HQOL at 12 months. Elderly patients with pMAC disease have reduced HQOL. Further large studies on HQOL are required to refine the use of this parameter in the treatment of these patients.

Predictors of In-Hospital Mortality among Patients with Pulmonary Tuberculosis: A Systematic Review and Meta-analysis

Background: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. Methods: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for in-hospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). Results: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01–3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40–2.48), or male sex (OR 1.09, 95% CI 0.84–1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38–4.46), and previous TB infection (OR 2.66, 95% CI 0.48–14.87). Conclusion: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients.

Experimental platform utilising melting curve technology for detection of mutations in Mycobacterium tuberculosis isolates

Tuberculosis (TB) remains one of the most deadly infections with approximately a quarter of cases not being identified and/or treated mainly due to a lack of resources. Rapid detection of TB or drug-resistant TB enables timely adequate treatment and is a cornerstone of effective TB management. We evaluated the analytical performance of a single-tube assay for multidrug-resistant TB (MDR-TB) on an experimental platform utilising RT-PCR and melting curve analysis that could potentially be operated as a point-of-care (PoC) test in resource-constrained settings with a high burden of TB. Firstly, we developed and evaluated the prototype MDR-TB assay using specimens extracted from well-characterised TB isolates with a variety of distinct rifampicin and isoniazid resistance conferring mutations and nontuberculous Mycobacteria (NTM) strains. Secondly, we validated the experimental platform using 98 clinical sputum samples from pulmonary TB patients collected in high MDR-TB settings. The sensitivity of the platform for TB detection in clinical specimens was 75% for smear-negative and 92.6% for smear-positive sputum samples. The sensitivity of detection for rifampicin and isoniazid resistance was 88.9 and 96.0% and specificity was 87.5 and 100%, respectively. Observed limitations in sensitivity and specificity could be resolved by adjusting the sample preparation methodology and melting curve recognition algorithm. Overall technology could be considered a promising PoC methodology especially in resource-constrained settings based on its combined accuracy, convenience, simplicity, speed, and cost characteristics.

Risk of tuberculosis transmission among healthcare workers.

Data from a prospective molecular-epidemiological study (1997–2015) of patients with culture-confirmed tuberculosis in Hamburg, Germany, were evaluated to assess the occupational risk of Mycobacterium tuberculosis complex transmission in a low-incidence setting.Isolates of M. tuberculosis complex were genotyped using IS6110 restriction fragment length polymorphism analysis. Results of structured questionnaires, geographical mapping and additional patient interviews were used for confirming epidemiological links.Out of the 2393 cases, 918 (38.4%) were classified into 224 clusters comprising 2–70 patients per cluster. Among the 918 cluster members, epidemiological links could be confirmed in 340 (37.0%) patients. In total, 55 (2.3%) patients were healthcare workers; 26 healthcare workers remained unclustered, but 29 healthcare workers belonged to cluster groups. Conventional contact tracing performed before genotyping to identify sources of the reported index cases detected only 73 (3.1%) patients.Logistic regression analysis confirmed work in the healthcare sector as strongest predictor for clustering of patients with verified epidemiological links (odds ratio (OR) 3.1, 95% CI 1.6–5.9), followed by alcoholism (OR 2.3, 95% CI 1.7–3.2) and sputum smear positivity (OR 1.8, 95% CI 1.4–2.3). Immigrants were more likely to be cluster nonmembers (OR 0.3, 95% CI 0.3–0.5). Recent transmission in Hamburg within the 19-year study period was found to be strongly associated with working in a healthcare facility. Although clusters also include many “imported” strains from abroad or regional highly prevalent M. tuberculosis strains with no evident epidemiological connection, routine molecular-epidemiological survey is indispensable to optimising and controlling the effectiveness of TB control strategies in German healthcare settings.

DETECTION OF MYCOBACTERIUM TUBERCULOSIS WITH TB ANTIGEN RAPID TEST IN PULMONARY TUBERCULOSIS PATIENTS WITH FOUR TYPES OF SPUCTUM SAMPLE PREPARATION

Pemeriksaan mikroskopis langsung untuk mendiagnosis TB memiliki banyak keterbatasan. TB Ag Rapid Test Device merupakanmetode pemeriksaan ICT TB yang mendeteksi antigen yang disekresi khas dari Regions of Difference (RD) M.tuberculosis. Penelitiansebelumnya menunjukkan uji sering tidak berjalan dengan baik. Sampel penelitian adalah 30 dahak BTA positif dengan pemeriksaanmikroskopis langsung. Dahak diberikan 4 perlakuan berbeda yaitu: perlakuan rutin sesuai tata langkah perangkat; penambahan0,5 mL NALC 2,5% dan dahak dikocok sesuai tata langkah perangkat; perlakuan vorteks dilanjutkan pemusingan 10.000g suhu 4°C;penambahan 0,5 mL NALC 2,5%, vorteks dilanjutkan pemusingan 10.000g suhu 4°C. Hasil pemeriksaan antigen M.tuberculosis sebagaiberikut: perlakuan kesatu 43,3% positif, perlakuan kedua hasil positif tinggi (96,7%), perlakuan ketiga dan keempat didapatkanhasil positif sebesar 36,7% dan 86,7%. Pemeriksaan Ag menggunakan vorteks-pemusingan dengan pemeriksaan rutin menunjukkankesesuaian sebesar 86,6% (33,3% positif dan 53,5% negatif) dengan nilai Kappa 0,724 (p&lt;0,0001). Perlakuan 2 (penambahan0,5 mL NALC 2,5%) dengan perlakuan 4 (penambahan NALC 2,5%-vorteks-pemusingan) menunjukkan kesesuaian sebesar 90% (86,7%positif dan 3,3% negatif) dengan nilai Kappa 0,366 (p=0,010). Pemberian pretreatment 0,5 mL NALC 2,5% dapat digunakan untukmeningkatkan hasil positif kit TB Ag Rapid Test Device untuk mendiagnosis tuberkulosis paru.

TINGKAT KECUKUPAN ZAT GIZI MAKRO DAN STATUS GIZI PASIEN TUBERKULOSIS DENGAN SPUTUM BTA (+) DAN SPUTUM BTA (–)

Tuberculosis is an infectious disease caused by mycobacterium t uberculosis germs. Germs in form of droplets spread through saliva splashes out when coughing, sneezing and talking then inhaled during breathing. The degree of sputum smear positivity of patients describe the increasing number of tuberculosis bacteria in the lungs that could potentially transmit the infection. In general, patients with tuberculosis have decreased appetite which impact on weight loss. This research was comparative observational analytic research using cross sectional approach with simple random sampling conducted at the Hospital Asy-Syaafi Pamekasan with a sample size of 50 people. The results of Mann Whitney test showed a signifi cant difference in adequacy level of energy (p= 0.026), carbohydrates (p = 0.000), protein (p = 0.001), fat (p = 0.029) and nutritional status (p = 0.022) between the groups of tuberculosis with sputum smear (+) and sputum smear (-). It was concluded that adequacy level (energy, p rotein, fat and carbohydrates) and nutrition status among respondents t uberculosis sputum smear (+) have signifi cant differences with the respondent t uberculosis sputum smear (-).

Highly Sensitive Detection of Isoniazid Heteroresistance in Mycobacterium tuberculosis by DeepMelt Assay.

Detection of heteroresistance of Mycobacterium tuberculosis remains challenging using current genotypic drug susceptibility testing methods. Here, we described a melting curve analysis-based approach, termed DeepMelt, that can detect less-abundant mutants through selective clamping of the wild type in mixed populations. The singleplex DeepMelt assay detected 0.01% katG S315T in 105M. tuberculosis genomes/μl. The multiplex DeepMelt TB/INH detected 1% of mutant species in the four loci associated with isoniazid resistance in 104M. tuberculosis genomes/μl. The DeepMelt TB/INH assay was tested on a panel of DNA extracted from 602 precharacterized clinical isolates. Using the 1% proportion method as the gold standard, the sensitivity was found to be increased from 93.6% (176/188, 95% confidence interval [CI] = 89.2 to 96.3%) to 95.7% (180/188, 95% CI = 91.8 to 97.8%) compared to the MeltPro TB/INH assay. Further evaluation of 109 smear-positive sputum specimens increased the sensitivity from 83.3% (20/24, 95% CI = 64.2 to 93.3%) to 91.7% (22/24, 95% CI = 74.2 to 97.7%). In both cases, the specificity remained nearly unchanged. All heteroresistant samples newly identified by the DeepMelt TB/INH assay were confirmed by DNA sequencing and even partially by digital PCR. The DeepMelt assay may fill the gap between current genotypic and phenotypic drug susceptibility testing for detecting drug-resistant tuberculosis patients.

Risk factors for infectiousness of patients with tuberculosis: a systematic review and meta-analysis.

We performed a systematic review and meta-analyses of studies assessing tuberculosis (TB) patient-related risk factors for transmission of Mycobacterium tuberculosis infection. Meta-analyses were conducted for sputum smear-positivity, lung cavitation and HIV seropositivity of index patients with both crude and adjusted odds ratios (AORs) pooled using random effect models. Thirty-seven studies were included in the review. We found that demographic characteristics such as age and sex were not significant risk factors, while behaviours such as smoking and alcohol intake were associated with infectiousness although inconsistently. Treatment delay of >28 days was a significant predictor of greater infectiousness. Contacts of sputum smear-positive index patients were found to be more likely to be infected than contacts of sputum smear-negative patients, with a pooled AOR of 2.15 (95% confidence interval (CI) 1.47-3.17, I 2 = 38%). Similarly, contacts of patients with the cavitary disease were around twice as likely to be infected as contacts of patients without cavitation (pooled AOR 1.9, 95% CI 1.26-2.84, I 2 = 63%). In contrast, HIV seropositive patients were associated with few contact infections than HIV seronegative patients (AOR 0.45, 95% CI 0.26-0.80, I 2 = 52%). In conclusion, behavioural and clinical characteristics of TB patients can be used to identify highly infectious patients for targeted interventions.

Direct Resazurin Microplate Assay in Drug Susceptibility Testing of Smear-Positive Sputum Samples against Mycobacterium tuberculosis.

BackgroundA new direct microplate-based colorimetric drug susceptibility test that omits the initial isolation of Mycobacterium tuberculosis from sputum specimens was evaluated.MethodsA total of 51 M. tuberculosis acid fast bacilli (AFB) smear-positive sputum specimens were inoculated directly into drug-free and serial dilutions of drug-containing Middlebrook 7H9 broth media. With this direct resazurin micro plate assay (REMA) method, resazurin dye was used as a growth indicator in microplate wells. The minimum inhibitory concentrations (MIC) of isoniazid (INH) and rifampicin (RIF) were compared with those of the ‘gold standard’ absolute concentration method (ACM). The turnaround time (TAT) of the direct REMA and the ACM were also determined.ResultsAt the selected cut-off points (INH: 0.0625 μg/mL; RIF: 0.125 μg/mL), good drug susceptibility test results were obtained for INH and RIF with an average sensitivity, specificity and accuracy of 90%, 100% and 97%, respectively, with a TAT of 15 days. The REMA method also correctly classified the resistant isolates with positive predictive values of 95% and negative predictive values of 98% for the two drugs.ConclusionsThe direct REMA was reliable in routine diagnostic laboratories for the drug susceptibility testing of M. tuberculosis and the rapid detection of multi-drug-resistant tuberculosis.

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.

Factors Associated with Persistent Sputum Positivity at the End of the Second Month of Tuberculosis Treatment in Lithuania.

BackgroundNon-conversion of sputum smear and culture prolongs the infectivity of the patient and has been associated with unfavorable outcomes. We aimed to evaluate factors associated with persistent sputum positivity at the end of two months of treatment of new case pulmonary tuberculosis (TB).MethodsData of 87 human immunodeficiency virus-negative patients with culture-positive drug-susceptible pulmonary TB admitted to local university hospital between September 2015 and September 2016 were reviewed. Factors associated with sputum smear and/or culture positivity at the end of the second month of treatment were analyzed.ResultsTwenty-two patients (25.3%) remained smear and/or culture-positive. Male sex, lower body mass index (BMI), unemployment, alcohol abuse, higher number of lobes involved and cavities on chest X-rays, shorter time to detection (TTD) on liquid cultures, higher respiratory sample smear grading and colony count in solid cultures, higher C-reactive protein, erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and anemia were all significantly associated with persistent sputum positivity. However, in the logistic regression analysis only male sex, lower BMI, alcohol abuse, higher radiological involvement, cavitation, higher smear grading, higher colony count in solid cultures and shorter TTD were determined as independent factors associated with persistent sputum positivity at the end of 2 months of treatment.ConclusionIn conclusion, higher sputum smear and culture grading at diagnosis, shorter TTD, higher number of lobes involved, cavitation, male sex, alcohol abuse, and lower BMI were independently associated with persistent sputum positivity. These factors should be sought when distinguishing which patients will remain infectious longer and possibly have worse outcomes.

Nutritional status in sputum positive and sputum negative cases of pulmonary tuberculosis

Background: In a developing country like India, tuberculosis (TB) and malnutrition, both the problems are of prime concern. There is an increase in the occurrence of sputum negative TB in regions having high human immunodeficiency virus prevalence. Furthermore, it seems that nutritional status may predict clinical outcome in TB. Aims and Objectives: To determine nutritional status in sputum smear positive and sputum smear-negative cases of pulmonary TB (PTB). Methods and Materials: A total of 54 male patients, diagnosed with PTB by an expert physician, based on sputum smear microscopy and radiography were recruited for study. They were divided into sputum smear-positive pulmonary tuberculosis (SPPT) and sputum smear-negative pulmonary tuberculosis (SNPT) group. Age, medical history (cough, fever, anorexia, weight loss, and hemoptysis), weight, height, body mass index, hemoglobin, and serum protein were recorded and compared in both groups. Results: About 62.96% of patients were smear positive and 37.03% were smear negative. Cough, fever, anorexia, and weight loss were more common in SPPT patients than in SNPT group, but it was not statistically significant except cough (P < 0.05). Nearly, 38% of SPPT patients were severely underweight and almost 30% of SNPT were severely underweight. Conclusions: It appears that undernutrition among SPPT and SNPT patients of PTB is a result of preexisting chronic undernutrition as well as concurrent active infection, which increases the severity of weight loss. As a result, nutritional support is of prime importance for the patient and must be given during treatment phase.

Correlation between serum adenosine deaminase and cancer antigen 125 in assessment of severity of active pulmonary tuberculosis

Objectives It is not always easy to diagnose tuberculosis (TB) accurately; thus, there are always continuous trials to find the best possible method with a short duration and acceptable accuracy. This study aimed to correlate between serum adenosine deaminase (ADA) and cancer antigen 125 (CA125) in the assessment of severity of pulmonary TB. Patients and methods A total of 45 sex-matched and age-matched patients were included in our study and were classified into three groups: group I included 15 patients with active pulmonary TB with positive sputum smear result, group II included 15 patients with multidrug resistance pulmonary TB, and group III included 15 patients with pulmonary TB after sputum conversion. All included patients were subjected to detailed medical history; full clinical examination; chest radiography to determine the severity of the disease whether minimal, moderate, advanced, or far advanced; laboratory investigations [white blood cells count, platelet count, erythrocyte sedimentation rate (ESR), and sputum Ziehl–Neelsen staining]; grading on sputum smear microscopy as 1+, 2+, or 3+; sputum culture on L-J media; and CA125 and ADA analysis, where 5 ml of blood was collected and centrifuged and serum was separated, from which CA125 and ADA were measured using CA125II kits and ADA016 kits, respectively. Patients received antituberculous treatment in the hospital according to WHO and national guidelines. Results There was a significant statistical difference among the studied groups regarding CA125 and ADA, where P values were 0.018 and 0.014, respectively. Both were higher in group I measuring 64.42 U/ml and 24.22 U/l, respectively, and lower in group III measuring 27.22 U/ml and 16.08 U/l, respectively, after treatment for 2 months. In the current study, there was an insignificant statistical difference in serum CA125 and ADA regarding age and sex, but there were statistically significant differences among the studied groups regarding sputum Ziehl–Neelsen staining, chest radiography, and ESR. In this study, there was a significant positive correlation between both serum CA125 and serum ADA and chest radiography and ESR. Regarding sputum analysis, there was no difference regarding CA125 between positive and negative cases, but serum ADA was higher in positive cases than in negative ones. On the contrary, there was an insignificant statistical correlation between serum ADA and serum CA125.

Does Cash Incentive Effect TB Case Notification by Public Private Mix-General Practitioners Model in Pakistan?

Setting: Private healthcare providers including solo practitioners and laboratories enrolled with Public Private Mix General Practitioners model in Pakistan who were enrolled with the program and maintained participation during 2014 to 2016. Objective: To assess the change in case notification by private healthcare providers as well as effect on sputum smear positivity rate at private laboratories after introduction of incentives. Design: A comparative cross-sectional study based on routinely maintained National TB Control Program data collected before and after the introduction of incentives (2014 and 2016). Results: In 2016, TB case notification increased by 71% after cash incentives was introduced. Among the 618 private healthcare providers who enrolled and maintained participation in the Public Private Mix program, only 1% of the GPs contributed to 19% increase in case notification, whereas 27% GPs had reported a reduced number of cases compared to the pre-intervention period. After incentives, slide positivity rate for diagnostic declined by 1.9% and follow-up increased by 0.6%. Number of slides for diagnostic and follow-up testing increased by 82% and 72% respectively. Conclusion: Engaging the private healthcare sector, by providing cash incentives to private health care Provider’s is an effective strategy for providing a substantial increase in National TB case notification.

A study on pattern of initial and acquired drug resistance for isoniazid and rifampicin in A.F.B. positive sputum smears of pulmonary tuberculosis patients at a Medical College in North Eastern Uttar Pradesh, India

Background: Despite availability of good quality anti-tubercular drugs and its administration through Directly Observed Therapy Short Course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP), tuberculosis remains a major cause of morbidity and mortality in India. The emergence of drug resistance necessitates the timely detection of susceptibility of anti-TB drugs. This can help in appropriate modification in treatment strategies.Methods: A total of 50 patients of pulmonary TB with AFB positive sputum smears attending the OPD of TB and Chest department of B.R.D. Medical College, Gorakhpur were included. Patients were grouped based on history into new (cat-I) and previously treated patients (cat-II). Cat-II patients were further subdivided into defaulter, treatment failure and relapse groups. The culture and DST of AFB positive sputum smears of these patients was done in VersaTREK™®. At the end of study, patients were grouped according to age, sex, category and drug sensitivity pattern for Isoniazid (INH) and Rifampicin (RIF) viz mono resistance (resistance to either INH or RIF) or multi drug resistance (M.D.R.) and the resultant data were analysed.Results: Of the total 50 patients included in this study, 18 (36%) patients were sensitive to both the drugs INH and RIF, of which 11 (22%) were of cat-I and 7 (14%) of category-II. Twenty-two (44%) patients were resistant to INH only of which 8 (16%) were of cat-I and 14 (28%) of cat-II. One (2%) case of cat-I showed resistance to RIF only, while M.D.R. type of resistance is seen in 1 (2%) patient of cat-I and 8 (16%) patients of cat-II. Pattern of resistance to both INH and RIF together (i.e. M.D.R. type) showed significant difference between cat-I and cat-II.Conclusions: Most of the patients showing resistance to INH, RIF or both INH and RIF (M.D.R.) belonged to category-II (previously treated) patients.

Mycobacterial blood culture as the only means of diagnosis of disseminated tuberculosis in advanced HIV infection.

The diagnosis of disseminated tuberculosis (TB) in advanced HIV infection is often delayed because of difficulty in obtaining suitable specimens for culture. A total of 32 such patients from South India with positive mycobacterial blood cultures were studied over ten years. Almost all (90%) had a febrile illness and the majority (68.7%) had clinical lung involvement, but only 27.3% had positive sputum smears. Liver biopsy yielded a positive diagnosis in only 1/7. Cytopenia was almost universal (96.9%). Bone marrow cultures were, however, positive in 54.8%, of whom one-quarter grew atypical mycobacteria. Mycobacterial blood culture is therefore a useful adjunct test to diagnose TB in advanced HIV.