Symptoms Of Pulmonary Tuberculosis Research Articles

Symptoms of dullness and retraction of the eye in pulmonary tuberculosis

Old authors (Yanovskiy, Kornet) noted vivid, phosphoric, shiny eyes as a symptom of pulmonary tuberculosis. Often these lively, glowing and even sometimes sparkling eyes are replaced by a special shade, as if a slight veil, with dullness of the sclera and cornea, with a simultaneous retraction of the eyeball (enophthalmus).

Acquired Bartter Like Syndrome in a Patient of Multi Drug Resistant Pulmonary Tuberculosis Secondary to Kanamycin Nephrotoxicity – A Case Report

India has the highest estimated burden of tuberculosis infection (TBI) globally caused by Mycobacterium Tuberculosis , with nearly 35-40 crores Indian population having TBI, of which 26 lakhs people (18-36 lakh) are estimated to develop Tuberculosis (TB) disease annually. An integrated and comprehensive ‘cascade of care’ approach and new advances in National Tuberculosis Elimination Program provided us with definitive management of tuberculosis infection and an active tuberculosis disease. Aminoglycosides are one of the cornerstones of drug resistant tuberculosis. Although highly effective they are very notorious for their dose dependent and independent nephrotoxicity . Our experience denotes a rare diagnosis of acquired Bartter like syndrome, in a 60-year man with long standing symp-tomatic pulmonary tuberculosis who received Kanamycin for a period of 5 months and subsequently presented with life threatening elec-trolyte imbalance. Subsequent prognosis showed improvement with conservative treatment and he was discharged in stable condition. It also highlights the importance of adherence to the standard guidelines under National Tuberculosis Elimination Program (NTEP) and the importance of the routine monitoring of electrolytes in Multi-Drug Resistant Tuberculosis (MDR-TB) patients receiving treatment that includes Kanamycin.

Longitudinal Variations of M. tuberculosis-Induced IFN-γ Responses in HIV-Negative Pregnant Women Exposed to Tuberculosis.

IntroductionPregnancy triggers an alteration of the immune functions and increases the risk of developing the active tuberculosis (TB) symptoms in exposed women. The effect of pregnancy on the Mycobacterium tuberculosis-specific immune responses used for most of the TB immunodiagnostic assays is not well documented. Here we investigated the changes in the M. tuberculosis-specific IFN-γ production in age-matched pregnant and non-pregnant women according to their TB exposition status.MethodsWe conducted a prospective cohort study on HIV-seronegative pregnant and non-pregnant women with compatible pulmonary TB symptoms addressed to TB healthcare facilities in Antananarivo, Madagascar. Active pulmonary TB was bacteriologically assessed with culture from sputum samples. Clinical data and blood samples were collected at inclusion and after 6 months of follow-up for each individual included. Whole blood samples were stimulated with QuantiFERON TB-Gold Plus (QFT-P) assay antigens. Plasma IFN-γ concentrations were then assessed by ELISA.ResultsA total of 284 women were investigated for the study including 209 pregnant women without confirmed TB (pNTB), 24 pregnant women with bacteriologically confirmed active TB (pATB), 16 non-pregnant women with active TB (ATB), and 35 non-pregnant healthy donors (HC). At inclusion, IFN-γ responses are lower in the pregnant women compared to their age-matched non-pregnant counterparts and independently of their TB status. Among the pregnant women, higher concentrations of M. tuberculosis-specific IFN-γ were observed in those exposed to TB, but with a lower magnitude in the active TB compared to the latently infected pregnant women (p < 0.05 with TB1 and p < 0.01 with TB2). After 6 months of follow-up, the M. tuberculosis-specific IFN-γ responses return to their baseline concentrations except for the pregnant women treated for TB for which none of the QFT-P positive reversed to negative (0%, 0/10) at the end of their TB treatment.ConclusionThese results support the concept of specific immune priorities characterized by a concomitant reduction in inflammatory immunity during pregnancy and corroborate the important role of activating the M. tuberculosis-specific immune responses to control the infection when the pregnant women are exposed to the pathogen.

Clinical Peripheral Atypical Presentation of Tuberculosis in the Head and Neck Region in Asian Population —11 Years Experience and Review of Literature

Tuberculosis TB one of the major health problem in developed countries, with extremely high prevalence in Asian countries, mainly caused by "Mycobacterium Tuberculosis". Although pulmonary tuberculosis is the most common form of the disease, it also can occur in other organ systems such as lymph nodes, central nervous system, skeletal system, hepatic system, and gastrointestinal system, including the oral cavity. Extrapulmonary tuberculosis is an uncommon form of chronic infection that does not present typical signs and symptoms of pulmonary tuberculosis. Oral tuberculosis is an uncommon form and is often overlooked as it shows no path gnomic signs. This article presents our experience of unusual atypical tuberculosis in the Head and Neck region.

Detection of isoniazid, fluoroquinolone, ethionamide, amikacin, kanamycin, and capreomycin resistance by the Xpert MTB/XDR assay: a cross-sectional multicentre diagnostic accuracy study

The WHO End TB Strategy requires drug susceptibility testing and treatment of all people with tuberculosis, but second-line diagnostic testing with line-probe assays needs to be done in experienced laboratories with advanced infrastructure. Fewer than half of people with drug-resistant tuberculosis receive appropriate treatment. We assessed the diagnostic accuracy of the rapid Xpert MTB/XDR automated molecular assay (Cepheid, Sunnyvale, CA, USA) to overcome these limitations. We did a prospective study involving individuals presenting with pulmonary tuberculosis symptoms and at least one risk factor for drug resistance in four sites in India (New Delhi and Mumbai), Moldova, and South Africa between July 31, 2019, and March 21, 2020. The Xpert MTB/XDR assay was used as a reflex test to detect resistance to isoniazid, fluoroquinolones, ethionamide, amikacin, kanamycin, and capreomycin in adults with positive results for Mycobacterium tuberculosis complex on Xpert MTB/RIF or Ultra (Cepheid). Diagnostic performance was assessed against a composite reference standard of phenotypic drug-susceptibility testing and whole-genome sequencing. This study is registered with ClinicalTrials.gov, number NCT03728725. Of 710 participants, 611 (86%) had results from both Xpert MTB/XDR and the reference standard for any drug and were included in analysis. Sensitivity for Xpert MTB/XDR detection of resistance was 94% (460 of 488, 95% CI 92-96) for isoniazid, 94% (222 of 235, 90-96%) for fluoroquinolones, 54% (178 of 328, 50-61) for ethionamide, 73% (60 of 82, 62-81) for amikacin, 86% (181 of 210, 81-91) for kanamycin, and 61% (53 of 87, 49-70) for capreomycin. Specificity was 98-100% for all drugs. Performance was equivalent to that of line-probe assays. The non-determinate rate of Xpert MTB/XDR (ie, invalid M tuberculosis complex detection) was 2·96%. The Xpert MTB/XDR assay showed high diagnostic accuracy and met WHO's minimum target product profile criteria for a next-generation drug susceptibility test. The assay has the potential to diagnose drug-resistant tuberculosis rapidly and accurately and enable optimum treatment. German Federal Ministry of Education and Research through KfW, Dutch Ministry of Foreign Affairs, and Australian Department of Foreign Affairs and Trade.

Prevalence of bacteriologically confirmed pulmonary tuberculosis and associated risk factors: A community survey in Thirvallur District, south India.

Tuberculosis (TB) prevalence surveys add to the active case detection in the community level burden of TB both national and regional levels. The aim of this study was to assess the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the community. Household community-based tuberculosis disease survey was conducted targeting 69054 population from 43 villages of 5 blocks in Tiruvallure district adopting cluster sampling methodology of ≥15 years old adult rural population of South India during 2015-2018. All eligible individuals with suspected symptoms of PTB were screened with chest X-ray. Two sputum specimens (one spot and the other early morning sample) were collected for M.tb smear and culture examination. Conversely demographical, smoking and alcohol drinking habits information were also collected to explore the risk factor. Stepwise logistic regression was employed to associate risk factors for PTB. A total of 62494 were screened among 69054 eligible population, of whom 6340 were eligible for sputum specimen collection. Sputum for M.tb smear and culture examination were collected in 93% of participants. The derived prevalence of PTB was 307/100000 population (smear-positive 130; culture positive 277). As expected that PTB has decreased substantially compared to preceding surveys and it showed that older age, male, low BMI, diabetes, earlier history of TB and alcohol users were significantly associated (p < .0001) with an increased risk of developing PTB. Upshot of the active survey has established a reduction in the prevalence of PTB in the rural area which can be accredited to better programmatic implementation and success of the National TB Control Programme in this district. It also has highlighted the need for risk reduction interventions accelerate faster elimination of TB.

Prevalence of non-tuberculosis mycobacteria among samples deposited from the National Tuberculous Reference Laboratory of Iran (2011-2018)

Objective: To investigate the prevalence of non-tuberculosis mycobacteria (NTM) among the samples deposited from the National Tuberculosis Reference Laboratory of Iran between 2011 and 2018. Methods: The study evaluated the prevalence of NTM among specimens from patients with pulmonary tuberculosis symptoms (n=15 771) deposited at the National Tuberculosis Reference Laboratory of Iran from 2011 to 2018. Detection of Mycobacterium (M.) tuberculosis was based on presence of a 190-bp amplicon from IS6110 insertion sequence using Tb1 and Tb2 primers, and amplicon-negative specimens were tested for NTM and M. tuberculosis (refractory to IS6110 amplification) using restriction fragment length polymorphism PCR of hsp65 amplicon fragment. Results: A total of 7 307 (46.33%) M. tuberculosis and 658 (4.17%) NTM specimens were found, the latter mainly comprising M. abscessus (10.18%), M. avium (2.28%), M. chelonae (8.97%), M. intracellulare (10.49%), M. kansasii (4.71%), and M. simiae (56.08%). Conclusions: As treatment for NTM differs from that for M. tuberculosis, accurate detection of Mycobacterium sp. is of public health significance.

DIAGNOSTIC ROLE OF ENDOBRONCHIAL WASHINGS AND BIOPSY IN SMEAR NEGATIVE PULMONARY TUBERCULOSIS AND ITS CORRELATION WITH HIGH RESOLUTION COMPUTED TOMOGRAPHY CHEST FINDINGS

Objective: To determine role of endobronchial washings/biopsy in diagnosis of smear negative pulmonary tuberculosis and evaluate their association with computed tomography findings.&#x0D; Study Design: Cross-sectional - analytical study.&#x0D; Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2020.&#x0D; Methodology: Patients having symptoms of pulmonary tuberculosis and abnormal findings on chest imaging with negative sputum smears for acid fast bacilli were selected for endobronchial washings. Bronchoscopy for washings was carried out in these patients and sample was sent for Acid fast bacilli stain, Mycobacterium tuberculosis gene Xpert and acid fast bacilli culture and sensitivity bacterial culture and fungal hyphae. In case of mass lung endobronchial and/or transbronchial lung biopsy was done and sample was sent for histopathology Active pulmonary tuberculosis was labelled as per definition.&#x0D; Results: Out of 105, 75 (71.4%) were male and 30 (28.6%) were female. Mean age was 55.69 ± 17.33 years. Total 40 (38.09%) were diagnosed with pulmonary tuberculosis (based on smear, genexpert, culture and histopathology). In these 40 patients, computed tomographic findings showed consolidation in 10 (25%) cases, cavity in 7 (17.5%), bronchiectasis in 3 (7.5%), mass in 1 (2.5%), pleural effusion in 2 (5%), lymphadenopathy in 1 (2.5%) and tree-in-budappearance in 12 (30%) cases.&#x0D; Conclusion: High resolution computed tomography and endobronchial washing both combined together increase the diagnostic yield in smear negative cases.

Hemopthisis in Patients with Lung Tuberculosis

Abstract Tuberculosis represents a great challenge for the public health sector, especially in Romania. Hemoptosis in one of the most significant symptoms of pulmonary tuberculosis. We evaluated the frequency of haemoptysis in patients with tuberculosis withni South-Eastern area of Romania, the consistency between the anatomical-clinical-radiological lesions and the mechanism of occurence of haemoptysis, the impact of different risk factors and with late detection of the infection.

Comparison of CD4 and CD8 Counts in HIV negative Pulmonary Tuberculosis Patients with Normal Healthy Controls in and around Prayagraj

Anti-tuberculosis immunity involves a cellular immune response for their control. A critical marker of immunologic integrity is the CD4 and CD8 cell counts. Tuberculosis may be a cause of non-HIV associated CD4 and CD8-T cell lymphopenia. This study compares mean CD4, CD8 cell count and CD4:CD8 Ratio in pulmonary tuberculosis patients never had treatment for tuberculosis, pulmonary tuberculosis patients had received anti-tuberculosis treatment for more than one month and normal healthy controls. A case control study done in Prayagraj from October 2019 to October 2020 includes HIV negative, sputum positive pulmonary tuberculosis patients never had treatment for tuberculosis(n=25), pulmonary tuberculosis patients had received anti-tuberculosis treatment for more than one month(n=24), and normal healthy controls(n=36). We collected details including age, sex, symptoms of pulmonary tuberculosis, anti-tuberculosis treatment and investigated for HIV testing by ELISA, Sputum for AFB, Sputum for CBNAAT, CD4 and CD8 cell count determined by flow cytometrically. The mean CD4 and CD8 cell count was significantly lower in HIV negative pulmonary tuberculosis patients never had treatment for tuberculosis than in normal healthy controls (p value&lt;0.001) and CD4:CD8 ratio also lower (p value=0.013). The mean CD4 and CD8 cell count higher in pulmonary tuberculosis patients who have received anti-tuberculosis treatment for more than one month than in pulmonary tuberculosis patients never had treatment for tuberculosis (p value&lt;0.001) and CD4:CD8 ratio also higher (p value=0.013). CD4 and CD8 lymphopenia is an acceptable phenomenon in HIV negative pulmonary tuberculosis patients and such lymphopenia improves with anti-tuberculosis drug regimens as per protocol. This study highlights the importance of CD4, CD8 cellular immune response conducted by T- lymphocytes in outcome of pulmonary tuberculosis.

ЧЕТЫРНАДЦАТЬ ВРАЧЕЙ ФРЕДЕРИКА ШОПЕНА: ЧЕТЫРНАДЦАТЬ СПОСОБОВ РАССКАЗАТЬ ПАЦИЕНТУ О ЕГО БОЛЕЗНИ

The narratives based on history of the disease of famous people are an effective pedagogical tool for future physicians’ preparation in medical ethics and psychology. The objective of this study was to analyze the methods that doctors used to inform Frederic Chopin about his disease. Frederic Chopin's and Georges Sand's letters, the works of the composer's biographers as well as scientific publications devoted to Chopin's illness were analysed. The analysis showed that most of Frederic Chopin's physicians hid from him an incurable and fatal diagnosis for ethical reasons. This tactic proved to be effective: Chopin lived for more than 10 years with severe symptoms of pulmonary tuberculosis.

Xpert MTB/XDR for detection of pulmonary tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and amikacin

Objectives This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To estimate the diagnostic accuracy of Xpert MTB/XDR for the detection of pulmonary tuberculosis in people with signs and symptoms of pulmonary tuberculosis. To estimate the diagnostic accuracy of Xpert MTB/XDR for resistance to isoniazid, fluoroquinolones, ethionamide, and amikacin in people irrespective of rifampicin resistance and people with detected rifampicin resistance. In these populations, pulmonary tuberculosis will have been detected by Xpert MTB/XDR (as it is a reflex test). Such populations typically will have received prior testing verifying tuberculosis with another WHO‐approved test. Secondary objectives To compare the diagnostic accuracy of Xpert MTB/XDR by direct testing versus indirect testing (whereby Xpert MTB/XDR is performed on a Mycobacterium tuberculosis isolate grown from culture). To investigate the effects of potential sources of heterogeneity on test accuracy. For pulmonary tuberculosis, potential sources include HIV status, smear status, history of tuberculosis, treatment status (no treatment or currently on treatment), and treatment response status (culture conversion, yes or no). For drug resistance, potential sources include the type of reference standard and history of tuberculosis treatment. In addition, for fluoroquinolone resistance, a potential source of heterogeneity is the specific drug (e.g. ofloxacin or moxifloxacin) used in the phenotypic culture‐based DST (pDST) reference standard. We will also consider whether the WHO‐recommended critical drug concentration was used for the pDST reference standard (WHO Critical Concentrations 2018; WHO Critical Concentrations 2021). Regarding previously treated people, these investigations are important questions for clinical practice. For tuberculosis detection, studies have highlighted the challenges in interpreting Xpert MTB/RIF‐positive and Xpert Ultra‐positive results in previously treated people (Mishra 2020; Theron 2016a). As mentioned, for detection of drug resistance, previous treatment may increase the likelihood of having drug resistance.

Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults, irrespective of signs or symptoms.

Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults, irrespective of signs or symptoms.

English

BACKGROUND Globally, tuberculosis (TB) is one of the top 10 causes of death due to infectious diseases. TB continues to rank among world’s most serious health problems despite effective diagnostic &amp; treatment measures. The objectives of the study were to asses and compare the knowledge of tuberculosis among rural and urban slum population and identify the factors associated with their knowledge of tuberculosis. METHODS A cross sectional study was conducted and multistage random sampling technique was applied for selection of the individual study subjects. Data was collected using a semi-structured and pre-tested interview schedule. RESULTS 200 individuals were included in the study with an overall mean age (SD) of the individuals of 36.66 (± 13.091) years. 189 (94.5) participants had heard of tuberculosis. 36 (37.9 %) urban slum and 20 (21.3 %) rural participants said that cough is the most common symptom of pulmonary tuberculosis. 42 (52.5 % among rural population was having good knowledge (rural vs. urban; 52.5 % vs. 47.5 %) compared to urban slum population. Literacy (P = 0.049) and family type (P = 0.044) have played a significant role in acquiring good knowledge of tuberculosis among the participants irrespective of their place of residence. CONCLUSIONS There was no significant difference in the knowledge of TB among rural and urban slum population. Literate persons were more aware compared to illiterate population irrespective of their place of living. In spite of having good awareness regarding TB, in general the knowledge level on risk factors was not satisfactory and needs further improvement. Therefore, a special drive has to be started for imparting knowledge to the community regarding risk factors as this could prevent further occurrence or progress of TB. KEYWORDS Tuberculosis, Knowledge of TB, Urban Rural Difference

Obstetrics outcome in pulmonary tuberculosis

BackgroundTo evaluate the maternal and perinatal outcome in pulmonary tuberculosis cases as compared to low risk pregnancies in a tertiary referral hospital. MethodsA total of 15 cases of pulmonary tuberculosis over a period of two years who delivered in our unit was studied in the retrospective study. The maternal and perinatal outcome in them was compared with 191 low risk pregnancies who delivered at the same time in the hospital after taking into account inclusion and exclusion criteria. ResultsThe mean age and mean parity was 25.73 ± 2.85 and 28.75 ± 3.11, 2.1 and 1.9 in the 2 groups. Symptoms of pulmonary tuberculosis were cough (100%), chest pain (80%), expectoration (100%), hemoptysis (33.3%), fever (93.33%), anorexia (86.66%) and loss of weight (80%). Symptoms in study patients were significantly more common in study patients. The presence of associated medical problems was similar in the 2 groups. The prevalence of oligoamnios, gestational diabetes mellitus, antepartum hemorrhage and intrahepatic cholestasis was similar in the 2 groups. Prevalence of preterm labor was 53.33% in study group which was significantly higher than in controls (8.9%). Risk of premature rupture of membrane was also significantly higher in the study groups (53.33%) as compared to control groups (8.9%). Mean gestational age was also significantly lower (36.2 weeks) in study group as compared to 38.6 weeks in control group. The incidence of cesarean delivery was similar in the 2 groups (26.66% vs 28.79%). The mean birth weights was 2308.6 gm in the study group as compared to 2707.56 gm in control group. Fetal growth restrictions and Respiratory distress syndrome in babies was significantly higher in study group than in control group. Low APGAR score (<8) was also higher (33.3%) in study group as compared to control group (2.61%). ConclusionPulmonary tuberculosis during pregnancy is associated with increased perinatal morbidity, low birth weight, poor APGAR and increased respiratory distress rates.

Comparative Yield of Pulmonary Tuberculosis by Different Symptoms among Saharia Tribe of Madhya Pradesh, India.

Background:Symptom elicitation is a simple and inexpensive screening tool used for population screening in tuberculosis (TB) prevalence surveys. However, the information on the yield of TB cases by symptoms is sparsely available.Methods:A cross-sectional pulmonary TB (PTB) prevalence survey was conducted. All available eligible individuals were interviewed for symptoms of PTB. Sputum samples were collected and tested for PTB by smear microscopy and culture.Results:Among 2890 individuals tested for PTB, 77% had cough for 2 weeks or more and one-third reported chest pain for 1 month or more. About 31% were having a history of anti-TB treatment. Cough contributed to 82% PTB cases and the history of anti-TB treatment contributed to another 8.4% confirmed cases. Fever recorded lowest yield among the symptoms of PTB.Conclusion:The study suggests that fever alone may be ignored from symptomatic elicitation, and history of previous anti-TB treatment should be treated as an important indication for PTB symptomatic elicitation.

GeneXpert MTB/RIF and Mycobacterium tuberculosis Sputum Culture in Establishing the Diagnosis of Pulmonary Tuberculosis and Rifampicin Resistance in Suspected Childhood Pulmonary Tuberculosis in Soetomo Hospital

The diagnosis of childhood tuberculosis remains a challenge worldwide. The GeneXpert MTB/RIF test, a rapid Mycobacteria tuberculosis diagnostic tool, was recommended for use in children. No pediatric studies of GeneXpert MTB/RIF assessing pulmonary tuberculosis within a hospital setting has been done in Indonesia. We evaluated the performance of the GeneXpert MTB/RIF test compared with sputum culture on Lowenstein-Jensen (LJ) for the diagnosis of childhood pulmonary tuberculosis. This study was conducted in pediatric respirology inpatient and outpatient Dr. Soetomo Hospital, a tertiary care facility in Surabaya between June and August 2015 with a cross-sectional design. We consecutively enrolled 27 children aged 3 months to 14 years who had history of close contact with adult tuberculosis patients and showed symptoms of pulmonary tuberculosis. Sputum collection was performed by induced sputum and three examination methods were performed (microscopic, GeneXpert MTB/RIF and sputum culture) simultaneously followed by a drug sensitivity test for specimens detected with MTB growth. The GeneXpert MTB/RIF test had a sensitivity of 100% (95% CI 100-100) and a specificity of 95% (95% CI 85-100). The positive predictive value for diagnosing pulmonary TB was 89% (95% CI 68-100), the negative predictive value was 100% (95% CI 100-100) and positive likelihood ratio was 20 (95% CI 2.82-128). The GeneXpert MTB/RIF test on one sputum sample rapidly and correctly identified all children with culture-confirmed pulmonary tuberculosis with high specificity. Similar results were obtained between GeneXpert MTB/RIF and sputum culture based on age groups and clinical manifestations. Rifampicin resistance were both detected in GeneXpert MTB/RIF and MTB sensitivity test

Disseminated Tuberculosis Mimicking Lung Cancer with Multiple Bone Metastasis: A Case Report

Tuberculosis (TB) is a contagious infectious disease caused by Mycobacterium tuberculosis (Mtb) of which attacking various organs particularly the lungs. Tuberculosis can occur together with malignancy or manifest as malignancy. Lung tuberculosis may appear in a variety of clinical and radiological manifestations caused by other diseases including tumors. These tumors are called pseudo-tumors. TB pseudo-tumor is a rare manifestation that can occur in immunocompetent patients in both primary and post-primary TB. The clinical presentation of TB pseudo-tumor is nonspecific and the clinical suspicion must be increased to diagnose related diseases. Radiological features can also be challenging to be distinguished from actual tumors. The classic manifestations of pulmonary TB are generally easy to diagnose due to the distinctive clinical and radiological characteristics nonetheless some pulmonary TB symptoms are also often found in patients with lung cancer. Infection patients resemble malignancies most were asymptomatic (&gt; 27%) and the remaining 27% showed symptoms that varied with the average symptoms experienced about 1 month earlier. Clinical presentations that require a lot of misdiagnosis result in delayed treatment and unnecessary procedures. Establishing a diagnosis in cases of tuberculosis that causes malignancy is very important since the management and outcomes of the infection and malignancy process are quite different. Consequently we report a 24-year-old man with tuberculosis possible lung cancer with multiple bone metastase. Extrapulmonary tuberculosis which attacks bones and joints constitutes 10% to 20% of all TB cases. The location of bone and joint TB generally develops in the lumbar or thoracic vertebrae

Rapid molecular assay gene Xpert in detection of multi-drug resistant tuberculosis (MTB/Rif)

Background: Tuberculosis (TB) is one of the deadliest threats today; TB due to Mycobacterium tuberculosis (MTB) remains a major public health issue: the infection affects up to one third of the world population, and almost two million people are killed by TB each year. However, in many areas of the world, TB diagnosis still relies on insensitive, poorly standardized sputum microscopy methods. Antibiotic resistance is a growing problem with increasing rate of drug-resistant tuberculosis (MDRTB) which is a serious public health problem in many developing countries. Treatment of MDTB takes longer and requires more expensive drugs. GeneXpert assay is a molecular technique that simultaneously detects (MTB) and Rifampicin resistant Tuberculosis (RR-TB) in approximately 2 h. Methods and materials: A retrospective cross sectional review of patients screened for TB with GeneXpert assay at TB Reference Laboratory,Khartoum State,Sudan from 20th June 2017 and 30th November 2017 (n = 583). Data analysis was done using Epi-Info Software, version 7.2 and Microsoft Office Excel 2007. Results: The total number of specimens collected from patients with symptoms of pulmonary TB was 583 (Males 402/Females 181). One hundred and fifty nine (159) (27.3%) of the screened samples had positive results for MTB, (Males 123/Females 36) of which 63 has history of past TB treatment, 71 New and 25 has un known past history of TB treatment. Among the positive MTB there is one case positive for HIV. Out of 159 there were 26 (4.4%) had rifampicin resistant MDR TB (22 males/4 females), all of MDR TB were more than 14 years, 16 has previous treatment of TB, 9 new and 1 has un known history of TB treatment. The male patients were more resistant to rifampicin when compared to the female patients.MTB was not detected in 424 (279 males 145 females). These despite the usefulness of GeneXpert assay method in early MTB/MDRTB diagnosis. Conclusion: Its simplicity, high sensitivity and specificity for RIF resistance detection make this technique a attractive tool for diagnostic of MTB and RIF resistance in MDR suspects.

Diagnostic accuracy of centralised assays for TB detection and detection of resistance to rifampicin and isoniazid: a systematic review and meta-analysis

Various diagnostic companies have developed high throughput molecular assays for tuberculosis (TB) and resistance detection for rifampicin and isoniazid. We performed a systematic review and meta-analyses to assess the diagnostic accuracy of five of these tests for pulmonary specimens. The tests included were Abbott RealTime MTB, Abbott RealTime RIF/INH, FluoroType MTB, FluoroType MTDBR and BD Max MDR-TB assay.A comprehensive search of six databases for relevant citations was performed. Cross-sectional, case-control, cohort studies, and randomised controlled trials of any of the index tests were included. Respiratory specimens (such as sputum, bronchoalveolar lavage, tracheal aspirate, etc) or their culture isolates.A total of 21 included studies contributed 26 datasets. We could only meta-analyse data for three of the five assays identified, as data were limited for the remaining two. For TB detection, the included assays had a sensitivity of 91% or more and the specificity ranged from 97% to 100%. For rifampicin resistance detection, all the included assays had a sensitivity of more than 92%, with a specificity of 99-100%. Sensitivity for isoniazid resistance detection varied from 70 to 91%, with higher specificity of 99-100% across all index tests. Studies that included head-to-head comparisons of these assays with Xpert MTB/RIF for detection of TB and rifampicin resistance suggested comparable diagnostic accuracy.In people with symptoms of pulmonary TB, the centralised molecular assays demonstrate comparable diagnostic accuracy for detection of TB, rifampicin and isoniazid resistance to Xpert MTB/RIF assay, a WHO recommended molecular test.