Tubercular Etiology Research Articles

Confluence of Challenges: Massive Tubercular Pericardial Effusion Entangled with Heart Failure and Diabetes Mellitus - A Multidisciplinary Odyssey

This case report describes a rare and compelling presentation of Massive Tubercular Pericardial Effusion (MTPE) concomitant with Heart Failure (HF) and Diabetes Mellitus (DM). Tuberculosis, once thought to be a disease of the past, continues to manifest in diverse clinical scenarios, emphasizing the importance of maintaining a high index of suspicion, particularly in endemic regions. The patient, a 60-year-old male with a known history of DM and HF, presented with symptoms of worsening dyspnea, fatigue, and peripheral edema. A diagnostic workup revealed a massive pericardial effusion with characteristics suggestive of tubercular etiology, subsequently confirmed by pericardial fluid analysis. The challenges in managing this triad of conditions: MTPE, HF, and DM were addressed through a multidisciplinary approach involving cardiology, infectious disease, and endocrinology specialists. This case underscores the significance of a comprehensive diagnostic evaluation and collaborative management in optimizing outcomes for patients with complex cardiovascular and infectious comorbidities. KYAMC Journal Volume: 15, No: 01, April 2024: 56-58.

Role of empirical antitubercular therapy for chronic mastitis—A prospective study

Objectives Chronic mastitis (CM) is an uncommon inflammatory condition of the breast, clinically mimicking malignancy with variable etiological factors. It often recurs, causing cosmetic disfigurement and hampering the quality of life of affected females. Limited literature reveals underlying bacterial infection as causative agents in a few cases, while the majority belong to idiopathic entities. CM can be seen as two histological types—chronic granulomatous mastitis (CGM) and chronic nonspecific inflammatory infiltrates (NGM). Etiological and ethnic variations exist globally, and there is lack of information from India. Understanding this entity is important for undertaking etiology-based therapy and preventing unnecessary mismanagement. Materials and Methods We evaluated the demographic, imaging profile and management protocol of CM patients presenting to a tertiary care center in India. Clinically suspected CM patients were prospectively evaluated by mammography and ultrasound (USG). USG-guided biopsy was performed for histopathological and microbiological analysis and treatment was administered accordingly. Response assessment was conducted at six months through USG and clinical evaluation. Results Out of the 53 clinically suspected CM patients, 48 biopsy-proven CM patients were enrolled (five breast carcinoma cases were excluded). All 48 patients were females, with a mean age of 36 ± 9 years. The most common symptom was a unilateral painful lump with skin discoloration. The etiology was idiopathic in 58.3% of cases, tuberculosis in 29%, and bacterial in 4%. Mammography revealed focal asymmetry, architectural distortion, and trabecular thickening. USG showed tracking fluid collections, microlobulated hypoechoic masses, and skin thickening. Etiology-based treatment was administered, and all patients showed 90–100% resolution between four and six months. Conclusion Mammography and USG are important for raising the suspicion while histopathology and microbiological analysis are mandatory for accurate treatment of CM. In India, idiopathic and tubercular etiology of CM is encountered and patients respond well to therapy.

Clinico-Epidemiological Profile of Children Admitted with Pericardial Effusion in a Tertiary Care Hospital: An Observational Study.

Pericardial effusion is rare in children, and the diagnosis is often delayed due to varied presentation and lack of classical Beck's triad manifestation. Delayed initiation of management leads to high mortality (30%). This study aimed to identify the clinico-epidemiological profile of children with pericardial effusion and their outcome. This retrospective study was conducted at the pediatric intensive care unit of a tertiary care center in northern India from January 2019-September 2021, and included children (1 month-18 years) with pericardial effusion. History, clinical presentation, examinations, radiological and laboratory investigations were analyzed. Fifty-four children [median age 63 months (46.5, 132)] were included. Of these children, 78% had at least one feature of Beck's triad; muffling was predominant (42.6%). Overall, 35.2% had severe effusion. The incidence rates of tamponade (66.7%), muffling (68.4%), cardiomegaly (100%), and low voltage electrocardiography (100%) were higher in those with severe effusion compared to those without severe effusion (48.4%, 42.6%, 83.3%, 59.3% respectively). Overall, 44.4% of the children underwent pericardiocentesis, and 9.3% had pigtail catheterization. The children requiring pigtail catheter insertion underwent the procedure within 24 hours of admission. Pericardial effusion of tubercular etiology (19/54) mainly presented with breathlessness (84.2%), poor appetite (63.1%), and weight loss (42.9%), and the incidence rates of severe effusion and pericardiocentesis were 52.6% and 68.4%, respectively. Overall, the mean duration of pigtail catheter in situ was 11.4 days (±6.05), including 8.66 days (±3.77) in the non-tubercular group and 15.5 days (±6.5) in the tubercular group (p = 0.33). Most of the children with pericardial effusion in this study had tubercular etiology, and most had a severe presentation and required pericardiocentesis. Early suspicion, even the presence of a single component of Beck's triad, may be helpful for prompt management.

Tuberculoma of deep peroneal nerve- a rare case report

Tuberculosis can mimick various diseases, causing a diagnostic dilemma.Tuberculomas of peripheral nerves arerare, only 9 cases were reported till date, we report a case of tuberculoma of deep peroneal nerve. A 29 year old subject, presented with complaints of painful swellings over right leg& foot since 2months. Patient developed diffuse swelling of right lower limb 5 years ago, for which he was treated with NSAIDs & serratiopeptidase by a local practitioner for 2 weeks after which he noticed tiny swellings on lower half of right shin & right foot which grew in size gradually &became painful since 2 months. Examination revealed tiny palpable mobile nodular soft swellings over lower aspect of right leg & over right foot. Ultrasonography of the swellings showed multiple ovale capsulated hypoechoic swellings largest measuring 18.9∗6.1 mm in the mid/lower leg subcutaneous plane anteriorly & similar lesions in the lower leg & dorsum of foot, suggesting benign neoplastic etiology of neural origin. Excision biopsy from deep peroneal nerve sheath tumour showed extensive areas of caseous necrosis with few epitheloid clusters with dense lymphocytic collections in the periphery, suggesting caseating granulomasof tubercular etiology. After making a diagnosis of tuberculoma of deep peroneal nerve, the patient has been initiated on Anti tubercular therapy & the patient respoded to ATT. Tuberculomas of peripheral nerves are rare. Final diagnosis comes from histopathology that reveals caseous necrosis surrounded by epitheloid histiocytes with or without granulomas Nerve exploration, lesion resection, and ATT results in good neurological recovery.

Correlation of Grayscale Ultrasound and Doppler Evaluation with Histopathological Diagnosis in Cases of Tubercular Cervical Lymphadenitis

ABSTRACT Introduction: Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities. Materials and Methods: The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis. Results: Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy. Conclusion: In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.

A Case Report on Heart Failure in Dengue Patients with Concurrent Capillary Leakage Syndrome: Unveiling a “Leakage-Failure” Co-existence

This case report describes a rare and compelling presentation of Massive Tubercular Pericardial Effusion (MTPE) concomitant with Heart Failure (HF) and Diabetes Mellitus (DM). Tuberculosis, once thought to be a disease of the past, continues to manifest in diverse clinical scenarios, emphasizing the importance of maintaining a high index of suspicion, particularly in endemic regions. The patient, a 60 year old male with a known history of DM and HF, presented with symptoms of worsening dyspnea, fatigue, and peripheral edema. Diagnostic workup revealed a massive pericardial effusion with characteristics suggestive of tubercular etiology, subsequently confirmed by pericardial fluid analysis. The challenges in managing this triad of conditions: MTPE, HF, and DM were addressed through a multidisciplinary approach involving cardiology, infectious disease, and endocrinology specialists. This case underscores the significance of a comprehensive diagnostic evaluation and collaborative management in optimizing outcomes for patients with complex cardiovascular and infectious comorbidities. KYAMC Journal Volume: 14, No: 04, January 2024: 246-248.

Lung infections in HIV-infected children: imaging pattern recognition and its correlation with CD4 counts

ContextChildren with human immunodeficiency virus (HIV) infection frequently present with opportunistic infections of the lung that may be associated with high mortality rate. There is no study, to the best of our knowledge, correlating specific radiographic patterns of chest infections with CD4 levels of immunity in HIV-infected children of Indian subcontinent (where prevalence of respiratory tuberculosis is very high).AimsTo study the radiological patterns of chest infections in HIV-infected children, and to correlate these radiological findings with CD4 cell count and final diagnosis.MethodsForty-five HIV-infected children (1–18 years of age) with suspected chest infections were included in the study. The baseline and the most recent CD4 counts were recorded for each patient. Chest X-ray (CXR) was obtained in all the patients, and multi-detector computed tomography (MDCT) chest was done in 27 patients having clinical suspicion of infection with normal or equivocal findings on CXR. Chest radiographs and MDCT chest were analyzed for different radiological patterns of chest infections. Imaging findings were correlated with CD4 count range for disease spectrum. The final etiopathological diagnosis was achieved in combination with clinico-radiological findings, laboratory data, cytohistopathology and follow-up imaging.ResultsOut of 45 children confirmed to be HIV-infected, 27 (60%) had bacterial infection, 14 (31.11%) had tuberculosis, and four (8.89%) had fungal infection.Consolidation on CXR/CT strongly suggested bacterial etiology (P < 0.05). Mediastinal/hilar lymphadenopathy (with or without necrosis) strongly suggested tubercular etiology (P value < 0.05). Diffuse GGO/haziness on CXR/CT strongly suggested fungal etiology (P value < 0.05).On correlation with CD4 count (cells/mm3), the bacterial infections occurred at early stages of HIV infection when immune status was relatively preserved, and most of the patients with tubercular infection had moderate immunosuppression. On the other hand, all patients of fungal infection showed severe immunosuppression.ConclusionA wide spectrum of pulmonary disease encountered in HIV-infected children warrants an integrated approach of image interpretation. Familiarity with the imaging patterns, combined with relevant clinical/laboratory details, may greatly help to improve the diagnostic confidence and to reach to a more meaningful differential diagnosis.

Epididymo-orchitis with epididymal abscess in a patient with disseminated tuberculosis

Abstract Tuberculosis remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations like genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old male with left scrotal swelling, backache, and fever, highlighting the importance of considering tuberculosis in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and contrast-enhanced magnetic resonance imaging Dorso-lumbar spine, confirmed disseminated tuberculosis. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital tuberculosis, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of tuberculous epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications like hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.

360° like iris nodules in ocular tuberculosis

The case of a young male with the uniocular presentation of iris nodules of tubercular etiology is described. Interestingly, this patient had 360° like iris nodules both at the surface and pupillary border which resolved within 2 weeks of starting the anti-tubercular treatment.

Study of cerebrospinal fluid adenosine deaminase activity for differential diagnosis of tuberculous and non-tuberculous meningitis

Background: Diagnosing a case of tuberculous meningitis (TBM) has always been challenging. Numerous previous studies have demonstrated that cerebrospinal fluid-Adenosine deaminase (CSF-ADA) estimation is useful in the diagnosis of TBM and can differentiate TBM from other types of meningitis. Aims and Objectives: The current study aims to look for a simple, rapid, cost-effective, and specific test to differentiate tubercular etiology from other causes of meningitis. Materials and Methods: A total of 80 patients admitted to the hospital with signs and symptoms of meningitis were selected and divided into two groups: Group 1 (Cases): 40 patients of TBM, Group 2 (Control): 40 patients of pyogenic and viral meningitis. The CSF ADA was estimated by enzymatic method, CSF Protein by turbidimetric method, and CSF Glucose by Glucose oxidase (GOD) and Peroxidase (POD) method. Results: CSF ADA levels (mean ± SD) in the TBM and non-TBM groups were 10.874+7.72 IU/L and 2.44+1.757 IU/L, respectively (highly significant, P&lt;0.001). With the CSF ADA cut off as &gt;6 IU/L, the sensitivity of the test was 95%, and the specificity of 92.5%. On comparison of the values of CSF ADA in the two groups, the t value is −6.75, and the difference in these two values was found to be highly significant (P&lt;0.01). Conclusion: ADA estimation in CSF is a simple, inexpensive, rapid, and specific method for making a diagnosis of tuberculous etiology in TBM. As a screening test, the determination of ADA activity in CSF can help the physician diagnose TBM early and reduce irreversible brain damage and neurologic sequelae by early administration of anti-tuberculous medications.

Serum Adenosine Deaminase Levels in Tubercular Lymphadenitis: Correlation and Cutoff

Objectives: Tubercular lymphadenitis accounts for the large majority of extrapulmonary tuberculosis (TB) worldwide. The available means for their diagnosis are often time-consuming, tedious, and costly. Adenosine deaminase (ADA) level estimation in body fluids has emerged as a popular method of diagnosing tuberculous infection. Very few studies have examined serum ADA levels in TB lymphadenitis and fewer such studies have used controls. The objective of the present study was to find any correlation between serum ADA and fine-needle aspiration cytology-confirmed tubercular lymphadenitis and, if a correlation existed, whether there existed any diagnostic cutoff for clinical utility. Material and Methods: This prospective study was done over 2 years. The patients were grouped into tubercular lymphadenitis (group 1, cases) and non-tubercular lymphadenitis (group 2, controls). Serum ADA level was estimated using the spectrophotometric method. Statistical methods were employed to examine the intergroup differences in serum ADA levels. The receiver operating characteristic curve (ROC curve) was used to assess the overall accuracy and corresponding diagnostic accuracy at different cutoff values of serum ADA. Results: Tubercular lymphadenitis (Group I) has a strong female predilection (M: F = 0.56:1, P = 0.017), a significantly late clinical presentation (P = 0.002), and a significantly higher incidence of cervical lymph node involvement (P = 0.019). A positive treatment history was significantly and more commonly found in patients of group 1 (P &lt; 0.001) than patients of group 2. The mean serum ADA level was 43.14 IU/L. A significantly higher serum ADA level was detected in group 1 patients than in group 2 (56.81 ± 12.42 vs. 32.07 ± 6.84, P &lt; 0.001). On ROC, the area under the curve was 97.2%, indicating a very good discriminating capability of serum ADA levels between groups 1 and 2. A cutoff value of 41.90 IU/L had the best sensitivity and specificity (93.15% and 92.1%, respectively) for detecting a tubercular etiology. Conclusion: Serum ADA level of 41.90 U/L can differentiate tubercular from non-tubercular lymphadenitis with a very high sensitivity and specificity. Therefore, serum ADA estimation can facilitate an early clinical diagnosis and institution of treatment.

Insight into tuberculosis of talus in children: A review of five cases

BackgroundTubercular affection of talus in children is considered extremely rare with literature limited to few case reports. This study reports five cases of tubercular infection of talus in children and traces the various presentations and the treatment outcome.MethodsThe series describes five children with biopsy proven affection of tuberculosis of talus. Data reviewed included the demographic data, clinical presentation, diagnosis, treatment and outcome at final follow up. ResultsAmong the five cases described in this series, the majority were osseous (4/5). The location of the osseous lesions was noted in the head as well as the head-neck junction of the talus. The duration of symptoms varied from three to 12 months. Three of the five cases healed uneventfully after the initiation of standard anti-tubercular therapy with normal appearing radiographs at the latest follow up. Two cases still had small, geographic lytic lesions in the talus. These might represent healed cystic cavities filled with fibrous. ConclusionThe diagnosis of tuberculosis of talus in children is challenging. A high index of suspicion is required for patients presenting pain around the ankle and hindfoot for more than four weeks. The involvement of the talar bone in tuberculosis can be osseous or synovial. Lesions in the head and neck should particularly be investigated for tubercular etiology. Once diagnosed, antitubercular drugs are effective in healing the lesions clinically as well as radiologically. The presence of lesions in the non-weight bearing area of the talus prevents bony collapse and eventual shape is maintained.

Role of thoracoscopy in diagnosis of tubercular pleural effusion in low ADA setting- A prospective, observational study

BackgroundTubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting. Aims and objectiveThis study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L). Material and methodsA Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis. ResultsOut of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002). ConclusionThe diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield.

Sellar Tuberculosis Mimicking Pituitary Adenoma

Tuberculosis of central nervous system accounts for only 1% of tuberculosis cases worldwide, of which pituitary is an extremely unusual site. We report a case of pituitary tuberculosis in a 29-year-old female presenting with complains of headache and diminished vision on right eye. It was misdiagnosed as pituitary adenoma on radiology. Biopsy showed epithelioid granulomas, langhans giant cells and caseous necrosis. Ziehl nelseen stain showed presence of acid fast bacilli confirming the tubercular etiology. Therefore, histology remains the mainstay for diagnosis of these lesions. Early diagnosis and prompt use of antitubercular drugs results in good outcome.

Tuberculosis with tubercular osteomyelitis of skull

Tuberculous osteomyelitis of skull is a rare form of tuberculosis with an incidence of 0.2 – 1.3% of all skeletal tuberculosis. A 9-year-old boy presented with a history of prolonged fever, recurrent cough since 2 months before admitted and painless scalp swelling for the previous 1 month. A diagnosis of tubercular etiology was established with the rapid molecular test and histopathology of the fine needle aspiration biopsy specimen. The patient was kept on antitubercular treatment for 12 months. After 2 months treatment he responded well, with a marked resolution of symptoms and physical examination findings.

Directly observed treatment short-course in management of peripheral tubercular lymphadenitis

Background: Tuberculosis (TB) is a major public health problem worldwide. It is one of the main causes of infectious disease and mortality, especially in the developing countries, and has been recognized as one of the top ten causes of death worldwide by the World Health Organization. Aims and Objectives: The aims of this study were to assess clinical pattern and efficacy of Directly Observed Treatment Short-Course (DOTS) in management of peripheral tubercular lymphadenitis. Materials and Methods: This was a prospective, observational study among pediatric peripheral tubercular lymphadenitis patients to assess the clinical pattern, investigations, and treatment outcome. Results: In this study, 72 patients having peripheral tubercular lymphadenitis were enrolled. Most cases had cervical node involvement (81%). Discharging sinus was found in 28.98% cases. Acid-fast bacillus (AFB) was detected by fine needle aspiration and cytology (FNAC) in 21 cases (30.43%). Among them, pulmonary TB was found in two cases (9.52%), one patient being sputum positive. After treatment completion, lymph node(s) enlargement persisted in 6 (8.69%) cases, of which two patients (2.89%) had persistent discharging sinus. On repeat FNAC, acid-fast bacilli were seen in two patients. Success rate was 91.3% confirming the efficacy of DOTS in the management of tubercular lymphadenitis. Conclusions: Cervical lymphadenitis was found to be most common type of peripheral lymphadenitis. Cytopathology from the suspected lymph nodes had better success rate than AFB detection or CBNAAT of FNAC samples for diagnosing tubercular etiology in the study. DOTS strategy was effective for peripheral tubercular lymphadenitis with high success rate in this study.

Utility of PCR in the Diagnosis of Tubercular Lymphadenitis on Fine Needle Aspirates

Background&#x0D; Extra-pulmonary tuberculosis is a diagnostic and therapeutic challenge. Diagnosing tubercular lymphadenitis includes identification of epithelioid granulomas, positive Acid Fast Bacilli detected with Ziehl Neelsen’s stain. The disadvantage is the time taken for formation of granulomas. With the advent of RT-PCR, the diagnosis of tubercular lymphadenitis can be made with ease [1].&#x0D; Aims and objectives: To utilize PCR and mycobacterial culture on samples obtained from Fine needle aspiration of lymph nodes in order to aid in early diagnosis of extra-pulmonary tuberculosis.&#x0D; Materials and methods: Observational descriptive prospective study; Patients with lymphadenopathy &gt;1 cm, above the age of 2 years were included ; FNA was performed, material was used for routine cytological studies (PAP, MGG and Ziehl Neelsen-stained slides), PCR and culture (wherever possible); Comparative values of PCR and culture were utilized for statistical analysis&#x0D; Results: Out of 80 cases studied, M. Tuberculosis by PCR was detected on 36 cases (45%); PCR and culture demonstrated MTB in 42.55% of the cases. 9 cases (11.25%) of reactive lymphadenitis were found to be of tubercular etiology on PCR analysis. The Chi-squared test was highly significant. PCR has been found to have a sensitivity, specificity, PPV and NPV of 100%, 92.59%, 90.91% and 100%, respectively. Positive RT-PCR was more common in cases with chronic granulomatous inflammation when compared against reactive lymphoid hyperplasia with a chronic inflammatory infiltrate.&#x0D; Conclusion: From this study, we conclude that RT-PCR is a useful ancillary technique to conclusively identify Mycobacterium tuberculosis in samples obtained from fine needle aspiration of lymph nodes.

AFB culture and adenosine deaminase levels in subjects with tubercular pleural effusion

Background: Tuberculosis is the communicable infectious disease usually caused by Mycobacterium Tuberculosis Bacteria (MTB). Tuberculosis generally affects lungs, but can also affect other parts of the body. ADA has been found to be useful parameter to conclude the tubercular etiology. Tuberculous Pleural effusion is diagnosed by demonstration of tubercular bacilli in pleural fluid or granuloma in pleural biopsy specimen. Objectives of this study: The objectives of this study were to estimate ADA levels and to study AFB culture in subjects with and without tubercular pleural effusion. Materials and Methods: Biochemical analysis for Protein and Glucose were performed on Automated Biochemistry Analyser and ADA was estimated by ADA-MTB kit method. Cytological examination and ADA Microbiological demonstration of AFB by ZN stain and AFB culture was done by conventional LJ method. Statistical Analysis: Data were expressed as mean ± SD. The Student t test was used for the comparison. Statistical analysis was done using Microsoft Excel spreadsheet, and statistical package for the social sciences (SPSS) version 20.0 software.

Novel biomarkers for Diagnosis of Pulmonary Tuberculosis and Tuberculous Pleural Effusion

Background: The present study aimed to evaluate the importance of serum, pleural adenosine deaminase (ADA), and Gene Xpert in Diagnosis of TB and TB Pleural Effusion (TB-PLE.).Material &amp; Methods:The study was done with 75 TB cases, 50 cases of them were diagnosed as Pulmonary TB and 25 cases as TB pleural effusion, collecting also 50 non-TB pleural effusion, Malignant and acute bacterial infection comprise 21 and 29 cases respectively. Cases with transudative pleural effusion were excluded from the study. Finally, 75 were healthy control group.Results:There was a highly significant difference between the mean age of TB-PE Patients and Patients non-TB-PLE (P-value &lt;0.001), while there was a non-significant difference with patients with P-TB (P-value &gt;0.05). Mean of Serum ADA level were highest 53.16 U/L in TB-PE cases, shown to be statistically significant when compared to 43.2 U/L in P-TB and 25.4 U/L in non TBpleural effusion. With p-value of 0.02 and 0.001respectively.Conclusions:We concluded that GeneXpert can be a useful diagnostic method in patients with suspected pulmonary tuberculosis. Serum and pleural fluid ADA level is a very helpful test to rule out a TB and can help differentiate tubercular etiology from non-tubercular.

Мезотеліома плеври у диференціальній діагностиці туберкульозного ексудативного плевриту

Метою роботи було на прикладі власних клінічних спостережень встановити особливості діагностики ексудативних плевритів внаслідок мезотеліоми плеври шляхом визначення інформативності та цінності застосованих діагностичних методів для подальшого використання у диференціальній діагностиці з ексудативними плевритами туберкульозної етіології. Встановлено, що всі застосовані діагностичні методи були високоінформативними, що дозволило швидко визначитися з діагнозом та призначити правильне лікування. На їх основі алгоритмом диференціальної діагностики специфічного ексудативного плевриту, викликаного мезотеліомою плеври, є рентгенографія органів грудної порожнини (по можливості — комп’ютерна томографія), ультразвукове дослідження органів грудної порожнини, цитологічне дослідження плевральної рідини, відеоторакоскопія з біопсією парієтальної плеври.