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DRAHL, CARMEN. "TB DIAGNOSIS: MURKY." Chemical & Engineering News 85, no. 39 (September 24, 2007): 39–42. http://dx.doi.org/10.1021/cen-v085n039.p039.
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Osman, Muhammad, Sue-Ann Meehan, Arne von Delft, Karen Du Preez, Rory Dunbar, Florian M. Marx, Andrew Boulle, Alex Welte, Pren Naidoo, and Anneke C. Hesseling. "Early mortality in tuberculosis patients initially lost to follow up following diagnosis in provincial hospitals and primary health care facilities in Western Cape, South Africa." PLOS ONE 16, no. 6 (June 14, 2021): e0252084. http://dx.doi.org/10.1371/journal.pone.0252084.
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In South Africa, low tuberculosis (TB) treatment coverage and high TB case fatality remain important challenges. Following TB diagnosis, patients must link with a primary health care (PHC) facility for initiation or continuation of antituberculosis treatment and TB registration. We aimed to evaluate mortality among TB patients who did not link to a TB treatment facility for TB treatment within 30 days of their TB diagnosis, i.e. who were “initial loss to follow-up (ILTFU)” in Cape Town, South Africa. We prospectively included all patients with a routine laboratory or clinical diagnosis of TB made at PHC or hospital level in Khayelitsha and Tygerberg sub-districts in Cape Town, using routine TB data from an integrated provincial health data centre between October 2018 and March 2020. Overall, 74% (10,208/13,736) of TB patients were diagnosed at PHC facilities and ILTFU was 20.0% (2,742/13,736). Of ILTFU patients, 17.1% (468/2,742) died, with 69.7% (326/468) of deaths occurring within 30 days of diagnosis. Most ILTFU deaths (85.5%; 400/468) occurred in patients diagnosed in hospital. Multivariable logistic regression identified increasing age, HIV positive status, and hospital-based TB diagnosis (higher in the absence of TB treatment initiation and being ILTFU) as predictors of mortality. Although hospitals account for a modest proportion of diagnosed TB patients they have high TB-associated mortality. A hospital-based TB diagnosis is a critical opportunity to identify those at high risk of early and overall mortality. Interventions to diagnose TB before hospital admission, improve linkage to TB treatment following diagnosis, and reduce mortality in hospital-diagnosed TB patients should be prioritised.
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Murwaningrum, Artati, Murdani Abdullah, and Dadang Makmun. "Pendekatan Diagnosis dan Tatalaksana Tuberkulosis Intestinal." Jurnal Penyakit Dalam Indonesia 3, no. 3 (January 23, 2017): 165. http://dx.doi.org/10.7454/jpdi.v3i3.28.
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Tuberkulosis (TB) telah menjadi masalah global yang terus membesar seiring dengan bertambahnya jumlah pasien TB. Infeksi TB masih merupakan hal yang umum ditemukan dan merupakan faktor penting terhadap angka kesakitan dan kematian, terutama pada negara yang belum dan sedang berkembang. Kasus Tuberkulosis usus (TB usus) juga meningkat seiring dengan meningkatnya jumlah kasus TB secara umum. Indonesia merupakan Negara ke-2 dengan prevalensi Tuberkulosis TB tertinggi di Asia Tenggara setelah Timor Leste pada tahun 2014. TB usus adalah manifestasi TB ekstrapulmonal terbanyak keenam.Manifestasi klinis yang tidak spesifik dan kadang menyerupai beberapa kondisi lain termasuk keganasan menyebabkan diagnosis TB usus sulit ditegakkan secara akurat. Temuan dari hasil endoskopi dan gambaran radiologi dari berbagai stage penyakit sudah sangat banyak, namun diagnosis tetap sulit dilakukan. Sampai saat ini belum ada metode tunggal yang dapat mendeteksi TB usus secara tepat dan akurat, berbagai metode investigasi telah digunakan dalam diagnosis TB usus. Diagnosis yang dilakukan sejak awal, pemberian terapi anti tuberculosis dan tindakan bedah adalah hal-hal esensial dalam pencegahan terjadinya kesakitan dan kematian akibat TB usus, sehingga dibutuhkan kombinasi penilaian klinis dan pemeriksaan berbagai modalitas. Pasien yang telah didiagnosis TB usus diberikan terapi obat anti tuberculosis (OAT) dan pertimbangan tindakan bedah jika mengalami komplikasi.Kata Kunci: diagnosis, tuberkulosis intestinal Diagnostic Approach and Treatment of Instestinal TuberculosisTuberculosis (TB) has become a resurgent global problem with increasing numbers of patients. TB infection is still common and remains an important cause of morbidity and mortality, particularly in underdeveloped and developing nations. Intestinal tuberculosis (intestinal TB) rates are rising, consistet with the overall trend. In 2014 Indonesia has the second highest TB prevalence in South East Asia after Timor Leste. Intestinal TB is the sixth highest manifestation of extrapulmonal TB. Manifestations can be non-specific and mimic many conditions, including malignancies causes’ intestinal TB diagnosis more difficult to be accurately determined. Findings from endoscopy and radiological imaging are countless, and depend on the stage of the disease and the time at which investigations are carried out. Hence, diagnosis can be difficult. Until recently there is no single method to identify intestinal TB accurately, various investigative methods have been used to aid in the diagnosis of intestinal TB. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Combined clinical assessment and some modalities examinations are needed to determine intestinal TB. Patient whom has been diagnosed with intestinal TB will be given anti tuberculosis therapy and surgery if any complications occur. Keywords: diagnosis, intestinal tuberculosis
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Ahammad, Faruk, Ahmed Manadir Hossain, Mohammad Abu Bakar Siddique, and Nipendra Nath Biswas. "Laboratory Diagnosis of Tuberculosis- an Update." Faridpur Medical College Journal 10, no. 2 (November 7, 2016): 71–75. http://dx.doi.org/10.3329/fmcj.v10i2.30275.
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Annually about two million deaths occur globally due to tuberculosis (TB). Bangladesh ranks the sixth position among 22 highest burden TB countries in the world and also one of the 27 high multidrug resistant tuberculosis (MDR-TB) burden countries where about 70,000 people die every year due to TB. Among six key components of Stop TB Strategy (STS) Plan, the first one includes increase case notification of all forms of TB and improve diagnosis of new smear negative, extrapulmonary cases and TB in children by 2016. As TB can affect any organ in human body, the TB cases are managed by any discipline in medical community. Unfortunately diagnostic accuracy is not satisfactory and is not only due to uniform unavailability of the latest diagnostic facilities but also due to inadequate knowledge of the professionals about currently available modern laboratory techniques to diagnose TB. Light-emitting diode (LED) microscopy with fluorescence (auramine-rhodamine staining) should be preferred than conventional microscopy with Zeihl-neelsen (acid fast) staining to identify TB bacilli. Mantoux test (MT) indicates only infection by TB bacilli, does not necessarily the active disease. It may be positive in latent TB and in BCG (Bacillus Calmette-Guerin) vaccinated cases. Antibodies from Lymphocyte Secretion or Antibodies in Lymphocyte Supernatant (ALS) assay can detect active TB cases within three days of sample collection. The test is very useful to diagnose TB in children where sputum collection is difficult. Interferon gamma release assay (IGRA) tests are not advocated in low and middle-income countries, typically those with a high TB and/or HIV burden. Anti TB IgG/IgM/IgA tests should be avoided because these are being misinterpreted by someone as active TB cases. Adenosine Deaminase Assay (ADA) is a reliable test to diagnose tuberculous pleural effusion together with other evidences. ADA in pleural fluid <40 IU/L is considered negative for TB. The more the ADA level, the more possibility to be tuberculous effusion. Level >100 IU/L is highly specific for TB origin. Gene Xpert MTB/RIF, an Xpert test for mycobacterium tuberculosis (MTB) and Rifampicin (RIF) resistance, is used for rapid identification for TB bacilli, specially when MDR-TB is suspected, in human immunodeficiency virus ( HIV) infected cases and highly suspected sputum negative cases ( as a follow on test ) where microscopy frequently failed due to low bacterial load. The test exhibits high sensitivity and specificity for detecting pulmonary TB.Faridpur Med. Coll. J. Jul 2015;10(2): 71-75
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Takhar, Rajendra, and Moti Lal Bunkar. "Diagnosis: Reactivation of pulmonary TB." Annals of Saudi Medicine 36, no. 2 (April 2016): 152a. http://dx.doi.org/10.5144/0256-4947.2016.152a.
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Khan, Nida, Abid Ghafoor Chaudhry, Shaheer Ellahi Khan, Muhammad Amir Khan, and Muhammad Ahmar Khan. "TUBERCULOSIS DIAGNOSIS AND TREATMENT." Professional Medical Journal 22, no. 01 (January 10, 2015): 054–63. http://dx.doi.org/10.29309/tpmj/2015.22.01.1412.
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Pakistan is eighth among countries with high burden of tuberculosis (TB). InPakistan free-of-charge TB diagnosis and treatment services are available. The objectiveof qualitative exploratory study was to understand how TB patients and their families copewith the lost earnings and increased expenditures (other than diagnosis and treatmentcost) related with disease and its treatment. The research methods included literaturereview, focus group discussion using vignettes and in-depth interviews with TB patients.The study was done in the rural areas of Lahore District with the support of district andlocal health facility staff. The study revealed that, Results like in many other developingcountries, TB patients rely mainly on financial and physical support of family membersand friends. Conclusion The study also highlighted the need for developing institutionalmechanisms to help patients cope with economic consequences of tuberculosis.
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Nataprawira, Heda Melinda D., Cissy B. Kartasasmita, Oma Rosmayudi, and Hudiyati Agustini. "Diagnosis of pediatric tuberculosis using The Indonesian National Concencus for Pediatric Tuberculosis." Paediatrica Indonesiana 41, no. 4 (August 30, 2001): 185. http://dx.doi.org/10.14238/pi41.4.2001.185-90.
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Diagnosing tuberculosis (TB) in children correctly is critical to appropriate treatment. However, diagnosing TB in children may be difficult and can be imprecise. As our national TB control program has not adequately covered TB in children and adult TB cases still in high rank, our national consensus for pediatric population may facilitate TB diagnosed especially in the field. This cross sectional study as part of longitudinal cohort study of epidemiology of Respiratory Syncitial Virus (RSV) in Indonesia (still ongoing) was conducted to know whether criteria used in the algorithm in the consensus compatible to suspected TB diagnosis. The study covered 1000 children under five randomly selected in two districts (Cikutra and Ujung Berung Indah) located in West Java. By using algorithm of The Indonesian National Consensus For Pediatric Tuberculosis (INCPT) with history of known or suspected adult source of TB or early reaction of BCG vaccination and certain general clinical symptoms associated TB as entry criteria for a higher index of suspicion, we diagnosed suspected TB in 57 children. We found that, history of known or suspected adult source of TB and certain general clinical symptoms are two main criteria for suspected TB diagnosis. It appeared that Mantoux test gave a smallest contribution to the diagnosis of suspected TB in the field. No other criterium except known or suspected adult source of TB fulfilled for other five children and prophylactic treatment for TB were given. Those children with suspected TB were given oral anti-tuberculosis (OAT) by Directly Observed Treatment Short course (DOTS) done by local trained persons.
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Rutakingirwa, Morris K., Fiona V. Cresswell, Richard Kwizera, Kenneth Ssebambulidde, Enock Kagimu, Edwin Nuwagira, Lillian Tugume, et al. "Tuberculosis in HIV-Associated Cryptococcal Meningitis is Associated with an Increased Risk of Death." Journal of Clinical Medicine 9, no. 3 (March 13, 2020): 781. http://dx.doi.org/10.3390/jcm9030781.
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Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were compared between three groups: ‘prevalent TB’ if TB treated >14 days prior to cryptococcal meningitis diagnosis, ‘concurrent TB’ if TB treated ± 14 days from diagnosis, or ‘No TB at baseline’. We used time-updated proportional-hazards regression models to assess TB diagnosis as a risk for death. Of 870 participants with cryptococcal meningitis, 50 (6%) had prevalent TB, 67 (8%) had concurrent TB, and 753 (86%) had no baseline TB. Among participants without baseline TB, 67 (9%) were diagnosed with incident TB (after >14 days), with a median time to TB incidence of 41 days (IQR, 22–69). The 18-week mortality was 50% (25/50) in prevalent TB, 46% (31/67) in concurrent TB, and 45% (341/753) in the no TB group (p = 0.81). However, TB co-infection was associated with an increased hazard of death (HR = 1.75; 95% CI, 1.33–2.32; p < 0.001) in a time-updated model. TB is commonly diagnosed in cryptococcal meningitis, and the increased mortality associated with co-infection is a public health concern.
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Medrano, Belinda A., Gloria Salinas, Connie Sanchez, Roque Miramontes, Blanca I. Restrepo, Maryam B. Haddad, and Lauren A. Lambert. "A Missed Tuberculosis Diagnosis Resulting in Hospital Transmission." Infection Control & Hospital Epidemiology 35, no. 5 (May 2014): 534–37. http://dx.doi.org/10.1086/675833.
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Objective.To find the source of tuberculin skin test conversions among 38 hospital employees on 1 floor during routine testing January–February 2010.Methods.Record review of patients at a private hospital during September-December 2009 and interviews with hospital employees. Names of patients from the state tuberculosis (TB) registry were cross-referenced with hospital records for admissions. Mycobacterium tuberculosis genotype results in the county and adjacent counties were examined, and contacts were evaluated for TB infection and disease.Results.One of the 38 employees, a nurse, was diagnosed with pulmonary TB with a matching M. tuberculosis genotype and drug resistance pattern (isoniazid monoresistant) to those of a county jail inmate also recently diagnosed with pulmonary TB. The nurse had no known contact with that inmate; however, another inmate in his 20's from the same jail had been hospitalized under that nurse's care in October 2009. That young man died, and a postmortem examination result subsequently confirmed TB, which had not been suspected. Exposure to this man with undiagnosed TB could explain the transmission: 87 (27%) of the 318 hospital-based contacts without previous positive tuberculin skin test results were infected, and 9 contacts had active TB.Conclusions.This investigation demonstrated M. tuberculosis transmission in a hospital due to a missed diagnosis and nonadherence to national TB infection control guidelines. Routine TB screening of employees allowed early detection of this missed TB diagnosis, facilitating prompt evaluation of contacts. Healthcare providers should suspect TB in symptomatic persons and adhere to TB control policies.
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Kesarwani, Pushkar, Versha Keshari, Reena Srivastava, Sarita Pandey, and Devendra Mishra. "A study on role of cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of genital tuberculosis among patients of infertility and pelvic inflammatory disease." Indian Journal of Obstetrics and Gynecology Research 8, no. 1 (March 15, 2021): 70–76. http://dx.doi.org/10.18231/j.ijogr.2021.014.
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Female genital TB (FGTB)– referring to TB of the uterus, fallopian tubes and/or Ovaries. It poses a diagnostic dilemma because of its varied presentations and lack of sensitive and specific methods of diagnosis, though CBNAAT gives rapid result. To study the role of CBNAAT in the Diagnosis of Genital Tuberculosis among infertility and Pelvic Inflammatory Disease (PID) Patients. 102 patient of infertility (52) and chronic PID (50) were enrolled for our cross-sectional study. Mantoux, ESR, Histopathology, CBNAAT was performed in all 102 cases and Hysterosalpingography (HSG), Laparoscopy, Hysteroscopy in selected cases. Patient with clinical features of genital TB, supported with TB suggestive test were diagnosed as high suspicious genital TB (GTB+) and rest Low suspicious GTB (GTB-) cases. 14/ 52 cases of infertility and 18/ 50 cases of chronic PID were clinically diagnosed as High suspicious genital TB (GTB+). In our study, overall Prevalance of GTB was 31.37%, among infertility patient prevalence was 26.92% and among chronic PID was 36%. 16/32 (50%) mantoux positive, 25/32 (78.13%) had increased ESR. On HSG, 10/52 (19.23%) infertility cases, on laparoscopy 24/32 (75%), on endometrial histopathology only 3/32 (9.37%) cases had finding suggestive of TB. CBNAAT could detect tubercular bacilli only in 25% (8/32) TB cases. High index of suspicion for FGTB is must for diagnosis. Unlike Pulmonary TB, role of CBNAAT in the diagnosis of female genital TB is limited. PPV of CBNAAT for diagnosis of GTB is almost 100%.
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Li, Tao, Hemant Deepak Shewade, Kyaw Thu Soe, Jeanette J. Rainey, Hui Zhang, Xin Du, and Lixia Wang. "Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015." BMJ Open 9, no. 1 (January 2019): e021529. http://dx.doi.org/10.1136/bmjopen-2018-021529.
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ObjectiveThe WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China.DesignA retrospective inventory study (record review).SettingCounties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015.Primary and secondary outcome measuresUnder-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes.ResultsOf the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system—but not both—were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region.ConclusionAlmost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.
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Sengai, T., C. Timire, A. D. Harries, H. Tweya, F. Kavenga, G. Shumba, J. Tavengerwei, et al. "Mobile targeted screening for tuberculosis in Zimbabwe: diagnosis, linkage to care and treatment outcomes." Public Health Action 9, no. 4 (December 21, 2019): 159–65. http://dx.doi.org/10.5588/pha.19.0040.
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Setting: Targeted active screening for tuberculosis (Tas4TB) using mobile trucks in the community was implemented in 15 high TB burden districts in Zimbabwe. At-risk populations were screened for TB based on symptoms and chest radiography (CXR) results. Those with any positive symptom and/or an abnormal CXR had sputum collected for investigation and diagnosis and were linked to care and treatment if found to have TB.Objective: To determine 1) the proportion and characteristics of those screened and diagnosed with TB; 2) the relationship between TB symptoms, CXR and diagnostic yields; and 3) the relationship between initiation of anti-TB treatment and treatment outcomes.Design: Cohort study using routinely collected dataResults: A total of 39 065 persons were screened, of whom 663 (1.7%) were diagnosed with TB; 126/663 (19.0%) were bacteriologically confirmed. The highest TB diagnostic yields were in symptomatic persons with CXRs suggestive of TB (19.4%), asymptomatic persons with CXRs suggestive of TB (8.4%) and persons at high-risk of TB (3.2%). For all diagnosed TB patients, pre-treatment loss to follow-up was 18.9% and treatment success was 59.9%.Conclusion: Tas4TB resulted in high diagnostic yields; however, linkage of diagnosis to care was poor. Reasons for loss to follow-up need to be better understood and rectified.
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Nawaz, Iram, Rabia Arshed Usmani, Taskeen Zahra, Asima Asif, and Shahbaz Baig. "TUBERCULOSIS DIAGNOSIS." Professional Medical Journal 25, no. 06 (June 10, 2018): 914–19. http://dx.doi.org/10.29309/tpmj/2018.25.06.281.
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Background: Delay in diagnosis of Tuberculosis (TB) and initiation of antituberculartreatment (ATT) contributes to more severe disease manifestations in the individualand higher disease transmission in the community. Objective: To find out the delays indiagnosis and treatment of TB patients and to describe determinants related to these delays.Study Design: Cross-sectional descriptive study. Setting: TB Directly Observed TreatmentShort course (DOTS) Center of Jinnah Hospital, Lahore. Period: July to September 2013.Methods: 373 tuberculosis patients attending TB Directly Observed Treatment Short course(DOTS) Center of Jinnah Hospital, Lahore were included using simple random sampling. Delaywas then categorized into low delay and high delay depending upon the median of total delaywhich was of 97 days. Results: It was concluded that the total median diagnostic and treatmentdelay related to both patients as well as health system was 97 days. Results revealed that about55.7% patients had high total delay (delay>median) and 44.3% patients had low total delay.Among those patients with high delay, 58.7% were aged above 35 years, 81.4% were females,96.4% were illiterate, 54.8%were living in rural areas, 76.7% travelled greater than 5 km to reachthe nearest health facility and 56.9% patients had more than one health seeking encounterswith health care professionals before initial diagnosis. Conclusion: Current study, therefore,highlights the delays in diagnosis, treatment and the determinants of delay showing healthsystem related diagnostic and treatment delay being the main contributor to the total delay.More than half of the patients with TB showed a delay in initiation of treatment. Efforts should bemade to minimize health system related delays. Local private practitioners should also be takenon board in combating tuberculosis.
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Williams, Michael U., Ashley Burris, Amy Zingalis, David A. Lindholm, and Brian K. White. "Disseminated Tuberculosis Presenting as Chronic Orchiepididymitis in a Military Trainee: A Case Report and Review of the Literature." Case Reports in Infectious Diseases 2018 (July 29, 2018): 1–4. http://dx.doi.org/10.1155/2018/7316097.
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Orchiepididymitis is a clinical diagnosis. The acute form secondary to sexually transmitted or enteric pathogens is well known to primary care providers. However, chronic orchiepididymitis may be secondary to genitourinary tuberculosis (TB), and physicians in countries with a low prevalence of TB might not consider it in their differential diagnosis. Indeed, cognitive errors, such as anchoring or availability bias, may contribute to a delayed diagnosis of genitourinary TB. We present a case of chronic orchiepididymitis as a result of disseminated TB in a Cameroonian male who was visiting the United States for military training. He experienced diagnostic delay and was ultimately diagnosed by orchiectomy. Early consideration of a diagnosis of TB for chronic or recurrent orchiepididymitis in a patient with epidemiologic risk factors is of utmost importance because delayed diagnosis could lead to organ loss.
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Khan, Sabina, Mukta Pujani, and Sujata Jetley. "Primary Nasal Tuberculosis: Resurgence or Coincidence − A Report of Four Cases with Review of Literature." Journal of Laboratory Physicians 9, no. 01 (January 2017): 026–30. http://dx.doi.org/10.4103/0974-2727.187921.
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ABSTRACT Background: Primary nasal tuberculosis (TB) is a rare form of TB even in areas with high TB incidence. It is timely diagnosis and proper management are often delayed due to its rarity and nonspecific clinical presentation. Aim: The aim of the study was to review histopathologically diagnosed cases of nasal TB over a period of 1 year and to describe its clinical presentation, diagnostic workup, the importance of histopathological diagnosis along with a brief review of the literature. Materials and Methods: This was a retrospective study done in the Department of Pathology of a Tertiary Care Hospital of Delhi over a period of 1 year where all the cases with histopathological diagnosis of nasal TB were reviewed. Patients’ clinical details, investigations and treatment details along with follow‑up were obtained from the medical records section. For each case, routine hematoxylin and eosin stain were studied along with Ziehl–Neelson staining. Results: A total of four patients were diagnosed with nasal TB histopathologically. Patients’ age ranged from 5 to 34 with an equal male to female ratio. All patients were immunocompetent. Primary nasal TB was seen in all of the four cases. None of the cases, it was clinically suspected, and histopathology was the mainstay of diagnosis. All the cases were treated with antituberculous treatment and showed considerable improvement. Conclusions: Although nasal TB is rare, it should be considered in the differential diagnosis of chronic nasal symptoms and granulomatous lesions of the nose. Histopathology plays an important role in the diagnosis of these clinically unsuspecting cases of nasal TB.
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Chhajed, Prashant N., Preyas J. Vaidya, Neha P. Mandovra, Vinod B. Chavhan, Tejashree T. Lele, Rekha Nair, Jörg D. Leuppi, and Avinandan Saha. "EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy." ERJ Open Research 5, no. 4 (October 2019): 00008–2019. http://dx.doi.org/10.1183/23120541.00008-2019.
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This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis.A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST).Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance.An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance.
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Lee, M. K., C. Moon, M. J. Lee, Y. G. Kwak, E. Lee, J. H. Jeon, W. B. Park, et al. "Risk factors for the delayed diagnosis of extrapulmonary TB." International Journal of Tuberculosis and Lung Disease 25, no. 3 (March 1, 2021): 191–98. http://dx.doi.org/10.5588/ijtld.20.0788.
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BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.
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Lee, Han Na, Jung Im Kim, and Yee Hyung Kim. "Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis." PLOS ONE 16, no. 5 (May 3, 2021): e0250616. http://dx.doi.org/10.1371/journal.pone.0250616.
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Purpose To determine the diagnostic accuracy of the Xpert MTB/RIF assay in patients with smear-negative pulmonary tuberculosis (TB) and to assess clinical and CT characteristics of Xpert-negative pulmonary TB. Material and methods We retrospectively reviewed the records of 1,400 patients with suspected pulmonary TB for whom the sputum Xpert MTB/RIF assay was performed between September 1, 2014 and February 28, 2020. Clinical and CT characteristics of smear-negative pulmonary TB patients with negative Xpert MTB/RIF results were compared with positive results. Results Of 1,400 patients, 365 (26.1%) were diagnosed with pulmonary TB and 190 of 365 patients (52.1%) were negative for sputum acid-fast bacilli. The diagnosis of pulmonary TB was based on a positive culture, positive Xpert MTB/RIF or the clinical diagnoses of patients treated with an anti-TB medication. The sensitivity, specificity, positive predictive and negative predictive values of sputum Xpert MTB/RIF for smear-negative pulmonary TB were 41.1%, 100%, 100%, and 90.1%, respectively. Finally, 172 patients with smear-negative pulmonary TB who underwent chest CT within 2 weeks of diagnosis were included to compare Xpert-positive (n = 66) and Xpert- negative (n = 106) groups. Patients with sputum Xpert-negative TB showed lower positive rates for sputum culture (33.0% vs. 81.8%, p<0.001) and bronchoalveolar lavage culture (53.3% vs. 84.6%, p = 0.042) than in Xpert-positive TB. Time to start TB medication was longer in patients with Xpert-negative TB than in Xpert-positive TB (11.3±16.4 days vs. 5.0±8.7 days, p = 0.001). On chest CT, sputum Xpert-negative TB showed significantly lower frequency of consolidation (21.7% vs. 39.4%, p = 0.012), cavitation (23.6% vs. 37.9%, p = 0.045), more frequent peripheral location (50.9% vs. 21.2 p = 0.001) with lower area of involvement (4.3±4.3 vs. 7.6±6.4, p<0.001). Multivariate analysis revealed peripheral location (odds ratios, 2.565; 95% confidence interval: 1.157–5.687; p = 0.020) and higher total extent of the involved lobe (odds ratios, 0.928; 95% confidence interval: 0.865–0.995; p = 0.037) were significant factors associated with Xpert MTB/RIF-negative TB. Regardless of Xpert positivity, more than 80% of all cases were diagnosed of TB on chest CT by radiologists. Conclusion The detection rate of sputum Xpert MTB/RIF assay was relatively low for smear negative pulmonary TB. Chest CT image interpretation may play an important role in early diagnosis and treatment of Xpert MTB/RIF-negative pulmonary TB.
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Moosazadeh, Mahmood, Motahareh Kheradmand, Mohsen Aarabi, Mahdi Afshari, Mohammadreza Parsaee, Asghar Nezammahalleh, and Amirhossein Hessami. "Factors associated with delay in diagnosis among tuberculosis patients in the north of Iran." Medical Journal of Indonesia 30, no. 1 (March 25, 2021): 60–5. http://dx.doi.org/10.13181/mji.oa.204476.
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BACKGROUND Recognizing factors that affect delay in diagnosis in patients with pulmonary tuberculosis (TB) is critical. This study aimed to identify such factors among TB patients in the north of Iran.
METHODS In this retrospective cohort study, we reviewed patient’s medical records from the TB registration system of the Health Deputy of Mazandaran University of Medical Sciences, Sari, Iran that was responsible for the TB registry in the province from 2007 to 2017. All hospitals affiliated with the university, including private hospitals, reported TB cases directly to the health deputy. Patient’s gender, age, TB smear result, TB type, imprisonment, diabetes, nationality, residence area, and drug use were considered factors of delay in diagnosis, which was defined as a delay of >30 days between symptom onset and diagnosis. Data from 3,453 patients were analyzed using the chi-square test and logistic regression models.
RESULTS The frequency of patients with delay in diagnosis was 67.7%. There was no association between delay in diagnosis and gender (p = 0.194), TB type (p = 0.140), and diabetes (p = 0.198). On the other hand, old age (≥60 years) was related to delay in diagnosis (OR = 1.37; 95% CI = 1.12–1.68; p = 0.002). The chance of delay in diagnosis in prisoners was lower than in non-prisoners (OR = 0.62; 95% CI = 0.46–0.82; p = 0.001).
CONCLUSIONS Old age was a risk factor for delay in diagnosis, and interestingly, prisoners had been diagnosed significantly faster.
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Prabhu, P. Rajesh, Mayank Jain, Piyush Bawane, Joy Varghese, and Jayanthi Venkataraman. "Role of Colonoscopy in Differentiating Intestinal Tuberculosis from Crohn’s Disease." Journal of Digestive Endoscopy 08, no. 02 (April 2017): 072–77. http://dx.doi.org/10.4103/jde.jde_13_17.
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ABSTRACT Background: The interface between tuberculosis (TB) and Crohn’s disease (CD) is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C‑TB) and colonic CD (C‑CD) at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty‑eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C‑TB and C‑CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C‑TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7). It was 50% (95% CI: 24.7–75.4) for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3) and low for TB at 46.9% (95% CI: 32.5–61.7). All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti‑TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long‑segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.
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Tu Phan, Le Minh, Lemma Teshome Tufa, Hwa-Jung Kim, Jaebeom Lee, and Tae Jung Park. "Trends in Diagnosis for Active Tuberculosis Using Nanomaterials." Current Medicinal Chemistry 26, no. 11 (June 28, 2019): 1946–59. http://dx.doi.org/10.2174/0929867325666180912105617.
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Background:Tuberculosis (TB), one of the leading causes of death worldwide, is difficult to diagnose based only on signs and symptoms. Methods for TB detection are continuously being researched to design novel effective clinical tools for the diagnosis of TB.Objective:This article reviews the methods to diagnose TB at the latent and active stages and to recognize prospective TB diagnostic methods based on nanomaterials.Methods:The current methods for TB diagnosis were reviewed by evaluating their advantages and disadvantages. Furthermore, the trends in TB detection using nanomaterials were discussed regarding their performance capacity for clinical diagnostic applications.Results:Current methods such as microscopy, culture, and tuberculin skin test are still being employed to diagnose TB, however, a highly sensitive point of care tool without false results is still needed. The utilization of nanomaterials to detect the specific TB biomarkers with high sensitivity and specificity can provide a possible strategy to rapidly diagnose TB. Although it is challenging for nanodiagnostic platforms to be assessed in clinical trials, active TB diagnosis using nanomaterials is highly expected to achieve clinical significance for regular application. In addition, aspects and future directions in developing the high-efficiency tools to diagnose active TB using advanced nanomaterials are expounded.Conclusion:This review suggests that nanomaterials have high potential as rapid, costeffective tools to enhance the diagnostic sensitivity and specificity for the accurate diagnosis, treatment, and prevention of TB. Hence, portable nanobiosensors can be alternative effective tests to be exploited globally after clinical trial execution.
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Triasih, Rina, Amalia Setyati, Dwikisworo Setyowireni, Titik Nuryastuti, Rachma Dewi Isnaini Putri, and Emi Rusdiyati. "Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia." Paediatrica Indonesiana 60, no. 4 (July 17, 2020): 198–204. http://dx.doi.org/10.14238/pi60.4.2020.198-204.
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Background The Xpert MTB/RIF assay demonstrated a better diagnostic value than sputum smear for TB in adults and children.
Objective To evaluate the use of Xpert MTB/RIF for TB diagnosis in children.
Methods We conducted a prospective study in Yogyakarta, Indonesia, involving 19 primary health centers (PHCs) and one provincial hospital. Children aged 0-14 years with suspected TB who visited the study sites were screened. Subjects underwent history-taking, physical examination, tuberculin skin test, chest X-ray, as well as sputum induction for Xpert MTB/RIF assay, sputum smear, and TB culture. The diagnosis of TB was made by doctors based on the results of investigations, as follows: certain TB (bacteriological confirmation), probable TB, and possible TB.
Results Of 80 subjects, 21 (26%) were diagnosed with TB disease (4 certain TB and 17 probable TB). Sputum induction was successfully performed in 79 children. None of the children had positive sputum smears. Mycobacterium tuberculosis was detected by Xpert MTB/RIF in 4 children, accounting for 5% of all children with suspected TB, or 19% among children with TB disease. The 4 Xpert MTB/RIF-positive subjects had severe TB disease and were rifampicin-sensitive.
Conclusion Xpert MTB/RIF may improve case finding among children with severe TB disease with negative sputum smear.
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Schwartz, Orna, Orit Yossepowitch, and Yasmin Maor. "1353. Effect of Implementing Xpert MTB/RIF Ultra Assay on Diagnosis of Tuberculosis in a Medical Center in Central Israel." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S489—S490. http://dx.doi.org/10.1093/ofid/ofz360.1217.
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Abstract Background Tuberculosis (TB) is a worldwide public health concern both in developing and developed countries. The new Xpert MTB/RIF Ultra assay (Ultra, Cepheid, Sunnyvale, USA) recently endorsed by the WHO has high sensitivity to TB detection. The aim of this study was to assess the impact of this assay on TB diagnosis in a medical center in Israel where the baseline prevalence of TB is low. Methods The Xpert MTB/RIF Ultra assay is a cartridge-based automated diagnostic test that can simultaneously identify Mycobacterium tuberculosis complex and resistance to Rifampicin. We began using this test in 1.1.2018. To assess the impact of this assay on the rate of TB diagnosis we compared TB tests and positive cases during two time periods: period I (1.1.2017-31.10.2017) when TB diagnosis was based on the Xpert MTB/RIF assay to period II (1.1.2018 to 31.10.2018) when TB diagnosis was based on Xpert MTB/RIF Ultra assay. Included were all TB tests performed on sputum, deep suction or bronchoalveolar lavage. Files of positive patients were reviewed. Results The study included 1034 samples from 717 patients. Results are presented in Table 1. During the second period, TB rates increased by 231%. During the entire study there was no change in the hospital’s guidelines regarding TB diagnosis policy and there was no epidemiological change in the population served by the hospital. Only three cases had rifampicin resistance. In 5 cases (20%) during period II the result was trace amounts, an entity that did not exist in the former assay and in 3 cases culture results were negative. In 2017, 6 patients (60%) were African born, 3 patients (30%) originated from Eastern Europe, and one patient (10%) was born in the Middle East region. In 2018, 9 patients (36%) were born in Africa, 9 patients (36%) were born in Eastern Europe, and 7 patients (28%) were born in the Middle East region. Mean age at diagnosis was 38 years for patients diagnosed during period I and 53 years for patients diagnosed during period II. Conclusion The new assay enabled a significantly higher diagnosis rate for TB at our institution. We believe that this mainly reflects a higher diagnosis rate in patients with paucibacillary TB. Further study is needed to assess the relation between cultured confirmed diseases and the assay results, particularly in patients with trace results. Disclosures All authors: No reported disclosures.
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Champatiray, Jyotiranjan, and G. Dharmaraj Patra. "Diagnosis of paediatric tuberculosis by cartridge based nucleic acid amplification test and its effectiveness as compared to the other conventional diagnostic methods." International Journal of Contemporary Pediatrics 6, no. 3 (April 30, 2019): 1204. http://dx.doi.org/10.18203/2349-3291.ijcp20192013.
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Background: Childhood TB constitutes 10-20% of all TB cases in high burden countries like India and accounting for 8-20% of TB related deaths. Diagnosis of TB in children is difficult. One test, CBNAAT which was recently endorsed by WHO has the potential to lead a revolution in diagnosis of active TB disease.Methods: A cross sectional study in SCB MCH and SVPPGIP, Cuttack in all the suspected TB patients admitted during the period from January 2016 to October 2017.Results: A total of 100 suspicious patients admitted to the Department of Pediatrics in SCB MCH and SVPPGIP during the study period. Of these 45 were diagnosed TB and rest others were diagnosed otherwise than TB. Diagnosis of TB was established on basis of Microscopy, CBNAAT, culture, biochemistry, cytology, clinical findings, neuroimaging, FNAC/biopsy, USG abdomen. Out of 45 TB patients 30 were CBNAAT positive taking the body fluid samples other than blood, urine and stool with a sensitivity of 66.7% and specificity of 100%. Out of 45 TB patients 14 were having ZN Smear positive taking the same fluid sample with a sensitivity of 31.1% and specificity of 100%. Whereas out of these 45 TB patients 32 were MGIT culture positive taking the same sample with a sensitivity of 71.1% and specificity of 100%. When diagnostic performances of CBNAAT and MGIT culture were compared, it was found to be statistically insignificant with a P value 0.54.Conclusions: The CBNAAT is able to confirm a diagnosis of TB with 66.7% sensitivity and 100% specificity within 2 hours. We can use CBNAAT as a diagnostic method as it provides rapid result and simultaneous better sensitive result, it can be helpful in starting ATT in sick patients and also in outdoor patients.
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Sangphoo, Thanthun, Naesinee Chaiear, and Patimaporn Chanpho. "Work-Related Tuberculosis among Health Workers Employed in a Tertiary Hospital in Northeastern Thailand: A Report of Nine Cases." International Journal of Environmental Research and Public Health 17, no. 14 (July 17, 2020): 5156. http://dx.doi.org/10.3390/ijerph17145156.
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Between October 2016 and September 2018, fifteen health workers were diagnosed with tuberculosis (TB) at a tertiary hospital in northeastern Thailand. However, the cases could not be diagnosed as occupational TB according to international standards because of hospital limitations. The use of occupational epidemiological information provides a more effective work-related TB diagnosis. This study aims to provide a report of work-related TB using individual case investigation methods. We collected secondary data from the Occupational Health and Safety Office of the hospital in question, including baseline characteristics for the health workers, occupational history, source of TB infection and occupational exposure, and working environmental measurements. We found that nine of the fifteen cases were diagnosable as work-related TB due to two important factors: daily prolonged exposure time to an infected TB patient, and aerosol-generating procedures without adequate respiratory protection. The other six cases were not diagnosable as work-related TB because of inadequate evidence of activities related to the TB infection. The diagnosis of work-related TB thus requires occupational epidemiological information in order to complete the differentiation process.
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Agarwal, Saroochi, Duc T. Nguyen, and Edward A. Graviss. "763. Risk Factors for Homeless Status and Mortality Among Homeless TB Cases in Texas, 2010–2017." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S274. http://dx.doi.org/10.1093/ofid/ofy210.770.
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Abstract Background A disproportionate amount of tuberculosis (TB) cases and mortality occur among people experiencing homelessness in the United States. Our objective was to identify risk factors for mortality among reported homeless TB cases in Texas, a state with an increased TB prevalence in the United States. Methods Using data from the Centers for Disease Control and Prevention TB Genotyping Information Management System (TB GIMS), we evaluated the demographic, laboratory and clinical characteristics of people identified as being homeless in the year preceding TB diagnosis in Texas from January 1, 2010 to December 31, 2017. TB cases with missing or unknown homeless status were removed from the analysis. Multivariate logistic regression was used to analyze and evaluate risk factors associated with homeless status and mortality among homeless TB cases. Results Of the 10,103 newly diagnosed TB cases over the 8-year period, 543 (5.4%) were reported as being homeless in the year preceding TB diagnosis. In 412 homeless TB patients with a reported outcome as “died” or “completed,” 57 (13.8%) died during treatment and 355 (86.2%) completed therapy. Age >45, male, black ethnicity, foreign-born, urban living, excessive alcohol consumption, IDU, long-term care facility resident, diabetes, previous TB, and pulmonary TB were associated with homeless TB cases. Being homeless and having TB increased the risk of mortality compared with having TB alone (OR 2.26, P < 0.01). Age >45 years, positive HIV status, cavitary and miliary radiographic findings, no or unknown culture conversion and TB case confirmation by a positive culture/NAA/smear compared with clinical case definition/provider diagnosis were independent risk factors for mortality among homeless TB cases in Texas. Conclusion Being homeless increased the risk of TB mortality by nearly 130% compared with being housed prior to TB diagnosis. Our findings indicate that homelessness may be being diagnosed and treated in more advanced TB diseased homeless individuals who probably have poorer health due to the stresses of poverty, comorbidities, and lack of access to healthcare, leading to higher mortality. Additionally, testing and treatment for HIV among those reporting homelessness may reduce mortality among this high-risk group. Disclosures All authors: No reported disclosures.
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Kumar, Divjot S., Lisa A. Ronald, Kamila Romanowski, Caren Rose, Hennady P. Shulha, Victoria J. Cook, and James C. Johnston. "Risk of active tuberculosis in migrants diagnosed with cancer: a retrospective cohort study in British Columbia, Canada." BMJ Open 11, no. 3 (March 2021): e037827. http://dx.doi.org/10.1136/bmjopen-2020-037827.
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ObjectivesTo describe the association between types of cancer and active tuberculosis (TB) risk in migrants. Additionally, in order to better inform latent TB infection (LTBI) screening protocols, we assessed proportion of active TB cases potentially preventable through LTBI screening and treatment in migrants with cancer.DesignPopulation-based, retrospective cohort study.SettingBritish Columbia (BC), Canada.Participants1 000 764 individuals who immigrated to Canada from 1985 to 2012 and established residency in BC at any point up to 2015.Primary and secondary outcome measuresUsing linked health administrative databases and disease registries, data on demographics, comorbidities, cancer type, TB exposure and active TB diagnosis were extracted. Primary outcomes included: time to first active TB diagnoses, and risks of active TB following cancer diagnoses which were estimated using Cox extended hazard regression models. Potentially preventable TB was defined as active TB diagnosed >6 months postcancer diagnoses.ResultsActive TB risk was increased in migrants with cancer ((HR (95% CI)) 2.5 (2.0 to 3.1)), after adjustment for age, sex, TB incidence in country of origin, immigration classification, contact status and comorbidities. Highest risk was observed with lung cancer (HR 11.2 (7.4 to 16.9)) and sarcoma (HR 8.1 (3.3 to 19.5)), followed by leukaemia (HR 5.6 (3.1 to 10.2)), lymphoma (HR 4.9 (2.7 to 8.7)) and gastrointestinal cancers (HR 2.7 (1.7 to 4.4)). The majority (65.9%) of active TB cases were diagnosed >6 months postcancer diagnosis.ConclusionSpecific cancers increase active TB risk to varying degrees in the migrant population of BC, with approximately two-thirds of active TB cases identified as potentially preventable.
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Nikam, Chaitali, Asawari Chavan, Swapna Naik, Archana Khillari, Lancelot Pinto, Anjali Shetty, and Camilla Rodrigues. "Rapid diagnosis of childhood TB: Can we meet pediatric TB requirements?" Pediatric Infectious Disease 8, no. 3 (July 2016): 91–97. http://dx.doi.org/10.1016/j.pid.2016.01.001.
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Sotgiu, G., S. Rosales-Klintz, R. Centis, L. D'Ambrosio, R. Verduin, A. M. Correia, A. Cirule, et al. "TB management in the European Union/European Economic Area: a multi‐centre survey." International Journal of Tuberculosis and Lung Disease 25, no. 2 (February 1, 2021): 126–33. http://dx.doi.org/10.5588/ijtld.20.0849.
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BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC).METHODS: In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability.RESULTS: Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug‐resistant TB (XDR‐TB) (n = 11), pre‐XDR‐TB (n = 29) and drug‐susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC.CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient‐centred approaches.
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Norsworthy, Jessica, Sara Huda, Gulru Sharifova, and Walter Chua. "TB PLEURAL EFFUSION: AN ANOMALOUS DIAGNOSIS." Chest 156, no. 4 (October 2019): A702. http://dx.doi.org/10.1016/j.chest.2019.08.679.
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Friedland, J. "Biomarkers for the Diagnosis of TB." International Journal of Infectious Diseases 14 (March 2010): e317. http://dx.doi.org/10.1016/j.ijid.2010.02.2193.
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Nguyen, Phuong, Trang Thai, Julie Huynh, and Ben Marais. "An Infant with Xpert® Confirmed TB Meningitis in Central Viet Nam." Journal of Clinical Medicine 7, no. 11 (October 29, 2018): 397. http://dx.doi.org/10.3390/jcm7110397.
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A 5-month-old boy presented with a focal seizure. Disseminated (miliary) tuberculosis (TB) was diagnosed on chest radiograph and TB meningitis was confirmed using Xpert MTB/RIF®. The case represents the first instance of cerebrospinal fluid Xpert MTB/RIF® testing in children in central Viet Nam. Family screening diagnosed the father with sputum smear-positive TB. The mother and a 2-year-old sibling had no symptoms or signs of TB disease and started preventive therapy. Early TB meningitis diagnosis is the single most important factor influencing clinical outcome, but is difficult due to the non-specific signs and symptoms at disease onset. Late diagnosis is associated with high mortality and severe neurologic handicap, which emphasizes the value of TB preventive therapy in vulnerable young children in close contact with an infectious TB case (recent is generally defined as within the last 12 months).
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Sari, Cut Yulia Indah, Faisal Yunus, and Elisna Sjahruddin. "Proportion of Patients Pulmonary Cancer With History of Slow Diagnosis Due to Diagnosis as Lung Tuberculosis." Jurnal Respirologi Indonesia 39, no. 2 (April 3, 2019): 92–102. http://dx.doi.org/10.36497/jri.v39i2.60.
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Background: In tuberculosis (TB) endemic countries, the diagnosis delay in lung cancer is due to initially misdiagnosed as pulmonary tuberculosis. The major concern that rose since early diagnosis of lung cancer could improve survival by tumor resectability chance and chemo-radiotherapy modality options. This study objective was to find out the proportion of lung cancer diagnosis delay due initially to misdiagnosed as pulmonary TB.
Method: The cross-sectional study was held in Persahabatan Hospital and the subjects were histopatologically proven lung cancer patients between September 2012 to February 2013 involving totally 100 patients. The diagnosis delay were determined as whether the patients had been diagnosed as pulmonary tuberculosis and received anti-tuberculosis treatment (ATT) more than one month since current symptoms onset. All patients were interviewed and all chest X-rays were documented.
Results: Fourty one of 100 patients were diagnosed as pulmonary TB and 29 of 41 patients received ATT more than one month. It consisted of 21 men and 8 women with the mean age of 51.5 years old. The cytology and histopatological biopsy revealed 28 Non Small Cell Lung Cancer (NSCLC) cases, and One Small Cell Lung Cancer (SCLC) case with all case were in end stage condition (6 cases in stage III and 22 cases in stage IV). Pre-referral sputum Acid Fast Bacilli (AFB) was conducted in only 9 cases with all negative results. Mean duration of ATT taken was 4.5±0.4 months. The ATT were given by 13 general practitioners, 12 pulmonologists and 4 internists.
Discussion: Similar radiological findings in highly incidence of pulmonary TB could cause a large number of diagnosis delay in lung cancer due to initially diagnosed as pulmonary tuberculosis. Without proper investigation based on International Standard of TB Care, starting ATT with inadequate evaluation leads to diagnosis delay and lung cancer progression. (J Respir Indo 2019; 39(2))
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Shen, Guomiao, Digambar Behera, Manpreet Bhalla, Arthur Nadas, and Suman Laal. "Peptide-Based Antibody Detection for Tuberculosis Diagnosis." Clinical and Vaccine Immunology 16, no. 1 (November 12, 2008): 49–54. http://dx.doi.org/10.1128/cvi.00334-08.
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ABSTRACT Tuberculosis (TB) is a major cause of morbidity and mortality, especially in developing countries. Despite significant limitations, microscopy remains the cornerstone of the global TB control strategy. As the TB epidemic escalates, new diagnostic methods that are accurate and also economical and simple to manufacture and deploy are urgently needed. Although several promising antigens have been identified and evaluated in recent years, the reproducible production of high-quality recombinant mycobacterial proteins with minimal batch-to-batch variation is difficult, laborious, and expensive. To determine the feasibility of devising a synthetic peptide-based diagnostic test for TB, we have delineated the immunodominant epitopes of three candidate antigens, Ag85B, BfrB, and TrxC, that were previously identified to be immunogenic in TB patients. The results demonstrate that combinations of carefully selected synthetic peptides derived from highly immunogenic proteins can be the basis for devising an immunodiagnostic test for TB.
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England, James H., Daniel W. Byrne, Bryan D. Harris, and Thomas R. Talbot. "Use of airborne infection isolation in potential cases of pulmonary tuberculosis." Infection Control & Hospital Epidemiology 41, no. 5 (March 16, 2020): 505–9. http://dx.doi.org/10.1017/ice.2020.23.
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AbstractObjective:To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.Methods:Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.Results:Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.Conclusions:The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.
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Firmanti, Stefani Candra, Rina Triasih, Tri Wibawa, and Sofia Mubarika Haryana. "Interferon-g-Inducible Protein 10 for Diagnosis of Tuberculosis in Children." Indonesian Biomedical Journal 12, no. 1 (March 19, 2020): 19–26. http://dx.doi.org/10.18585/inabj.v12i1.973.
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BACKGROUND: The diagnosis of tuberculosis (TB) in children is challenging by the absence of a practical gold standard. Interferon (IFN)-ginducible protein 10 (IP-10) is a chemokine that may serve as the leading candidate marker in child TB diagnosis. The aim of this study is to assess the diagnostic value of IP-10 in the diagnosis of TB in children.METHODS: We recruited eligible symptomatic and asymptomatic children aged <15 years actively by contact investigation and passively from inpatient and outpatient clinics in two hospitals, in Yogyakarta, Indonesia. We conducted clinical examination and chest X-ray in all eligible children. Sputum smear and the rapid molecular TB test were performed in children with TB symptoms. All participants underwent blood sampling for IFN-g Release Assay and IP-10 test.RESULTS: A total of 79 children were recruited to this study. Twelve children were with TB disease, 16 with latent TB infection (LTBI), 40 were TB-exposed only and 11 were non-TB. Children with evidence of TB infection either with TB disease or LTBI had higher levels of antigen-stimulated IP-10 compared to non-infected children, both TB exposed only and non-TB (p=0.000). A cut-off 408.74 pg/mL for antigen-stimulated IP-10 showed high diagnostic accuracy for diagnosis of TB infection (AUC: 0.97, 95% CI: 0.92-1.00, sensitivity: 92.3%, and specificity: 91.9%). However, the stimulated levels of IP-10 between children with TB disease and LTBI were not significantly different (p=0.268).CONCLUSION: IP-10 performed well to diagnose TB infection in children. However, it cannot be used to differentiate TB infection from TB disease.KEYWORDS: IFN-g, IP-10, latent TB, active TB, children
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Wang, Yamei, and Yuhong Tao. "Tuberculosis-associated IgA nephropathy." Journal of International Medical Research 46, no. 7 (June 4, 2018): 2549–57. http://dx.doi.org/10.1177/0300060518774127.
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Immunoglobulin A nephropathy (IgAN) is the most frequent pathological diagnosis of tuberculosis (TB)-associated glomerulonephritis. Diagnosing TB-associated IgAN (TB-IgAN) is difficult because of its non-specific and insidious symptoms. An inaccurate diagnosis of TB-IgAN could result in the spread of TB and reduced renal function. Haematuria and proteinuria in conjunction with TB should be assessed because of the potential for diagnosis of IgAN. Renal biopsy is important in securing an accurate diagnosis prior to initiating treatment. Detection of Mycobacterium tuberculosis DNA and assessment of early secreted antigenic target of 6 kDa in renal biopsy tissues may have great potential diagnostic value in patients with TB-IgAN. Anti-TB therapy can effectively alleviate TB and TB-IgAN.
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Zhang, Hui-Zhang, Qiang Fang, Jian Guo, Yong Shen, Sui-Hua Lu, Xiang-Nan Hu, Gui-Lin Deng, and Wen-Juan Wu. "Usefulness of the mycobacterium tuberculosis direct assay in early diagnosis of extrapulmonary TB." Archives of Biological Sciences 66, no. 3 (2014): 1003–8. http://dx.doi.org/10.2298/abs1403003z.
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The aim of this study was to evaluate the in situ detection of living mycobacterium TB rRNA by the mycobacterium TB direct assay (MTD) and its clinical significance in the early diagnosis of extrapulmonary TB. Eighty-six patients were recruited from the Shanghai Public Health Clinical Center from June to November in 2010, having been diagnosed with extrapulmonary TB, including tuberculous peritonitis (n=22), lymphatic TB (n=21), tuberculous meningitis (n=15), HIV-associated TB (n=13), nephroTB (n=9), spinal TB (n=2), cutaneous TB (n=13), parotid TB (n=1), chest wall TB (n=1), intestinal TB (n=1). One hundred and five extrapulmonary specimens, including CSF, puncture fluid, drainage, pleural fluid, urine, secretion, ascites, lymphatic tissue and marrow were collected from the patients. The samples were examined using acid-fast stain, solid culture, liquid culture and MTD in parallel. In MTD, the target segments of MTB rRNA in either cultures or clinical specimens were amplified prior to being qualitatively detected with the hybridization protection assay (HPA). The sensitivities of MTD and acid-fast staining in liquid and solid cultures were 48.6%, 41.9%, 20.0% and 14.3%, respectively. MTD sensitivity was higher than that of the others and its specificity was 100%. We concluded that MTD rRNA detection is an effective, rapid, convenient, sensitive and reliable method for the early diagnosis of extrapulmonary TB.
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Larroude, Martina, and Gustavo Ariel Budmann. "Intraocular tuberculosis, a challenge in diagnosis and treatment." Latin American Journal of Ophthalmology 3 (May 12, 2020): 4. http://dx.doi.org/10.25259/lajo_17_2019.
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Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition and has variable manifestations. The incidence of TB is still high in developing countries, and a steady increase in new cases has been observed in industrial countries as a result of the growing number of immunodeficient patients and migration from developing countries. Choroidal granuloma is a rare and atypical location of TB. We present a case of a presumptive choroidal granuloma. This case exposes that diagnosis can be remarkably challenging when there is no history of pulmonary TB. The recognition of clinical signs of ocular TB is extremely important since it provides a clinical pathway toward tailored investigations and decision making for initiating anti-TB therapy and to ensure a close follow-up to detect the development of any complication.
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Lagrange, Philippe H., Satheesh K. Thangaraj, Rajeshwar Dayal, Alaka Deshpande, Nirmal K. Ganguly, Enrico Girardi, Beenu Joshi, et al. "A Toolbox for Tuberculosis (TB) Diagnosis: An Indian Multicentric Study (2006–2008). Evaluation of QuantiFERON-TB Gold in Tube for TB Diagnosis." PLoS ONE 8, no. 9 (September 6, 2013): e73579. http://dx.doi.org/10.1371/journal.pone.0073579.
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Jafari, Claudia, Ioana D. Olaru, Franziska Daduna, Martin Ernst, Jan Heyckendorf, Christoph Lange, and Barbara Kalsdorf. "Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods." European Respiratory Journal 51, no. 5 (March 29, 2018): 1702189. http://dx.doi.org/10.1183/13993003.02189-2017.
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Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by aMycobacterium tuberculosis-specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed byM. tuberculosisculture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially hadM. tuberculosisdetected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of >4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.
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Diko, Sindi, Jackie P. Johnston, Priya Patel, Sayali Kulkarni, Jin S. Suh, Osama Elsawy, and Maria Heaney. "Abdominal Tuberculosis: A Report Outlining Surgical and Unique Pharmacologic Management in the Absence of Enteral Access." European Journal of Medical and Health Sciences 3, no. 4 (July 28, 2021): 8–11. http://dx.doi.org/10.24018/ejmed.2021.3.4.799.
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Abdominal tuberculosis (TB) occurs only in a subset of TB-infected persons. With a higher incidence in the immunocompromised population, successful treatment includes early diagnosis and initiation of anti-TB medications. This case report discusses a 22-year-old immunocompetent male diagnosed with advanced duodenal and peritoneal TB after perforation requiring emergent surgery and intravenous anti-TB treatment secondary to lack of enteral access.
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Dharmawan, Bobby S., Darmawan B. Setyanto, and Rinawati R. "Diagnosis dan Tata Laksana Neonatus dari Ibu Hamil Tuberkulosis Aktif." Sari Pediatri 6, no. 2 (December 5, 2016): 85. http://dx.doi.org/10.14238/sp6.2.2004.85-90.
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Tuberkulosis (TB) pada kehamilan selain dapat mengenai ibu juga dapat menular padabayi baik intrauterin, saat persalinan, maupun pasca natal. Kejadian TB kongenital selamapersalinan sangat jarang. Gejala klinis TB pada neonatus sulit dibedakan dengan sepsisbakterial umumnya dan hampir semua kasus meninggal karena keterlambatan diagnosis.Manifestasi klinis TB kongenital dapat timbul segera setelah lahir maupun dalambeberapa hari. Gejala yang paling sering ditemukan adalah distres pernapasan,hepatosplenomegali, dan demam. Tata laksana TB pada neonatus mencakup beberapaaspek yaitu ibu, bayi yang dilahirkan dan lingkungan keluarga. Untuk diagnosis dantata laksana diperlukan pemeriksaan klinis dan penunjang berupa pemeriksaan patologidari plasenta darah v.umbilikalis, foto toraks, bilas lambung serta evaluasi uji tuberkulinsecara berkala. Deteksi dini TB pada neonatus dan penanganan yang baik pada ibudengan TB aktif akan memperkecil kemungkinan terjadinya TB perinatal.
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Almeida, Carlos Podalirio Borges de, Erika Cavalheiro Skupien, and Denise Rossato Silva. "Health care seeking behavior and patient delay in tuberculosis diagnosis." Cadernos de Saúde Pública 31, no. 2 (February 2015): 321–30. http://dx.doi.org/10.1590/0102-311x00195413.
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Delays in diagnosis of TB cases are major impeding factors in the control of TB. The objectives of this study were to describe the health care seeking behavior of TB patients, assessing patient delay and the number of health care facilities visited before the start of TB treatment. A cross-sectional study was carried out with adult patients with pulmonary TB presenting to two TB facilities to start treatment. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of TB. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. We demonstrated that the median patient delay in TB diagnosis in two TB services in a region with a high prevalence of TB was 20 days, and the protective factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.
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Raqib, Rubhana, Dinesh Mondal, M. Anwarul Karim, Fahima Chowdhury, Sultan Ahmed, Stephen Luby, Alejandro Cravioto, Jan Andersson, and David Sack. "Detection of Antibodies Secreted from Circulating Mycobacterium tuberculosis-Specific Plasma Cells in the Diagnosis of Pediatric Tuberculosis." Clinical and Vaccine Immunology 16, no. 4 (February 4, 2009): 521–27. http://dx.doi.org/10.1128/cvi.00391-08.
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ABSTRACT Diagnosis of tuberculosis (TB) in children is difficult because symptoms are often nonspecific or absent in infected children, diagnostic specimens are difficult to obtain from younger children, and >50% have negative TB cultures. Thus, there is an urgent need for improved diagnosis of pediatric TB. This study aimed to evaluate the diagnostic value of a new serological method, the ALS (antibodies in lymphocyte supernatant) assay, for the diagnosis of active TB in children with clinically identified TB. The ALS test is based on the concept that antigen-specific plasma cells are present in the circulation only at times of acute infection and not in latency. A cross-sectional study of pediatric patients (age range, 11 to 167 months) who were clinically identified as TB (n = 58) or non-TB (n = 16) patients was conducted, and they were monitored for 6 months. Healthy children (n = 58) were enrolled as controls. Spontaneous release of TB antigen-specific antibodies by in vitro-cultured, unstimulated peripheral blood mononuclear cells was assessed by an enzyme-linked immunosorbent assay using Mycobacterium bovis bacillus Calmette-Guérin (BCG) as the detecting antigen. Of the patients clinically diagnosed with TB, 15% had culture-confirmed TB, 64% were positive for TB by clinically established scoring charts (K. Edwards, P. N. G. Med. J. 30: 169-178, 1987; G. Stegen, K. Jones, and P. Kaplan, Pediatrics 43: 260-263, 1969; and stop TB Partnership, Childhood TB subgroup, World Health Organization, Int. J. Tuberc. Lung Dis. 10: 1091-1097, 2006), and 91% were TB positive by the ALS method. All TB patients had significantly higher BCG-specific ALS titers at enrollment (optical density [OD], 1.06 ± 0.32) than healthy-control children (OD, 0.18 ± 0.06) and non-TB children (OD, 0.21 ± 0.10) (P = 0.001). The ALS titers declined in children with active disease from enrollment through 6 months following anti-TB therapy (P = 0.001). The ALS assay is a novel diagnostic method with potential applications in the diagnosis of pediatric TB and in subsequent monitoring of treatment effectiveness.
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Barua, R., and MA Hossain. "Adenosine Deaminase in Diagnosis of Tuberculosis: A Review." Anwer Khan Modern Medical College Journal 5, no. 2 (December 3, 2014): 43–48. http://dx.doi.org/10.3329/akmmcj.v5i2.21132.
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The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but do not provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. ADA is an enzyme that increases in TB because of the stimulation of T-cell lymphocytes by mycobacterial antigens. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices. There is sufficient data supporting yield of ADA in various body fluids for the diagnosis of TB. ADA may be used for early diagnosis of TB, especially in case of negative acid fast bacilli (AFB) smear from the body specimens. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21132 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 43-48
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Jayasooriya, S., A. Jobe, S. Badjie, O. Owolabi, A. Rachow, J. Sutherland, and B. Kampmann. "The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert® MTB/Rif era." Public Health Action 9, no. 4 (December 21, 2019): 166–68. http://dx.doi.org/10.5588/pha.19.0046.
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In some low and middle-income countries, 10–20% of patients presenting with a persistent cough have tuberculosis (TB). Once TB is excluded, health service provision for alternative diagnoses is limited. We prospectively studied patients with two Xpert-negative sputum results presenting to a TB clinic in The Gambia. Of 239 patients, 108 did not have TB; 65/102 (6 were lost to follow-up) had alternative diagnoses, 24.6% of which were non-respiratory; 37/102 had no diagnosis, 27.0% of whom were HIV-1-positive; 37.8% had a history of TB and 24.3% smoked. We highlight the need for general health service integration with TB platforms and exploration of non-TB patients with chronic respiratory symptoms.
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Lebina, Limakatso, Nigel Fuller, Tolu Osoba, Lesley Scott, Katlego Motlhaoleng, Modiehi Rakgokong, Pattamukkil Abraham, Ebrahim Variava, and Neil Alexander Martinson. "The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa." Tuberculosis Research and Treatment 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/4282313.
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Introduction.Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB.Methods.Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB.Results.2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44%) were unable to give sputum, but 24 of these were already on TB treatment. 863 (53%) participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78) were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21%) participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68).Discussion and Conclusions.Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.
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Galagali, J. R., and Roohie Singh. "Metastatic neck node: a straying journey to diagnosis." International Journal of Otorhinolaryngology and Head and Neck Surgery 4, no. 4 (June 23, 2018): 1101. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20182723.
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<p class="abstract">Squamous cell carcinoma of lung is most commonly associated with smoking. Its metastasis to contralateral neck node as the first presenting symptom is very rare. Tuberculosis (TB) and cancer of lung have causal relationship. There may also be coexistence of another neoplasm around the time of diagnosis of primary neoplasm. We present a case report of an 80 years old man who presented with a contralateral metastatic neck node. He was diagnosed to have coexistent lung cancer and pulmonary TB. In this journey towards diagnosis, the findings suggestive of tubercular larynx might have been a sequel of pulmonary TB.</p>
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Sekaggya-Wiltshire, Christine, Barbara Castelnuovo, Amrei von Braun, Joseph Musaazi, Daniel Muller, Allan Buzibye, Ursula Gutteck, et al. "Cohort profile of a study on outcomes related to tuberculosis and antiretroviral drug concentrations in Uganda: design, methods and patient characteristics of the SOUTH study." BMJ Open 7, no. 9 (September 2017): e014679. http://dx.doi.org/10.1136/bmjopen-2016-014679.
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PurposeTuberculosis (TB) is a leading cause of death among people living with HIV in sub-Saharan Africa. Several factors influence the efficacy of TB treatment by leading to suboptimal drug concentrations and subsequently affecting treatment outcome. The aim of this cohort is to determine the association between anti-TB drug concentrations and TB treatment outcomes.ParticipantsPatients diagnosed with new pulmonary TB at the integrated TB-HIV outpatient clinic in Kampala, Uganda, were enrolled into the study and started on first-line anti-TB treatment.Findings to dateBetween April 2013 and April 2015, the cohort enrolled 268 patients coinfected with TB/HIV ; 57.8% are male with a median age of 34 years (IQR 29–40). The median time between the diagnosis of HIV and the diagnosis of TB is 2 months (IQR 0–22.5). The majority of the patients are antiretroviral therapy naive (75.4%). Our population is severely immunosuppressed with a median CD4 cell count at enrolment of 163 cells/µL (IQR 46–298). Ninety-nine per cent of the patients had a diagnosis of pulmonary TB confirmed by sputum microscopy, Xpert/RIF or culture and 203 (75.7%) have completed TB treatment with 5099 aliquots of blood collected for pharmacokinetic analysis.Future plansThis cohort provides a large database of well-characterised patients coinfected with TB/HIV which will facilitate the description of the association between serum drug concentrations and TB treatment outcomes as well as provide a research platform for future substudies including evaluation of virological outcomes.Trial registration numberNCT01782950; Pre-results.