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Cureus May 2020Tuberculosis (TB) is a major public health problem in developing countries. It can affect any organ of the body, and can have a multitude of clinical presentations. We...
Tuberculosis (TB) is a major public health problem in developing countries. It can affect any organ of the body, and can have a multitude of clinical presentations. We present the case of a 22-year-old male who presented with fever, abdominal pain, and weight loss, and was found to have enlarged liver and spleen, both studded with multiple microabscesses. He had deranged liver functions, mild anemia, and elevated acute phase reactants. Examination of the aspirate from the liver did not reveal any organism on microscopy or culture. Based on the demographics, history of contact with a TB patient, positive Mantoux test, and clinical and radiological features, the patient was successfully managed with empirical treatment for TB.
PubMed: 32596067
DOI: 10.7759/cureus.8247 -
Journal of Ophthalmic Inflammation and... Jun 2013Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the...
Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the developed world. However, recent reports suggest that the disease is found in the developing countries as well. Clinical, radiological, and histopathological similarities with tuberculosis pose a great challenge in countries endemic for tuberculosis. Mantoux test, high resolution computed tomography, and transbronchial lymph node and lung biopsies are diagnostic modalities, which play an important role in the diagnosis of sarcoid. In this review, we look at the epidemiology of sarcoid in tuberculosis-endemic regions, the sarcoidosis-tuberculosis link, clinical profile, diagnostic modalities, dilemma in the diagnosis, and the treatment of this disease.
PubMed: 23803558
DOI: 10.1186/1869-5760-3-53 -
Journal of Clinical Microbiology Jun 2000Seven serological tests, two immunochromatographic tests, ICT Tuberculosis and RAPID TEST TB, and five enzyme-linked immunosorbent assays, TUBERCULOSIS IgA EIA,... (Clinical Trial)
Clinical Trial Comparative Study
Seven serological tests, two immunochromatographic tests, ICT Tuberculosis and RAPID TEST TB, and five enzyme-linked immunosorbent assays, TUBERCULOSIS IgA EIA, PATHOZYME-TB complex, PATHOZYME-MYCO IgG, PATHOZYME-MYCO IgA, and PATHOZYME-MYCO IgM, were evaluated simultaneously with 298 serum samples from three groups of individuals: 44 patients with active tuberculosis, 204 controls who had undergone the Mantoux test (89 Mantoux test-positive and 115 Mantoux test-negative controls), and 50 anonymous controls. The sensitivities of the tests with sera from patients with active tuberculosis were poor to modest, ranging from 16 to 57%. All the tests performed equally with sera from subgroups of those with active tuberculosis, those with pulmonary (33 patients) versus extrapulmonary (11 patients) disease, and those who were smear positive (24 patients) versus smear negative (12 patients) (P > 0.05). The specificities of the tests ranged from 80 to 97% with sera from the Mantoux test controls and 62 to 100% with sera from the anonymous controls. The TUBERCULOSIS IgA EIA had the highest sensitivity (57%) with sera from patients with active tuberculosis, with a high specificity of 93% with sera from the Mantoux test controls, but a very poor specificity of 62% with sera from the anonymous controls. Overall, ICT Tuberculosis followed by PATHOZYME-MYCO IgG had the best performance characteristics, with sensitivities of 41 and 55%, respectively, with sera from patients with active tuberculosis and specificities of 96 and 89%, respectively, with sera from the Mantoux test controls and 88 and 90%, respectively, with sera from the anonymous controls. By combining all the test results, a maximum sensitivity of 84% was obtained, with reciprocal drops in specificities to 55 and 42% for the Mantoux test controls and anonymous controls, respectively. The best combination was that of ICT Tuberculosis and PATHOZYME-MYCO IgG, with a sensitivity of 66% and a specificity of 86% for the Mantoux test controls and a sensitivity and specificity of 78% for the anonymous controls. While a negative result by any one of these tests would be useful in helping to exclude disease in a population with a low prevalence of tuberculosis, a positive result may aid in clinical decision making when applied to symptomatic patients being evaluated for active tuberculosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chromatography, Affinity; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoenzyme Techniques; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Serologic Tests; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 10834981
DOI: 10.1128/JCM.38.6.2227-2231.2000 -
Singapore Medical Journal Dec 2011Although genital tuberculosis is a condition that is prevalent worldwide, it is still a diagnostic dilemma. This study aimed to find an effective diagnostic modality for...
INTRODUCTION
Although genital tuberculosis is a condition that is prevalent worldwide, it is still a diagnostic dilemma. This study aimed to find an effective diagnostic modality for the condition.
METHODS
A total of 100 infertile women were clinically evaluated with haemoglobin estimation, total and differential count, Mantoux test, tubercle bacilli enzyme-linked immunosorbent assay (TB ELISA), hysterosalpingography, pelvic ultrasonography, laparohysteroscopy, premenstrual endometrial biopsy for histopathology, culture and tubercle bacilli polymerase chain reaction (TBPCR). The womens' Day 2 hormonal profile (luteinising, follicle-stimulating, prolactin and thyroidstimulating hormones) and their husbands' semen analysis were also conducted.
RESULTS
A total of 58 women had primary infertility and 42 had secondary infertility. Female factor infertility was present in 63 percent of the cases (mostly tubal; 45.97 percent). 26 women tested positive for endometrial TBPCR. Erythrocyte sedimentation rate, Mantoux test, TB ELISA and hysterosalpingography were found to have high negative predictive value (greater than 80 percent), while the positive predictive value was 35-45 percent. Laparoscopy findings were suggestive of tuberculosis in 13 percent of the women, out of which 83.3 percent were positive for endometrial TBPCR. Hysteroscopy revealed intrauterine adhesions in 34.8 percent of the women, with 68.8 percent being positive for tubercular bacilli.
CONCLUSION
Our study established that in cases of genital tuberculosis, the use of expensive endometrial TBPCR tests may be avoided with a detailed workup, which would also help in the institution of anti-tubercular treatment in early disease, thus enhancing the chance of pregnancy.
Topics: Adult; Algorithms; Biomarkers; Enzyme-Linked Immunosorbent Assay; Female; Gynecology; Hemoglobins; Humans; Hysteroscopy; Infertility, Female; Male; Polymerase Chain Reaction; Pregnancy; Prevalence; Treatment Outcome; Tuberculosis, Female Genital
PubMed: 22159927
DOI: No ID Found -
Journal of Reproduction & Infertility Jan 2011Tuberculous endometritis is often a diagnostic dilemma for gynecologists in the evaluation of infertility. This study evaluated and compared different diagnostic methods...
BACKGROUND
Tuberculous endometritis is often a diagnostic dilemma for gynecologists in the evaluation of infertility. This study evaluated and compared different diagnostic methods in tuberculous endometritis.
METHODS
100 infertile women were investigated for tuberculous endometritis. The endometrial samples obtained by curettage were evaluated by Ziehl-Neelsen (ZN) staining of the smears for acid-fast bacilli (AFB), the samples were also cultured on Lowenstein-Jensen medium, and histopathological examination and nested PCR targeting 'hupB' gene (Rv 2986c in M. tuberculosis and Mb3010c in M. bovis) which can differentiate between M. tuberculosis and M. bovis were performed. Antibodies against 38-kDa and 16-kDa mycobacterial antigens were detected in serum using ELISA. Statistical analysis was done by online GraphPad Prism software, version 5.0. McNemar's test was applied and Kappa agreement coefficient was calculated for agreement between various methods. A p-value < 0.05 was considered significant.
RESULTS
Among the 100 evaluated endometrial samples, one was AFB smear positive, none was positive by culture, four were positive by histopathology and 13 were positive by PCR. Of the 13 PCR-positive cases, 38.4% were positive for M. tuberculosis, 23.07% for M. bovis, and 38.4% showed co-infection with both species. 40% of the patients had raised IgG against M. tuberculosis 38-kDa antigen. McNemar's test was applied to PCR and the conventional methods of TB diagnosis (AFB, Culture and histopathology) and the p-value was < 0.001 (highly significant) for PCR. Detection by PCR showed a fair agreement with detection by Mantoux test and ELISA.
CONCLUSION
In paucibacillary endometrial tuberculosis, the positive detection rate was found to be significantly higher for PCR compared to other methods. The 'in-house' nested PCR assay targeting the hupB gene and used in this study, can serve as a rapid diagnostic aid for tubercular endometritis. It can also differentiate between members of the Mycobacterium tuberculosis complex, namely M. tuberculosis and M. bovis.
PubMed: 23926494
DOI: No ID Found -
Indian Pediatrics Jan 2010Revised National Tuberculosis Control Program (RNTCP) has focused on adults with smear positivity a tool not so well used in children with tuberculosis. There is a need...
JUSTIFICATION
Revised National Tuberculosis Control Program (RNTCP) has focused on adults with smear positivity a tool not so well used in children with tuberculosis. There is a need to redefine standardization of diagnosis and management protocols for childhood tuberculosis.
PROCESS
Indian Academy of Pediatrics constituted a Working Group to develop consensus statement on childhood tuberculosis (TB). Members of the Group were given individual responsibilities to review the existing literature on different aspects of the childhood TB. The group deliberated and developed a consensus which was circulated to all the members for review. Efforts were made to ensure that the recommendations are standardized.
OBJECTIVES
To produce recommendations and standard protocols for reasonably accurate diagnosis and rational treatment of tuberculosis in children.
RECOMMENDATIONS
Fever and or cough > 2 weeks with loss of weight and recent contact with infectious case should arouse suspicion of TB. Chest Xray and trial with broad-spectrum antibiotic for 7-10 days is justified. In case of clinical and radiological non-response, Mantoux test and sputum or gastric aspirate for AFB is recommended. If AFB is positive, diagnosis is confirmed. If AFB is negative but chest Xray is suggestive and Mantoux test is positive, it is a probable case and if these tests are negative, alternate diagnosis must be sought and referral made to an expert. Ideally it is recommended to use 1TU of PPD for Mantoux test but 2 or 5 TU may be acceptable (but less preferred). Cut-off point of 10 mms for natural infection may be used for test done with 1, 2 or 5 TU. There is no linear relation of reaction to tuberculin strength and so no more than 5 TU should be used. BCG test is not recommended. Diagnosis must not be made without an attempt to look for AFB in gastric aspirate or sputum, as it is possible to get AFB even in primary complex. Elisa and PCR tests for TB are not recommended. There is no place for trial of anti tubercular therapy. Lymphnode enlargement > 2 cm with or without typical findings suggestive of TB and failure of antibiotic response demands FNAC for histopathology and bacteriology. Clinical suspicion of tubercular meningitis (TBM) should be confirmed by CSF examination and CT scan though none of these investigations are confirmatory and hence should not be considered in isolation. CSF tests for TB antibody and PCR are not recommended for routine use. Diagnosis of abdominal TB is made on circumstantial evidence and there are no standard guidelines. For treatment, disease is divided into three categories. The Category I and III are recommended for different types of new cases i.e. those who have received treatment for not more than 4 weeks. Category III includes primary pulmonary complex, one site peripheral lymphadenitis and pleural effusion, while all other forms of TB are included in Category I, that corresponds to smear positive TB in adults. This is because AFB is often found in many Category I disease in children. Category II includes defaulters, relapses and failure cases irrespective of the site of disease. Standard protocol is followed for each of these categories. Intermittent thrice weekly therapy with higher dose has been found to be equally effective as daily therapy and so is recommended in DOTS Direct Observed Therapy Short term. Compliance of treatment must be ensured. Repeat chest X-ray is ideal at the end of therapy. Liver function tests are not routinely recommended. Recommendations are also made for special situations such as MDRTB, TB and HIV and neonate born to mother suffering from TB.
Topics: Antitubercular Agents; Chemoprevention; Child; Consensus; Humans; India; Tuberculosis; Tuberculosis, Multidrug-Resistant
PubMed: 20139477
DOI: 10.1007/s13312-010-0008-3 -
British Medical Journal Apr 1932
PubMed: 20776792
DOI: 10.1136/bmj.1.3719.701 -
Journal of Ophthalmic Inflammation and... Feb 2022Serpiginous-like choroiditis is a rare immune-mediated sub-entity of tubercular uveitis with a usually deleterious outcome. Treatment is still controversial. The purpose... (Review)
Review
Tuberculosis-related serpiginous choroiditis: aggressive therapy with dual concomitant combination of multiple anti-tubercular and multiple immunosuppressive agents is needed to halt the progression of the disease.
BACKGROUND/PURPOSE
Serpiginous-like choroiditis is a rare immune-mediated sub-entity of tubercular uveitis with a usually deleterious outcome. Treatment is still controversial. The purpose in this case series is to indicate that only aggressive treatment comprising multiple anti-tubercular and multiple immunosuppressive agents seems to be able to halt the disease progression.
METHODS
This retrospective case series included patients diagnosed with Interferon Gamma Release Assays (IGRA) -positive serpiginous choroiditis, seen at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland, treated with combined multiple antitubercular and immunosuppressive agents at presentation and having a sufficient follow-up. Disease history before referral, appraisal of disease, treatment modalities and follow-up were analyzed. Inclusion criteria were positive IGRA patients with serpiginous choroiditis with complete Spectral-Domain Optic coherence tomography (SD-OCT) and angiography images.
RESULTS
From 2001 to 2020, 24 of 1525 new patients (0.26%) were diagnosed as serpiginous choroiditis. 10/24 were related to tuberculosis (positive IGRA and/or hyper-positive Mantoux test), 8/24 were IGRA negative and in 6 there was no information available. 4/10 tuberculosis related serpiginous patients fulfilled the inclusion criteria. Mean age was 39 ± 5.3 years. Snellen best corrected vision acuity (BCVA) at presentation in 3/4 where the macula was preserved was 0.96 ± 0.08. In 3/4 patients, treatment with multiple tuberculostatic therapy combined with multiple immunosuppressive agents, started at presentation or in the initial months after the first consultation, was shown to stop the progression of the disease, with a retained visual acuity of 1.0. One patient with macular involvement and a bilateral visual acuity of hand movements after 11 years of insufficient treatment, improved his visual acuity to 0.25 OD and 0.05 OS and presented a substantial visual field improvement that stabilized once multiple anti-tubercular and immunosuppressive therapy was introduced.
CONCLUSION
IGRA-positive serpiginous choroiditis (serpiginous-like choroiditis) could be halted by combined multiple tuberculostatic and multiple immunosuppressive agents, as seen in our study where 3/4 early treated patients had conserved central function and one late treated patient had recovered a substantial amount of visual field. In all 4 patients this treatment regimen halted the progression of the disease.
PubMed: 35132499
DOI: 10.1186/s12348-022-00282-6 -
Journal of Microbiology & Biology... 2019Teaching methods need continuous innovation to encourage undergraduate medical students to enhance their competency level and skills. Every undergraduate medical student...
Teaching methods need continuous innovation to encourage undergraduate medical students to enhance their competency level and skills. Every undergraduate medical student should be able to discuss the Revised National Tuberculosis Control Program (RNTCP) and Direct Observed Treatment Short (DOTS) course recommended by the World Health Organization (WHO). The DOTS strategy was launched in 1992, with the objective of detecting at least 70% of new sputum-positive tuberculosis (TB) patients and curing at least 85% of such patients. The aim of this study was to improve the competency level of Undergraduate (UG) Bachelor of Medicine and Bachelor of Surgery (MBBS) students by teaching them the objectives of the RNTCP at a program implementation site in the medical college. The RNTCP could be considered and conducted as Program-Based Teaching and Learning (PBTL) for the UG medical students. The following skills were to be implemented in the RNTCP PBTL: Sputum Collection, Ziehl-Neelsen staining and Grading, Mantoux test, and TB Culture and Molecular test (Gene Xpert). Phase II undergraduate MBBS students (N = 104) participated in the PBTL. This study was conducted in the RNTCP laboratory of a tertiary-care teaching medical college hospital. This descriptive study included advanced skill-based teaching such as Directly Observed Practical Skill, Demonstration-Observation-Assistance-Performance, Video Demonstrations, Role Play, and Group interaction as teaching tools. Pre-/post-test, Objective Structured Practical Examination, and frequently asked questions were used as assessment tools. The pre- and post-test marks were compared, and other assessments were also analyzed using SPSS. At the end of the teaching program, the feedback forms were collected from students and analyzed. The mean score obtained for 104 MBBS students in the pre-test, post-test, and other assessment tools were 213.3 and 487.5, respectively ( < 0.001). We conclude that skill-based teaching and learning tools to teach public health program like RNTCP provide valuable essential skills for undergraduate medical students. This Program Based Teaching and Learning could be successfully extended to all medical colleges.
PubMed: 31160936
DOI: 10.1128/jmbe.v20i1.1649 -
PloS One 2020Abdominal tuberculosis (ATB) continues to pose a major diagnostic challenge for clinicians due to its nonspecific clinical presentation, variable anatomical location and...
Abdominal tuberculosis (ATB) continues to pose a major diagnostic challenge for clinicians due to its nonspecific clinical presentation, variable anatomical location and lack of sensitive diagnostic tools. In spite of the development of several assays till date; no single test has proved to be adequate for ATB diagnosis. In this study, we for the first time report the detection of circulating cell-free Mycobacterium tuberculosis (M. tuberculosis) DNA (cfMTB-DNA) in ascitic fluid (AF) samples and its utility in ATB diagnosis. Sixty-five AF samples were included in the study and processed for liquid culture, cytological, biochemical and molecular assays. A composite reference standard (CRS) was formulated to categorize the patients into 'Definite ATB' (M. tuberculosis culture positive, n = 2), 'Probable ATB' (n = 16), 'Possible ATB' (n = 13) and 'Non-TB' category (n = 34). Two molecular assays were performed, namely, the novel cfMTB-DNA qPCR assay targeting M. tuberculosis devR gene and Xpert MTB/RIF assay (Xpert), and their diagnostic accuracy was assessed using CRS as reference standard. Clinical features such as fever, loss of weight, abdominal distension and positive Mantoux were found to be strongly associated with ATB disease (p<0.05). cfMTB-DNA qPCR had a sensitivity of 66.7% (95% CI:40.9,86.7) with 97.1% specificity (95% CI:84.7,99.9) in 'Definite ATB' and 'Probable ATB' group collectively. The sensitivity increased to 70.9% (95% CI:51.9,85.8) in the combined 'Definite', 'Probable' and 'Possible' ATB group with similar specificity. The cfMTB-DNA qPCR assay performed significantly better than the Xpert assay which demonstrated a poor sensitivity of ≤16.7% with 100% (95% CI:89.7,100) specificity (p<0.001). We conclude that cfMTB-DNA qPCR assay is an accurate molecular test that can provide direct evidence of M. tuberculosis etiology and has promise to pave the way for improving ATB diagnosis.
Topics: Abdomen; Adolescent; Adult; Aged; Ascitic Fluid; Bacterial Proteins; Cell-Free Nucleic Acids; DNA, Bacterial; DNA-Binding Proteins; Female; Humans; Male; Middle Aged; Molecular Diagnostic Techniques; Mycobacterium tuberculosis; Real-Time Polymerase Chain Reaction; Tuberculosis; Young Adult
PubMed: 32845896
DOI: 10.1371/journal.pone.0238119