With culture used as the reference standard, what is the accuracy of the Xpert® MTB/RIF assay for detecting extrapulmonary tuberculosis (TB) using cerebrospinal fluid, pleural fluid, lymph node aspirate, or urine?

2021 ◽  
Author(s):  
Jane Burch ◽  
Agustín Ciapponi
Keyword(s):  
Cerebrospinal Fluid ◽  
Lymph Node ◽  
Pleural Fluid ◽  
Extrapulmonary Tuberculosis ◽  
Reference Standard

scholarly journals Use of a multiplexed immunoassay for detection of serotype-specific Streptococcus pneumoniae antigen in pleural fluid and cerebrospinal fluid specimens

2011 ◽  
Vol 60 (12) ◽  
pp. 1879-1881 ◽  
Author(s):  
Carmen L. Sheppard ◽  
Malcolm Guiver ◽  
John Hartley ◽  
Timothy G. Harrison ◽  
Robert C. George
Keyword(s):  
Cerebrospinal Fluid ◽  
Streptococcus Pneumoniae ◽  
Pleural Fluid ◽  
Multiplexed Immunoassay

scholarly journals 1641. A Comparative Analysis Of Lymph Node Tuberculosis Between Children And Adults

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S810-S810
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Amal Chakroun ◽  
Khaoula Rekik ◽  
Fatma Smaoui ◽  
...  
Keyword(s):  
Lymph Node ◽  
Family History ◽  
Extrapulmonary Tuberculosis ◽  
Diagnostic Delay ◽  
Disease Evolution ◽  
Evolutionary Features ◽  
Significant Difference ◽  
History Of ◽  
Adults And Children ◽  
Lymph Node Tuberculosis

Abstract Background Lymph node tuberculosis (LNTB) represents the most common site of extrapulmonary tuberculosis. Among children, due to non-specific clinical features, the diagnosis is often delayed. We aimed to compare the clinical, therapeutic and evolutionary features of LNTB between adults and children. Methods We conducted a retrospective study including patients hospitalized for LNTB in the infectious diseases and pediatric department between 1993 and 2018. Children aged ≤18 years were included. Results Overall, we encountered 231 cases of LNTB. There were 40 children (17.3%) with a mean age of 11±4 years and 191 adults (82.7%) with a mean age of 42±16 years. As to gender, females were more affected (adults: 67% vs children: 70%), with no significant difference (p >0.05). A family history of tuberculosis was significantly more frequent among children (20% vs 6.3%; p=0.01). Raw milk consumption (38.2% vs 30%; p >0.05) and close contact with animals (29.8% vs 35%; p >0.05) were noted among both adults and children. Fever (53.4% vs 32.5%; p=0.01), night sweats (35.8% vs 10%; p=0.001), loss of appetite (38.2% vs 17.5%; p=0.01) and weight loss (35.1% vs 15%; p=0.01) were significantly more frequent among adults. Tuberculin skin test was positive in 75.8% of the cases among adults and in 86.2% of the cases among children (p >0.05). Multifocal tuberculosis was significantly more frequent among adults (23.8% vs 5.7%; p=0.01). Antitubercular therapy was prescribed for a mean duration of 10±4 months among adults and for 9±3 months among children, with no significant difference (p >0.05). Side effects of antitubercular drugs were more frequent among adults (33% vs 10.3%), with a significant difference (p=0.004). Comparison of the disease evolution showed no significant difference between adults and children, regarding recovery (94.8% vs 90%), relapse (5.2% vs 5%) and death (0.5% vs 2.5%). Conclusion The clinical presentation of LNTB among children was less common and misleading. A family history of tuberculosis and a high index of suspicion might shorten the diagnostic delay. Disclosures All Authors: No reported disclosures

scholarly journals Utility of GeneXpert in Diagnosis of Multidrug-resistant Extrapulmonary Tuberculosis

2017 ◽  
Vol 03 (02) ◽  
pp. 085-087
Author(s):  
Ankush Chaudhary ◽  
Ketaki Utpat ◽  
Unnati Desai ◽  
Jyotsna Joshi
Keyword(s):  
Lymph Node ◽  
Psoas Abscess ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
False Negative ◽  
Multidrug Resistant ◽  
Nucleic Acid Amplification ◽  
Lower Sensitivity ◽  
Care Hospital ◽  
Gluteal Abscess

ABSTRACT Background: The Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay (GeneXpert) is a rapid semi-quantitative nucleic acid amplification test with established role in the diagnosis of pulmonary tuberculosis (PTB) and multidrug-resistant (MDR) PTB. We determined the performance of the GeneXpert assay for the diagnosis of extrapulmonary tuberculosis (EPTB) MDR cases. Aims and objectives: To study the role of GeneXpert in the diagnosis of EPTB MDR. Materials and methods: A retrospective study was conducted over a period of 2 years at a tertiary care hospital after Ethics Committee permission. Data of 44 consecutive patients of diagnosed EPTB MDR were retrieved for GeneXpert and culture drug susceptibility test (DST). Sensitivity of GeneXpert in the diagnosis of EPTB MDR was calculated comparing culture DST results. Results: Various EPTB MDR cases studied were lymph node TB (n = 23) 51%, pleural effusion (n = 14) 32%, central nervous system TB/spinal TB/psoas abscess/gluteal abscess (n = 7) 17%. Sensitivity for GeneXpert was found to be 91.30, 57, 100% respectively. True positive and false negative were 36 and 8 cases respectively. The overall sensitivity of GeneXpert in diagnosing EPTB MDR was 81.80%. The sensitivity among lymph node, pleural effusions, and spinal/psoas abscess/gluteal abscess was 91.30, 57.14, and 100% respectively. Conclusion: GeneXpert sensitivity for the diagnosis of EPTB MDR varied with site of extrapulmonary involvement, with lower sensitivity in pleural fluid as compared with higher sensitivity among lymph node and spine TB. Nevertheless, given the rapid turnaround time and simplicity, it is a useful tool in the diagnosis of EPTB MDR when used in correct clinical context. Subsequent confirmation with culture DST, however, is recommended to diagnose false negatives.

scholarly journals 2156. To Evaluate the Role of Kit-Based Loop-Mediated Isothermal Amplification (TB-LAMP) Assay in the Diagnosis of Tubercular Lymphadenitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S731-S732
Author(s):  
Neeraj Nischal ◽  
Saurav Das ◽  
Binit Kumar Singh ◽  
Naveet Wig ◽  
Manish Soneja ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lamp Assay ◽  
Infectious Agent ◽  
Drug Susceptibility Testing ◽  
Isothermal Amplification ◽  
World Health ◽  
Reference Standard ◽  
Loop Mediated Isothermal Amplification ◽  
Tubercular Lymphadenitis ◽  
Composite Reference Standard

Abstract Background Tuberculosis (TB) is the leading cause of death as a single infectious agent worldwide. In 2017, there were an estimated 1.3 million TB deaths among HIV-negative people and 300,000 deaths among HIV-positive people. The rapid and accurate diagnosis of TB in lymphnode specimens remains a challenging task today. In 2016, World Health Organization endorsed a commercial molecular assay, the LoopAMP™ Mycobacterium tuberculosis complex (MTBC) detection kit (Eiken Chemical Company, Tokyo, Japan), which uses loop-mediated isothermal amplification (LAMP) for sputum samples only. No prospective studies on LAMP in diagnosis of Tubercular Lymphadenitis in adults have been done yet. Methods A prospective observational study with a total of 70 lymph-node aspirate specimens from suspected cases of Tubercular Lymphadenitis with age >18 years were selected and subjected to Ziehl–Neelsen staining, LAMP and culture in mycobacterial growth indicator tube (MGIT960). The immunochromatographic test was used to confirm MTB complex (MTBC) in culture positive samples and phenotypic drug susceptibility testing was done using MGIT-960. The composite reference standard (CRS) used in the study includes symptoms, radiological evidence and follow-up of 2 months. 2 × 2 tables were made and Sensitivity, Specificity, PPV, NPV of TB-LAMP were calculated with respect to AFB smear and composite reference standard (CRS). Results LAMP assay was able to detect MTBC in 34.3% (24/70) of lymph-node specimens. Sensitivity and specificity of the assay were 100% and 69.7%, respectively, considering smear as gold standard. On comparing with CRS, the assay showed 100% sensitivity and 100% specificity in the diagnosis of MTBC. Conclusion In our study, LAMP assay was found to be a promising tool for the diagnosis of Tubercular Lymphadenitis and could be used for rapid and cost-effective diagnosis of Tubercular Lymphadenitis in resource-limited settings. Disclosures All authors: No reported disclosures.

scholarly journals Isolation and Identification of Mycobacterium from Extrapulmonary Specimen at NTRL, NIDCH

1970 ◽  
Vol 11 (2) ◽  
pp. 128-130 ◽  
Author(s):  
SM Mostofa Kamal ◽  
HAM Nazmul Ahasan ◽  
Sharmin Ahmed ◽  
KFM Ayaz ◽  
Md Shahriar Mahbub ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pleural Fluid ◽  
Laboratory Data ◽  
Gastric Lavage ◽  
Laboratory Diagnosis ◽  
Reference Laboratory ◽  
Isolation And Identification ◽  
Female Ratio ◽  
Lowenstein Jensen ◽  
Extra Pulmonary

Objective of the study was to see the frequency of isolation of Mycobacterium among different extrapulmonaryspecimens. The study was carried out at NTRL (National Tuberculosis reference laboratory), NIDCH Bangladeshduring January 2008-June 2009.This study was carried out retrospectively by analyzing NTRL laboratory data. Atotal of 514 extra-pulmonary specimens from different treatment centre of Dhaka was analyzed. Clinical specimens,such as lymph node aspirate, pleural fluid, urine, stool, gastric lavage, pus, ascitic fluid, cerebrospinal fluids, etc wascollected. Lowenstein-Jensen media was used for culture and antimicrobial susceptibility testing. Mycobacteria wereisolated from 113 extra-pulmonary specimens. Male and female ratio was almost equal among positive cases. Thecommonest source of isolation was lymph nodes(frequency 55.8%) and lymph node aspirate( frequency 68.4%)pleural fluid (frequency10.6%).Anti-microbial susceptibility of the isolates to the four first line anti-tuberculosis drugs,rifampicin, isoniazid, streptomycin and ethambutol was tested, susceptibility rate was 100%.The results suggest that,,emphasis should be placed on laboratory diagnosis and treatment of extra-pulmonary tuberculosis.Keywords: Pulmonary tuberculosis; extrapulmonary; Microbial Sensitivity Test; Laboratory Technics and Procedures;BangladeshDOI: 10.3329/jom.v11i2.5454J MEDICINE 2010; 11 : 128-130

scholarly journals OC 8277 IDENTIFICATION OF NEW CEREBROSPINAL FLUID AND BLOOD-BASED BIOMARKERS FOR THE DIAGNOSIS OF TUBERCULOUS MENINGITIS IN CHILDREN

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A3.2-A3
Author(s):  
Masilo Charles Manyelo ◽  
Regan S Solomons ◽  
Gerhard Walzl ◽  
Novel N Chegou
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Point Of Care ◽  
Extrapulmonary Tuberculosis ◽  
Diagnostic Delay ◽  
Severe Form ◽  
High Morbidity ◽  
Serum Samples ◽  
Meningitis In Children ◽  
Study Participants

BackgroundTuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis (TB). It mostly affects young children and results in high morbidity and mortality, mainly due to diagnostic delay. There is an urgent need for new tests for the earlier and accurate diagnosis of the disease. We previously identified a 3-marker cerebrospinal fluid (CSF) biosignature (VEGF, IL-13, and LL-37) with potential to diagnose TBM. In the present study, we show that CSF and blood-based biosignatures may be useful in the diagnosis of TBM.MethodsCSF and serum samples were consecutively collected from 47 children that were admitted to the Tygerberg Academic Hospital in Cape Town, South Africa, on suspicion of having TBM. Using a multiplex platform, the concentrations of 69 host markers were evaluated in the CSF and serum samples from all the study participants, followed by statistical analysis to ascertain the usefulness of these biomarkers as diagnostic candidates for TBM disease.ResultsOut of the 47 study participants, 23 (48.9%) were finally diagnosed with TBM and 6 (12.8%) were infected with HIV. Several CSF and serum biomarkers showed potential individually as diagnostic candidates for TBM as ascertained by area under the receiver operator characteristics curve (AUC). However, the main findings of our study were the identification of a four-marker CSF biosignature which diagnosed TBM with an AUC of 0.97 (95% CI, 0.92–1.00), and a 3-marker serum biosignature which diagnosed TBM with an AUC of 0.84 (95% CI, 0.73–0.96). We also validated a previously identified 3-marker CSF biosignature (VEGF, IL13 and LL37) in the study.ConclusionCSF and serum biosignatures may be useful in the diagnosis of TBM in children. Our findings require further validation in larger, multi-site studies after which the biosignatures may be incorporated into point-of-care diagnostic tests for TBM.

Isolation of Mycoplasma pneumoniae from Pleural Fluid and/or Cerebrospinal Fluid: Report of Four Cases

1987 ◽  
Vol 19 (5) ◽  
pp. 521-524 ◽  
Author(s):  
Yoko Nagayama ◽  
Nobukiyo Sakurai ◽  
Kazuto Tamai ◽  
Atsuko Niwa ◽  
Koshi Yamamoto
Keyword(s):  
Cerebrospinal Fluid ◽  
Pleural Fluid ◽  
Mycoplasma Pneumoniae

scholarly journals MON-482 Thyroid Tuberculosis - An Unlikely Diagnosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alexandra Novais Araújo ◽  
Tânia Matos ◽  
Ema Nobre ◽  
Maria Joao Bugalho
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Histopathological Examination ◽  
Extrapulmonary Tuberculosis ◽  
Needle Aspiration ◽  
Tuberculous Infection ◽  
Rare Presentation ◽  
Adequate Treatment ◽  
Fine Needle ◽  
The Right

Abstract Background: Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for the most cases of tuberculous infection. Approximately one-third of the world’s population is infected. Tuberculosis (TB) of the thyroid gland is an unusual diagnosis with an estimated prevalence of 0.1 to 0.6%. The thyroid TB can mimic different pathologies (thyroid neoplasms, lymphoma, infectious or granulomatous thyroiditis, Graves’ disease or bacterial abscess) and the diagnosis can be easily disregarded, especially in non-endemic countries and if the patient doesn’t have systemic symptoms. The fine needle aspiration and histopathological examination, with acid-fast bacilli staining and TB culture, are the gold standard exams. Clinical Case: A 71-year-old female was referred to our Endocrinology department after a diagnosis of nodular thyroid disease. She had complaints of slight cervical discomfort, with 6 months of duration. She hadn’t personal or familiar relevant antecedents. At observation, a movable, elastic and non-tender nodule of 15mm at the right superior thyroid lobe was identified. Blood tests including a thyroid profile were normal. The neck ultrasound showed, at the right lobe of the thyroid, multiple solid nodules; the dominant had 18mm, was heterogeneous and had multiple calcifications. Moreover, lymph nodes with suspicious ultrasonographic features along the right internal jugular chain were reported. The patient underwent fine-needle aspiration (FNA) of the suspicious thyroid nodule and one lymph node. Results were respectively: non-diagnostic (Bethesda I) and reactive pattern. FNA was repeated on a different occasion and results were similar. Due to ultrasound suspicious of malignancy, a total thyroidectomy was performed and a lymph node from level IV was sampled for extemporaneous examination. Necrotizing granulomas were documented; the Ziehl-Neelson staining (ZNS) was negative; material was sent to microbiology. Following this finding, ganglion emptying was not performed. The thyroid histology showed tuberculoid type granulomas with lymphoid border and central necrosis. However, the ZNS was negative. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection, by polymerase chain reaction (PCR), of MTB. Pulmonary involvement was excluded and she started antituberculous agents planned for 9 months (rifampicin and isoniazid during 9 months and ethambutol and pyrazinamide for 2 months). Conclusion: Thyroid TB is a rare presentation of extrapulmonary tuberculosis. In presence of systemic or specific complaints or history of exposition the diagnosis may be suspected and confirmatory tests requested in order to ensure an adequate treatment. However, sometimes, histopathology remains a key step and the use of cultures improves the sensitivity and specificity of TB tests.

scholarly journals Laryngeal Tuberculosis: an uncommon but important cause of odynophagia

2017 ◽  
Vol 4 (6) ◽  
pp. 1699
Author(s):  
Abhishek Agarwal ◽  
Asna Khan ◽  
Saurav Pandey ◽  
Arvind Kumar Vaish
Keyword(s):  
Lymph Node ◽  
Pulmonary Tuberculosis ◽  
Extrapulmonary Tuberculosis ◽  
Interesting Case ◽  
Fibreoptic Bronchoscopy ◽  
Direct Visualization ◽  
X Ray ◽  
Chest X Ray ◽  
Lymph Node Tuberculosis ◽  
Laryngeal Tuberculosis

Tuberculosis can occur as pulmonary tuberculosis or as extrapulmonary tuberculosis. The commonest forms of extrapulmonary tuberculosis include the pleural tuberculosis and the lymph node tuberculosis. Here we are describing an interesting case of laryngeal tuberculosis which presented to us with odynophagia. The diagnosis was suspected on basis of chest x-ray and CT thorax, but it could only be confirmed after direct visualization of the larynx on fibreoptic bronchoscopy and by taking biopsy from the epiglottis under direct visualization.

scholarly journals The advantage of PCR for MTB in comparison to ADA in diagnosing tubercular pleural effusion

2018 ◽  
Vol 5 (1) ◽  
pp. 131
Author(s):  
Abhishek Agarwal ◽  
Ahbab Hussain ◽  
Rajendra Prasad ◽  
Anand Verma ◽  
Amitabh Banka ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Cell Count ◽  
Pleural Fluid ◽  
Extrapulmonary Tuberculosis ◽  
Total Cell ◽  
Differential Cell Count ◽  
Tuberculosis Patients ◽  
Lung Consolidation ◽  
Differential Cell ◽  
Important Health

Background: Tuberculosis continues to be an important health problem globally. The bacteriological confirmation of diagnosis in extrapulmonary tuberculosis patients is more difficult because most of the cases of extrapulmonary tuberculosis are paucibacillary in nature. In this study we have compared the pleural fluid ADA levels with PCR for MTB in pleural fluid to confirm the diagnosis of tuberculosis in the pleural fluid.Methods: The study was done over two years and a total of 106 patients with a clinico-radiological diagnosis of pleural effusion were enrolled for the study. The pleural fluid was aspirated and examined for total cell count, differential cell count, protein, sugar, ADA and PCR for MTB.A CT Thorax was done in all the 106 patients of pleural effusion and underlying consolidation along with pleural effusion was found in 60 patients.Results: The pleural fluid was exudative in nature in all the patients. 90 patients (84.9%) had lymphocyte predominant pleural effusion while 16 patients (15.1%) had neutrophil predominant pleural effusion. The overall sensitivity of ADA in all the cases of pleural effusion was 85.2% while the overall sensitivity of PCR for MTB in all the cases of pleural effusion was 51.1%. However, in the 60 patients of pleural effusion with underlying lung consolidation, the overall sensitivity of ADA was 69.1% while the overall sensitivity of PCR for MTB was 92.8% for diagnosing tubercular pleural effusion.Conclusions: PCR for MTB is a useful test along with ADA for diagnosing tubercular pleural effusion. PCR for MTB is especially useful in the diagnosis of tubercular pleural effusion in patients with underlying lung consolidation.  

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