Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum

2017 ◽  
Vol 28 (1) ◽  
pp. 243-256 ◽  
Author(s):  
Jun -Jun Yeh
Keyword(s):  
Pulmonary Tuberculosis ◽  
Active Pulmonary Tuberculosis ◽  
Acid Fast Bacilli ◽  
Smear Negative ◽  
Negative Sputum

Detection of Mycobacterium tuberculosis in smear negative sputum by PCR

2012 ◽  
Vol 6 (2) ◽  
pp. 2-6 ◽  
Author(s):  
Mohammad Jobayer ◽  
SM Shamsuzzaman ◽  
Kazi Zulfiquer Mamun
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Accurate Method ◽  
Major Health Problem ◽  
Major Health ◽  
Tuberculosis Patients ◽  
Diagnostic Potential ◽  
Total Death ◽  
Smear Negative ◽  
Negative Sputum

Pulmonary tuberculosis is a major health problem in Bangladesh that is responsible for about 7% of total death in a year. This study was conducted to isolate and identify Mycobacterium tuberculosis from sputum and to evaluate the efficacy of PCR as a modern diagnostic tool, for diagnosis of pulmonary tuberculosis, especially in the smear negative cases. One hundred and fifty suspected pulmonary TB patients (male/ female: 97/53) were included in this study. Single morning sputum was collected from each patient and diagnostic potential of PCR was compared with staining and culture. Twenty five (16.7%) sputum were positive by ZN stained smear. Among 125 smear negative samples, 13 (10.4%) yielded growth in culture in LJ media and 21 (16.8%) samples were positive by PCR. The sensitivity and specificity of PCR in smear negative cases was 100% and 92.9% respectively. Mean detection time in PCR was 24 hours. PCR detected M. tuberculosis in 21 smear negative and 9 culture negative samples. For diagnosis of tuberculosis in smear negative cases, PCR directly from sputum was a very sensitive and accurate method. In conclusion, PCR may be done, especially in clinically suspected pulmonary tuberculosis patients who remain negative by conventional methods.DOI: http://dx.doi.org/10.3329/bjmm.v6i2.19368 Bangladesh J Med Microbiol 2012; 06(02): 2-6

scholarly journals Xpert MTB/Rif assay in the diagnosis of smear-negative pulmonary tuberculosis: a prospective study from Nepal

2019 ◽  
Author(s):  
Priyatam Khadka ◽  
Januka Thapaliya ◽  
Ramesh Bahadur Basnet ◽  
Gokarna Raj Ghimire ◽  
Jyoti Amatya ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Disease Transmission ◽  
Clinical Information ◽  
University Teaching ◽  
Smear Microscopy ◽  
Line Probe Assay ◽  
Smear Negative ◽  
Negative Sputum ◽  
Probe Assay ◽  
A Prospective Study

Abstract Background For improving patient care and abbreviating the disease transmission chain, speedy detection of tuberculosis and its drug-resistance with precision is crucial. Methods We analyzed, pulmonary tuberculosis (PTB) suspected, 360 smear-negative sputum from the patients attending Tribhuvan University Teaching Hospital (TUTH). The patients were selected as per the algorithm of National Tuberculosis Programme(NTP) for Xpert MTB/RIF testing. Participants’ demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer’s protocol. The same samples were stained using Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with Line Probe Assay. Result Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3 of them were rifampicin resistance. The infection was higher in male, i.e. 60(25.3%) compared to female 25(20.3%). The age group, >45(nearly 33%) with median age 42± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH; consequently, with Xpert MTB/RIF assay, additional case 16.5% (n=85/515) missed on the smear microscopy, were detected—surging overall confirmed cases. Among the most occurring clinical presentations, cough and chest pain were more evident in PTB with relative-risk at 95% confident-levels i.e. 3.03(1.01-9.11) and 3.47(2.29-5.27) respectively. A higher number of new suspects (n=63) were found positive compared to previously treated suspects. The upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were peculiar radiological impression noted in PTB patient. 94 MDR suspected cases were enrolled; of total suspected cases, 29 samples were found rifampicin sensitive, 1 indeterminant while 2 of them were rifampicin-resistant. However, a single rifampicin-resistant; case was detected in patient which was not MDR suspected. Conclusion Additional cases of PTB which are neglected as smear-negative on microscopy and other conventional tests can be detected with gene Xpert test. Hence, recommended to every suspect as a presumptive test could be a wise investment in diagnosis to restrict the global burden to some extent. Keywords: Xpert MTB/Rif assay, Mycobacterium tuberculosis, Line Probe Assay, MDR-TB

scholarly journals Unilateral Nonconfluent Cluster of Micronodules: Atypical Radiologic Appearance of Pulmonary Tuberculosis in an Immunocompetent Patient

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bushra Johari ◽  
Mohammad Hanafiah
Keyword(s):  
Pulmonary Tuberculosis ◽  
Urine Culture ◽  
Left Kidney ◽  
Lung Parenchyma ◽  
Immunocompetent Patient ◽  
Duplex System ◽  
Genitourinary Tuberculosis ◽  
Active Pulmonary Tuberculosis ◽  
Negative Sputum ◽  
The Right

Active pulmonary tuberculosis involving the lung parenchyma is typically seen on CT as consolidation, centrilobular nodules with tree-in-bud branching, cavitating lesions, and miliary nodules. However, some atypical CT patterns of granulomatous disease including tuberculosis have been recently described, namely, clusters of nodules without confluence or with confluence. We present a case of a patient who was found to have nonconfluent clusters of micronodules in the right lung with negative sputum culture for tuberculosis. There were also incidental findings of the partial duplex system of the left kidney with mild-to-moderate hydronephrosis in the lower moiety with proximal hydroureter. The urine culture was then positive for mycobacterium tuberculosis; hence, he was commenced on antituberculous medications. A repeated CT scan revealed significant improvement of the aforementioned clusters of micronodules and left hydronephrosis. In the present case, we would like to highlight the atypical appearances of pulmonary tuberculosis in the form of nonconfluent micronodules on HRCT despite negative sputum workup, with the concurrent active genitourinary tuberculosis.

scholarly journals Role of fiberoptic bronchoscopy in sputum smear negative suspected cases of pulmonary tuberculosis: a study conducted in Southern part of Rajasthan

2020 ◽  
Vol 8 (12) ◽  
pp. 4302
Author(s):  
Atul Luhadia ◽  
Shanti K. Luhadia ◽  
Shubham Jain ◽  
Mohammad Hamza Hanfe ◽  
Divax Oza ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diagnostic Yield ◽  
Radiological Finding ◽  
Fiberoptic Bronchoscopy ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Acid Fast Bacilli ◽  
Predominant Symptom ◽  
Smear Negative

Background: Sputum smear negative pulmonary tuberculosis is a common problem faced by clinicians. Fiberoptic bronchoscopy may be very useful in diagnosing these cases which have no sputum or whose sputum smear is negative for acid fast bacilli. Objective of the current study was to assess the role of fiberoptic bronchoscopy in sputum smear negative under NTEP and radiologically suspected cases of pulmonary tuberculosis.Methods: Clinico-radiological suspected cases of pulmonary tuberculosis patients in whom two sputum smear for acid fast bacilli by Ziehl Neelsen stain under NTEP was negative were included in the study. Fiberoptic bronchoscopy was performed in all these patients and samples taken were sent for investigations.Results: Fiberoptic bronchoscopy was performed in 250 patients of suspected pulmonary tuberculosis whose sputum for AFB smear was negative. Cough was the most predominant symptom. Radiologically, right side disease was more common and upper zone was most commonly involved and infiltrates were common radiological finding. During bronchoscopy, congestion and hyperaemia (36%) and mucopurulent/mucoid secretions (32%) was seen in maximum number of cases. BAL was positive in 200 patients (80%), post bronchoscopy sputum was positive in 70 cases (28%) and biopsy was positive in 12 patients out of 16 performed biopsies (75%). The total TB positive cases after combining all the methods were 215 making the overall diagnostic yield of 86%.Conclusions: Fiberoptic bronchoscopy and post bronchoscopy sputum can be very useful for diagnosing sputum for AFB smear negative but clinico-radiological suspected cases of pulmonary tuberculosis patients.

scholarly journals Utility of Bronchoalveolar Lavage in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

2020 ◽  
Vol 8 (1) ◽  
pp. 19-22
Author(s):  
Subodh Sagar Dhakal ◽  
Ashmita Neupane ◽  
Shatdal Chaudhary ◽  
Navin Mishra ◽  
Damber Bdr Karki
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Diagnostic Yield ◽  
Cross Sectional Study ◽  
Fibreoptic Bronchoscopy ◽  
Sputum Smear ◽  
Cross Sectional ◽  
Acid Fast Bacilli ◽  
Smear Negative

INTRODUCTION: Sputum smear examination for acid fast bacilli (AFB) by Ziehl-Neelsen stain (ZN stain) is the initial approach to the diagnosis of pulmonary tuberculosis (PTB). But 50% of the cases are reported to be sputum smear negative. This study was aimed to investigate the diagnostic yield of fibreoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. The sample was tested for Mycobacterium tuberculosis using the XpertMTB/RIF assay, which is a new test that detects Mycobacterium tuberculosis complex and resistance to rifampin in less than two hours. MATERIAL AND METHODS: This is a prospective cross sectional study carried out on 58 sputum smear negative patients who were clinically suspected to have pulmonary tuberculosis from April 2017 to January 2019. All patients are subjected to FOB, BAL and BAL specimens were stained for AFB and also sent for Xpert (MTB)/RIF. RESULTS: Among 58 patients enrolled for the study 26 patients were positive for acid fast bacilli (AFB) through BAL stain and Xpert (MTB)/RIF combined. CONCLUSION: FOB guided BAL is a reliable, alternative and rapid method for diagnosing smear negative pulmonary tuberculosis with minimal complications.

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

2021 ◽  
Vol 71 (4) ◽  
pp. 1341-45
Author(s):  
Maryam Hussain ◽  
Sultan Mehmood Kamran ◽  
Rizwan Azam ◽  
Asifullah Khan ◽  
Sohaib Ahmed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Pulmonary Tuberculosis ◽  
Diagnostic Yield ◽  
Military Hospital ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Acid Fast Bacilli ◽  
Smear Negative

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

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