“Allergic bronchopulmonary aspergillosis misdiagnosed as smear negative pulmonary tuberculosis; a retrospective study from Pakistan”

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

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Role of fibreoptic bronchoscopy in sputum smear negative pulmonary tuberculosis

Tubercle and Lung Disease ◽

10.1016/0962-8479(94)90786-2 ◽

1994 ◽

Vol 75 ◽

pp. 29

Author(s):

A. McDaniel ◽

N. Schoenfeld ◽

W. Frank ◽

A. Grassot ◽

H. Mauch ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Fibreoptic Bronchoscopy ◽

Sputum Smear ◽

Smear Negative

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Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037913 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037913

Author(s):

Mala George ◽

Geert-Jan Dinant ◽

Efrem Kentiba ◽

Teklu Teshome ◽

Abinet Teshome ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Cross Sectional Study ◽

Clinical Suspicion ◽

Secondary Outcome ◽

Northern Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Smear Negative ◽

Culture Positive ◽

Culture Negative

ObjectivesTo evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.DesignA cross-sectional study.SettingTwo public referral hospitals in Tigray, Ethiopia.ParticipantsA total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.Primary and secondary outcome measuresA total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.ResultsThe strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.ConclusionsOur finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

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Diagnosis of sputum smear-negative forms of pulmonary tuberculosis by transthoracic fine-needle aspiration

Tubercle ◽

10.1016/0041-3879(91)90010-p ◽

1991 ◽

Vol 72 (3) ◽

pp. 210-213 ◽

Cited By ~ 6

Author(s):

I. Gomes ◽

E. Trindade ◽

O. Vidal ◽

O. Yeep ◽

I. Amendoeirai ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Sputum Smear ◽

Fine Needle ◽

Smear Negative

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Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004–2019

BMJ Open ◽

10.1136/bmjopen-2020-044349 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044349

Author(s):

Ning-ning Tao ◽

Yi-fan Li ◽

Wan-mei Song ◽

Jin-yue Liu ◽

Qian-yun Zhang ◽

...

Keyword(s):

Risk Factors ◽

Drug Resistance ◽

Retrospective Study ◽

Pulmonary Tuberculosis ◽

Logistic Models ◽

Smoking History ◽

Categorical Variables ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis

ObjectiveThis study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB).DesignA retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher’s exact or Pearson’s χ2 test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity.ResultsA total of 10 975 patients with PTB were recorded during 2004–2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05).ConclusionSmoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host’s health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.

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