Nontuberculous Mycobacteria Isolated from Tuberculosis Suspects in Ibadan, Nigeria

In Nigeria, one of the highest tuberculosis (TB) burdened nations, sputum smear microscopy is routinely employed for TB diagnosis at Directly Observed Treatment Short-Course (DOTS) Centers. This diagnostic algorithm does not differentiateMycobacterium tuberculosiscomplex (MTC) from nontuberculous mycobacteria (NTM). Between December 2008 and January 2009, consecutive patients diagnosed with TB were screened for inclusion at 10 DOTS centers in Ibadan, Nigeria. To verifyMycobacteriumspecies in patients diagnosed, we cultured and identified mycobacterial isolates using PCR, line probe assay, and spoligotyping techniques. From 48 patients screened, 23 met the inclusion criteria for the study. All the 23 study patients had a positive culture. Overall, we identified 11/23 patients (48%) with MTC only, 9/23 (39%) with NTM only, and 3/23 (13%) with evidence of both MTC and NTM. Strains of MTC identified were Latin American Mediterranean (LAM) genotype (n=12),M. africanum(n=1), and the genotype family T (n=1). FourM. avium-intracellulare-M. scrofulaceum complexes, oneM. chelonae complex, oneM. abscessus, and oneM. intracellularewere identified. Our findings underscore the need to incorporate molecular techniques for more precise diagnosis of TB at DOTS centers to improve clinical outcomes and safe guard public health, particularly in TB endemic countries.

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Patient’s satisfaction regarding directly observed treatment short course under RNTCP in a district of North India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20171759 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1536 ◽

Cited By ~ 1

Author(s):

Kuldeep Srivastava ◽

Abhishek Gupta ◽

Ruchi Saxena ◽

R. P. Sharma ◽

Tanu Midha

Keyword(s):

Treatment Compliance ◽

Sampling Technique ◽

North India ◽

Sputum Smear ◽

Smear Microscopy ◽

Duration Of Treatment ◽

Patient’S Satisfaction ◽

Short Course ◽

Directly Observed Treatment ◽

To Come

Background: In 2015, RNTCP covered a population of 1.28 billion. A total of 9132,306 TB suspects were examined by sputum smear microscopy and 14, 23, 181 cases were registered for treatment. Most peripheral unit under the RNTCP network is the designated microscopy centre (DMC) which serves a population of around 100,000 (50,000 in tribal and hilly areas). Treatment compliance and patients satisfaction is important concern for quality service success of RNTCP. Objectives of this study were to assess the treatment compliance and patient’s satisfaction regarding directly observed treatment short course chemotherapy (DOTS).Methods: It was an observational study conducted among DMCs of Kanpur district. Multistage random sampling technique was used for selection of DMC in both rural and urban area. 300 subjects interviewed in this study.Results: Most of the study subjects (87%) were satisfied with the services provided at the DMC. Compliant status was better in rural DMC (94.50%). Non-compliance was more in urban DMC (18.4%). Majority of the study subjects (67%) were satisfied due to availability of free medicines at the centres. Difficulty to come on alternate days was the most common reason for dissatisfaction among study subjects (43.6%) followed by wastage of time (23.1%).Conclusions: About 13 percent patient was not satisfied with DMC services. Among urban DMCs 18.4 percent patient were not compliant where it was 5.5 percent among rural DMCs. About 22.0 percent patient was unaware about duration of treatment. Whereas important reason for dissatisfaction with service was ‘difficulty to come on alternate day’.

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The Quality of Sputum Smear Microscopy in Public-Private Mix Directly Observed Treatment Laboratories in West Amhara Region, Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0123749 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0123749 ◽

Cited By ~ 5

Author(s):

Almaw Manalebh ◽

Meaza Demissie ◽

Daniel Mekonnen ◽

Bayeh Abera

Keyword(s):

Sputum Smear ◽

Smear Microscopy ◽

Sputum Smear Microscopy ◽

Amhara Region ◽

Directly Observed Treatment ◽

Public Private Mix

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Comparative analysis of antibodies and lymphocytes in pulmonary tuberculosis patients with negative and positive cultures

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10583 ◽

2019 ◽

Vol 13 (01) ◽

pp. 28-34

Author(s):

Fernando-Renato Cázares-Sosa ◽

Alejandro Hernández-Solís ◽

Atenea-Estela Andrés-Dionicio ◽

Heliodora González-González ◽

Miguel Ibáñez-Hernández ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Sputum Sample ◽

Positive Culture ◽

Diagnostic Algorithm ◽

Sputum Smear ◽

Appropriate Treatment ◽

Healthy Donors ◽

Co Morbidity ◽

Positive Smear ◽

Lowenstein Jensen

Introduction: The sputum smear or the culture are the definitive diagnosis of pulmonary tuberculosis. Only a fraction of clinical patients are culture-confirmed. Methodology: A total of 24 clinical cases (40 ± 14 years old) with positive smear and negative co-morbidity were studied. Cases were selected from 600 patients who attended the pneumology service over two years. A sputum sample was cultured in Löwenstein-Jensen medium with consequent amplification of the rrnA V2 promoter, the differentiation region 4, and the IS6110 insertion sequence of Mycobacterium tuberculosis. After the culture result, the patients were divided into negative (n = 14) or positive (n = 10) culture groups. In addition, 30 samples from healthy donors (45 ± 10 years) were studied. The numbers of CD4, CD8 and CD19 lymphocytes were determined by flow cytometry. Levels of IgA and IgG to M. tuberculosis were measured by ELISA. Results: IgG and IgA levels were detected in patients with positive culture, while only IgA was found in patients with negative cultures. The lymphocyte populations in the two groups were similar. The presence of a pleural apical cap was found more frequently in patients with negative- (57%) than with positive cultures (10%). Conclusions: The isotype profile in patients with positive cultures was both IgA and IgG positive, while in patients with negative culture, only IgA was found. The results will contribute to improve the diagnostic algorithm and appropriate treatment of patients with clinical tuberculosis. Further studies are needed to determine if this profile is predictive of the outcome of isolation.

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Characteristics of tuberculosis in the state of Minas Gerais, Brazil: 2002-2009

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132013000300013 ◽

2013 ◽

Vol 39 (3) ◽

pp. 357-364 ◽

Cited By ~ 15

Author(s):

Claudio Jose Augusto ◽

Wania da Silva Carvalho ◽

Alan Douglas Goncalves ◽

Maria das Gracas Braga Ceccato ◽

Silvana Spindola de Miranda

Keyword(s):

Multidrug Resistant ◽

Minas Gerais ◽

The State ◽

Sputum Smear ◽

Smear Microscopy ◽

X Rays ◽

Resistant Tuberculosis ◽

Short Course ◽

Directly Observed Treatment ◽

Treatment Noncompliance

OBJECTIVE: To analyze the profile of tuberculosis cases reported between 2002 and 2009 in the state of Minas Gerais, Brazil, according to sociodemographic, clinical, and laboratory characteristics, as well as to comorbidities and mortality. METHODS: This was a descriptive, epidemiological study based on data obtained from the Brazilian Case Registry Database and the Brazilian Mortality Database for the 2002-2009 period. RESULTS: There were 47,285 reported cases of tuberculosis, corresponding to a mean incidence of 22.3/100,000 population. The individuals diagnosed with tuberculosis were predominantly in the 20- to 49-year age bracket and male (62.4% and 67.0%, respectively). Individuals with a low level of education accounted for 18.5% of the cases. New cases, cases of recurrence, and cases of retreatment accounted for 83.7%, 5.7%, 5.7%, respectively. The rates of cure and treatment noncompliance were 66.2% and 11.2%, respectively; multidrug-resistant tuberculosis was identified in 0.2% of the cases; and the mortality rate was 12.9%. The directly observed treatment, short-course (DOTS) strategy was applied in 21.8% of the cases. Sputum smear microscopy and culture were performed in only 73.9% and 12.9% of the cases, respectively. Chest X-rays were performed in 90.5% of the cases. Pulmonary tuberculosis was the predominant form (in 83.9%). Comorbidity with alcoholism, HIV infection, and diabetes mellitus were identified in 17.2%, 8.3%, and 3.8%, respectively. CONCLUSIONS: During the study period, the numbers of new cases, cases of treatment noncompliance, and deaths were high, comorbidities were common, and there was a failure to perform adequately basic tests for the diagnosis of tuberculosis. Multidisciplinary approaches, expanded use of the DOTS strategy, better knowledge of the distribution of tuberculosis, and improvements in the databases are needed in order to achieve better control of the disease in the state of Minas Gerais.

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Diagnostic Performance of Xpert MTB/RIF in Bronchoalveolar Lavage of Sputum-Scarce Recurrent Pulmonary Tuberculosis Cases

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1714650 ◽

2020 ◽

Vol 10 (02) ◽

pp. 74-78

Author(s):

Pratibha Sharma ◽

Abhishek Kumar ◽

Mamatha S. ◽

Ranganath T. Ganga

Keyword(s):

Bronchoalveolar Lavage ◽

Predictive Value ◽

Diagnostic Performance ◽

Nontuberculous Mycobacteria ◽

Cross Reactivity ◽

Rifampicin Resistance ◽

Nontuberculous Mycobacterium ◽

Sputum Smear ◽

Smear Microscopy ◽

Composite Reference Standard

Abstract Introduction Xpert MTB/RIF has greater sensitivity and specificity than smear microscopy. Bronchoalveolar lavage (BAL) is safe and valuable tool in sputum-scarce and sputum-negative tuberculosis (TB) patients. Our study evaluated the performance of Xpert in BAL specimen of sputum-scarce recurrent TB cases exclusively. Materials and Methods Sputum-scarce recurrent TB patients who underwent BAL between July 2018 and July 2019 were included. The diagnostic performance of Xpert and acid-fast bacilli (AFB) smear examination in BAL specimen was compared with liquid culture Mycobacterium TB (MTB) and composite reference standard. Results A total of 126 patients were included in the study. MTB culture was positive in 70 cases and nontuberculous mycobacteria were seen in five cases. Xpert was positive was in 63 patients. Sensitivity of Xpert and AFB smear was 84.29% (95% confidence interval [CI]: 73.62–91.89) and 18.57% (95% CI: 10.28–29.66), respectively, with p < 0.001 proving the superiority of Xpert. Xpert had a specificity of 97.96 (89.15–99.95), positive predictive value of 93.65% (95% CI 85.19–97.42), and negative predictive value of 80.36% (95% CI: 70.26–87.63). Smear had a specificity of 91.84% (95% CI: 80.21–97.58) against 97.96 (89.15–99.95) of Xpert, and smear was positive in nontuberculous mycobacterium cases as well. Xpert showed no cross-reactivity between mycobacterial species. Rifampicin resistance was seen in 8 (12.69%) cases, and 21 patients had other diagnoses. Conclusion Xpert has greater sensitivity in comparison to AFB smear in BAL specimen. Sputum-scarce recurrent TB cases have a similar chance of rifampicin resistance as sputum smear-positive cases should undergo BAL for Xpert analysis routinely.

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A Retrospective Cross-Sectional Study of the Utility of Cartridge-Based Nucleic Acid Amplification Test in Diagnosis of Pulmonary and Extrapulmonary Tuberculosis in People Living with HIV in Second Highest HIV Prevalent State in India

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730242 ◽

2021 ◽

Author(s):

Tade Bagbi ◽

Ningthoukhongjam Reema ◽

S. Bhagyabati Devi ◽

Thangjam Gautam Singh ◽

Mohammad Jaleel ◽

...

Keyword(s):

Nucleic Acid ◽

Cross Sectional Study ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Rifampicin Resistance ◽

Sputum Smear ◽

Smear Microscopy ◽

Sectional Study ◽

Cross Sectional ◽

Smear Negative

Abstract Introduction Tuberculosis (TB) in people living with human immunodeficiency virus (PLHIV) is difficult to diagnose due to fewer organisms in sputum and extrapulmonary samples. Sputum culture takes 4 to 8 weeks for growth of the mycobacteria. Delayed treatment for TB in PLHIV leads to increased mortality. This study evaluated cartridge-based nucleic acid amplification test (CBNAAT) as a diagnostic tool for diagnosis of pulmonary TB (PTB) and extrapulmonary TB (EPTB) in PLHIV in the second most HIV prevalent state in India and for comparing its efficacy between Ziehl–Neelsen (ZN) staining sputum smear–positive and sputum smear–negative TB. Methods This cross-sectional study was conducted in RIMS, Imphal, with 167 PLHIV patients, age 15 years or older, having signs and symptoms of TB. Appropriate samples for sputum microscopy and CBNAAT were sent. Conclusion The overall sensitivity of sputum smear for acid-fast bacillus (AFB) was found to be 30.71% and that of CBNAAT was 38.57%. Sensitivity of CBNAAT for sputum smear–positive and sputum smear–negative TB was 100 and 11.3%, respectively. Sensitivity of ZN smear for AFB of EPTB sample was 48.1% and that of CBNAAT was 59.25%. In both PTB and EPTB, CBNAAT showed an increase in diagnosis of microbiologically confirmed PTB cases by 7.8 and 11.1%, respectively, over and above the cases diagnosed by ZN smear microscopy. Rifampicin resistance was detected in five patients. We conclude that CBNAAT is a rapid test with better sensitivity in diagnosis of PTB and EPTB in PLHIV, compared with ZN smear microscopy. It detects rifampicin resistance for multidrug-resistant TB and helps in early treatment intervention.

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Characterization of Drug-Resistant Lipid-Dependent Differentially Detectable Mycobacterium tuberculosis

Journal of Clinical Medicine ◽

10.3390/jcm10153249 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3249

Author(s):

Annelies W. Mesman ◽

Seung-Hun Baek ◽

Chuan-Chin Huang ◽

Young-Mi Kim ◽

Sang-Nae Cho ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Culture Media ◽

Multidrug Resistant ◽

Culture Conditions ◽

Sputum Smear ◽

Smear Microscopy ◽

Solid Culture ◽

Lowenstein Jensen ◽

Genetic Mechanisms ◽

Lipid Resuscitation

An estimated 15–20% of patients who are treated for pulmonary tuberculosis (TB) are culture-negative at the time of diagnosis. Recent work has focused on the existence of differentially detectable Mycobacterium tuberculosis (Mtb) bacilli that do not grow under routine solid culture conditions without the addition of supplementary stimuli. We identified a cohort of TB patients in Lima, Peru, in whom acid-fast bacilli could be detected by sputum smear microscopy, but from whom Mtb could not be grown in standard solid culture media. When we attempted to re-grow Mtb from the frozen sputum samples of these patients, we found that 10 out of 15 could be grown in a glycerol-poor/lipid-rich medium. These fell into the following two groups: a subset that could be regrown in glycerol after “lipid-resuscitation”, and a group that displayed a heritable glycerol-sensitive phenotype that were unable to grow in the presence of this carbon source. Notably, all of the glycerol-sensitive strains were found to be multidrug resistant. Although whole-genome sequencing of the lipid-resuscitated strains identified 20 unique mutations compared to closely related strains, no single genetic lesion could be associated with this phenotype. In summary, we found that lipid-based media effectively fostered the growth of Mtb from a series of sputum smear-positive samples that were not culturable in glycerol-based Lowenstein–Jensen or 7H9 media, which is consistent with Mtb’s known preference for non-glycolytic sources during infection. Analysis of the recovered strains demonstrated that both genetic and non-genetic mechanisms contribute to the observed differential capturability, and suggested that this phenotype may be associated with drug resistance.

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Impact of Xpert MTB/RIF on Antiretroviral Therapy-Associated Tuberculosis and Mortality: A Pragmatic Randomized Controlled Trial

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu038 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 30

Author(s):

L. Mupfumi ◽

B. Makamure ◽

M. Chirehwa ◽

T. Sagonda ◽

S. Zinyowera ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Limited Resource ◽

Hiv Treatment ◽

Treatment Programs ◽

Sputum Smear ◽

Smear Microscopy ◽

Pragmatic Randomized Controlled Trial ◽

Randomized Controlled ◽

Art Initiation

Abstract Introduction. GeneXpert® MTB/RIF (Xpert) is now widely distributed in high human immunodeficiency virus (HIV)/tuberculosis (TB)-burden countries. Yet, whether the test improves patient-important outcomes within HIV treatment programs in limited resource settings is unknown. Methods. To investigate whether use of Xpert for TB screening prior to initiation of antiretroviral treatment (ART) improves patient-important outcomes, in a pragmatic randomized controlled trial we assigned 424 patients to Xpert or fluorescence sputum smear microscopy (FM) at ART initiation. The primary endpoint was a composite of 3-month mortality and ART-associated TB. Results. There was no difference in overall TB diagnosis at ART initiation (20% [n = 43] Xpert vs 21% [n = 45] FM; P = .80), with most patients in both groups treated empirically. There was no difference in time to TB treatment initiation {5 days (interquartile range [IQR], 3–13) vs 8 days [IQR, 3–23; P = .26]} or loss to follow-up (32 [15%] vs 38 [18%]; P = 0.38). Although a nonsignificant reduction in mortality occurred in the Xpert group (11 [6%] vs 17 [10%]; 95% CI, −9% to 2%; P = .19), there was no difference in the composite outcome (9% [n = 17] Xpert vs 12% [n = 21] FM; difference −3%; 95% CI, −9% to 4%). Conclusions. Among HIV-infected initiating ART, centralized TB screening with Xpert did not reduce the rate of ART-associated TB and mortality, compared with fluorescence microscopy.

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