Role of Cartridge Based Nucleic Acid Amplification Test in Diagnosing Tuberculous Empyema Thoracis – A Study from Telangana, India

BACKGROUND The pleura is involved in pulmonary or systemic tuberculosis by various mechanisms like delayed hypersensitivity. Tuberculous empyema usually results from failure of a primary tubercular effusion to resolve and further progresses to chronic suppurative form. In tuberculous empyema, the pleural fluid is purulent, and is loaded with tuberculous organisms on direct acid-fast bacillus (AFB) smear examination and / or culture of pus. We need to assess the role of cartridge based nucleic acid amplification test (CBNAAT) in the diagnosis of tuberculous empyema. METHODS This study was a prospective observational study of all adult patients of empyema above 15 years of age, admitted in the Department of Pulmonology, over a period of 1 year, 6 months after obtaining clearance from ethical committee and proper consent from the study subjects. RESULTS A total of sixty-three (63) empyema cases were recruited and analysed further. On evaluation, we diagnosed 26 cases with tubercular aetiology (41.27 %) and remaining thirty-seven (58.73 %) cases with non-tubercular aetiology. CONCLUSIONS Pleural fluid (pus) cartridge based nucleic acid amplification test (CBNAAT) is very sensitive and provides a rapid confirmed diagnosis within 2 hrs. including drug susceptibility. In this study, sensitivity of CBNAAT in suspected tuberculous empyema patients was 88.5 % and specificity was 100 %. Pleural fluid CBNAAT is more sensitive in both pleural fluid AFB smear positive (100 %) and pleural fluid AFB smear negative (72.7 %) cases. So, pleural fluid and sputum direct AFB smear and CBNAAT should be sent in all suspected tuberculous empyema cases for early diagnosis of tuberculosis and early detection of rifampicin resistance. KEY WORDS Mycobacterium Tuberculosis, Tubercular Empyema, Pleural Fluid, CBNAAT, AFB, Anti-Tubercular Drugs

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Role of cartridge based nucleic acid amplification test in bronchoscopy guided bronchial wash specimens in sputum smear negative PTB patients attending government general hospital, Kakinada

IP Indian Journal of Immunology and Respiratory Medicine ◽

10.18231/j.ijirm.2020.041 ◽

2020 ◽

Vol 5 (2) ◽

pp. 115-118

Author(s):

Kiran Mathangi ◽

◽

Potla Harika ◽

K Chakravarthi ◽

K Rajendra Kumar ◽

...

Keyword(s):

Nucleic Acid ◽

General Hospital ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Sputum Smear ◽

Bronchial Wash ◽

Smear Negative

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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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Prospective study to find out the role of gastric aspirate examination by Ziehl-Neelsen staining (ZN staining) and cartridge based nucleic acid amplification test (CB-NAAT) as a diagnostic method in childhood tuberculosis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182574 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1609

Author(s):

Akansha Arora ◽

Anil Jain ◽

B. S. Karnawat ◽

Rakesh Kumawat

Keyword(s):

Nucleic Acid ◽

Predictive Value ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Mantoux Test ◽

P Value ◽

Specific Method ◽

Gastric Aspirate ◽

Tuberculosis In Children

Background: Tuberculosis in children has been relatively neglected mainly because clinical diagnosis has low specificity, radiological interpretation is subject to inter-observer variability and the tuberculin skin test is a marker of exposure, not disease. The recent introduction of Cartridge based nucleic acid amplification test has significantly transformed the diagnostics of tuberculosis in adults but its application for Paediatric Tuberculosis is under evaluation. Therefore, authors conducted a study on role of gastric aspirate examination by ZN stain and Cartridge based nucleic acid amplification test in the diagnosis of childhood Tuberculosis.Methods: Authors did a prospective hospital-based study from Nov 2016 to Nov 2017 consisting of 100 randomly selected patients suspected of tuberculosis who had their gastric aspirate tested for CBNAAT and ZN stain for acid fast bacilli (AFB) along with Mantoux test and other routine investigations. Chi square test was used.Results: Culture positive tuberculosis was found in 21 out of 100 children. The sensitivity, specificity, positive predictive value and negative predictive value for CBNAAT were 76.1%, 98.7%, 94.1% and 93.9% and for ZN stain were 47.6%, 98.7%, 90.9% and 87.6% respectively. Positive history of contact (p value 0.0217), reactive Mantoux test (p value < 0.001) and low socioeconomic status were independently associated with a positive CBNAAT result.Conclusions: Analysis of gastric aspirate samples with CBNAAT is a sensitive and specific method for rapid diagnosis of pulmonary tuberculosis in children who cannot produce sputum. Compared with microscopy, CBNAAT offers better sensitivity and its scale up will improve access to tuberculosis diagnostics in children.

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