scholarly journals Role of cartridge-based nucleic acid amplification test to diagnose tuberculosis at tertiary care teaching hospital in Rajasthan, India

2019 ◽  
Vol 7 (11) ◽  
pp. 4243
Author(s):  
Rajendra Babu Mathur ◽  
Uma Shankar Shukla ◽  
Hemant Kumar Bindal
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Tertiary Care ◽  
Fluorescent Microscopy ◽  
Resistance Rate ◽  
Health Care Facilities ◽  
Rifampicin Resistance ◽  
Smear Negative ◽  
Extra Pulmonary

Background: Tuberculosis is one of the top 10 causes of death worldwide as per the Global TB report 2017, the estimated incidence of TB in India was approximately 28,00,000 cases accounting for about a quarter of the world’s TB cases (10 million). It is of utmost important to diagnose early and treat it to reduce disease transmission. GeneXpert MTB/RIF, an automated cartridge-based molecular technique detects Mycobacterium Tuberculosis and rifampicin resistance within two hours, has been recommended by WHO for rapid diagnosis of TB.Methods: Author conducted a retrospective study in the Department of TB and Chest, of tertiary care center at Jhalawar Medical College (JMC), Jhalawar to evaluate and analyze the role of CBNAAT to diagnose tuberculosis from 1st January 2018 to 31st December 2018. Author included all patients who came to department of TB and Chest of JMC, Jhalawar either new/ relapsed/ defaulters/ referred cases from ART/ ICTC center, Pediatric Department; Gynaecology and Obstetrics Department, peripheral Government Health Care Facilities and Private Hospitals of Jhalawar District catering about 15.5 lac population were subjected to both ZN staining/ Fluorescent microscopy and CBNAAT in the study period.Results: A total of 3078 samples (pulmonary 2739+EP 339) were tested for ZN staining / Fluorescent microscopy and CBNAAT during the study period. Mean age of the study population was 36.5±10.3 years. 1873 tested were negative and 1205 samples were positive for CBNAAT. Of these 1205 positive samples, 1174 were sputum/ BAL samples and 31 were extra pulmonary samples. Authors found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases, 3 rifampicin resistance cases were detected in extra pulmonary samples. CBNAAT could identify 255 cases (14.01%) that were smear negative. Author found TB-HIV coinfection rate of 18.75%.Conclusions: Author found CBNAAT to be an important diagnostic modality especially in smear negative patients for early diagnosis and treatment. Author could detect Mycobacterium Tuberculosis in 14.01% of patients with negative smear microscopy for AFB. In PLHIV, CBNAAT detected Mycobacterium Tuberculosis in 18.75% (12/64) of patients. Author found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases.

scholarly journals Diagnostic yield of cartridge based nucleic acid amplification test in Mycobacterium tuberculosis in a tertiary care medical college and hospital of Southern Odisha, India

2019 ◽  
Vol 7 (12) ◽  
pp. 4460
Author(s):  
Dash Manoranjan ◽  
Satyajit Samal ◽  
Swain Trupti Rekha ◽  
Behera Bibhuprasad ◽  
Sahu Swapnasarit ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Pleural Fluid ◽  
Tertiary Care ◽  
Resistance Rate ◽  
Rifampicin Resistance ◽  
Pulmonary Medicine ◽  
Medical College ◽  
Study Population ◽  
Extra Pulmonary

Background: Tuberculosis is the ninth leading cause of death worldwide. India contributes to about one fifth of global TB burden. It is very important to diagnose early and treat tuberculosis to cut down transmission of tuberculosis.Methods: Author conducted a retrospective study in Department of Pulmonary Medicine SLN Medical College, Koraput, Odisha to analyze the utility and yield of CBNAAT. Study period was from April 2018 to March 2019. Inclusion criteria was all patients whose samples were subjected to CBNAAT were included in our study.  Sputum samples from pulmonary tuberculosis patients, and extra pulmonary samples (pleural fluid, ascitic fluid, CSF, synovial fluid and gastric lavage etc. were included in our study population. Exclusion criteria was patients who were under anti tubercular therapy for pulmonary, extra pulmonary and MDR TB were excluded from this study. Data were collected from Pulmonary Medicine Department, ART center, DOTS center and CBNAAT center. Total number of samples tested for CBNAAT, different sample collection sites, age and sex distribution of patients, HIV status of all patients, result of smear microscopy for AFB and CBNAAT and Rifampicin resistance status were analyzed.The detail statistical analysis was done in tabulation form.Results: A total of 2621 samples were tested in CBNAAT during the study period. Mean age of the study population was 38.03 years. 1881 tested were negative and 740 samples were positive for CBNAAT. Of these 2621 samples, 2526 were pulmonary samples (sputum, pleural fluid samples) and 95 were extra pulmonary samples. Author found rifampicin resistance rate of 0.54% (4/740)) in pulmonary tuberculosis cases. There was no rifampicin resistance detected in extra pulmonary samples. CBNAAT could identify 536 cases (23.2%) that were smear negative. Author found TB- HIV co-infection rate of 6.22%.Conclusions: CBNAAT is an important diagnostic modality especially in sputum negative patients for early diagnosis and treatment. In our study it detected Mycobacterium tuberculosis in 23.2% of patients with negative smear for microscopy. Rifampicin resistance rate detected was very low compared to other studies.

scholarly journals Utility of cartridge based nucleic acid amplification test in the diagnosis of extra pulmonary tuberculosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1801
Author(s):  
Mahesh Chand Bairwa ◽  
Mahendra Kumar Banera ◽  
Chandan Mal Fatehpuria
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Nucleic Acid ◽  
Pulmonary Tuberculosis ◽  
Pleural Fluid ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
World Health ◽  
Rifampicin Resistance ◽  
Extra Pulmonary Tuberculosis ◽  
Extra Pulmonary

Background: Tuberculosis is one of the top 10 cause of death globally. Extra-pulmonary tuberculosis is an important clinical problem. Extra-pulmonary tuberculosis range from 30%-53% in India. Diagnosis of extra-pulmonary tuberculosis is still challenging despite many investigations. World Health Organization recommends Gene-Xpert Mycobacterium Tuberculosis/Rifampicin (Cartridge Based Nucleic Acid Amplification Test-CBNAAT) over conventional tests for diagnosis of extra-pulmonary tuberculosis which permits rapid tuberculosis diagnosis through detection of the genetic sequence of DNA of mycobacterium tuberculosis and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of multi-drug resistant tuberculosis.Methods: Study was carried out over a period of one year.  Patients with suggestive of extra-pulmonary tuberculosis were included in study. Diagnosis of extra-pulmonary tuberculosis carried out by clinical, radiological, biochemical analysis, cytological, bacteriological confirmation. Based on mycobacterium tuberculosis result, the study population were divided into ‘Mycobacterium Tuberculosis detected’ and ‘Mycobacterium Tuberculosis not detected’ groups. Mycobacterium Tuberculosis detected group was further divided into ‘Rifampicin resistant’ and ‘Rifampicin sensitive’.Results:  Total 220 patients were included. Among extra-pulmonary tuberculosis, there were 83.64% were pleural fluid. 65.91% patients where be <45 years of age. Mostly patients were from rural areas and illiterate. Diabetes Mellitus found as the most common co-morbidities. CB-NAAT was able to detect mycobacterium tuberculosis in 35% (77) extra-pulmonary samples, out of which 6 were rifampicin resistant. Out of 184 samples of pleural fluid, 53 were rifampicin sensitive and 4 were found rifampicin resistant.Conclusions: CB-NAAT has to be endorsed in every health care centres as the test gives rapid result and also detection of rifampicin resistance which is the major concern for every clinician.

scholarly journals Dysglycemia is associated with Mycobacterium tuberculosis lineages in tuberculosis patients of North Lima - Peru

2020 ◽  
Author(s):  
Kattya Lopez ◽  
María B. Arriaga ◽  
Juan G. Aliaga ◽  
Nadia N. Barreda ◽  
Oswaldo M. Sanabria ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Latin American ◽  
Tandem Repeats ◽  
Scientific Evidence ◽  
Variable Number ◽  
Health Care Facilities ◽  
Variable Number Tandem Repeats ◽  
Epidemiological Characteristics

AbstractThis study was performed to investigate the role of dysglycemia on the genetic diversity of Mycobacterium tuberculosis (MTB) among pulmonary tuberculosis (TB) patients to build scientific evidence about the possible mechanisms of TB transmission. MTB isolates obtained of patients affected by pulmonary tuberculosis from health care facilities of North Lima - Peru, were analyzed using whole genome sequencing and 24-locus mycobacterial interspersed repetitive-unit-variable-number tandem repeats (MIRU-VNTR). Subsequently, clinical and epidemiological characteristics were associated with clustering, lineages and comorbid conditions. The analysis carried out 112 pulmonary TB patients from various health centers in North Lima, 17 (15%) had diabetes mellitus (DM) and 33 (29%) had pre-diabetes (PDM). Latin American-Mediterranean, Haarlem and Beijing were the most frequent MTB lineages found in those patients. Previous TB (adjusted odds ratio [aOR]=3.65; 95%CI: 1.32-17.81), age (aOR=1.12; 95%CI: 1.03-1.45) and Beijing lineage (aOR=3.53; 95%CI: 1.08-13.2) were associated with TB-DM comorbidity. Alcoholism (aOR=2.92; 95%CI: 1.10-8.28), age (aOR=1.05; 95%CI: 1.03-1.12) and Haarlem lineage (aOR=2.54; 95%CI: 1.04-6.51) were associated with TB-PDM comorbidity. Beijing and Haarlem lineages were independently associated with TB-DM and TB-PDM comorbidities, respectively. Although these findings may be surprising, we must be cautious to suggest that dysglycemia could be associated with a highly clustering and predisposition of MTB lineages related to a serious impact on the severity of TB disease, which requires further research.

scholarly journals Diagnostic Utility of Bronchial Washing CBNAAT for Mycobacterium Tuberculosis in Sputum Smear Negative and Sputum CBNAAT Negative Patients of Suspected Pulmonary Tuberculosis

2021 ◽  
Vol 6 (03) ◽  
pp. 201-204
Author(s):  
Afshan Ali Shaik ◽  
Uday Kakodkar ◽  
Cigy Borges
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Fluorescent Microscopy ◽  
Case Series ◽  
Tuberculosis Treatment ◽  
Sputum Smear ◽  
Diagnostic Utility ◽  
Fungal Culture ◽  
Bronchial Washing ◽  
Smear Negative

Introduction: Diagnosis of sputum negative pulmonary tuberculosis can be challenging and time consuming, with many patients being put on empirical anti-tuberculosis treatment. Bronchoscopy helps in early diagnosis in such patients. Aims and Objectives: To assess the diagnostic utility of bronchial washing CBNAAT for Mycobacterium Tuberculosis in sputum smear negative and sputum CBNAAT negative patients of suspected pulmonary tuberculosis. Methodology: This case series was conducted on 71 patients in the Department of Pulmonary Medicine, Goa Medical College from May 2018- February 2020. Patients with suspected pulmonary tuberculosis on chest radiograph and/or CT thorax, but with sputum smear as well as CBNAAT for Mycobacterium Tuberculosis negative were subjected to flexible video bronchoscopy. Bronchial washings were collected from the affected lobes and the specimen were subjected to fluorescent microscopy, CBNAAT, MGIT, bacterial and fungal culture. Results: The diagnosis of tuberculosis was established in 23 (32.4%) patients in bronchial washings specimen by CBNAAT. These patients were followed up after 6 months of anti-tuberculosis treatment and have shown significant clinical and radiological improvement. Conclusion: Bronchoscopy is a useful tool in diagnosis of pulmonary tuberculosis in sputum negative patients. It also play an important role in diagnosis of other infectious /malignant disorder which can mimic tuberculosis.

Sensitivity of sputum exam with respect to gene expert in detection of MTB at tertiary care hospital

2021 ◽  
Vol 19 (3) ◽  
pp. 126-129
Author(s):  
Sanjiv Vithalrao Zangde ◽  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Predictive Value ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Reliable Technique ◽  
Extra Pulmonary Tuberculosis ◽  
Smear Negative ◽  
Extra Pulmonary ◽  
Incident Cases

Background: According to the WHO Tuberculosis Report 2014, there were 9 million incident cases of TB worldwide, with the South–East Asia and Western Pacific areas accounting for 58 percent of the global burden and India accounting for 24 percent. Aims and Objective: To study Sensitivity of sputum exam with respect to gene expert in detection of MTB at tertiary care hospital Methodology: The present study is an observational cross-sectional study of the patients with pulmonary tuberculosis attending Department of Pulmonary Medicine at a tertiary care centre during period of 1 January 2019 to 30 June 2020 by the permission of Institutional Ethical Committee . Genexpert test / CBNAAT [ Xpert MTB/RIF Assay] Statistical analysis done buy of (version 20) for Windows package (SPSS Science, Chicago, IL, USA). Result: Ziehl and Neelsen staining was done for 200 samples of cases of pulmonary tuberculosis. Out of these 55(27.50%) sputa samples were ZN smear positive and 145(72.50%) were negative. Then all the samples were tested on Gene Xpert MTB/RIF assay. Out of these 200 patients, 186(93%) were MTB detected and 14(7.00%) were MTB not detected. The MTB/RIF assay detect the agent in 54 out of 55 ZN smear positive cases and 132 out of 145 AFB smear negative cases as shown in table No.10. So, MTB detection rate by Gene Xpert 186cases (93.00%) is more as compared to ZN staining 55cases (27.50%). Out of 55 sputum positive cases, 54 were positive for MTB by Gene Xpert but in 01 sputum positive case MTB was not detected by Gene Xpert assay. There was statistically significant better detection with Genexpert when compared to microscopy AFB test in pulmonary tuberculosis patients.The Sensitivity of Sputum was 29.03% and Specificity was 92.86%, Positive Likelihood Ratio4.06, Negative Likelihood Ratio 0.76, Positive Predictive Value (*) was 98.18% and Negative Predictive Value (*) was 8.97%. Conclusion: It can be concluded from our study that the Genexpert is highly sensitive test for the detection of the Mycobacteria and Xpert MTB/RIF assay can quickly identify possible multidrug-resistant TB. From our study we conclude that Gene Xpert MTB/RIF is simple and reliable technique for diagnosing extra pulmonary tuberculosis with high sensitivity and specificity not only in smear positive cases but also in smear negative cases. It is a game changer not only in pulmonary tuberculosis control but probably also in extra pulmonary tuberculosis.

scholarly journals Improved detection of Mycobacterium tuberculosis using two independent PCR targets in a tertiary care centre in South India

2011 ◽  
Vol 6 (01) ◽  
pp. 46-52 ◽  
Author(s):  
Ramya Barani ◽  
Gopalsamy Sarangan ◽  
Tessa Antony ◽  
Soundararajan Periyasamy ◽  
Anupma Jyoti Kindo ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
South India ◽  
Tertiary Care ◽  
Fluorescent Microscopy ◽  
Improve Patient Care ◽  
Target Site ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Auramine O ◽  
Extra Pulmonary

Introduction:  Tuberculosis (TB) causes significant morbidity and mortality worldwide as one of the leading infectious diseases. In India, more than 1.8 million new cases occur every year. Rapid and accurate diagnosis of TB would improve patient care and limit its transmission.This study aimed to evaluate a dual target polymerase chain reaction (PCR) diagnostic assay to detect Mycobacterium tuberculosis from pulmonary and extra-pulmonary samples at a tertiary care centre in South India. Methodology: Samples were collected from patients with a low index of suspicion of TB. Acid-fast smears were performed by Auramine O fluorescent microscopy and PCR was performed by using two site-specific primer pairs targeting IS6110 by nested PCR and TRC4 by conventional PCR. Amplified products for IS6110 and/or TRC4 were indicative of M. tuberculosis.Results: Among 114 (19 pulmonary and 95 extra-pulmonary) samples tested by PCR assay, 12 (11%) were positive for both IS6110 and TRC4, of which 11 (10%) were non-respiratory and one was (1%) respiratory in origin. PCR for TRC4 alone was positive for eight (7%) non-respiratory and two (2%) respiratory samples, while IS6110 alone tested positive for six (5%) non-respiratory samples and one (1%) respiratory sample. Of a total of 29 PCR positive samples, 17 (15 %) were acid-fast smear positive. Conclusion: Although the target site of IS6110 is specific for M. tuberculosis, some strains from South India may lack this region. Therefore, the use of an additional target site (TRC4) is required for improved detection of M. tuberculosis.

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