scholarly journals Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan

2021 ◽  
Author(s):  
Taymmia Ejaz ◽  
Mahmood Iqbal Malik ◽  
Jamal Ahmed ◽  
Rizwan Azam ◽  
Yousaf Jamal ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Yield ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Age Groups ◽  
Military Hospital ◽  
Sputum Smear ◽  
P Value ◽  
High Resolution Computed Tomography ◽  
Smear Negative

To determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy were included. HIV positive patients and those on anti-tuberculosis therapy for more than one week were excluded. High-Resolution Computed tomography (HRCT) findings were classified based on active and inactive tuberculosis features. Washings were sent for Acid-Fast Bacillus (AFB) smear, GeneXpert assay and cultures. Out of 215 patients, 42.3% (91) were diagnosed with microbiological or histological evidence of TB. On univariate analysis, cavitation (p-value <0.001), soft-tissue nodules (p-value 0.04), and endobronchial mucosal changes (p-value 0.02) were associated with culture positivity. Presence of cavitation (OR= 4.10; CI= 2.18,7.73; p-value<0.001) was the only independent predictor of microbiological yield. Diagnostic yield was 70%, 50%, 12.5% and 8.6% in patients with definitely active, probably active, indeterminate and inactive tuberculosis HRCT features respectively. Sensitivity, specificity, positive predictive value and negative predictive value of HRCT active TB were 95.38% (95% CI 87.10 -99.04), 48.00 % (95% CI 39.78 -56.30), 44.29% (95% CI 40.31 -48.33), 96.00 % (95%CI 88.70 -98.66) respectively. There was no significant association between age groups, smoking status and gender with diagnosis of tuberculosis in our study. Radiological activity and certain visualized bronchoscopic changes were associated with good diagnostic performance and can be used as predictive factors in diagnosis of active smear negative tuberculosis.  

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.

Evaluation of efficacy of serum and broncho-alveolar lavage Galactomannan estimation by ELISA in high-risk persistent febrile neutropenic patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16505-16505
Author(s):  
M. Sengar ◽  
L. Kumar ◽  
S. Thulkar ◽  
V. Kochupillai
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Diagnostic Yield ◽  
Miliary Tuberculosis ◽  
Screening Tools ◽  
High Resolution Computed Tomography ◽  
Ct Guided ◽  
Chest X Ray ◽  
Neutropenic Patients ◽  
Sensitivity Specificity

16505 Background: Chest infections constitute 36% of all infections in our acute leukemia patients. Conclusively establishing the diagnosis of invasive fungal aspergillosis (IPA), an important cause pulmonary infiltrates and mortality in high-risk febrile neutropenic patients, however, is difficult. We therefore evaluated the value of ELISA for Galactomannan (Gm) antigen and correlated the results with radiological findings. Methods: Twenty patients with persistent high-risk febrile neutropenia were assessed with chest X-ray, high resolution computed tomography (HRCT) chest and bronchoalveolar lavage (BAL) from the affected segment on day 5 of fever. Microbial cultures of blood, sputum and BAL and Galactomannan estimation in serum and BAL were done. IPA was defined as per the Mycoses Study Group criteria. Sensitivity, specificity and negative and positive predictive value of Galactomannan assay and diagnostic yield of each investigation was determined. Results: Diagnostic yield of CXR was 10%, blood culture, mainly gram negative bacilli, 15%, and BAL 20% (Aspergillus - 10%). Based on microbiology, radiology and cytopathology IPA was diagnosed in 16 cases (proven -1, probable -2, possible -13) and miliary tuberculosis, bacterial pneumonia and nocardiosis constituted the remaining. Nodules and halo sign were the most frequent (60%) CT findings in IPA. Sensitivity, specificity and positive and negative predictive value for serum were 78%, 100%, 100% and 64%, respectively, and for BAL, were 87.5%, 100%, 100% and 75%, respectively. Conclusions: CT-guided BAL and serial serum GM estimations are valuable non-invasive screening tools for IPA in high-risk persistent febrile neutropenic patients. No significant financial relationships to disclose.

Lung cancer as a subsequent neoplasm: A report from the Childhood Cancer Survivor Study (CCSS).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10551-10551
Author(s):  
Taumoha Ghosh ◽  
Yan Chen ◽  
Andrew C Dietz ◽  
Gregory T. Armstrong ◽  
Rebecca M. Howell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Childhood Cancer ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Bone Cancer ◽  
Age At Diagnosis ◽  
Field Size ◽  
P Value ◽  
Increased Risk

10551 Background: Lung cancer has been reported as a subsequent neoplasm (SN) in childhood cancer survivors. We aimed to assess the prevalence of and risk factors for lung cancer in the CCSS. Methods: Among 25,654 five-year survivors participating in the CCSS, lung cancer was self-reported and then confirmed by pathologic record review. Cancer treatment exposures were evaluated including chemotherapy and chest radiation by field size (none, small, large) and in a dose group (0-10 Gy, 10-30 Gy, 30-40 Gy, and > 40 Gy). Standardized incidence ratios (SIR) were calculated using rates from the Surveillance, Epidemiology, and End Results program. Hazard ratios (HR) were estimated for demographic and treatment variables using Cox proportional-hazards models. Results: Forty-two survivors developed subsequent malignant lung cancer (SIR 4.0, 95% CI 2.9-5.4), including 25 carcinomas, 7 mesotheliomas and 10 others. Two additional benign neoplasms were also identified. The cumulative incidence of lung SNs was 0.18% at 30 years (95% CI 0.10-0.25). Median time from primary diagnosis was 28 years (range 11-46); median age at diagnosis was 45 years of age (range 15-65). A multivariable model, including all covariates with a p-value < 0.2 in univariate analysis, showed significant associations between lung cancer and older age at diagnosis (HR 10.5, 95% CI 1.4-76.4, for 15-21 years vs. 0-4 years), as well as with primary diagnoses (relative to leukemia, HR 8.7, 95% CI 1.1-66.0, for Hodgkin lymphoma; HR 20.7, 95% CI 1.3-331.0 for neuroblastoma; and HR 21.4, 95% CI 2.3-202.7, for bone cancer). In a treatment model, maximum chest radiation dose (HR 4.1, 95% CI 1.4-11.7, for 30-40 Gy; and HR 8.1, 95% CI 3.0-22.2, for > 40 Gy, relative to 0-10Gy), but not sex, smoking status, or chemotherapy exposures, was associated with lung cancer. Notably, six survivors who developed lung cancer received no radiation and of these, five had a primary bone cancer. At the end of follow-up, 65.9% of survivors with lung cancer were deceased vs. 14.1% of survivors without lung cancer ( p < 0.001). Conclusions: Survivors of childhood cancer are at increased risk for developing lung cancer associated with exposure to high doses of chest radiotherapy. To our knowledge, this is the first study to describe associations with neuroblastoma and bone cancer. Future studies to understand additional treatment-related risk factors beyond chest radiotherapy dose are needed.

Diagnostic performance of automated liquid culture and molecular line probe assay in smear-negative pulmonary tuberculosis

2016 ◽  
Vol 47 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Aarti Kotwal ◽  
Debasis Biswas ◽  
Shailendra Raghuvanshi ◽  
Girish Sindhwani ◽  
Barnali Kakati ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Liquid Culture ◽  
Diagnostic Yield ◽  
Drug Susceptibility ◽  
Complete Agreement ◽  
Sputum Smear ◽  
Molecular Line ◽  
Diagnostic Potential ◽  
Smear Negative ◽  
Probe Assay

The diagnosis of smear-negative pulmonary tuberculosis (PTB) is particularly challenging, and automated liquid culture and molecular line probe assays (LPA) may prove particularly useful. The objective of our study was to evaluate the diagnostic potential of automated liquid culture (ALC) technology and commercial LPA in sputum smear-negative PTB suspects. Spot sputum samples were collected from 145 chest-symptomatic smear-negative patients and subjected to ALC, direct drug susceptibility test (DST) testing and LPA, as per manufacturers’ instructions. A diagnostic yield of 26.2% was observed among sputum smear-negative TB suspects with 47.4% of the culture isolates being either INH- and/or rifampicin-resistant. Complete agreement was observed between the results of ALC assay and LPA except for two isolates which demonstrated sensitivity to INH and rifampicin at direct DST but were rifampicin-resistant in LPA. Two novel mutations were also detected among the multidrug isolates by LPA. In view of the diagnostic challenges associated with the diagnosis of TB in sputum smear-negative patients, our study demonstrates the applicability of ALC and LPA in establishing diagnostic evidence of TB.

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.

TB-PCR and drug resistance pattern in BALF in smear-negative active pulmonary TB

2017 ◽  
Vol 21 (12) ◽  
pp. 1294-1299 ◽  
Author(s):  
K. Chavalertsakul ◽  
V. Boonsarngsuk ◽  
S. Saengsri ◽  
P. Santanirand
Keyword(s):  
Predictive Value ◽  
Resistance Pattern ◽  
Sputum Smear ◽  
Pcr Assay ◽  
Tertiary Referral Hospital ◽  
Standard Drug ◽  
Pulmonary Tb ◽  
Drug Resistance Pattern ◽  
Smear Negative ◽  
Tb Pcr

SETTING: A tertiary referral hospital in Bangkok, Thailand.OBJECTIVES: To evaluate the efficacy of a bronchoalveolar lavage fluid (BALF) tuberculosis (TB) polymerase chain reaction (PCR) assay for the diagnosis of sputum smear-negative pulmonary TB (PTB) and the usefulness of a drug-resistant (DR) TB-PCR assay compared with standard drug susceptibility testing (DST).DESIGN: BALF samples from 918 patients with acid-fast bacilli (AFB) negative sputum smears who underwent bronchoscopy for diagnostic evaluations of pulmonary diseases were prospectively determined for specific genetic elements of TB using the AnyplexTM MTB/NTM Real-Time Detection kit. Positive TB-PCR samples were subsequently evaluated for DR-TB using the Anyplex II MTB/MDR Detection kit.RESULTS: A total of 224 patients were finally diagnosed with PTB. The sensitivity, specificity, positive predictive value and negative predictive value of the TB-PCR assay were respectively 38.8%, 100%, 100%, and 83.5%. The TB-PCR assay was more sensitive than culture (30.4%) and smear (6.7%). Of the 68 TB-positive culture samples, three cases with either isoniazid (INH) or rifampicin (RMP) resistance were detected by DST. The Anyplex II MTB/MDR assay provided similar results.CONCLUSIONS: The BALF TB-PCR assay is a useful tool in the diagnosis of sputum smear-negative PTB. It can also provide INH and RMP susceptibility patterns similar to those of standard DST.

scholarly journals Methionine synthase A2756G polymorphism associated with an increased risk of head and neck cancer

2020 ◽  
Vol 6 (7) ◽  
pp. 237
Author(s):  
Muhammad Tahir ◽  
Aamir Khattak ◽  
Haroon Rashid
Keyword(s):  
Multivariate Analysis ◽  
Head And Neck ◽  
Univariate Analysis ◽  
Age Groups ◽  
Cancer Control ◽  
Methionine Synthase ◽  
P Value ◽  
Chi Square ◽  
Increased Risk ◽  
And Control

<p class="abstract"><strong>Background:</strong> The 5-methyltetrahydrofolate-homocysteine methyltransferase gene (<em>MTR</em>) encodes the methionine synthase enzyme (OMIM 156570). Methionine synthase synthesizes methionine by re-methylation of homocysteine. A single nucleotide variation <em>MTR</em>-A2756G may affects the function of methionine synthase enzyme, which could lead to the development of head and neck squamous cell carcinoma (HNSCC).</p><p class="abstract"><strong>Methods:</strong> In current study, 292 HNSCC patients and 324 normal individuals without any history of cancer (control) were enrolled. EDTA whole blood samples of patients and control individuals were collected, and DNA was extracted. All samples were genotyped for <em>MTR</em>-A2756G polymorphism using polymerase chain reaction-restriction fragment length polymorphism. Frequency of polymorphism was compared between HNSCC patients and control individuals. The association of <em>MTR</em>-A2756G polymorphism with risk factors was statistically analysed through multivariate analysis (multiple logistic regression) whereas univariate analysis (chi square) was performed for group comparisons.  </p><p class="abstract"><strong>Results:</strong> Univariate analysis revealed that the frequency of groups like age, smoking and <em>MTR</em>-A2756G genotype was different in HNC patients and controls (p value &lt;0.05). Multivariate analysis showed that smoking (adjusted OR, 3.7; 95% CI, 2.3-6.0), age groups 41-50 years (adjusted OR, 3.6; 95% CI, .9-6.7) and &gt;60 years (adjusted OR, 3.5; 95% CI, 1.7-7.3), <em>MTR</em>-A2756G genotype (adjusted OR, 2.1; 95% CI, 1.3-3.5) is associated with increased risk of HNSCC.</p><p class="abstract"><strong>Conclusions:</strong> Our data suggests that the <em>MTR</em>-A2756G polymorphism is associated with the occurrence of HNSCC in Pakistani population while the individuals between 40 to 50 years of age and tobacco smokers are at a greater risk of developing HNSCC.</p>

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.

Sign in / Sign up

Export Citation Format

Share Document