Case Report: Kampo Medicine for Non-tuberculous Mycobacterium Pulmonary Disease

Background: While the number of pulmonary tuberculosis cases has decreased, increase in non-tuberculous mycobacterium pulmonary disease (NTM-PD) is a global problem. Guideline-based therapy for NTM-PD sometimes causes complications that prevent treatment completion, and there are many cases of relapse even if the treatment can be completed. In addition to antibacterial treatment, care of host risk factors, such as aging, lean physique and immunosuppressive state, is also very important for the management of NTM-PD. In Japan, Kampo medicine, a traditional Japanese herbal formulation, used alone or in combination with standard multidrug therapy for NTM-PD, has been found to be effective for such cases.Case Presentation: A 77-year-old lean woman had been diagnosed with Mycobacterium intracellulare pulmonary infection 6 years earlier, and had received the standard multidrug treatment 5 years later at a former hospital due to worsening of her symptoms of cough, breathlessness and hemoptysis. However, the treatment was discontinued within a year due to the development of adverse events. She refused the guideline-based antibacterial treatment, and asked for Kampo medicine instead. Bukuryoshigyakuto was subsequently prescribed, which led to cough and sputum, especially hemosputum, being well controlled. With 3 years of Kampo medicine treatment, she gained weight and her hemosputum disappeared. High-resolution computed tomography images showed improvement in her lung condition, and her sputum smear culture was negative for acid-fast bacillus.Conclusion: Various kinds of Kampo medicines have been used empirically for NTM-PD in Japan. A literature review from 1992 to 2020 showed that hozais, in particular, seem to be key drugs for the treatment of host NTM-PD risk factors. Kampo medicines can contribute to comprehensive treatment for NTM-PD management that does not rely solely on antibacterial drugs.

Comparison of N-acetyl-L-cysteine-sodium hydroxide and Modified Petroff’s Decontamination Methods for Mycobacterium tuberculosis Culture

Indonesia is one of 22 countries with a high incidence of TB in the world, particularly related to TB-HIV and MDR-TB cases. Contamination of normal flora from nasopharyngeal tract is the main problem to isolate Mycobacterium tuberculosis (MTB) from sputum. It is needed a safe solution to decontaminate without killing MTB bacilli. N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) is compared with modified Petroff’s which is widely used in laboratories, to get better outcome. Of the 110 sputum samples were collected from suspected cases of Pulmonary TB. Decontamination using 2% NALC-NaOH and Modifed Petroff (4% NaOH) was performed before AFB smear and culture on LJ medium. Each group was assessed for contamination and culture positive rate. The positive culture was validated using chromatography test for detected antigen MPT-64 and PNB. Result of this study showed that NALC-NaOH and modified Petroff’s methods did not significantly affect positivity rate of Acid-Fast Bacillus (AFB) smear, 71% and 66% respectively. Contamination on culture was significantly (p=0,034) higher in samples treated with NALC-NaOH (21%) compared to Modified Petroff methods(13%). Proportion of positive culture on samples treated with NALC-NaOH was lower than Modified Petroff, 65% and 70% respectively with p value=1. Conclusion of this study showed that sputum decontamination using Modified Petroff methods is still more effective than NALC-NaOH to increase positivity rate of MTB culture. However, the two methods were not significantly different to get positivity result on the microscopic examination of AFB.

AN OBSERVATIONALANALYTICAL STUDY ON THE PREVALENCE OF FEMALE GENITAL TRACT TUBERCULOSIS AND ITS RELATION TO FEMALE INFERTILITY

INTRODUCTION:Tuberculosis is an infectious disease caused by Mycobacterium species, which are the acid fast bacillus. OBJECTIVES: The present study investigates the prevalence of genital tract tuberculosis among infertile women and its relation to infertility. MATERIALS AND METHOD: The present study is an hospital based analytical and observational study. Department of gynecology and obstetrics, IPGMER hospitals. March 2018 to august 2020. 100 female patients with infertility. CONCLUSION: In our study we reported 11 cases of female with genital tract tuberculosis, diagnosed during laparoscopy, conrmed by CBNAAT, conventional culture method and histopathological examination.

Diagnostic approaches and prevalence of Rifampicin resistant Mycobacterium tuberculosis in District Mardan

The disease tuberculosis (TB) caused by Mycobacterium Tuberculosis (MTB) is most common infectious disease in developing countries. The disease is fatal if not treated during the early stages of infection, thereby early and precise detection is a decisive step in curing the disease. The aim of this study was to analyze the prevalence of tuberculosis in patients reporting to Mardan Medical Complex (MMC), located in the district Mardan, KPK, Pakistan. The sputum of patients was analysed by Ziehl-Nilsen (ZN) staining technique followed by light microscopy called Acid-Fast Bacillus (AFB) staining. The sputum samples were collected from the patients and analysed by special PCR method called GeneXpert MTB/RIF assay, for genomic detection and resistance assay for rifampicin antibiotic were used, are the commonly used medicine for the treatment of MTB infection. Total 121 patients reported to MMC, represented 74 % patients from Mardan, 12% from Nowshera and 14% from Swabi. These patients were screened for the aim to evaluate the techniques for the detection of MTB. The light microscopy method confirmed 66 (55%) of the patients positive for MTB, whereas the same samples reported 78 (68%) patients positive for MTB through GeneXpert MTB/RIF assay, The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) found for light microscopy were 99% and 78.1% respectively. The most used drug rifampicin was found ineffective in 9 patients (7%). Additionally, 83% of the patients when interviewed had a folk history of tuberculosis. Keywords: Microscopy, PCR, Mycobacterium tuberculosis, Rifampicin.

355Tuberculosis care cascade in an indigenous population of a Colombian region

Background It is estimated, there are around 370 million indigenous people in the world. For 2017, 5.4% of tuberculosis cases in Colombia occurred in the indigenous population (IP), while in the Cauca region, it was 32% and only 19.3% of new cases were detected. This is the second region with the highest proportion of IP in Colombia. This could affect the fulfillment of the aims of the Colombian Strategic Plan Towards the End of TB. Our aim was to evaluate the pulmonary tuberculosis (PTB) care cascade in IP of Cauca and identified gaps in the cascade. Methods Mixed methods (explanatory sequential desing). In the quantitative phase, the care cascade was evaluated. In the qualitative phase we sought to explain the gaps in the cascade. Tuberculosis program information and semi-structured interviews were used. Results In the care cascade in IP, 202 cases of presumptive PTB (New smear-positive expected) were estimated. A gap of undiagnosed cases of 47.5% was found (n = 96). This gap was explained by poor quality of the Acid-Fast Bacillus Smear, failures in the identification of presumptive tuberculosis, limited access to diagnostic methods, poor training and high turnover of healthcare workers were identified as possible explanations. Conclusions The efforts of the tuberculosis control program in the IP should focus on reducing the gap of undiagnosed cases. Key messages The PTB in IP could affect the fulfillment of the goals of the program. Approximately half of the expected cases were not detected during 2016-2017.

Increasing Trend of Nontuberculous Mycobacteria Isolation in a Referral Clinical Laboratory in South Korea

Background and Objectives: Nontuberculous mycobacteria (NTM) infections are increasing worldwide. We evaluated the annual trends of NTM isolation on acid-fast bacillus (AFB) culture, compared to that of Mycobacterium tuberculosis, and the distribution of NTM species nationwide in South Korea. Materials and Methods: The study was conducted in a diagnostic center that is a major referral laboratory for the diagnosis of tuberculosis and NTM in South Korea. All laboratory results of AFB culture from January 2014 to December 2019 were collected. All NTM identified were definitively identified to the species level. Results: A total of 345,871 tests were performed for the diagnosis of mycobacteria. The isolation rate of NTM and M. tuberculosis was 3.7% (12,969 cases) and 4.4% (15,081 cases), respectively. The annual isolation rate of NTM increased gradually from 2.7% in 2014 to 4.8% in 2019, whereas that of M. tuberculosis decreased from 6.2% to 3.3%. There were 4988 cases of NTM identified to the species level. M. avium complex (MAC) was the most common species isolated from pulmonary sites (59.8%), followed by M. gordonae (9.2%), M. abscessus (7.0%), and M. fortuitum (5.5%). Extrapulmonary NTM were identified in 29 cases (0.6%). MAC was also the most common NTM species isolated from extrapulmonary sites (65.5%), followed by M. kansasii (10.3%), M. abscessus (6.9%), and M. fortuitum (6.9%). Conclusions: The annual isolation rate of NTM has increased gradually, whereas that of M. tuberculosis has decreased. Follow-up studies of the increases in NTM identification and NTM infections in South Korea are needed.

Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent

Cryptococcus exposure in certain global regions is common and yet virulence in the immunocompetent host remains rare. Radiological findings of pulmonary cryptococcosis may include nonspecific lung nodules or masses indistinguishable from lung cancer or pulmonary tuberculosis. We present a case of an immunocompetent diabetic female who presented with progressively worsening pleuritic chest pain and cough with travel between Tibet and New York 2 months earlier. Chest imaging demonstrated a large lobulated mass, acid-fast bacillus smears were negative, and our patient underwent pulmonary biopsy, which grew rare budding yeast later confirmed by mucicarmine staining as Cryptococcus. Our patient was successfully treated with fluconazole therapy. We hypothesize that the high altitude of Tibet may allow for clinical latency followed by symptomatic reactivation on descent. A raised index of suspicion for pulmonary cryptococcosis with careful attention to travel history is expected to facilitate timely diagnosis.

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

First Pathological, Molecular and Serological Investigation of Ovine Johne's Disease (Paratuberculosis) in Northeastern Algeria

Paratuberculosis (PTCB) or Johne's disease (JD) caused by a slow growing acid fast bacillus Mycobacterium avium subspecies paratuberculosis (MAP), is an infectious disease of many species including humans. The disease is responsible for important economic losses to livestock industry worldwide. Although the disease is widespread, it had not been studied in Algerian sheep. In this study we inspected the presence of the infection in sheep (aged 2 years old or older) using histopathology and IS900-PCR techniques in randomly 378 tissues (ileum, ileoceacale valve and lymph nodes) and fecal samples. Gross lesions were detected in 16 (4%) of samples. Histopathological examination revealed the presence of pathognomonic lesions of JD in 61 (14%) animals. Ziehl-Neelsen (ZN) staining of tissue samples was positive in 28 (7%) cases. MAP-DNA was detected in 34 (9%) fecal samples. 14 (4%) animals were tested positive for antibodies against MAP. This study showed that not only ovine paratuberculosis present in Algeria but infected animals are excreting the bacteria in feces. This could be a significant threat for other ruminants and humans. Other studies should be carried out in order to better understand the prevalence and the molecular epidemiology of MAP in the country.