Diagnostic utility of microRNA profiles in cavitatory and noncavitatory pulmonary tuberculosis:Research protocol

BACKGROUND Tuberculosis(TB)is a common infection causing huge morbidity and mortality to mankind.The analytical methods used in diagnosing TB are not sensitive in paucibacillary infections and also require trained technical personnel.MicroRNAs are stable in serum and other body fluids,and hold great potential in the diagnosis of TB.AIM To analyze the dysregulated microRNA profiles among patients with cavitatory and non-cavitatory pulmonary TB.METHODS The prospective study will be conducted in a tertiary care center in India.Adult patients with newly diagnosed pulmonary TB will be included.There will be two groups:Patients with sputum positive pulmonary TB with cavity and without cavity(group1),and apparently healthy individuals(group 2).The participants will undergo sputum examination,Xpert Mycobacterium TB complex/resistance to rifampin(Mtb/RIF)assay,chest X-ray,and blood investigations and serum microRNA detection.Ethics approval has been obtained.Written informed consent will be obtained.Appropriate statistical analyses will be used.RESULTS MicroRNAs will be correlated with sputum positivity,Xpert Mtb/RIF assay,radiological involvement,inflammatory markers,and course of the disease among cases and controls.CONCLUSION MicroRNAs could serve as potential diagnostic biomarkers in diagnostically challenging TB patients.

Organizing pneumonia secondary to pulmonary tuberculosis:A case report

BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of secondary organizing pneumonia associated with pulmonary tuberculosis occurring after nine months of antituberculosis treatment.CASE SUMMARY A 54 years old man,previously diagnosed with pulmonary tuberculosis and tuberculous pleurisy,underwent nine months of antituberculosis treatment.Follow-up lung computed tomography revealed multiple new subpleural groundglass opacities in both lungs,and a lung biopsy confirmed organizing pneumonia.Treatment continued with anti-tuberculosis agents and hormone therapy,and subsequent dynamic pulmonary computed tomography exams demonstrated improvement in lesion absorption.No disease recurrence was observed after corticosteroid therapy discontinuation.CONCLUSION When treating patients with active pulmonary tuberculosis,if an increase in lesions is observed during anti-tuberculosis treatment,it is necessary to consider the possibility of tuberculosis-related secondary organizing pneumonia,timely lung biopsy is essential for early intervention.

Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Identification of pathological characteristics in pulmonary tuberculosis using polarization-sensitive optical coherence tomography

The low detection rate of Mycobacterium tuberculosis in clinical practice leads to a high rate of missed diagnosis for pulmonary tuberculosis(PTB).As a noninvasive,high-resolution,real-time imaging technology,polarization-sensitive optical coherence tomography(PS-OCT)may be feasible for the rapid identification of pathological feature.This study aimed to explore the feasibility of using PS-OCT to identify pathological features of PTB.In the experiments,PTB samples containing some surrounding lung tissues were imaged using PS-OCT.It is demonstrated that PS-OCT images showed good consistency with the corresponding pathological images and were able to identify PTB-related characteristic pathological regions.We think PS-OCT can serve as an effective supplement for the diagnosis of PTB,enabling rapid and accurate diagnosis,and aiding in the understanding of the pathological characteristics and pathophysiological processes of PTB.

Symptomatic bradycardia in tuberculosis-related giant bullae(vanishing lung syndrome):A case report

Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use.The occurrence of giant bullae can also be linked to infections,particularly tuberculosis in tropical countries.Patient concerns:A 26-year-old male complained of weakness,severe vomiting,and reduced breathlessness when lying on the left side.He had a history of pulmonary tuberculosis two years ago.Diagnosis:Symptomatic bradycardia in tuberculosis-related giant bullae.Interventions:The patient was recommended to undergo an elective bullectomy,but he decided not to proceed with the procedure.Atropine sulfate was administered to alleviate symptoms of bradycardia,while a standardized anti-tuberculosis regimen were started for the next six months.Outcomes:Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate,the patient achieved hemodynamic stability,opting against bullectomy despite residual symptoms of dyspnea.Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy.Lessons:Increasing intrathoracic pressure can also be caused mechanically by giant bullae.Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed.In this case,symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention。

Computed tomography imaging and clinical significance of bacterium-positive pulmonary tuberculosis complicated with diabetes

BACKGROUND The increasing prevalence of tuberculosis(TB)and diabetes on a global scale poses a significant health challenge,particularly due to their co-occurrence,which amplifies the severity,recurrence and mortality rates associated with both conditions.This highlights the need for further investigation into their interrelationship.AIM To explore the computed tomography(CT)imaging and clinical significance of bacterium-positive pulmonary TB(PTB)combined with diabetes.METHODS There were 50 patients with bacterium-positive PTB and diabetes,and 50 with only bacterium-positive PTB.The latter were designated as the control group.The CT imaging of the two groups of patients was compared,including lesion range,shape,density and calcification.RESULTS No significant differences were observed in age,gender,smoking and drinking history,high blood pressure,hyperlipidemia and family genetic factors between the groups.However,compared to the patients diagnosed solely with simple bacterium-positive PTB,those with concurrent diabetes showed a wider range of lesions and more complex and diverse morphology on CT images.Among them,intrapulmonary tuberculosis lesions were often accompanied by manifestations of pulmonary infection,such as cavity formation and bronchiectasis.At the same time,diabetes-related signs were often seen on CT images,such as pulmonary infection combined with diabetic pulmonary lesions.Logistic regression analysis identified age and medical history as significant factors influencing the degree of pulmonary infection and CT imaging outcomes in patients with both TB and diabetes.This suggests that older age and specific medical histories may increase the risk or severity of pulmonary damage in these patients.CONCLUSION CT imaging reveals more complex lesions in PTB patients with diabetes,emphasizing the need for careful evaluation and comprehensive analysis to enhance diagnostic accuracy.

Carrimycin in the treatment of acute promyelocytic leukemia combined with pulmonary tuberculosis: A case report

BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for acute promyelocytic leukemia(APL)combined with PTB is lacking.These patients show an extremely poor prognosis.Therefore,studies should establish efficient treatment options to improve patient survival and prognosis.CASE SUMMARY A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital.Peripheral blood smear revealed 54%blasts.Following bone marrow examinations,variant APL with TNRC18-RARA fusion gene was diagnosed.Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions,partial atelectasis in the lower lobes of both lungs,and the bronchoalveolar lavage fluid gene X-Pert test was positive,indicative of PTB.Carrimycin,ethambutol(EMB),and isoniazid(INH)were administered since he could not receive chemotherapy as the WBC count decreased continuously.After one week of treatment with carrimycin,the patient recovered from fever and received chemotherapy.Chemotherapy was very effective and his white blood cells counts got back to normal.After being given five months with rifampin,EMB and INH and chemotherapy,the patient showed complete remission from pneumonia and APL.CONCLUSION We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.

Perianal tuberculous ulcer with active pulmonary,intestinal and orificial tuberculosis:A case report

BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.

Prevalence of Pulmonary Tuberculosis and HIV Co-Infection among Women in Bogodogo, Burkina Faso

Introduction: The tuberculosis (TB) and HIV co-infection is a deadly combination, each accelerating the progression of the other. TB, caused by Mycobacterium tuberculosis (M. tuberculosis), is the leading cause of deaths among people living with HIV, accounting for around 40% of all HIV-positive deaths. The aim of this study was to estimate the prevalence of the tuberculosis-HIV co-infection in women. Material and Methods: The study population consisted of all suspected patients visiting the laboratory of the Bogodogo University Hospital, from May 2023 to January 2024, to be screened for M. tuberculosis. This was a descriptive cross-sectional study. Socio-demographic data were collected during individual interviews with consenting patients. M. tuberculosis was identified using the GeneXpert device, and HIV was diagnosed using the Abbott Determine diagnostic test. Results: Our study population was aged, on average, 37 ± 17.5 years. The overall tuberculosis infection rate was 65%, and 35% were married. Housewives were the most infected with 22.5%. The most infected age group was the ]20 - 40], with 32.5%. Some 37.5% of the women were anorexic and 45% had asthenia. Of the suspected cases, 47.5% were people who had contact with infected persons. TB/HIV co-infection was 5%. Conclusion: Tuberculosis is still rife in many parts of the world. It infects both men and women very quickly. HIV-tuberculosis co-infection is a reality, with HIV accelerating the progression of tuberculosis and vice versa. Raising awareness of HIV and tuberculosis should be done in tandem, as their co-infection leads to a poor vital prognosis.

EGFR Mutation and FHIT Methylation: Inverse Relationship in Patients with Lung Adenocarcinoma and Tuberculosis

Objective:To investigate the genetic correlations between epithelial growth factor receptor(EGFR)mutation and FHIT methylation in patients diagnosed with lung adenocarcinoma(AC)and pulmonary tuberculosis(TB).Methods:The presence of EGFR mutations and the methylation status of the FHIT gene in patients presenting with AC and TB were analyzed.The correlation between TB status and the observed genetic and epigenetic variations was also examined.Results:Among the 90 patients included in the study,38 exhibited EGFR mutations(14 among those with TB and 24 among those without TB),while 29 exhibited FHIT myelination(19 among those with TB and 10 among those without TB).Furthermore,the protein expression levels of EGFR and FHIT were significantly higher in patients diagnosed solely with AC compared to those presenting with both AC and TB.A robust inverse correlation was identified between TB status and the frequency of EGFR mutation(P<0.001).Moreover,significant associations were observed between TB status and FHIT methylation(P<0.01).Conclusion:The findings suggest a correlation between TB and the prevalence of EGFR mutation and FHIT methylation in the pathogenesis of AC.

A complicated case of lung cancer and pulmonary tuberculosis initially presented with painful scapular metastasis in other side

We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.

Observation on the Effect of Integrated Medical and Nursing Care in Patients with Pulmonary Tuberculosis Combined with Lung Cancer

Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.

Risk of Active Pulmonary Tuberculosis among Patients with Coal Workers'Pneumoconiosis:A Case-control Study in China

The aim of this study was to estimate the association between occupational, environmental, behavioral risk factors, and active pulmonary tuberculosis（PTB） among coal workers＇ pneumoconiosis（CWP） patients. A matched case-control study was conducted in 86 CWP patients with active PTB and 86 CWP controls without TB. A standardized questionnaire was used for risk factors assessment. Conditioned logistic regression analysis was used to identify associations between the risk factors and active PTB among CWP patients. The results showed that the stage of CWP, poor workplace ventilation, family history of TB, and exposure to TB were independent risk factors for active PTB in patients with CWP with which recommendations for improving work environments, and for case finding activities in patients with CWP could be made.

Radiomics model for distinguishing tuberculosis and lung cancer on computed tomography scans

BACKGROUND Pulmonary tuberculosis(TB)and lung cancer(LC)are common diseases with a high incidence and similar symptoms,which may be misdiagnosed by radiologists,thus delaying the best treatment opportunity for patients.AIM To develop and validate radiomics methods for distinguishing pulmonary TB from LC based on computed tomography(CT)images.METHODS We enrolled 478 patients(January 2012 to October 2018),who underwent preoperative CT screening.Radiomics features were extracted and selected from the CT data to establish a logistic regression model.A radiomics nomogram model was constructed,with the receiver operating characteristic,decision and calibration curves plotted to evaluate the discriminative performance.RESULTS Radiomics features extracted from lesions with 4 mm radial dilation distances outside the lesion showed the best discriminative performance.The radiomics nomogram model exhibited good discrimination,with an area under the curve of 0.914(sensitivity=0.890,specificity=0.796)in the training cohort,and 0.900(sensitivity=0.788,specificity=0.907)in the validation cohort.The decision curve analysis revealed that the constructed nomogram had clinical usefulness.CONCLUSION These proposed radiomic methods can be used as a noninvasive tool for differentiation of TB and LC based on preoperative CT data.

Comparison of Two Molecular Assays For Detecting Smear Negative Pulmonary Tuberculosis

Objective To compare the performance of MTBDRplus V2 and Xpert MTB/RIF for detecting smear negative pulmonary tuberculosis （PTB）. Methods Clinical PTB suspects were enrolled consecutively in Anhui Chest Hospital and Xi＇an Chest Hospital from January to December in 2014. The sputum samples of smear negative PTB suspects were collected and decontaminated. The sediment was used to conduct MTBDRplus V2, Xpert MTB/RIF and drug susceptibility test （DST）. All the samples with discrepant drug susceptibility result between molecular methods and phenotypic method were confirmed by DNA sequencing. Results A total of 1973 cases were enrolled in this study. The detection rates of Mycobacterium tuberculosis complex （MTBC） by MTBDRplus V2 and Xpert MTB/RIF were 27.67% and 27.98%, respectively. When setting MGIT culture result as a gold standard, the sensitivity and specificity of MTBDRplus V2 were 86.74% and 93.84%, and the sensitivity and specificity of Xpert MTB/RIF were 86.55% and 93.43%, respectively. For the detection of the resistance to rifampin, the sensitivity and specificity of MTBDRplus V2 were 94.34% and 96.62%, and the sensitivity and specificity of Xpert MTB/RIF were 88.68% and 95.96%, respectively. For the detection of the resistance to isoniazid, the sensitivity and specificity of MTBDRplus V2 were 77.38% and 98.02%, respectively. Conclusion MTBDRplus V2 and Xpert MTB/RIF can be used to detect MTBC in smear negative samples with satisfactory performance.

-592 and -1082 interleukin-10 polymorphisms in pulmonary tuberculosis with type 2 diabetes

Objective:To determine the polymorphisms of Interleukin-10(IL-10)(-592,-1082) in pulmonary tuberculosis(PTB)with and without type 2 diabetes(T2D).Methods:We studied a Mexican mestizo population of 37 patients with TB in remission(TBr) and 40 with active pulmonary TB (PTB),21 patients with TB + T2D.47 blood donors accepted,and 13 healthy health-care workers with tuberculin skin lest positive.Determination of IL-10 polymorphisms was performed by real-lime Polymerase chain reaction.Results:IL-10-592C/A presented in a greater proportion in healthy individuals than in patients with type 2 diabetes and TB in a not quite significant statistically manner.IL-10-1082A/A presented more frequently in the group of patients with both diseases,not being statistically significant in comparison with the group of healthy subjects. Conclusions:This study describes two important new findings.First,it reveals that the IL-10 (-592 A/A and -592 C/C) polymorphisms were found in a greater proportion in a group of patients with T2D and TB than in healthy subjects.Second,the study provides evidence that the(-1082 G/G) polymorphism presented with greater frequency in healthy individuals than in patients with both ol these diseases.

Association of TNF-α-238G/A and 308 G/A Gene Polymorphisms with Pulmonary Tuberculosis among Patients with Coal Worker’s Pneumoconiosis

Objectives Tumor necrosis factor-α （TNF-α） may play an important role in host＇s immune response to mycobacterium tuberculosis （M. tuberculosis） infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis （TB） among patients with coal worker＇s pneumoconiosis （CWP）. Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism （PCR-RFLP）. Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher＇s exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls （2,2=5.44, P=-0.07）. But difference in frequency of the TNF-α-308 A allele was identified between them （2,2-5.14, P=0.02）. No significant difference in frequencies of the TNF-α-238 genotype and allele （P=0.23 and P=0.09, respectively） was found between cases and controls either, with combined （GG and AA） OR of 3.96 （95% confidence interval of 1.30-12.09） at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 （95% CI of 1.06-3.71） for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index （OR=4.92）, as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.

High Incidence of Pulmonary Tuberculosis in ART Naive Remunerated Blood Donors with Human Immunodeficiency Virus Type-1 Infection: Possible Role of Iron Overload

Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated immunity at early stage of HIV-1 infection that may facilitate subsequent acquisition of pulmonary tuberculosis, shorter ARI free duration and reduced survival.

Drug Resistance Pattern in Pulmonary Tuberculosis Patients and Risk Factors Associated with Multi-Drug Resistant Tuberculosis

Introduction: Anti-tuberculosis drug resistance is a major problem in tuberculosis (TB) control programme, particularly multi-drug resistance TB (MDR-TB) in Nepal. Drug resistance is difficult to treat due to its associated cost and side effects. The objective of this study was to assess the drug resistance pattern and assess risk factor associated with MDR-TB among pulmonary tuberculosis patients attending National Tuberculosis Center. Methodology: The comparative cross sectional study was conducted at National Tuberculosis Center during August 2015 to February 2015. Early morning sputum samples were collected from pulmonary tuberculosis suspected patients and subjected to Ziehl-Neelsen staining and fluorochrome staining and culture on Lowenstein-Jensen (LJ) medium. Drug Susceptibility test was performed on culture positive isolates by using proportion method. Univariate and multivariate analysis was computed to assess the risk factors of MDR-TB. Results: Out of 223 sputum samples, 105 were fluorochrome staining positive, 85 were ZN staining positive and 102 were culture positive. Out of 102 culture positive isolates, 37.2% were resistance to any four anti-TB drugs. 11 (28.9%) were initial drug resistance and 28 (43.7%) were acquired drug resistance. The overall prevalence of MDR-TB was 11.7%, of which 2 (5.3%) were initial MDR-TB and 10 (15.6%) were acquired MDR-TB. Univariate and multivariate analysis showed female were significantly associated (P = 0.05) with MDR-TB. Conclusion: Drug resistance TB particularly MDR-TB is high. The most common resistance pattern observed in this study was resistance to both isoniazid and rifampicin. Female were found to be associated with MDR-TB. Thus, early diagnosis of TB and provision of culture and DST are crucial in order to combat the threat of DR-TB.

Comparison of LAMP,GeneXpert,Mycobacterial Culture,Smear Microscopy,TSPOT.TB,TBAg/PHA Ratio for Diagnosis of Pulmonary Tuberculosis

Objective:To investigate the application value of loop-mediated isothermal amplification(LAMP),GeneXpert,mycobacterial culture,smear microscopy,TSPOT.TB(TSPOT),ratio of TB-specific antigen to phytohemagglutinin(TBAg/PHA ratio)in the detection of mycobacterium tuberculosis in the bronchoalveolar lavage fluid.Methods:A retrospective analysis was performed on the patients who underwent bronchoscopy from December 2018 to November 2019 in Tongji Hospital.The patients with positive tuberculosis culture or positive GeneXpert in bronchoalveolar lavage fluid were selected as the case group,and those without tuberculosis served as the control group.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of LAMP,GeneXpert,culture,smear microscopy,TSPOT,and TBAg/PHA ratio.Results:For the patients with positive cultures as case,the sensitivity of LAMP,GeneXpert,smear microscopy,TSPOT and TBAg/PHA ratio was 73.49%,89.16%,25.30%,80.00%,33.85%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the area under the ROC curve(AUC)was 0.849,0.938,0.633,0.830,0.669,respectively.For the patients with positive GeneXpert as case,the sensitivity of LAMP,mycobacterial culture,smear microscopy,TSPOT and TBAg/PHA ratio was 73.20%,74.23%,22.68%,68.92%,29.73%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the AUC was 0.853,0.878,0.623,0.775,0.649,respectively.Conclusion:The sensitivity of GeneXpert was best.The sensitivity and diagnostic value of LAMP were slightly lower than those of GeneXpert,and were similar to tuberculosis culture.The sensitivity of smear microscopy was low.The specificity of TSPOT was low.When TBAg/PHA ratio>0.2 was used as a diagnostic index,the specificity was improved,but the sensitivity was low.