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Epidemiological characteristics of extrapulmonary tuberculosis patients with or without pulmonary tuberculosis. Epidemiol Infect 2022; 150:e158. [PMID: 35904011 PMCID: PMC9472030 DOI: 10.1017/s0950268822001236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Our study aimed to investigate the epidemiology of extrapulmonary tuberculosis (EPTB) and analyse the epidemiological characteristics of EPTB patients with or without pulmonary tuberculosis (PTB). EPTB cases admitted in our hospital from January 2015 to December 2020 were included. Uni- and multi-variable logistic regression analysis was carried out to identify risk factors and prognostic factors of concomitant EPTB and PTB or exclusively EPTB. A total of 3488 EPTB patients were reviewed, including 2086 patients with concurrent PTB and EPTB, and 1402 patients with exclusively EPTB. Logistic regression analysis showed that age >60 years (OR = 1.674, 95% CI = 1.438–1.949, P < 0.001) and female (OR = 1.325, 95% CI = 1.155–1.520, P < 0.001) were risk factors of exclusively EPTB, while co-morbidities (OR = 0.676, 95% CI = 0.492–0.929, P = 0.016) and severe symptoms (OR = 0.613, 95% CI = 0.405–0.929, P = 0.021) were risk factors for concurrence of EPTB and PTB. Age >60 years was an independent prognostic factor in EPTB patients with or without PTB (HR = 11.059, 95%CI = 5.097–23.999, P < 0.001; HR = 23.994, 95%CI = 3.093–186.151, P = 0.0020). Female gender was an independent prognostic factor in patients with concurrent PTB and EPTB (HR = 23.994, 95%CI = 3.093–186.151, P = 0.002). Our study disclosed the differential epidemiological characteristics of EPTB patients with or without PTB in China.
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102
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Knyazev OV, Kagramanova AV, Fadeeva NA, Pelipas IG, Lishchinskaya AA, Zvyaglova MI, Parfenov AI. Difficulties in differential diagnosis tuberculosis and Crohn's disease. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.5.201760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We present a clinical case of intestinal tuberculosis in a young patient with a clinical simulation of Crohn's disease. The article addresses clinical presentation, challenges of differential diagnostics of intestinal tuberculosis, and nonsurgical and surgical treatment approaches.
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103
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Urrego Díaz JA, Trujillo-Trujillo J, Meza-Cárdenas M, Cruz ÓA. Caracterización de la tuberculosis multidrogorresistente y resistente a rifampicina en Colombia. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v23n6.98937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Caracterizar la población afectada por tuberculosis multidrogorresistente y resistente a rifampicina (TB-MDR/RR) en Colombia.
Métodos Estudio transversal a partir de la información nominal de los pacientes con TB-MDR/RR tratados y reportados en Colombia desde 2009 hasta 2020, usando la totalidad de las fuentes de información oficiales. Se compararon, además, las tasas de TB-MDR/RR de diferentes grupos de riesgo con la de la población general y se evaluaron variables asociadas a la TB-MDR/RR extrapulmonar y a resistencias medicamentosas.
Resultados La TB-MDR/RR ha aumentado progresivamente durante la última década y se ha concentrado en hombres (64% vs. 36%, p<0,001), edades medias (mediana: 39,5 años; RIC: 27) y zonas de mayor densidad poblacional (59% de los casos en Antioquia, Valle del Cauca y Santiago de Cali). Además, al compararlas con las poblaciones de referencia que aplicaran, se evidenciaron tasas 2, 10 y 200 veces mayores en población indígena (9,45/1 000 000 vs. 4,31/1 000 000; p=0,02), prisioneros (169/1 000 000 vs. 16,9/1 000 000; p<0,001) y habitantes de calle (21/100000 vs. 0,1/100 000; p<0,001), respectivamente.
Conclusiones El aumento en los casos de TB-MDR/RR y sus grupos de riesgo deben tenerse en cuenta para la planeación de políticas, distribución de recursos y atención clínica.
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104
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Fan J, An J, Shu W, Tang K, Shang Y, Xue Y, Qin S, Pang Y. Impact of Xpert MTB/RIF on Outcomes of Adults Hospitalized With Spinal Tuberculosis: Findings From a Comparative Cohort in Beijing, China. Front Public Health 2022; 10:901504. [PMID: 35784201 PMCID: PMC9247639 DOI: 10.3389/fpubh.2022.901504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSpinal tuberculosis (TB) is one of the most common forms of extrapulmonary tuberculosis, causing increased morbidity and lifelong disabilities. Here, we conducted a retrospective study to determine the impact on patient outcomes of the Xpert MTB/RIF test vs. phenotypical drug susceptibility testing for spinal TB.MethodsIn-patients with spinal TB were enrolled in 2013 and 2017 at Beijing Chest Hospital. Data were collected from an electronic patient record system that documented demographic and clinical characteristics. All the patients were routinely followed-up at 1, 3, 6, 9, and 12 months after surgery during outpatient treatment.ResultsA total of 361 patients affected by spinal TB were enrolled in our analysis, including 178 patients in 2013 and 183 patients in 2017. In 2013, the cumulative postoperative recurrence rate of patients with spinal TB was 23% (41/178), which was significantly higher than that in 2017 (8.2%, 15/183, P < 0.001). Additionally, the patients with spinal TB diagnosed in 2013 relapsed significantly sooner than those in 2017 (P < 0.001). In the multivariate analysis, rifampicin (RIF) resistance was associated with the recurrence of spinal TB. The turnaround time of Xpert ranged from 1 to 3 days, with a median of 1 day (IQR: 1–2). For the phenotypic drug susceptibility test (pDST)-based algorithm, the median turnaround time was 67 days, considerably longer than that of the Xpert-based algorithm (P < 0.001).ConclusionThe RIF resistance is an independent risk factor for postoperative recurrence in patients with spinal TB. Early detection of RIF resistance due to the application of Xpert is an effective strategy to reduce spinal TB recurrence.
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Affiliation(s)
- Jun Fan
- Orthopaedics Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Jun An
- Medical Records Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Wei Shu
- Clinical Center on TB Control, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Kai Tang
- Orthopaedics Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Yuanyuan Shang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Yi Xue
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Shibing Qin
- Orthopaedics Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China
- *Correspondence: Yu Pang
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105
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Hoffmann AM, Wolke M, Rybniker J, Plum G, Fuchs F. In vitro Activity of Repurposed Nitroxoline Against Clinically Isolated Mycobacteria Including Multidrug-Resistant Mycobacterium tuberculosis. Front Pharmacol 2022; 13:906097. [PMID: 35721137 PMCID: PMC9198898 DOI: 10.3389/fphar.2022.906097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial treatment options for mycobacterial infections are limited due to intrinsic resistance and the emergence of acquired resistance in Mycobacterium tuberculosis. Isolates resisting first- and second line drugs are raising concerns about untreatable infections and make the development of new therapeutic strategies more pressing. Nitroxoline is an old oral antimicrobial that is currently repurposed for the treatment of urinary tract infection (UTI). In this study, we report the in vitro activity of nitroxoline against 18 clinical isolates of M. tuberculosis complex (MTBC) (M. tuberculosis N = 16, M. bovis BCG N = 1, M. bovis sp. bovis N = 1). Since nitroxoline achieves high concentrations in the urinary tract, we included all MTBC-isolates from urinary samples sent to our laboratory between 2008 and 2021 (University Hospital of Cologne, Germany). Isolates from other sources (N = 7/18) were added for higher sample size and for inclusion of drug-resistant M. tuberculosis isolates (N = 4/18). Based on our clinical routine the fluorescence-based liquid media system BACTEC MGIT 960 was used for susceptibility testing of nitroxoline and mainstay antitubercular drugs. Nitroxoline yielded a MIC90 of 4 mg/L for MTBC. In all M. tuberculosis isolates nitroxoline MICs were at least two twofold dilutions below the current EUCAST susceptibility breakpoint of ≤16 mg/L (limited to E. coli and uncomplicated UTI). In vitro activity of nitroxoline can be considered excellent, even in multidrug-resistant isolates. Future studies with in vivo models should evaluate a potential role of nitroxoline in the treatment of tuberculosis in the era of drug resistance.
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Affiliation(s)
- Ada Marie Hoffmann
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Martina Wolke
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine and University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- *Correspondence: Frieder Fuchs, , orcid.org/0000-0001-7075-5378
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106
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Chinpong K, Thavornwattana K, Armatrmontree P, Chienwichai P, Lawpoolsri S, Silachamroon U, Maude RJ, Rotejanaprasert C. Spatiotemporal Epidemiology of Tuberculosis in Thailand from 2011 to 2020. BIOLOGY 2022; 11:755. [PMID: 35625483 PMCID: PMC9138531 DOI: 10.3390/biology11050755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
Tuberculosis is a leading cause of infectious disease globally, especially in developing countries. Better knowledge of spatial and temporal patterns of tuberculosis burden is important for effective control programs as well as informing resource and budget allocation. Studies have demonstrated that TB exhibits highly complex dynamics in both spatial and temporal dimensions at different levels. In Thailand, TB research has been primarily focused on surveys and clinical aspects of the disease burden with little attention on spatiotemporal heterogeneity. This study aimed to describe temporal trends and spatial patterns of TB incidence and mortality in Thailand from 2011 to 2020. Monthly TB case and death notification data were aggregated at the provincial level. Age-standardized incidence and mortality were calculated; time series and global and local clustering analyses were performed for the whole country. There was an overall decreasing trend with seasonal peaks in the winter. There was spatial heterogeneity with disease clusters in many regions, especially along international borders, suggesting that population movement and socioeconomic variables might affect the spatiotemporal distribution in Thailand. Understanding the space-time distribution of TB is useful for planning targeted disease control program activities. This is particularly important in low- and middle-income countries including Thailand to help prioritize allocation of limited resources.
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Affiliation(s)
- Kawin Chinpong
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand; (K.C.); (K.T.); (P.A.); (P.C.)
- Department of Computer Engineering, Faculty of Engineering, King Mongkut’s University of technology Thonburi, Bangkok 10140, Thailand
| | - Kaewklao Thavornwattana
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand; (K.C.); (K.T.); (P.A.); (P.C.)
- Department of Computer Engineering, Faculty of Engineering, King Mongkut’s University of technology Thonburi, Bangkok 10140, Thailand
| | - Peerawich Armatrmontree
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand; (K.C.); (K.T.); (P.A.); (P.C.)
- Department of Computer Engineering, Faculty of Engineering, King Mongkut’s University of technology Thonburi, Bangkok 10140, Thailand
| | - Peerut Chienwichai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand; (K.C.); (K.T.); (P.A.); (P.C.)
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Udomsak Silachamroon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Richard J. Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02115, USA
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Road, Oxford OX1 1NF, UK
- The Open University, Milton Keynes MK7 6AA, UK
| | - Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
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107
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Bone Penetration of Cycloserine in Osteoarticular Tuberculosis Patients of China. Antimicrob Agents Chemother 2022; 66:e0222421. [PMID: 35400177 DOI: 10.1128/aac.02224-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The cycloserine concentrations in plasma and bone that were collected during operations on 28 osteoarticular tuberculosis (TB) patients treated daily with a 500-mg cycloserine-containing regimen were determined. The median concentrations in plasma and bone were 16.29 μg/mL (interquartile range [IQR], 6.47 μg/mL) and 24.33 μg/g (IQR, 14.68 μg/g), respectively. The median bone/plasma penetration ratio was 0.76 (range, 0.33 to 1.98). Cycloserine could effectively penetrate bone and acquire concentrations comparable to those in plasma, which favors its usage in osteoarticular TB treatment.
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108
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Rinaldi I, Muthalib A, Gosal D, Wijayadi T, Sutedja B, Setiawan T, Gunawan A, Susanto N, Magdalena L, Handjari DR, Kurniawan F, Rifani A, Winston K. Abdominal Tuberculosis Mimicking Ovarian Cancer: A Case Report and Review of the Literature. Int Med Case Rep J 2022; 15:169-185. [PMID: 35431583 PMCID: PMC9012314 DOI: 10.2147/imcrj.s348434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Tuberculosis (TB) is a disease with high morbidity and mortality resulting from infection by Mycobacterium tuberculosis. TB can disseminate to any organ system of the body resulting in extrapulmonary tuberculosis. Interestingly, CA-125, which is a biomarker for some cancer, also rises in benign diseases such as pulmonary and extrapulmonary tuberculosis which may complicate diagnosis. In this case report, we present an abdominal tuberculosis patient that was initially presented as ovarian cancer. Case Report A 30-year-old woman admitted to the emergency department with chief complaint of fatigue and shortness of breath since 3 months ago. She had lost around 20 kg weight in the past 5 months. She was previously suspected with ovarian cancer because of the characteristic features of malignancy, high levels of CA-125, and positive PET scan. She was later diagnosed with abdominal TB. Subsequently, the patient was given anti-TB drugs, and the patient showed clinical improvement. Conclusion In the case of an elevated CA-125, clinicians should consider extrapulmonary TB as a differential diagnosis of ovarian cancer, especially in countries with high burden of tuberculosis.
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Affiliation(s)
- Ikhwan Rinaldi
- Divison of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Gading Pluit Hospital, Jakarta, Indonesia
- Correspondence: Ikhwan Rinaldi, Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Tel +62 811-177-997, Email
| | - Abdul Muthalib
- Divison of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Gading Pluit Hospital, Jakarta, Indonesia
| | - Djaja Gosal
- Department of Internal Medicine, Gading Pluit Hospital, Jakarta, Indonesia
| | - Teguh Wijayadi
- Department of Internal Medicine, Gading Pluit Hospital, Jakarta, Indonesia
| | - Barlian Sutedja
- Departement of General Surgery, Gading Pluit Hospital, Jakarta, Indonesia
| | - Tjondro Setiawan
- Departement of Radiology, Gading Pluit Hospital, Jakarta, Indonesia
| | - Andika Gunawan
- Departement of Nuclear Medicine, Gading Pluit Hospital, Jakarta, Indonesia
| | - Nelly Susanto
- Departement of Radiology, Gading Pluit Hospital, Jakarta, Indonesia
| | - Lingga Magdalena
- Departement of Radiology, Gading Pluit Hospital, Jakarta, Indonesia
| | - Diah Rini Handjari
- Department of Anatomical Pathology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Departement of Pathology, Gading Pluit Hospital, Jakarta, Indonesia
| | - Fetisari Kurniawan
- Department of Anatomical Pathology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Departement of Pathology, Gading Pluit Hospital, Jakarta, Indonesia
| | - Aisyah Rifani
- Departement of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Winston
- Departement of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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109
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Wang J, Li S, Zhang Q. Brucellar Knee Arthritis with Knee Joint Tuberculosis: A Case Report and Review of the Literature. Infect Drug Resist 2022; 15:1659-1665. [PMID: 35422641 PMCID: PMC9004727 DOI: 10.2147/idr.s359693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Brucella and Mycobacterium tuberculosis (MTB) primarily affect the spine and only rarely the knee joint in osteoarticular disease in adults. We present an unusual instance of brucellar knee arthritis combined with knee joint tuberculosis. A 59-year-old man was initially diagnosed with brucellar knee arthritis in the orthopedics department of our hospital, while two weeks of standardized treatment did not improve the joint discomfort and inflammation indexes. Subsequent evaluation of serum tuberculosis interferon-gamma release assays (TB-IGRAs) and the effectiveness of empirical anti-tuberculosis therapy confirmed the mixed infection of tuberculosis. This case report demonstrates that clinical signs and imaging for brucellar knee arthritis and knee joint tuberculosis are similar. Patients with both disorders are more likely to be misdiagnosed or have their diagnosis delayed; clinicians should be aware of this uncommon combination of mixed infections.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Shuguang Li
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Correspondence: Qiang Zhang, Email
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110
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Integration of cytopathology with molecular tests to improve the lab diagnosis for TBLN suspected patients. PLoS One 2022; 17:e0265499. [PMID: 35358212 PMCID: PMC8970391 DOI: 10.1371/journal.pone.0265499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Tuberculosis lymphadenitis (TBLN) diagnosis is often challenging in most resource poor settings. Often cytopathologic diagnosis of TBLN suspected patients is inconclusive impeding timely clinical management of TBLN suspected patients, further exposing suspected patients either for unnecessary use of antibiotics or empirical treatment. This may lead to inappropriate treatment outcome or more suffering of suspected patients from the disease. In this study, an integrated diagnostic approach has been evaluated to elucidate its utility in the identification of TBLN suspected patients. Methods A cross-sectional study was conducted on 96 clinically diagnosed TBLN suspected patients, where fine needle aspirate (FNA) samples were collected at the time of diagnosis. FNA cytology, Ziehl-Neelsen (ZN), Auramine O (AO) staining, GeneXpert MTB/RIF and Real time PCR (RT-PCR) were performed on concentrated FNA samples. Considering culture as a gold standard, the sensitivity, specificity, positive and negative predictive values were calculated. Cohen’s Kappa value was used to measure interrater variability and level of agreement and a P-value of <0.05 was considered as statistically significant. Result Out of the 96 FNA sample, 12 (12.5%) were identified to have Mycobacterium tuberculosis (Mtb) using ZN staining, 27 (28.1%) using AO staining, 51 (53.2%) using FNAC, 43 (44.7%) using GeneXpert MTB/RIF, 51 (53.1%) using Real time PCR (RT-PCR) and 36 (37.5%) using Lowenstein-Jensen (LJ) culture. Compared to LJ culture, the sensitivities of GeneXpert MTB/RIF, RT-PCR, and FNAC were 91.7%, 97.2%, and 97.2%, respectively and the specificities were 83.3%, 73.3%, and 68.3%, respectively. GeneXpert MTB/RIF and RT-PCR when combined with FNAC detected 61 (63.5%) cases as having Mtb, and the sensitivity and specificity was 100% and 58.3%, respectively. Conclusion FNA cytology and RT-PCR detected more TBLN cases compared to other Mtb detection tools and the detection sensitivity even improved when FNA cytology was combined with GeneXpert MTB/RIF, performed on concentrated FNA sample, suggesting the combined tests as an alternative approach for improved diagnosis of TBLN.
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111
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Quan S, Jiang T, Jiao W, Zhu Y, Liao Q, Liu Y, Fang M, Shi Y, Duan L, Shi X, Wang Y, Tian X, Wan C, Sun L, Shen A. A Novel Cross-Priming Amplification-Based Assay for Tuberculosis Diagnosis in Children Using Gastric Aspirate. Front Microbiol 2022; 13:819654. [PMID: 35401442 PMCID: PMC8988679 DOI: 10.3389/fmicb.2022.819654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Low detection rates of Mycobacterium tuberculosis (MTB) by culture and smear microscopy prevent early diagnosis of tuberculosis (TB) in children. Therefore, developing rapid and accurate diagnostic techniques are critical to achieving the global aim of minimizing childhood TB. The present study was performed to evaluate the diagnostic effectiveness of the novel cross-priming amplification-based EasyNAT MTB complex assay (EasyNAT) in childhood TB. Five hundred and six children with suspected TB were enrolled from January 2018 to October 2021. Gastric aspirate (GA) samples were tested by bacterial culture, acid-fast bacillus microscopy, EasyNAT, Xpert MTB/RIF (Xpert), or Xpert MTB/RIF Ultra (Xpert Ultra). Among 239 children simultaneously tested by EasyNAT and Xpert methods, both assays showed similar sensitivities in total active TB cases [22.6% (31/137) vs. 26.3% (36/137), p = 0.441] and in bacteriologically confirmed TB cases [both 60.0% (9/15)]. The two assays presented similar specificities of 98.0% (100/102) and 99.0% (101/102), respectively (p = 1.000). Among 267 children who were simultaneously tested with EasyNAT and Xpert Ultra, Xpert Ultra demonstrated higher sensitivity than EasyNAT in total active TB cases [50.9% (89/175) vs. 30.3% (53/175), p < 0.001]. EasyNAT and Xpert Ultra yielded similar specificities, at 97.8% (90/92) and 100.0% (92/92), respectively (p = 0.155). These findings indicated that Xpert Ultra was superior to EasyNAT despite its higher cost and EasyNAT was not inferior to Xpert in the diagnosis of childhood TB using GA samples. EasyNAT may therefore be a suitable alternative diagnostic method for childhood TB based on its cost-effectiveness, speed, and accuracy.
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Affiliation(s)
- Shuting Quan
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | | | - Weiwei Jiao
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yu Zhu
- West China Second Hospital, Sichuan University, Chengdu, China
| | - Qiong Liao
- West China Second Hospital, Sichuan University, Chengdu, China
| | - Yang Liu
- West China Second Hospital, Sichuan University, Chengdu, China
| | - Min Fang
- The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Yan Shi
- The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Li Duan
- The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Xiaomei Shi
- The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Yacui Wang
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xue Tian
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Chaomin Wan
- West China Second Hospital, Sichuan University, Chengdu, China
- Chaomin Wan,
| | - Lin Sun
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Lin Sun,
| | - Adong Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Baoding Children's Hospital, Baoding, China
- *Correspondence: Adong Shen,
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Hashem MK, Hussein AARM, Amin MT, Mahmoud A, Shaddad AM. The burden of COVID-19 pandemic on tuberculosis detection: a single-center study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [PMCID: PMC8931790 DOI: 10.1186/s43168-022-00117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Since being declared a global pandemic, Coronavirus disease 2019 (COVID-19) took over healthcare providers and researchers’ interest. However, other epidemic diseases, including tuberculosis (TB), are still a health issue that aggravate under the umbrella of health facilities exhaustion. This study aims to evaluate the impact of the COVID-19 pandemic on tuberculosis management. Methods A retrospective analysis of the quarterly reports issued by a tuberculosis management unit from 2017 to June 2021, including data of 12 subunits. The changes in pulmonary and extrapulmonary tuberculosis incidence trends (new + relapsed cases) throughout the 4 years were reported. The quarterly changed percentages in cases numbers along 2020 and first half of 2021 was compared with that of the same periods in 2019. Results Incidence of extrapulmonary tuberculosis was higher than pulmonary tuberculosis throughout the 4 year study periods (7.69 vs. 4.49, 9.44 vs. 4.33, 7.75 vs. 3.58, and 7.82 vs. 2.94/100.000 population, respectively) with a noticeable decline in the incidence of pulmonary TB during 2020. The second quarter of 2020 showed the lowest tuberculosis incidence rate with a 41.6% decline in the total number of diagnosed cases while 2nd quarter of 2021 showed 21.2% decline. During 2020, only 4 cases of multidrug-resistant TB were reported (compared to an average of 8 cases of MDR-TB yearly before the COVID-19 era). Conclusion There was a noticeable drop in tuberculosis case detection during the COVID-19 pandemic. The lockdown, started in Egypt by the end of March 2020, could contribute to the marked drop in the second quarter. However, a steady partial decline was continued during the first half of 2021, which foretells a growing problem.
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Ma J, Liu H, Wang J, Li W, Fan L, Sun W. HIV-Negative Rifampicin Resistance/Multidrug-Resistant Extrapulmonary Tuberculosis in China from 2015 to 2019: A Clinical Retrospective Investigation Study from a National Tuberculosis Clinical Research Center. Infect Drug Resist 2022; 15:1155-1165. [PMID: 35340674 PMCID: PMC8943829 DOI: 10.2147/idr.s342744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background China is the region with a high global burden of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the clinical and demographic characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) from 2015 to 2019 to provide evidence for the prevention and control of the disease in high TB burden areas. Methods We investigated the clinical and demographic data of all MDR/RR-EPTB cases in a TB specialized hospital from China and compared the cases with the MDR/RR-pulmonary tuberculosis (PTB) patients over the same period. Results Of the RR/MDR-TB patients enrolled, 15.4 were EPTB. The most common anatomical site was pleural/chest wall (25.9%). Compared with RR/MDR-PTB, females were more likely to be susceptible to RR/MDR-EPTB (OR 1.65, 95% CI 1.52–1.77); the risk of RR/MDR-EPTB for 25–44 years group increased (OR 1.61, 95% CI 1.52–1.77), and then decreased with the increasing age (OR 1.48, 95% CI 0.74–1.69 for 44–65 years group and OR 2.23, 95% CI 0.98–2.71 for ≥65 years group); more likely to be newly diagnosed (p < 0.01) and less likely to to combine with diabetes (P < 0.01), more dependent on GeneXpert MTB/RIF (Xpert, 90.9%) for diagnosis, with significantly higher rates of pre-XDR/XDR and significantly lower favorable treatment outcomes (both p < 0.01). Conclusion There are clinical and demographic differences between RR/MDR-PTB and RR/MDR-PTB. Xper should be recommended at an early stage for suspected patients, and fluoroquinolones should be used cautiously for anti-infective therapy in this population.
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Affiliation(s)
- Jun Ma
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Hongcheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Jingjing Wang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Wenting Li
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Lin Fan
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Wenwen Sun
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Correspondence: Wenwen Sun; Lin Fan, Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China, Email ;
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Djannah F, Massi MN, Hatta M, Bukhari A, Hasanah I. Profile and histopathology features of top three cases of Extra Pulmonary Tuberculosis (EPTB) in West Nusa Tenggara: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 75:103318. [PMID: 35242312 PMCID: PMC8857446 DOI: 10.1016/j.amsu.2022.103318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an infectious disease that might threaten life with a high incidence rate globally, especially in developing countries such as Indonesia. Although some TB cases are found in the lungs, the incidence of patients with extra-pulmonary TB infection also shows a significant number. However, these cases are still underreported, especially in Indonesia. Histopathological examination is one of the gold standards for diagnosing EPTB. MATERIALS AND METHODS This is a cross-sectional retrospective descriptive study. This study uses data from medical records and histopathological examination results of extra-pulmonary TB patients at two hospitals in West Nusa Tenggara between May 2010 and February 2020. The inclusion criteria for this study were patients diagnosed with EPTB histopathologically and had complete paraffin block. In addition, the exclusion criteria were patients with incomplete data in the medical record. The data recorded include gender, age, organ location, area of residence, and histopathological features. RESULTS There were 1.817 cases of extra-pulmonary TB in West Nusa Tenggara from May 2010 to February 2020. The top three organs were from the neck (84.7%), breast (14.1%), and colon (1.2%), with a total of 1362 cases. Women dominate the top three cases of EPTB with 894 patients (65.7%) and in the age group 21-30 (28%). Central Lombok has the most EPTB patients (450; 33.07%). Microscopic examination revealed well-organized granulomas in 988 patients (72.6%) and poorly organized granulomas in 374 patients (27.4%). CONCLUSION The three most frequent cases of EPTB found in West Nusa Tenggara are cervical lymphadenitis TB, mastitis TB, and colitis TB, with the majority of cases being well-organized granulomas. Further studies dealing with better designs and larger sample sizes need to be considered. The results of this study are significantly needed to determine the intervention strategies to reduce morbidity and mortality due to EPTB.
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Affiliation(s)
- Fathul Djannah
- Department Anatomy Pathology, Faculty of Medicine, Universitas Mataram, Mataram, 83126, Indonesia
| | - Muhammad Nasrum Massi
- Department of Microbiology, Faculty of Medicine, Universitas Hasanuddin, Makassar, 90245, Indonesia
| | - Mochammad Hatta
- Department of Microbiology, Faculty of Medicine, Universitas Hasanuddin, Makassar, 90245, Indonesia
| | - Agussalim Bukhari
- Faculty of Medicine, Universitas Hasanuddin, Makassar, 90245, Indonesia
| | - Idyatul Hasanah
- Faculty of Health Sciences, Universitas Nahdlatul Wathan, Mataram, 83115, Indonesia
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Fallah S, Nasehi M, Etemadinezhad S, Fallah S, Yazdani Charati J. A Five-Year Epidemiological Study of Extra-Pulmonary Tuberculosis and Its Related Risk Factors in Iran. TANAFFOS 2022; 21:221-229. [PMID: 36879733 PMCID: PMC9985131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/10/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tuberculosis is the most common worldwide cause of death from microbial diseases. Extra-pulmonary tuberculosis accounts for 20% to 25% of all cases. In this study, we used generalized estimation equations to investigate the trend of changes in extra-pulmonary tuberculosis incidence. MATERIALS AND METHODS The recorded data of all patients with extra-pulmonary tuberculosis from 2015 to 2019 in Iran's National Tuberculosis Registration Center were included. The trend of standardized incidence changes in provinces of Iran was calculated and reported linearly. Also, we identified the risk factors related to the extra-pulmonary tuberculosis incidence in five consecutive years using generalized estimating equations. RESULTS We studied the data of 12,537 patients with extra-pulmonary tuberculosis, of whom 50.3% were female. The mean age of the subjects was 43.61±19.88 years. Around 15.4% of all patients had a history of contact with a tuberculosis patient, 43% had a history of hospital stay, and 2.6% had a human immunodeficiency virus infection. Regarding disease types, 25% were lymphatic, 22% were pleural, and 14% were bone. Golestan province had the highest (average of 28.50 ± 8.65 cases), and Fars province had the lowest (average of 3.06 ± 0.75 cases) standardized incidences in these five years. Also, time trend (P < 0.001), employment rate (P = 0.037), and average annual rural income (P = 0.001) had a significant effect on reducing extra-pulmonary tuberculosis incidence. CONCLUSION Extra-pulmonary tuberculosis has a decreasing trend in Iran. Still, Golestan, Sistan and Baluchestan, Hormozgan, and Khuzestan provinces have a higher incidence rate compared to the other provinces.
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Affiliation(s)
- Sahar Fallah
- Faculty of Health, Mazandaran university of Medical Sciences, Sari, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Siavash Etemadinezhad
- Department of Occupational Health and Ergonomics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Simin Fallah
- Department of Linguistics, School of Literature and Human Sciences, Razi University, Kermanshah, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Qiao W, Fan J, Shang X, Wang L, Tuohetaerbaike B, Li Y, Zhang L, Huo Y, Wang J, Ma X. Bioinformation Analysis Reveals IFIT1 as Potential Biomarkers in Central Nervous System Tuberculosis. Infect Drug Resist 2022; 15:35-45. [PMID: 35027832 PMCID: PMC8749771 DOI: 10.2147/idr.s328197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Central nervous system tuberculosis is the most serious form of extrapulmonary tuberculosis. We aim to discover potential biomarkers involved in the development of the disease. Methods Through gene difference analysis, construction of a protein interaction network and tissue specific analysis and other bioinformatics analysis methods, we found out the relatively high expression of important substances in the central nervous system, interferon induced protein with tetratricopeptide repeats 1. Subsequently, the lesion tissue and the resection margin tissue away from the lesion were collected from the 6 cases of central nervous system tuberculosis patients diagnosed from 2019 to 2020, and the pathological manifestations were observed by Hematoxylin and Eosin (H&E) staining, and the expression of IFIT1 was verified by immunohistochemistry. Results A total of 101 differential genes were analyzed between extrapulmonary tuberculosis patients and normal people, and they were mainly enriched in the interferon pathway. The protein interaction network unearthed 34 key genes. Through tissue specific analysis, it was found that IFIT1 is relatively high in the central nervous system. H&E staining showed the expression of multinucleated macrophages, and immunohistochemistry showed that IFIT1 was significantly positively expressed in the lesion tissue. Conclusion IFIT1 is an important substance involved in central nervous system tuberculosis.
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Affiliation(s)
- Wenbin Qiao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
| | - Jiahui Fan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
| | - Xiaoqian Shang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
| | - Liang Wang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China
| | - Bahetibieke Tuohetaerbaike
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China
| | - Ying Li
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China
| | - Li Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China
| | - YiShan Huo
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
| | - Jing Wang
- Respiratory Department of the Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan, 570000, People's Republic of China
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China.,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China
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Ara SJF, Ahmed S, Saleh AA, Molla MMA, Chowdhury S, Anwar S. Endometrial Cytokine Expression from Clinically Suspected Genital Tuberculosis Patients at Tertiary Care Hospitals in Dhaka. J Clin Tuberc Other Mycobact Dis 2022; 27:100301. [PMID: 35198736 PMCID: PMC8841884 DOI: 10.1016/j.jctube.2022.100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to measure gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) expression in endometrial tissue and/or aspirate from suspected genital tuberculosis patients with ectopic pregnancy and infertility in Bangladesh. Methodology A total 78 women of clinically suspected genital tuberculosis patients were enrolled as study population. These patients underwent manual vaccum aspiration (MVA) procedure, and endometrial tissues and/or aspirates were collected. Ziehl -Neelsen staining (Z-N staining) and Lowen–Stein Jensen (L-J) culture were done to detect Mycobacterium. The study participants were categorized as genital tuberculosis positive cases, genital tuberculosis negative cases and presumptive for tuberculosis cases based on the case definition used in this study. TNF-α and IFN-γ were measured by ELISA. Statistical analysis was done using SPSS (version-22). Results Out of 78 participants, pro-inflammatory cytokines IFN-γ and TNF-α were significantly increased in TB positive patients than TB negative patients (p < 0.05). IFN-γ value of TB positive patients (41.26 ± 41.05) was higher than TB negative (22.94 ± 44.51) patients. TNF-α value (44.31 ± 64.22) of TB positive patients was higher than TB negative (15.86 ± 41.45) patients. IFN-γ and TNF-α value of presumptive for tuberculosis cases were not statistically significant. According to ROC analysis, cut off value for IFN-γ was 23.5 and for TNF-α was 10 with highest sensitivity and specificity of 66.7%, 89.3%, and 66.7% and 73.1% respectively. Conclusion IFN-γ and TNF-α were significantly higher in TB positive patients and it may act as a potential biomarker for diagnosis of genital tuberculosis.
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Khan A, Hussain A, Wahab M, Rehman A, Latif SA, Naqvi SWA, Farooq M, Zubair M. DISTRIBUTION OF DRUG SENSITIVE TUBERCULOSIS BY SEX, AGE GROUPS AND TYPE OF DISEASE IN DS-TB POPULATION OF DISTRICT D.I.KHAN, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.46903/gjms/19.02.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Tuberculosis (TB) is the 10th leading cause of death globally and is leading cause of death from a single infectious disease. The objectives of our study were to determine the distribution of drug sensitive tuberculosis (DS-TB) by sex, age groups and type of disease in DS-TB population of District D.I.Khan, Pakistan.Materials Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from January 5, 2021 to January 25, 2021. The data of 3,916 patients was retrieved from District Health Office, D.I.Khan for the period from January 1, 2019 to December 31, 2020. Sex, age groups and type of disease were categorical variables and analyzed by count and percentage with CI at 95%CL. Distribution of DR-TB by sex, age groups and type of disease was analyzed separately by chi-square goodness-of-fit test at alpha .05. Results: Out of 3,916 patients with DS-TB, women 2,110 (53.88%, 95% CI 52.32-55.44) were more than men 1,806 (46.12%, 95%CI 44.55-47.67), with most common age group of 15-44 years 1,948 (49.74%, 95%CI 48.17-51.31), and with more pulmonary 2,877 (73.47%, 95%CI 72.08-74.85%) than extrapulmonary 1,039 (26.53%, 95%CI 25.14-27.91) cases. Our observed prevalence of DS-TB in men was lower 46.12% than expected 51.72% and in women it was higher 53.88% than expected 48.28% (p.00001). Our observed distribution of DS-TB in different age groups was not similar to expected (p.00001). Our observed prevalence of pulmonary TB was lower 73.47% than expected 80.35% and in extrapulmonary TB it was higher 26.53% than expected 19.65% (p.00001).Conclusions: Drug sensitive tuberculosis was more common in women than men in DS-TB population of District D.I.Khan, Pakistan. It was highest in age group 15-44 years and higher for pulmonary TB than extrapulmonary TB. Our observed prevalence in men was lower than expected and in women it was higher than expected. Our observed prevalence for drug sensitive TB in various age groups was different than expected. Our observed prevalence for pulmonary TB was lower than expected and for extrapulmonary TB it was higher than expected.
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Li PC, Jia CY, Li DJ, Chen LP, Zheng ML, Shen ZA. [Clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects]. ZHONGHUA SHAO SHANG ZA ZHI = ZHONGHUA SHAOSHANG ZAZHI = CHINESE JOURNAL OF BURNS 2021; 37:1110-1115. [PMID: 34937152 PMCID: PMC11917352 DOI: 10.3760/cma.j.cn501120-20210929-00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects. Methods: A retrospective observational study was conducted. From April 2010 to February 2021, twelve patients who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Eighth Medical Center of PLA General Hospital, including 9 males and 3 females with age of (42±18) years. The sizes of tubercular chest wall defects of patients were ranged from 4 cm×3 cm×2 cm to 16 cm×8 cm×5 cm, which were all repaired with partial de-epithelized local flaps. The widths of flaps were equal to the widths of the defects, and the lengths of flaps were 2 cm longer than those of the defects. In one patient, the local flap was too large to close the donor site directly by suturing, so an autologous back free medium thickness skin graft was used for repair. In other patients, the collection areas of local flaps were small, and the donor areas of flaps were directly closed. The duration of operation, intraoperative bleeding, and postoperative drainage volume and indwelling time of drainage tube were observed and recorded. In two weeks after operation, the survival, color, and texture of flaps, the presence of subcutaneous hydrops and skin ulcer, and donor site healing including wound disruption, local infection, hematoma were observed. Chest X-ray, CT scan, or nuclear magnetic resonance imaging was performed in one month after operation to check whether new local hydrops and bone destruction occurred in the chest wall defects and the concomitant tuberculose focus of patients. All patients were followed up for more than 6 months to record whether the surgical incisions of the chest wall defects of the patients were complicated by hypertrophic scar, redness, swelling, and sinus. Results: In surgery, the patient had (104±18) min of operation duration, (119±53) mL of intraoperative bleeding, (134±49) mL of cumulative drainage of drainage tube, and (5.3±1.7) days of drainage tube indwelling time. In two weeks after operation, all the grafted local flaps survived, and the color and texture of flaps were similar to the surrounding normal skin. One patient had fluid leakage from the incision of chest wall defect area with the incision partially dehisced, which healed well after a phase Ⅱ operation; no wound infection, subcutaneous hydrops, or wound rupture occurred in other patients. The incisions of donor sites in all the patients healed well and no wound disruption, local infection, or hematoma occurred. One month after operation, no new bone destruction was observed in the operative region by chest imaging examination. Patients were followed up for 6 to 96 months, with one patient having wound swelling, ulceration, and sinus in the operative area of the chest wall defect in 12 months after surgery, which healed after phase Ⅱ operation; the incisions of chest wall defect wounds in other patients healed well and had no scar, redness and swelling, or sinus. Conclusions: Partially de-epithelized local flap could be used in repairing tubercular chest wall defect wounds, with the advantages of flexible flap design, minimal donor site injury, and good postoperative wound healing.
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Affiliation(s)
- P C Li
- Senior Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital, Beijing 100048, China
| | - C Y Jia
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, Xiamen 361102, China
| | - D J Li
- Senior Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital, Beijing 100048, China
| | - L P Chen
- Department of Thoracic Surgery, the Eighth Medical Center of PLA General Hospital, Beijing 100193, China
| | - M L Zheng
- Department of Thoracic Surgery, the Eighth Medical Center of PLA General Hospital, Beijing 100193, China
| | - Z A Shen
- Senior Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital, Beijing 100048, China
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Luo Y, Xue Y, Lin Q, Mao L, Tang G, Song H, Liu W, Wu S, Liu W, Zhou Y, Xu L, Xiong Z, Wang T, Yuan X, Gan Y, Sun Z, Wang F. Diagnostic Model for Discrimination Between Tuberculous Meningitis and Bacterial Meningitis. Front Immunol 2021; 12:731876. [PMID: 34867952 PMCID: PMC8632769 DOI: 10.3389/fimmu.2021.731876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background The differential diagnosis between tuberculous meningitis (TBM) and bacterial meningitis (BM) remains challenging in clinical practice. This study aimed to establish a diagnostic model that could accurately distinguish TBM from BM. Methods Patients with TBM or BM were recruited between January 2017 and January 2021 at Tongji Hospital (Qiaokou cohort) and Sino-French New City Hospital (Caidian cohort). The detection for indicators involved in cerebrospinal fluid (CSF) and T-SPOT assay were performed simultaneously. Multivariate logistic regression was used to create a diagnostic model. Results A total of 174 patients (76 TBM and 98 BM) and another 105 cases (39 TBM and 66 BM) were enrolled from Qiaokou cohort and Caidian cohort, respectively. Significantly higher level of CSF lymphocyte proportion while significantly lower levels of CSF chlorine, nucleated cell count, and neutrophil proportion were observed in TBM group when comparing with those in BM group. However, receiver operating characteristic (ROC) curve analysis showed that the areas under the ROC curve (AUCs) produced by these indicators were all under 0.8. Meanwhile, tuberculosis-specific antigen/phytohemagglutinin (TBAg/PHA) ratio yielded an AUC of 0.889 (95% CI, 0.840–0.938) in distinguishing TBM from BM, with a sensitivity of 68.42% (95% CI, 57.30%–77.77%) and a specificity of 92.86% (95% CI, 85.98%–96.50%) when a cutoff value of 0.163 was used. Consequently, we successfully established a diagnostic model based on the combination of TBAg/PHA ratio, CSF chlorine, CSF nucleated cell count, and CSF lymphocyte proportion for discrimination between TBM and BM. The established model showed good performance in differentiating TBM from BM (AUC: 0.949; 95% CI, 0.921–0.978), with 81.58% (95% CI, 71.42%–88.70%) sensitivity and 91.84% (95% CI, 84.71%–95.81%) specificity. The performance of the diagnostic model obtained in Qiaokou cohort was further validated in Caidian cohort. The diagnostic model in Caidian cohort produced an AUC of 0.923 (95% CI, 0.867–0.980) with 79.49% (95% CI, 64.47%–89.22%) sensitivity and 90.91% (95% CI, 81.55%–95.77%) specificity. Conclusions The diagnostic model established based on the combination of four indicators had excellent utility in the discrimination between TBM and BM.
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Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiji Wu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiyong Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhou
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Lingqing Xu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Zhigang Xiong
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Yuan
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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The Role of Thyroid Hormones in the Differential Diagnosis of Tuberculous and Parapneumonic Pleural Effusions. Am J Med Sci 2021; 363:495-501. [PMID: 34843677 DOI: 10.1016/j.amjms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/07/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The differential diagnosis of tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE) is challenging due to similar clinical manifestations and body fluid biochemical profiles. Thyroid hormone levels change in response to lymphocyte proliferation in the peripheral blood of patients with mycobacterial infections such as tuberculosis; therefore, this study aimed to investigate the utility of assessing thyroid hormone levels to aid in the differential diagnosis of TPE and PPE. METHODS We measured free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels in the pleural effusions of 59 newly admitted patients (32 and 27 with TPE and PPE, respectively). Hormone levels were assessed using an electrochemiluminescence technique, and the diagnostic parameters for tuberculosis were evaluated. Differences in hormone levels between patients with TPE and PPE were assessed by t-tests, and their diagnostic value for a differential diagnosis was evaluated by receiver operating characteristic curve analyses. RESULTS FT3 and FT4 levels in patients with TPE were significantly higher than those in patients with PPE (p < 0.01 and p < 0.05, respectively), whereas TSH expression did not significantly differ between the two groups (p > 0.05). FT3 and FT4 levels showed no correlation with sex or history of smoking, although FT3 levels decreased with age. The highest sensitivity was observed for the quantification of FT3 levels (84.38%). CONCLUSIONS Increased FT3 and FT4 levels could potentially be used for the differential diagnosis of TPE and PPE.
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Qiao X, Shao MM, Yi FS, Shi HZ. Complement Component C1q as an Emerging Biomarker for the Diagnosis of Tuberculous Pleural Effusion. Front Microbiol 2021; 12:765471. [PMID: 34790186 PMCID: PMC8591783 DOI: 10.3389/fmicb.2021.765471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: The accurate differential diagnosis of tuberculous pleural effusion (TPE) from other exudative pleural effusions is often challenging. We aimed to validate the accuracy of complement component C1q in pleural fluid (PF) in diagnosing TPE. Methods: The level of C1q protein in the PF from 49 patients with TPE and 61 patients with non-tuberculous pleural effusion (non-TPE) was quantified by enzyme-linked immunosorbent assay, and the diagnostic performance was assessed by receiver operating characteristic (ROC) curves based on the age and gender of the patients. Results: The statistics showed that C1q could accurately diagnose TPE. Regardless of age and gender, with a cutoff of 6,883.9 ng/mL, the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of C1q for discriminating TPE were 0.898 (95% confidence interval: 0.825-0.947), 91.8 (80.4-97.7), 80.3 (68.2-89.4), 78.9 (69.2-86.2), and 92.5 (82.6-96.9), respectively. In subgroup analysis, the greatest diagnostic accuracy was achieved in the younger group (≤ 50 years of age) with an AUC of 0.981 (95% confidence interval: 0.899-0.999) at the cutoff of 6,098.0 ng/mL. The sensitivity, specificity, PLR, NLR, PPV, and NPV of C1q were 95.0 (83.1-99.4), 92.3 (64.0-99.8), 97.4 (85.2-99.6), and 85.7 (60.6-95.9), respectively. Conclusion: Complement component C1q protein was validated by this study to be a promising biomarker for diagnosing TPE with high diagnostic accuracy, especially among younger patients.
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Affiliation(s)
- Xin Qiao
- Department of Respiratory and Critical Care Medicine, Clinical Center for Pleural Diseases, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ming-Ming Shao
- Department of Respiratory and Critical Care Medicine, Clinical Center for Pleural Diseases, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Feng-Shuang Yi
- Department of Respiratory and Critical Care Medicine, Clinical Center for Pleural Diseases, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Clinical Center for Pleural Diseases, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Kang W, Liu S, Du J, Tang P, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Dong Y, Yang Z, Mei Z, Deng Q, Wang P, Han W, Yan X, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A E, Du Y, Liu F, Cui W, Wang Q, Chen X, Han J, Xie Q, Feng Y, Liu W, Yang S, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Shen X, Zhang J, Liu Y, Guo S, Yan K, Yang M, Lei D, Zhang Y, Wu M, Lia N, Tang S. The epidemiology of concurrent extrapulmonary tuberculosis in inpatients with extrapulmonary tuberculosis lesions in China: a large-scale observational multi-center investigation. Int J Infect Dis 2021; 115:79-85. [PMID: 34781005 DOI: 10.1016/j.ijid.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
AIMS A high proportion of all tuberculosis (TB) cases present with extrapulmonary tuberculosis (EPTB), including concurrent EPTB involving more than one extrapulmonary lesion site within the body. However, previous reports only characterised lesions of single-site EPTB cases. This study aimed to investigate epidemiological characteristics and association rules of concurrent EPTB cases in China. METHODS An observational multi-centre study was carried out in China from Jan 2011 to Dec 2017 that included a total of 208,214 patients with EPTB lesions. Multivariable logistic regression analysis was used to identify associations between gender and age with concurrent EPTB. Association rules were analysed for significance using the Apriori algorithm. RESULTS The most prevalent form of EPTB lesion was tuberculous pleurisy (49.8%), followed by bronchial tuberculosis (14.8%) and tuberculous meningitis (7.6%). The most predominant concurrent EPTB case type was tuberculous pleurisy concurrent with tuberculous peritonitis (1.80%). Altogether 22 association rules were identified that included 20 strong association rules, among which highest confidence rates were found for tuberculous myelitis concurrent with tuberculous meningitis and sacral TB concurrent with lumbar vertebral TB. Moreover, association rules of EPTB concurrent with other EPTB types were found to vary with gender and age. The confidence rate of tuberculous myelitis concurrent with tuberculous meningitis was higher in females (83.67%) than males and highest in patients of ages 25-34 years (87.50%). CONCLUSIONS Many types of concurrent EPTB were found. Thus, greater awareness of concurrent EPTB disease characteristics is needed to ensure timely clinical diagnosis and treatment of this disease.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | | | - Jian Du
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Peijun Tang
- The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu, China
| | - Hongyan Chen
- Shenyang Chest Hospital, Liaoning, Shenyang, China
| | - Jianxiong Liu
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Mingwu Li
- The Third People's Hospital of Kunming, Kunming, Yunnan, China
| | - Jingmin Qin
- Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Wei Shu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Peilan Zong
- Jiangxi Chest Hospital, Nanchang, Jiangxi, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, Changchun, Jilin, China
| | - Yongkang Dong
- Taiyuan Fourth People's Hospital, Taiyuan, Shanxi, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, Fuzhou, Fujian, China
| | | | - Qunyi Deng
- Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenge Han
- Weifang NO.2 People's Hospital, Weifang, Shandong, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, Chongqing, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Xinguo Zhao
- The Fifth People's Hospital of Wuxi, Wuxi, Jiangsu, China
| | - Lei Tan
- TB Hospital of Siping City, Siping, Jilin, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, Baoding, Hebei, China
| | - Chao Zheng
- The First Affiliated of Xiamen University, Xiamen, Fujian, China
| | - Hongwei Liu
- Shenyang Chest Hospital, Liaoning, Shenyang, China
| | - Xinjie Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Ertai A
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Yingrong Du
- The Third People's Hospital of Kunming, Kunming, Yunnan, China
| | - Fenglin Liu
- Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, Changchun, Jilin, China
| | - Quanhong Wang
- Taiyuan Fourth People's Hospital, Taiyuan, Shanxi, China
| | - Xiaohong Chen
- Fuzhou Pulmonary Hospital of Fujian, Fuzhou, Fujian, China
| | | | - Qingyao Xie
- Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyu Liu
- Weifang NO.2 People's Hospital, Weifang, Shandong, China
| | - Song Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jian Zheng
- The Fifth People's Hospital of Wuxi, Wuxi, Jiangsu, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, Baoding, Hebei, China
| | - Xiangyang Yao
- The First Affiliated of Xiamen University, Xiamen, Fujian, China
| | - Tong Ren
- Shenyang Chest Hospital, Liaoning, Shenyang, China
| | - Yan Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Lei Wu
- The Third People's Hospital of Kunming, Kunming, Yunnan, China
| | - Qiang Song
- Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Xinghua Shen
- The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, Changchun, Jilin, China
| | | | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Yan
- Weifang NO.2 People's Hospital, Weifang, Shandong, China
| | - Mei Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, Baoding, Hebei, China
| | - Meiying Wu
- The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu, China.
| | - Ng Lia
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
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The potential of metagenomic next-generation sequencing in diagnosis of spinal infection: a retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:442-447. [PMID: 34677679 DOI: 10.1007/s00586-021-07026-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Metagenomic next-generation sequencing (mNGS) is a new approach to identify the infecting organism in infectious diseases. Our aim was to evaluate the accuracy of mNGS in determining the etiology of spinal infection. METHODS In this retrospective study, patients who had a suspected spinal infection and underwent mNGS for diagnosis in our hospital were eligible for inclusion. Samples for mNGS, culture, and histopathological tests were collected surgically or with a CT-guided needle biopsy. Sensitivity and specificity were calculated for mNGS and culture test, using histopathological results as reference. RESULTS A total of 31 mNGS tests in 30 cases were included. Twenty-six cases were classified as infected, and four cases were considered aseptic. mNGS achieved a specificity of 75.0% [95% confidence interval (CI), 21.9% to 98.7%], sensitivity was 70.3% (95% CI, 49.7% to 85.5%). mNGS was more sensitive than culture at 14.8% (95% CI, 4.9% to 34.6%, P < 0.0001). However, the specificities of mNGS and culture were statistically similar. CONCLUSION We described here the power of mNGS in the etiological diagnosing of spinal infection. Our study opens the possibility for more extensive use of mNGS techniques in the identification of pathogens in patients with suspected spinal infection.
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125
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Lau LHW, Wong NS, Leung CC, Chan CK, Lau AKH, Tian L, Lee SS. Seasonality of tuberculosis in intermediate endemicity setting dominated by reactivation diseases in Hong Kong. Sci Rep 2021; 11:20259. [PMID: 34642391 PMCID: PMC8511215 DOI: 10.1038/s41598-021-99651-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022] Open
Abstract
Summer-spring predominance of tuberculosis (TB) has been widely reported. The relative contributions of exogenous recent infection versus endogenous reactivation to such seasonality remains poorly understood. Monthly TB notifications data between 2005 and 2017 in Hong Kong involving 64,386 cases (41% aged ≥ 65; male-to-female ratio 1.74:1) were examined for the timing, amplitude, and predictability of variation of seasonality. The observed seasonal variabilities were correlated with demographics and clinical presentations, using wavelet analysis coupled with dynamic generalised linear regression models. Overall, TB notifications peaked annually in June and July. No significant annual seasonality was demonstrated for children aged ≤ 14 irrespective of gender. The strongest seasonality was detected in the elderly (≥ 65) among males, while seasonal pattern was more prominent in the middle-aged (45–64) and adults (30–44) among females. The stronger TB seasonality among older adults in Hong Kong suggested that the pattern has been contributed largely by reactivation diseases precipitated by defective immunity whereas seasonal variation of recent infection was uncommon.
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Affiliation(s)
- Leonia Hiu Wan Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong , China
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Chiu Leung
- Hong Kong Tuberculosis, Chest and Heart Disease Association, Hong Kong, China
| | - Chi Kuen Chan
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, China
| | - Alexis K H Lau
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Hong Kong, China.,Division of Environment and Sustainability, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Linwei Tian
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
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Diriba G, Tola HH, Alemu A, Yenew B, Gamtesa DF, Kebede A. Drug resistance and its risk factors among extrapulmonary tuberculosis in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0258295. [PMID: 34624050 PMCID: PMC8500428 DOI: 10.1371/journal.pone.0258295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background Drug-resistant tuberculosis and extrapulmonary tuberculosis are the world major public health issues. Although some primary studies have been reported on the burden of drug-resistant tuberculosis in extrapulmonary tuberculosis patients in Ethiopia, there is no systematic review and meta-analysis that attempt to summarize the available literature. Thus, we aimed to estimates the prevalence of drug-resistance in extrapulmonary tuberculosis patients and summarize the risk factors associated with the occurrence of extrapulmonary tuberculosis in Ethiopia. Methods We conducted a systematic review of the published primary studies on extrapulmonary drug-resistant tuberculosis in Ethiopia. Results Eight observational studies were included in this review from different regions of Ethiopia. The overall pooled prevalence of rifampicin resistance was 6% (95% CI 0.03–0.10), while isoniazid resistance was 7% (95% CI 0.03–0.12). The pooled prevalence of multidrug-resistant tuberculosis was 4% (95% CI 0.01–0.07). Previous tuberculosis treatment history and male gender are frequently reported risk factors for developing drug-resistant tuberculosis in extrapulmonary tuberculosis patients. Conclusion The current review has identified a high proportion of resistance to rifampicin, isoniazid, and multidrug-resistant tuberculosis in patients with extrapulmonary tuberculosis in Ethiopia. Clinicians should request drug susceptibility testing for all patients with presumptive extrapulmonary tuberculosis to detect drug-resistance.
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Affiliation(s)
- Getu Diriba
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Habteyes Hailu Tola
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bazezew Yenew
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dinka Fikadu Gamtesa
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebaw Kebede
- Ethiopia National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Chen L, Fu X, Tian P, Li Q, Lei D, Peng Z, Liu Q, Li N, Zhang J, Xu P, Zhang H. Upward trends in new, rifampicin-resistant and concurrent extrapulmonary tuberculosis cases in northern Guizhou Province of China. Sci Rep 2021; 11:18023. [PMID: 34504296 PMCID: PMC8429731 DOI: 10.1038/s41598-021-97595-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/19/2021] [Indexed: 01/26/2023] Open
Abstract
Similar to global trends, the incidence rate of tuberculosis (TB) in China declined from 2000 to 2018. In this study, we aimed to evaluate TB trends in northern Guizhou Province and identify risk factors associated with rifampicin-resistant (RR) and concurrent extrapulmonary TB (EPTB). We analyzed data of TB patients hospitalized in Affiliated Hospital of Zunyi Medical University from 2011 to 2018, and assessed correlations between demographic characteristics of patients and RR-TB as well as concurrent EPTB. Our results showed that numbers of new, retreated, RR-TB and concurrent EPTB cases increased gradually from 2011 to 2018. Retreated patients had the highest odds of RR-TB but a lower likelihood of concurrent EPTB compared to new patients. Patients between 21 and 40 years of age had a higher likelihood of RR-TB compared to those 20 years and younger. Female patients and patients from Bijie city as well as the Miao ethnic minority had higher odds of concurrent EPTB. In summary, our data demonstrate upward trends in new, rifampicin-resistant and concurrent extrapulmonary TB cases in northern Guizhou Province of China, which should not be overlooked especially during and post the COVID-19 pandemic because TB is a greater long-term global health threat than COVID-19.
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Affiliation(s)
- Ling Chen
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Xuefeng Fu
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Peng Tian
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Qing Li
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Dan Lei
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Zhangli Peng
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Quanxian Liu
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Nana Li
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - Jianyong Zhang
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China.
| | - Peng Xu
- Institute of Life Sciences, Zunyi Medical University, Zunyi, 563003, China.
| | - Hong Zhang
- Tuberculosis Division of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China. .,Z-BioMed, Inc., Rockville, MD, 20855, USA.
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Al-Zanbagi AB, Shariff MK. Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment. Saudi J Gastroenterol 2021; 27:261-274. [PMID: 34213424 PMCID: PMC8555774 DOI: 10.4103/sjg.sjg_148_21] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.
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Affiliation(s)
- Adnan B. Al-Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - M. K. Shariff
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
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129
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Oda N, Koyama T, Ikeda G, Takata I. Nasopharyngeal tuberculosis detected on imaging. BMJ Case Rep 2021; 14:e245736. [PMID: 34376427 PMCID: PMC8356152 DOI: 10.1136/bcr-2021-245736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Naohiro Oda
- Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Takahisa Koyama
- Otorhinolaryngology, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Genyo Ikeda
- Respiratory Medicine, Chugoku Central Hospital, Fukuyama, Hiroshima, Japan
| | - Ichiro Takata
- Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
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Li SY, Li J, Dong XH, Teng GG, Zhang W, Cheng H, Gao W, Dai Y, Zhang XH, Wang WH. The effect of previous eradication failure on antibiotic resistance of Helicobacter pylori: A retrospective study over 8 years in Beijing. Helicobacter 2021; 26:e12804. [PMID: 33860967 DOI: 10.1111/hel.12804] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Antibiotic resistance is the main cause of Helicobacter pylori (H. pylori) treatment failure. This study aimed to explore the characteristics of antibiotic resistance of H. pylori isolates in Beijing in the last 8 years and to estimate the impact of previous eradication failure on resistance patterns. MATERIALS AND METHODS This retrospective study included data from a single center in Beijing from 2013 to 2020. Antibiotic susceptibility of 365 clinical H. pylori isolates was tested for amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline. The characteristics of the included patients and their previous eradication history were collected. Primary and secondary resistance rates of H. pylori to the six antibiotics and the impact of previous eradication failure on antibiotic resistance patterns were analyzed. RESULTS The overall primary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline were 0.7%, 55.2%, 68.0%, 49.7%, 64.5%, and 0%, with no significant increase during the observed period; while the secondary resistance rates were 3.2%, 96.7%, 90.7%, 93.1%, 80.0%, and 0%, respectively. The secondary resistance rate of clarithromycin (p < .001), metronidazole (p = .001), and levofloxacin (p < .001) significantly increased to 100% as the number of previous eradication therapies increased and exhibited a linear association. For strains naive to eradication, only 6.8% were susceptible to all the antibiotics, while 32.4% were single resistant, and 60.8% dual or multiple resistant. Clarithromycin+metronidazole+fluoroquinolone multiple resistance was the predominant pattern (0 course: 21.6%, 1 course: 37.5%, 2 courses: 56.1%, ≥3 courses: 71.1%; p < .001) for patients with treatment failure. The prevalence of dual or multiple-resistance patterns increased significantly as the number of previous therapies increased. CONCLUSIONS The prevalence of primary and secondary resistance rates of clarithromycin, metronidazole, moxifloxacin, and levofloxacin were high in Beijing. Multiple-resistance patterns were common after treatment failure. Resistance rates of amoxicillin and tetracycline remained low and stable.
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Affiliation(s)
- Si-Yu Li
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Jiang Li
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Xin-Hong Dong
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Gui-Gen Teng
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Hong Cheng
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Wen Gao
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Yun Dai
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Xiao-He Zhang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Wei-Hong Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
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Sun J, Zhang H, Song Z, Jin L, Yang J, Gu J, Ye D, Yu X, Yang J. The negative impact of increasing age and underlying cirrhosis on the sensitivity of adenosine deaminase in the diagnosis of tuberculous peritonitis: a cross-sectional study in eastern China. Int J Infect Dis 2021; 110:204-212. [PMID: 34332087 DOI: 10.1016/j.ijid.2021.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Our study aimed to evaluate the correlation between the sensitivity of adenosine deaminase (ADA) testing for the diagnosis of tuberculous peritonitis (TBP) and patient age or cirrhosis status. METHODS Clinical data for patients clinically diagnosed with TPB (n = 132) or not (n = 147) were assessed. ADA activity was compared among three age groups (< 45 yr, 45-60 yr, and ≥ 60 yr) and among cirrhosis-related subgroups. Cut-off values for the ADA test were analyzed among three patient populations (young non-cirrhotic, n = 97; older non-cirrhotic, n = 115; cirrhotic, n = 67), and validated in a cohort of 259 participants. RESULTS According to the multivariate regression analyses, age < 45 yr is highly predictive of TBP risk. The young non-cirrhotic TBP patients had higher ADA activity than the middle-aged or old controls (p < 0.01). Significantly decreased activity and efficacy of ADA were observed in the cirrhotic subgroup/population, regardless of age or cohort. For the above-mentioned two non-cirrhotic populations in the validation cohort, the ADA test showed excellent performance using thresholds of 30.5 IU/L and 20.5 IU/L, with respective sensitivities of 91.1% and 92.6%. CONCLUSIONS ADA activity is negatively associated with increasing age and underlying cirrhosis. Optimizing cut-off values for the ADA test can increase its sensitivity in non-cirrhotic individuals older than 45 years.
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Affiliation(s)
- Jian Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Huatang Zhang
- Department of Infectious Diseases, the First Hospital of Quanzhou, Fujian Medical University, Quanzhou 362000, China
| | - Zhiwei Song
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou 318000, China
| | - Lei Jin
- Department of Gastroenterology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Jian Yang
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Jun Gu
- Department of Gastroenterology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Dan Ye
- Department of Infectious Diseases, Taizhou Municipal Hospital, Taizhou 318000, China
| | - Xueping Yu
- Department of Infectious Diseases, the First Hospital of Quanzhou, Fujian Medical University, Quanzhou 362000, China.
| | - Jianghua Yang
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China.
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132
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Yu G, Shen Y, Ye B, Shi Y. Diagnostic accuracy of Mycobacterium tuberculosis cell-free DNA for tuberculosis: A systematic review and meta-analysis. PLoS One 2021; 16:e0253658. [PMID: 34161399 PMCID: PMC8221493 DOI: 10.1371/journal.pone.0253658] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diagnosis of tuberculosis (TB) is still difficult. The purpose of our study was to evaluate the diagnostic accuracy of Mycobacterium tuberculosis cell-free DNA (cfDNA) for diagnosing of TB. METHODS We searched relevant databases for studies that used cfDNA to diagnose TB. We evaluated the accuracy of cfDNA compared with the composite reference standard (CRS) and culture. True positive, false positive, false negative, and true negative values for cfDNA were obtained first, then the estimated pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve (AUC) of cfDNA for diagnosing TB were calculated with 95% confidence intervals (CIs). Heterogeneity was determined using the I2 statistic. When the heterogeneity was obvious, the source of heterogeneity was further discussed. RESULTS We included 14 independent studies comparing cfDNA with the CRS, and 4 studies compared with culture. The pooled sensitivity, specificity, PPV, NPV, DOR, and AUC of the SROC were 68%, 98%,99%, 62%, 83, and 0.97 as compared with the CRS, respectively. The pooled sensitivity, specificity, PPV, NPV, DOR, and AUC of the SROC were 48%, 91%, 92%, 60%, 5, and 0.88 as compared with culture, respectively. The heterogeneity between studies was significant. CONCLUSIONS The accuracy of cfDNA testing for TB diagnosis was good compared with CRS and culture. cfDNA can be used for rapid early diagnosis of TB.
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Affiliation(s)
- Guocan Yu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Ye
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Shi
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Isaguliants M, Nosik M, Karlsen A, Petrakova N, Enaeva M, Lebedeva N, Podchufarova D, Laga V, Gromov K, Nazarov A, Chowdhury S, Sinitsyn M, Sobkin A, Chistyakova N, Aleshina S, Grabarnik A, Palefsky JM. Prevalence and Risk Factors of Infection with High Risk Human Papilloma Viruses among HIV-Positive Women with Clinical Manifestations of Tuberculosis in a Middle-Income Country. Biomedicines 2021; 9:biomedicines9060683. [PMID: 34208764 PMCID: PMC8234035 DOI: 10.3390/biomedicines9060683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022] Open
Abstract
Women living with HIV-1 are at high risk of infection with human papillomavirus of high carcinogenic risk (HR HPVs). M. tuberculosis (TB) promotes HPV infection and increases the risk to develop HPV-associated cancer. Our knowledge of persisting HR HPVs genotypes, and of the factors promoting HR HPV infection in people living with HIV-1 with clinical TB manifestations is sparse. Here, we analyzed 58 women living with HIV-1 with clinical TB manifestations (WLWH with TB) followed up in specialized centers in Russia, a middle income country endemic for HIV-1 and TB, for the presence in cervical smears of DNA of twelve HR HPV genotypes. DNA encoding HPV16 E5, E6/E7 was sequenced. Sociodemographic data of patients was collected by questionnaire. All women were at C2-C3 stages of HIV-infection (by CDC). The majority were over 30 years old, had secondary education, were unemployed, had sexual partners, experienced 2–3 pregnancies and at least one abortion, and were smokers. The most prevalent was HPV16 detected in the cervical smears of 38% of study participants. Altogether 34.5% of study participants were positive for HR HPV types other than HPV16; however, but none of these types was seen in more than 7% of tested samples. Altogether, 20.7% of study participants were positive for several HR HPV types. Infections with HPVs other than HPV16 were common among WLWH with generalized TB receiving combined ART/TB-therapy, and associated with their ability to work, indirectly reflecting both their health and lifestyle. The overall prevalence of HR HPVs was associated with sexual activity of women reflected by the number of pregnancies, and of HPV 16, with young age; none was associated to CD4+-counts, route of HIV-infection, duration of life with HIV, forms of TB-infection, or duration of ART, characterizing the immune status. Thus, WLWH with TB—especially young—were predisposed to infection with HPV16, advancing it as a basis for a therapeutic HPV vaccine. Phylogenetic analysis of HPV16 E5, E6/E7 DNA revealed no common ancestry; sequences were similar to those of the European and American HPV16 strains, indicating that HPV vaccine for WLWH could be the same as HPV16 vaccines developed for the general population. Sociodemographic and health correlates of HR HPV prevalence in WLWH deserve further analysis to develop criteria/recommendations for prophylactic catch-up and therapeutic HPV vaccination of this highly susceptible and vulnerable population group.
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Affiliation(s)
- Maria Isaguliants
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
- Institute of Microbiology and Virology, Riga Stradins University, LV-1007 Riga, Latvia
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
- Correspondence: or
| | - Marina Nosik
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia;
| | - Anastasia Karlsen
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia;
- Medical Academy for Continuous Professional Education, 125993 Moscow, Russia
| | - Natalia Petrakova
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | - Marina Enaeva
- Moscow Clinical Scientific Center Named after A.S. Loginov, 111123 Moscow, Russia;
| | - Natalia Lebedeva
- Moscow Regional Center for Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia; (N.L.); (D.P.)
| | - Daria Podchufarova
- Moscow Regional Center for Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia; (N.L.); (D.P.)
| | - Vita Laga
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | - Konstantin Gromov
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | | | - Sona Chowdhury
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (S.C.); (J.M.P.)
| | - Mikhail Sinitsyn
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Alexander Sobkin
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (A.S.); (N.C.)
| | - Natalya Chistyakova
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (A.S.); (N.C.)
| | - Svetlana Aleshina
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Alexei Grabarnik
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Joel M. Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (S.C.); (J.M.P.)
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Ruan H, Liu F, Gong C, Yang X, Han M. Risk factors associated with postoperative respiratory failure in tuberculous empyema patients. Medicine (Baltimore) 2021; 100:e25754. [PMID: 34114982 PMCID: PMC8202599 DOI: 10.1097/md.0000000000025754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.
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Affiliation(s)
| | | | | | - Xinting Yang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, PR China
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Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
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136
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Sun W, Zhou Y, Li W, Wang Y, Xiong K, Zhang Z, Fan L. Diagnostic yield of Xpert MTB/RIF on contrast-enhanced ultrasound-guided pleural biopsy specimens for pleural tuberculosis. Int J Infect Dis 2021; 108:89-95. [PMID: 33992762 DOI: 10.1016/j.ijid.2021.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A 3-year prospective study was conducted to evaluate the efficacy of Xpert MTB/RIF (Xpert) in the diagnosis of pleural tuberculosis (pTB) on contrast -enhanced ultrasound (CEUS)-guided pleural biopsy specimens. METHOD Patients suspected with pTB were prospectively enrolled to receive CEUS-guided biopsy. Specimens (pleural tissue and fluid) were submitted for Xpert and other routine examinations. Surgical thoracoscopy was performed on undiagnosed cases. RESULT A total of 316 patients were enrolled, including 280 cases of pTB (definite 195, possible 85) and 36 cases of non-pTB. The sensitivity of Xpert was 69.64% (195/280) in biopsy specimens, which was significantly higher than that in pleural effusion specimens (p < 0.01). In 195 definite cases, the highest sensitivity of 100% (195/195) and NPV of 29.75% (36/121) were achieved by Xpert on biopsy specimens. Xpert-positive results were obtained in 149 culture-negative cases and 90 histopathological MTB PCR-negative cases. The incidence of necrosis by CEUS in Xpert-positive pTB was significantly higher than that in Xpert-negative pTB (χ2 = 72.41; p < 0.01). No serious complications occurred. CONCLUSION Xpert achieved highly diagnostic sensitivity in pTB through CEUS-guided biopsy sampling, especially on necrotic lesions, which was proven to be efficient, minimally invasive and safe.
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Affiliation(s)
- Wenwen Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Yiming Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenting Li
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Yin Wang
- Department of Ultrasound, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kunlong Xiong
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Zhemin Zhang
- Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China.
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137
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Junus HN, Mertaniasih NM, Soedarsono S. Validity of Method for MTBC and NTM Detection in FNAB Specimens from Tuberculous Lymphadenitis Using Microscopy, XPERT MTB / RIF and Culture Method. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2021. [DOI: 10.20473/ijtid.v9i1.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium tuberculosis and Nontuberculous Mycobacteria usually cause infection in tuberculous lymphadenitis. To improve accuracy of the detection MTB and NTM bacteria it is necessary to select valid methods. This study aims to compare validity of diagnostic methods from FNAB specimens for determining tuberculous lymphadenitis patients. a descriptive observational laboratory study involved 35 samples were obtained from tuberculous lymphadenitis patients in Dr. Soetomo Hospital Surabaya East Java. All specimens examined Ziehl-Neelsen staining microscopy, Xpert MTB/RIF , culture method Middlebrook7H10 solid media and MGIT as Gold standard. Identification of MTB dan NTM with SD Bioline TB Ag MPT64 and niacin paper strip BD . Used diagnostic test 2x2 to analyze sensitivity, specificity, negative predictive value and positive predictive value. Ziehl-Neelsen staining microscopy Sensitivity 83,33 % and Specificity 95,65% of , PPV 90,91%and NPV 91,67%, Diagnostic Accuracy 91,43 % . Xpert MTB/RIF Sensitivity 75% and Specificity 95,65% , PPV 90 % and NPV 88 %, Diagnostic Accuracy 88,57 % with 95% CI (Confidence Interval ) . Characteristics female dominated 23/35 (65.7%) while Male numbered 12/35 (34.3%), age range distribution of TB lymphadenitis patients is highest in young adults 17 years to 25 years as many as 15/35 (42.9%) the second highest is the age group of 36 years to 45 years by 8/35 (22.9%), Clinicial presentation are mostly lymph node enlargement in cervical 37% patients other locations supraclavicular ,mamae. Clinical symptoms mostly lymphadenopathy 31,5% and other lymphadenopathy with fever. Microscopy method still have the good validity shoul be conjunction with the molecular rapid tests and culture as gold standard in determining the diagnosis of TB lymphadenitis.
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Addo SO, Mensah GI, Mosi L, Abrahams A, Bonfoh B, Kazwala R, Zinsstag J, Addo KK. Trends in extrapulmonary TB cases at three teaching hospitals in Ghana, 2008-2017. Public Health Action 2021; 11:26-32. [PMID: 33777718 PMCID: PMC7987251 DOI: 10.5588/pha.20.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Three teaching hospitals in Ghana. OBJECTIVE To elucidate trends in demographics, clinical characteristics and treatment outcomes in extrapulmonary TB (EPTB) patients. DESIGN This was a retrospective study involving the review and comparison of EPTB and pulmonary TB (PTB) data from 1 January 2008 to 31 December 2017 in TB registers and treatment cards. RESULTS Of 15,392 TB cases, 4607 (30%) were EPTB, including 4477/4607 (97%) new cases. There were 2,679/4607 (58%) males and the age range was 0.3 to 96 years. Pleural TB (1021/4607, 22%) was the most common. Treatment success rates for EPTB and PTB were respectively 72% and 84%. HIV positivity was high among patients with disseminated/miliary TB (429/779, 55%) and TB meningitis (242/526, 46%). To note, disseminated/miliary TB (χ2 = 33.53, P < 0.0001) increased, whereas TB meningitis (χ2 = 19.43, P < 0.0001) decreased over the 10-year period. Mortality among EPTB patients was associated with increasing age (⩾25 years), disseminated/miliary TB, TB meningitis and HIV positivity. CONCLUSIONS There is male preponderance for both EPTB and PTB in Ghana. Increasing age, disseminated/ miliary TB, TB meningitis and HIV are risk factors for mortality among EPTB patients. This emphasises the need for public education on the risk factors for EPTB and preventive strategies.
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Affiliation(s)
- S O Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - G I Mensah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - L Mosi
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - A Abrahams
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - B Bonfoh
- Centre Suisse de Recherches Scientifique en Cote d'Ivoire, Abidjan, Cote d'Ivoire
| | - R Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - J Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - K K Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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139
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Lin L, Li S, Xiong Q, Wang H. A retrospective study on the combined biomarkers and ratios in serum and pleural fluid to distinguish the multiple types of pleural effusion. BMC Pulm Med 2021; 21:95. [PMID: 33740937 PMCID: PMC7980630 DOI: 10.1186/s12890-021-01459-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/05/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate the biomarkers and ratios in serum and pleural fluid (PF) for the differential diagnosis of the multiple types of PE and search for a new diagnostic strategy for PE. Methods In-patients, who developed tuberculous PE (TPE), malignant PE (MPE), complicated parapneumonic effusion (CPPE), uncomplicated PPE (UPPE), or PE caused by connective tissue diseases (CTDs) and underwent thoracentesis at Peking University People’s Hospital from November 2016 to April 2019, were included in this study. Eleven biomarkers and their ratios in serum and PF were investigated and compared between pairs of the different PE groups, and a decision-tree was developed. Results Totally 112 PE cases, including 25 MPE, 33 TPE, 19 CPPE, 27 UPPE, and 8 PE caused by CTDs, were reviewed. Biomarkers and ratios showed good diagnostic performance with high area under the curve values, sensitivities, and specificities for the differential diagnosis of the multiple types of PE. According to the decision-tree analysis, the combination of adenosine deaminase (ADA), serum albumin, serum lactate dehydrogenase, total protein, PF-LDH/ADA, and PF-LDH/TP provided the best predictive capacity with an overall accuracy of 84.8%; the sensitivity and specificity for TPE diagnosis were 100% and 98.7%, respectively. Conclusion The biomarkers and ratios showed good diagnostic performance, and a decision-tree with an overall accuracy of 84.8% was developed to differentiate the five types of PE in clinical settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01459-w.
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Affiliation(s)
- Liyan Lin
- Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China.,Department of Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
| | - Shuguang Li
- Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China. .,Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
| | - Qiao Xiong
- School of Public Health, The University of Sydney, Sydney, 2006, Australia
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China. .,Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
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140
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Lei X, Wang J, Yang Z. Diagnostic Accuracy of Pleural Effusion Mononuclear Cells/Leukocyte Ratio in Tuberculous Pleurisy. Front Med (Lausanne) 2021; 8:639061. [PMID: 33816527 PMCID: PMC8012480 DOI: 10.3389/fmed.2021.639061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Tuberculous pleurisy (TBP) is a common clinical type of tuberculosis (TB) in China. TBP is difficult to diagnose. Whether the mononuclear cell/leukocyte (MNC/LEU) ratio in pleural effusion can contribute to accurate TBP diagnosis remains yet unclear. Objective: To explore the diagnostic value of MNC/LEU ratio in pleural effusion for TBP in China. Methods: This study was a retrospective case-control study involving 406 patients with pleural effusion of unknown cause who were hospitalized at the Henan Provincial People's Hospital. Using histopathological examination of thoracoscopic pleural biopsy as the gold standard for TBP diagnosis, a final total of 215 subjects were included in this study including 91 cases of TBP and 124 cases of non-TBP. The receiver operating characteristic (ROC) curve of pleural effusion MNC/LEU ratio for TBP diagnosis was plotted and the area under curve (AUC) and the optimal cutoff value were determined. In addition, the sensitivity, specificity and accuracy of the MNC/LEU ratio at the optimal cutoff value for TBP diagnosis were also evaluated. Results: The MNC/LEU ratio was significantly higher in TB pleural effusion [95.9% (89.7–98.0%)] than in non-TB pleural effusion [77.8% (39.3–93.2%)] (P < 0.001). The AUC was 0.776 (95% CI, 0.714–0.830), and the sensitivity, specificity and accuracy for TBP diagnosis at the 93.7% cutoff value were 64.83%, 79.03%, and 0.730, respectively. Conclusion: The pleural effusion MNC/LEU ratio may be a new and valuable laboratory indicator for the diagnosis of tuberculous pleurisy in China.
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Affiliation(s)
- Xiaoli Lei
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Junli Wang
- Department of Cardiopulmonary Function, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Zhigang Yang
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
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141
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Prihadi JC, Putra AC, Wahyudi Y. Biopsy-confirmed Genitourinary Tuberculosis in a Secondary Health Care Hospital: An Evidence-based Clinical Review. Res Rep Urol 2021; 13:133-137. [PMID: 33763390 PMCID: PMC7982704 DOI: 10.2147/rru.s286899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Tuberculosis (TB) is a worldwide disease and remains a major public health problem in developing countries, with 95% of cases occurring in developing countries, including Indonesia. It is caused by Mycobacterium tuberculosis, an acid-fast aerobic bacillus. When M. tuberculosis infects other than lung, it is called extrapulmonary tuberculosis (EPTB). Among other organs, genitourinary tuberculosis (GUTB) is responsible for 30–40% of all EPTB cases. Methods The study was conducted in a secondary health-care hospital in central Jakarta over a five-year period. We took data from hospital’s medical records and collected all the positive histopathological reports on biopsied tissue of the genitourinary tract from 2014–2019. Results Eleven patients showed positive histopathological results for TB on their biopsied genitourinary tissue. The genitourinary tracts involved were as follows: prostate (n=2), kidney (n=1), ureter (n=2), epididymis (n=1), epididymo-orchitis (n=1), bladder (n=4). All of them presented with specific genitourinary symptoms, such as lower urinary tract symptoms (LUTS) (n=8), dysuria (n=9), urinary retention (n=2), flank pain (n=6), and incontinence (n=1). Nine of 11 patients (81.8%) exhibited systemic manifestations, with fever being the most common (n=8), followed by malaise (n=6), dyspepsia syndrome (n= 4), and weight loss (n=3). Discussion Consistent with other studies, our research found that the prevalence of GUTB is substantially decreased with advancing age. Kidney is the most common site infected in GUTB infection. GUTB is easily overlooked, because its signs and symptoms are usually typical of a conventional bacterial cystitis. Conclusion Because of its insidious nature and late-onset symptoms, diagnosis of GUTB is often late to approach, leading to higher morbidity and even mortality rate. This leads into further complications of the disease, which are largely preventable by a correct and timely diagnosis followed by appropriate therapy.
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Affiliation(s)
- Johannes Cansius Prihadi
- Department of Surgery, Urology Division, School of Medicine and Health Sciences, Atma Jaya Catholic University, Jakarta, Indonesia.,Department of Urology, St. Carolus Hospital, Jakarta, Indonesia
| | - Andika Chandra Putra
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Pulmonology and Respiratory Medicine, St. Carolus Hospital, Jakarta, Indonesia
| | - Yuvi Wahyudi
- Department of Urology, St. Carolus Hospital, Jakarta, Indonesia
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de Oliveira MCB, Sant'Anna CC, Raggio RL, Kritski AL. Tuberculosis among children and adolescents in Rio de Janeiro, Brazil - Focus on extrapulmonary disease. Int J Infect Dis 2021; 105:105-112. [PMID: 33596481 DOI: 10.1016/j.ijid.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To compare the socio-demographic, clinical, and diagnostic characteristics and treatment outcomes between extrapulmonary tuberculosis (EPTB) and pulmonary tuberculosis (PTB) in children and adolescents in Rio de Janeiro, a high TB-burdened Brazilian city. METHODS This retrospective study used data from patients with EPTB and PTB aged 0 - 18 years, notified on two national databases from 2014 to 2016. RESULTS Among the 1008 patients, 144 (14.2%) had EPTB. Patients with EPTB showed higher odds of hospital-based diagnosis (odds ratio (OR): 6.76 [95% confidence interval (95% CI): 4.62-9.90]; p < 0.001), no laboratory confirmation (OR: 4.9 2.14 [95% CI: 3.07 - 7.85]; p < 0.001), and being <14 years old (OR: 3.13 [95% CI: 2.18-4.49]) than those with PTB. A diagnosis without laboratory investigation was observed among 301/864 (34.8%) patients with PTB, 48/144 (33.3%) with EPTB, and among those aged under five years with EPTB (15/27 [55.6%]). TB deaths were more frequent in patients with EPTB (5/144 [3.5%]) than in those with PTB (4/864[0.5%]) (p = 0.001); 4/5 (80%) TB deaths were due to TB meningitis; 50% died within 14 days of diagnosis. CONCLUSIONS EPTB remains a clinical diagnostic challenge that needs to be addressed to fully benefit from the higher sensitivity laboratory investigations.
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Affiliation(s)
| | - Clemax Couto Sant'Anna
- Pediatrics Department, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
| | - Ronir Luiz Raggio
- Federal University of Rio de Janeiro, Instituto de Estudos de Saúde Coletiva, Rio de Janeiro(RJ), Brazil.
| | - Afrânio Lineu Kritski
- Academic Program of Tuberculosis, School of Medicine, Institute of Torax Disease, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (RJ), Brazil.
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143
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Sun W, Gu J, Bi K, Zhang Y, Shen MJ, Wang Y, Fan L. Clinical performance of Xpert MTB/RIF on contrast-enhanced ultrasound-guided core biopsy specimens for rapid diagnosis of superficial tuberculous lymphadenitis in high TB burden settings. Infection 2021; 49:653-660. [PMID: 33543403 DOI: 10.1007/s15010-021-01578-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The diagnosis of superficial tuberculous lymphadenitis (TBLN) remains difficult due to low detection rate of etiology. To increase the diagnostic value for TBLN, contrast-enhanced ultrasound (CEUS) guided core biopsy was introduced to obtain the specimen followed by Xpert MTB/RIF (Xpert) and other methods testing and to explore the optimum diagnostic pattern for TBLN in China. METHODS A prospective study was performed on patients with suspected superficial TBLN. All patients underwent CEUS-guided core biopsy from which specimens were tested by histopathology, Xpert, acid-fast bacilli (AFB), and MGIT960 culture (MGIT960), respectively. The diagnostic values were calculated and compared. RESULTS A total of 328 patients were included the study, 272 were diagnosed as TBLN (254 definite TB, 18 probable TB) and 56 cases with Non-TBLN, and 100% (272/272) of TBLN patients obtained diagnosis sampled by CEUS-guided core biopsy. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of comprehensive diagnosis on the specimens by CEUS-guided core biopsy for TBLN were 100% ( 272/272, 95% CI 98.26-100.00), 94.64% (53/56, 95% CI 84.20-98.61), 98.91% (272/275, 95% CI 96.58-99.72), and 100% (53/53, 95% CI 91.58-100%), respectively. Xpert obtained 93.31% (237/254) of etiology detection rate on the specimens sampling by CEUS-guided biopsy. The etiology detection rate was associated with histopathological caseous necrosis. CONCLUSIONS Current examinations on specimens by CEUS-guided core biopsy can achieve a high diagnostic efficacy for TBLN. Pathological differentiation of CEUS-guided biopsy tissue, then followed by Xpert, may be the best pattern for the diagnosis of TBLN in high TB burden areas.
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Affiliation(s)
- Wenwen Sun
- Clinic and Research Center of Tuberculosis, Department of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Rd, Shanghai, 200433, China
| | - Jin Gu
- Clinic and Research Center of Tuberculosis, Department of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Rd, Shanghai, 200433, China
| | - Ke Bi
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meng-Jun Shen
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Lin Fan
- Clinic and Research Center of Tuberculosis, Department of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Rd, Shanghai, 200433, China.
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Kohli M, Schiller I, Dendukuri N, Yao M, Dheda K, Denkinger CM, Schumacher SG, Steingart KR. Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2021; 1:CD012768. [PMID: 33448348 PMCID: PMC8078545 DOI: 10.1002/14651858.cd012768.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Xpert MTB/RIF Ultra (Xpert Ultra) and Xpert MTB/RIF are World Health Organization (WHO)-recommended rapid nucleic acid amplification tests (NAATs) widely used for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum. To extend our previous review on extrapulmonary tuberculosis (Kohli 2018), we performed this update to inform updated WHO policy (WHO Consolidated Guidelines (Module 3) 2020). OBJECTIVES To estimate diagnostic accuracy of Xpert Ultra and Xpert MTB/RIF for extrapulmonary tuberculosis and rifampicin resistance in adults with presumptive extrapulmonary tuberculosis. SEARCH METHODS Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, 2 August 2019 and 28 January 2020 (Xpert Ultra studies), without language restriction. SELECTION CRITERIA Cross-sectional and cohort studies using non-respiratory specimens. Forms of extrapulmonary tuberculosis: tuberculous meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, disseminated tuberculosis. Reference standards were culture and a study-defined composite reference standard (tuberculosis detection); phenotypic drug susceptibility testing and line probe assays (rifampicin resistance detection). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias and applicability using QUADAS-2. For tuberculosis detection, we performed separate analyses by specimen type and reference standard using the bivariate model to estimate pooled sensitivity and specificity with 95% credible intervals (CrIs). We applied a latent class meta-analysis model to three forms of extrapulmonary tuberculosis. We assessed certainty of evidence using GRADE. MAIN RESULTS 69 studies: 67 evaluated Xpert MTB/RIF and 11 evaluated Xpert Ultra, of which nine evaluated both tests. Most studies were conducted in China, India, South Africa, and Uganda. Overall, risk of bias was low for patient selection, index test, and flow and timing domains, and low (49%) or unclear (43%) for the reference standard domain. Applicability for the patient selection domain was unclear for most studies because we were unsure of the clinical settings. Cerebrospinal fluid Xpert Ultra (6 studies) Xpert Ultra pooled sensitivity and specificity (95% CrI) against culture were 89.4% (79.1 to 95.6) (89 participants; low-certainty evidence) and 91.2% (83.2 to 95.7) (386 participants; moderate-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 168 would be Xpert Ultra-positive: of these, 79 (47%) would not have tuberculosis (false-positives) and 832 would be Xpert Ultra-negative: of these, 11 (1%) would have tuberculosis (false-negatives). Xpert MTB/RIF (30 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 71.1% (62.8 to 79.1) (571 participants; moderate-certainty evidence) and 96.9% (95.4 to 98.0) (2824 participants; high-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 99 would be Xpert MTB/RIF-positive: of these, 28 (28%) would not have tuberculosis; and 901 would be Xpert MTB/RIF-negative: of these, 29 (3%) would have tuberculosis. Pleural fluid Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity against culture were 75.0% (58.0 to 86.4) (158 participants; very low-certainty evidence) and 87.0% (63.1 to 97.9) (240 participants; very low-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 192 would be Xpert Ultra-positive: of these, 117 (61%) would not have tuberculosis; and 808 would be Xpert Ultra-negative: of these, 25 (3%) would have tuberculosis. Xpert MTB/RIF (25 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 49.5% (39.8 to 59.9) (644 participants; low-certainty evidence) and 98.9% (97.6 to 99.7) (2421 participants; high-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 60 would be Xpert MTB/RIF-positive: of these, 10 (17%) would not have tuberculosis; and 940 would be Xpert MTB/RIF-negative: of these, 50 (5%) would have tuberculosis. Lymph node aspirate Xpert Ultra (1 study) Xpert Ultra sensitivity and specificity (95% confidence interval) against composite reference standard were 70% (51 to 85) (30 participants; very low-certainty evidence) and 100% (92 to 100) (43 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 70 would be Xpert Ultra-positive and 0 (0%) would not have tuberculosis; 930 would be Xpert Ultra-negative and 30 (3%) would have tuberculosis. Xpert MTB/RIF (4 studies) Xpert MTB/RIF pooled sensitivity and specificity against composite reference standard were 81.6% (61.9 to 93.3) (377 participants; low-certainty evidence) and 96.4% (91.3 to 98.6) (302 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 118 would be Xpert MTB/RIF-positive and 37 (31%) would not have tuberculosis; 882 would be Xpert MTB/RIF-negative and 19 (2%) would have tuberculosis. In lymph node aspirate, Xpert MTB/RIF pooled specificity against culture was 86.2% (78.0 to 92.3), lower than that against a composite reference standard. Using the latent class model, Xpert MTB/RIF pooled specificity was 99.5% (99.1 to 99.7), similar to that observed with a composite reference standard. Rifampicin resistance Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity were 100.0% (95.1 to 100.0), (24 participants; low-certainty evidence) and 100.0% (99.0 to 100.0) (105 participants; moderate-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 100 would be Xpert Ultra-positive (resistant): of these, zero (0%) would not have rifampicin resistance; and 900 would be Xpert Ultra-negative (susceptible): of these, zero (0%) would have rifampicin resistance. Xpert MTB/RIF (19 studies) Xpert MTB/RIF pooled sensitivity and specificity were 96.5% (91.9 to 98.8) (148 participants; high-certainty evidence) and 99.1% (98.0 to 99.7) (822 participants; high-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 105 would be Xpert MTB/RIF-positive (resistant): of these, 8 (8%) would not have rifampicin resistance; and 895 would be Xpert MTB/RIF-negative (susceptible): of these, 3 (0.3%) would have rifampicin resistance. AUTHORS' CONCLUSIONS Xpert Ultra and Xpert MTB/RIF may be helpful in diagnosing extrapulmonary tuberculosis. Sensitivity varies across different extrapulmonary specimens: while for most specimens specificity is high, the tests rarely yield a positive result for people without tuberculosis. For tuberculous meningitis, Xpert Ultra had higher sensitivity and lower specificity than Xpert MTB/RIF against culture. Xpert Ultra and Xpert MTB/RIF had similar sensitivity and specificity for rifampicin resistance. Future research should acknowledge the concern associated with culture as a reference standard in paucibacillary specimens and consider ways to address this limitation.
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MESH Headings
- Adult
- Antibiotics, Antitubercular/therapeutic use
- Bias
- Drug Resistance, Bacterial
- False Negative Reactions
- False Positive Reactions
- Humans
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/isolation & purification
- Nucleic Acid Amplification Techniques/methods
- Nucleic Acid Amplification Techniques/statistics & numerical data
- Reagent Kits, Diagnostic
- Rifampin/therapeutic use
- Sensitivity and Specificity
- Tuberculosis/cerebrospinal fluid
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis, Lymph Node/cerebrospinal fluid
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/drug therapy
- Tuberculosis, Multidrug-Resistant/cerebrospinal fluid
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Pleural/cerebrospinal fluid
- Tuberculosis, Pleural/diagnosis
- Tuberculosis, Pleural/drug therapy
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Affiliation(s)
- Mikashmi Kohli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Mandy Yao
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Keertan Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia M Denkinger
- FIND, Geneva , Switzerland
- Division of Tropical Medicine, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Sun H, Fan J, Shang X, Tuohetaerbaike B, Li Y, Lv J, Wang Y, Wang L, Wang J, Ma X. Study on the relationship between CXCR3 and its ligands and tubal tuberculosis. Life Sci 2021; 272:119047. [PMID: 33454369 DOI: 10.1016/j.lfs.2021.119047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Chemokines play an important role in Mycobacterium tuberculosis infection. We aimed to investigate CXCR3, CXCL9, CXCL10 and CXCL11 to explore the correlation between the severity of tubal tuberculosis and chemokines. METHODS 26 patients with tubal tuberculosis diagnosed in our hospital from 2016 to 2019 were selected as the experimental group, and 18 female patients who underwent high-risk pregnancy supervision in our hospital from 2016 to 2018 were selected as the control group. The pathological manifestations of tubal tuberculosis were observed by HE staining, the expressions of CXCR3 and its ligands in fallopian tubes were detected by immunohistochemistry. RESULTS Typical granulomatous structure of tubal tuberculosis was observed by HE staining and most of them were accompanied by massive necrosis in the experimental group, while no granulomatous lesions were found in the control group. The results of immunohistochemical staining showed that CXCR3 and its ligands were expressed in the cytoplasm and nucleus of oviduct epithelial cells and inflammatory cells, in the granuloma area. CXCL9, CXCL10 and CXCL11 were related to the severity of the disease. KEY FINDINGS CXCR3 and its ligands were positively expressed in tubal tuberculosis, especially CXCL9, CXCL10 and CXCL11 were positively correlated with the severity of fallopian tube disease. SIGNIFICANCE It is helpful for clinical diagnosis and treatment detection, and provides a new therapeutic target for the study of female genital tuberculosis in the future.
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Affiliation(s)
- Hu Sun
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China; First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Jiahui Fan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China; First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Xiaoqian Shang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | | | - Ying Li
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Jie Lv
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Yue Wang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Liang Wang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Jing Wang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China; Respiratory Department of the Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570000, China.
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China.
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146
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Yang X, Zhang J, Liang Q, Pan L, Duan H, Yang Y, Li H, Guo C, Sun Q, Jia H, Du B, Wei R, Xing A, Zhang Z, Chen X. Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: a prospective analysis of 601 cases. BMC Infect Dis 2021; 21:4. [PMID: 33397312 PMCID: PMC7784372 DOI: 10.1186/s12879-020-05676-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. METHODS We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. RESULTS A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30-2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). CONCLUSIONS In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.
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Affiliation(s)
- Xinting Yang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jing Zhang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Qingtao Liang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Liping Pan
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Hongfei Duan
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yang Yang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Hua Li
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Chao Guo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Qi Sun
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Hongyan Jia
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Boping Du
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Rongrong Wei
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Aiying Xing
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China
| | - Zongde Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China. .,Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China.
| | - Xiaoyou Chen
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beiguan St #9, Beijing, 101149, China.
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147
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Wang HR, Han C, Wang JL, Zhang YA, Wang MS. Risk Factor for Retreatment Episode on Admission Among TB Patients With Schizophrenia. Front Psychiatry 2021; 12:793470. [PMID: 34955934 PMCID: PMC8695840 DOI: 10.3389/fpsyt.2021.793470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical characteristics of patients with tuberculosis (TB) and schizophrenia remain largely unknown. Furthermore, TB retreatment is associated with a poor outcome. Hence, we aimed to address the risk factors of TB retreatment in schizophrenia patients in this retrospective cohort. Methods: Between March 2005 and August 2020, patients diagnosed with schizophrenia and TB were included in the study. Patient characteristics, such as demographics, medical history, underlying diseases, symptoms, outcome, and lab examinations, were collected from medical records using a structured questionnaire. TB retreatment was defined as treatment failures and relapses. Subsequently, multivariate logistic regression was performed using variables selected based on prior findings as well as factors found to be associated with a retreatment episode in univariate analyses (p < 0.1). Results: A total of 113 TB patients with schizophrenia were included. Of them, 94 (83.2%) patients were classified as initial treatment group, and 19 (16.8%) were classified as retreatment group. The mean age was 53.0 ± 23.2 years, and males accounted for 61.9% of all cases. Multivariate analysis revealed that continuous antipsychotics treatment (OR = 0.226, 95% CI: 0.074, 0.693; p = 0.009) and extra-pulmonary TB (OR = 0.249, 95% CI: 0.080, 0.783; p = 0.017) were associated with the retreatment in TB patients with schizophrenia. Conclusion: Retreatment is a significant concern for TB patients with schizophrenia. To improve the current dilemma, continuous antipsychotics treatment is required, and increasing awareness of schizophrenia would reduce the disease burden.
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Affiliation(s)
- Hai-Rong Wang
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Chao Han
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Jun-Li Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yan-An Zhang
- Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China
| | - Mao-Shui Wang
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China.,Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Lab Medicine, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China
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148
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Nikonajad A, Azimi SA, Allami A, Qasemi Bargi R, Tabarraei A. Epidemiology of extrapulmonary tuberculosis in Northeast of Iran. MEDICAL LABORATORY JOURNAL 2021. [DOI: 10.29252/mlj.15.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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149
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Luo Y, Xue Y, Mao L, Lin Q, Tang G, Song H, Wang F, Sun Z. Diagnostic Value of T-SPOT.TB Assay for Tuberculous Peritonitis: A Meta-Analysis. Front Med (Lausanne) 2020; 7:585180. [PMID: 33425937 PMCID: PMC7785855 DOI: 10.3389/fmed.2020.585180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Tuberculous peritonitis (TP) is a common form of abdominal tuberculosis (TB). Diagnosing TP remains challenging in clinical practice. The aim of the present meta-analysis was to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and peritoneal fluid (PF) T-SPOT for diagnosing TP. Methods: PubMed, EmBase, Cochrane, Scopus, Google scholar, China national knowledge internet, and Wan-Fang databases were searched for relevant articles from August 1, 2005 to July 5, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. Diagnostic parameters including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic curve was used to determine the area under the curve (AUC). Results: Twelve studies were eligible and included in the meta-analysis. The analysis showed that the pooled sensitivity and specificity of PB T-SPOT in diagnosing TP were 0.91 (95% CI, 0.88–0.94) and 0.78 (95% CI, 0.73–0.81), respectively, while the pooled PLR, NLR, and DOR were 4.05 (95% CI, 2.73–6.01), 0.13 (95% CI, 0.07–0.23), and 37.8 (95% CI, 15.04–94.98), respectively. On the other hand, the summary estimates of sensitivity, specificity, PLR, NLR, and DOR of PF T-SPOT for TP diagnosis were 0.90 (95% CI, 0.85–0.94), 0.78 (95% CI, 0.72–0.83), 6.35 (95% CI, 2.67–15.07), 0.14 (95% CI, 0.09–0.21), and 58.22 (95% CI, 28.76–117.83), respectively. Furthermore, the AUC of PB T-SPOT and PF T-SPOT for TP diagnosis were 0.91 and 0.94, respectively. Conclusions: Our results indicate that both PB T-SPOT and PF T-SPOT can be served as sensitive approaches for the diagnosis of TP. However, the unsatisfactory specificities of these two methods limit their application as rule-in tests for TP diagnosis. Furthermore, the standardization of the operating procedure of PF T-SPOT is further needed.
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Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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150
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Diriba G, Kebede A, Tola HH, Yenew B, Moga S, Addise D, Alemu A, Mohammed Z, Getahun M, Fantahun M, Tadesse M, Dagne B, Amare M, Assefa G, Abera D, Desta K. Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia. PLoS One 2020; 15:e0243493. [PMID: 33284842 PMCID: PMC7721190 DOI: 10.1371/journal.pone.0243493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Molecular characterization of Mycobacterium tuberculosis (MTB) is important to understand the pathogenesis, diagnosis, treatment, and prevention of tuberculosis (TB). However, there is limited information on molecular characteristics and drug-resistant patterns of MTB in patients with extra-pulmonary tuberculosis (EPTB) in Ethiopia. Thus, this study aimed to determine the molecular characteristics and drug resistance patterns of MTB in patients with EPTB in Addis Ababa, Ethiopia. Methods This study was conducted on frozen stored isolates of EPTB survey conducted in Addis Ababa, Ethiopia. A drug susceptibility test was performed using BACTEC-MGIT 960. Species and strain identification were performed using the Geno-Type MTBC and spoligotyping technique, respectively. Data were entered into the MIRU-VNTRplus database to assess the spoligotype patterns of MTB. Analysis was performed using SPSS version 23, and participants’ characteristics were presented by numbers and proportions. Results Of 151 MTB isolates, 29 (19.2%) were resistant to at least one drug. The highest proportion of isolates was resistant to Isoniazid (14.6%) and Pyrazinamide (14.6%). Nine percent of isolates had multidrug-resistant TB (MDR-TB), and 21.4% of them had pre-extensively drug-resistant TB (pre-XDR-TB). Among the 151 MTB isolates characterized by spoligotyping, 142 (94.6%) had known patterns, while 9 (6.0%) isolates were not matched with the MIRU-VNTRplus spoligotype database. Of the isolates which had known patterns, 2% was M.bovis while 98% M. tuberculosis. Forty-one different spoligotype patterns were identified. The most frequently identified SpolDB4 (SIT) wereSIT149 (21.2%), SIT53 (14.6%) and SIT26 (9.6%). The predominant genotypes identified were T (53.6%), Central Asia Strain (19.2%) and Haarlem (9.9%). Conclusion The present study showed a high proportion of MDR-TB and pre-XDR-TB among EPTB patients. The strains were mostly grouped into SIT149, SIT53, and SIT26. The T family lineage was the most prevalent genotype. MDR-TB and pre-XDR-TB prevention is required to combat these strains in EPTB. A large scale study is required to describe the molecular characteristics and drug resistance patterns of MTB isolates in EPTB patients.
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Affiliation(s)
- Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.,Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.,Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Bazezew Yenew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shewki Moga
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Mengistu Fantahun
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Biniyam Dagne
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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