Clinical Utility of CT-Based Bronchial Aspirate TB-PCR for the Rapid Diagnosis of Pleural Tuberculosis

Extrapulmonary Tuberculosis in Federation of Bosnia and Herzegovina

Introduction:

Health Introduction: The two types of tuberculosis (TB) are: pulmonary TB (PTB) and extrapulmonary TB (EPTB).

Objective:

to represent the frequency of ETPB of all localization , ratio between EPTB and PTB and demographic characteristics of EPTB in FBiH in the period of four years : from 2014 to 2017.

Material and methods:

This is the retrospective analysis of all the reported cases of TB in FBiH with the special insight in EPTB from 2014 to 2017. A standard set of data for TB patients is used which is included in the standardized form–“Minimum information for reporting tuberculosis” which has been used according to the recommendation of the WHO and IUATLD all over the Europe and elsewhere in the world.

Results:

we registered 2588 patients with TB and among them there were 316 patients or 12.21% with EPTB. In the 2014 there were 795 cases of TB and of that 103 (13.0%) were EPTB ;in 2015 of 728 cases of TB 91 (12.5%) were EPTB ; in 2016 of 573 cases of TB 69 (12%) were ETPB ;2017 of 492 cases of TB 53 (11%) were ETPB. ETPB is more frequent in males but with no statistical significance. The most cases of EPTB were in the group of patients aged from 21 to 30 years because of frequency of tuberculous pleurisy. The tuberculous pleuritis is the most frequent form of ETPB (p<0.01).

Conclusion:

The frequency of TB and ETPB in FBiH decreases over the years. This indicates good control and therapeutic regimen of TB in FBiH. The ratio of PTB and EPTB remains approximately the same–about 12% of all TB cases are EPTB. Thus we are getting close to the situation in developed countries.

Diagnosis and treatment of extrapulmonary tuberculosis

Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment.

Radiologic and laboratory differences in patients with tuberculous and parapneumonic pleural effusions showing non-lymphocytic predominance and high adenosine deaminase levels

PURPOSE

Tuberculous pleural effusion (TPE) is characterized by lymphocytic predominance and high adenosine deaminase (ADA) levels. However, TPEs sometimes present non-lymphocytic predominance, and parapneumonic effusion (PPE) often exceeds the cutoff value of ADA for TPE. Thus, the differential diagnosis of cases with pleural fluid (PF) showing non-lymphocytic predominance and high ADA levels is challenging. However, limited data concerning the clinical differences in these patients are available.

METHODS

A retrospective study was conducted on TPE and PPE patients with PF showing non-lymphocytic predominance and ADA levels ≥40 U/L in 2009-2013 in a South Korean tertiary referral hospital. The clinical, laboratory, and computed tomography (CT) findings between the groups were analyzed using multivariate logistic regression to develop a prediction model with independent factors for TPE.

RESULTS

Among 353 patients with TPE, 24 (6.8 %) showed PF with non-lymphocytic predominance and ADA levels of ≥40 U/L. Twenty-eight PPE patients who presented PF findings comparable with those of TPE patients were included in the control group. In the final analysis, PF ADA levels >58 U/L and nodular lung lesions on CT were independent positive predictors, while loculated effusion was an independent negative predictor for TPE. Using the prediction model, a score ≥ +3 provided a sensitivity of 88 %, specificity of 93 %, positive predictive value of 91 %, and negative predictive value of 90 % for TPE.

CONCLUSION

PF ADA levels, nodular lung lesions, and loculated pleural effusion may help differentiate TPE from PPE in patients with PF showing non-lymphocytic predominance and ADA levels ≥40 U/L.