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Gopalaswamy R, Dusthackeer VNA, Kannayan S, Subbian S. Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JoR 2021; 1:141-64. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Torun Parmaksiz E, Caglayan B, Kiral N, Dogan C, Salepci B, Comert S. An Unusual Case of Multidrug Resistant Miliary Tuberculosis. Arch Clin Infect Dis 2016; 11. [DOI: 10.5812/archcid.37805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee YS, Kang HR, Lee SH, Kim Y, Kim MY, Shin JH, Moon JY, Lee HK, Park SY, Mo EK, Park YB, Moon SY, Oh M, Ko Y. Diagnostic usefulness of the GenoType MTBDRplus assay for detecting drug-resistant tuberculosis using AFB smear-negative specimens with positive TB-PCR result. Infect Dis (Lond) 2015; 48:350-5. [PMID: 26654187 DOI: 10.3109/23744235.2015.1122831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic accuracy of the GenoType MTBDRplus assay in detecting drug-resistant tuberculosis (DR-TB) by using acid-fast bacilli (AFB) smear-negative specimens with positive TB-PCR results. METHODS The MTBDRplus assay was performed with 2 different categories of 117 samples, including AFB smear-positive specimens (n = 53) and AFB smear-negative specimens (n =64), which exhibited positive TB-PCR results, at a single institution. The results were retrospectively compared with the results of the phenotypic drug susceptibility test (DST), for reference. RESULTS A total of 105 tests were finally analyzed. Of these, 54 tests were conducted using AFB smear-negative specimens with positive TB-PCR results. The MTBDRplus assay for these 54 samples demonstrated a sensitivity of 100%, specificity of 98%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 100% in detecting rifampicin resistance. With these same species, the sensitivity, specificity, PPV, and NPV values for the MTBDRplus assay were 83.3%, 97.9%, 83.3%, and 97.9%, respectively, for the detection of isoniazid resistance. The overall correlation between the MTBDRplus assay and phenotypic DST demonstrated excellent agreement for detection of rifampicin resistance (κ = 0.847) and for detection of INH resistance (κ = 0.812), respectively. CONCLUSIONS The MTBDRplus assay can be used effectively even on AFB smear-negative specimens from TB patients, when the TB-PCR is positive. This result might help clinicians to manage patients with suspected DR-TB in difficult situations.
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Affiliation(s)
- Young Seok Lee
- a Division of Pulmonology, Department of Internal Medicine , Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine , Seoul
| | - Hye-Rim Kang
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - Si-Hyeong Lee
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - Yunmi Kim
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - Mi-Yeong Kim
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - Jeong Hwan Shin
- c Department Laboratory Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - Jae Young Moon
- d Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine , Chungnam National University Hospital , Daejeon
| | - Hyun-Kyung Lee
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan
| | - So Young Park
- e Department of Pulmonary and Critical Care Medicine , Hallym University Kangdong Sacred Heart Hospital , Seoul
| | - Eun-Kyung Mo
- e Department of Pulmonary and Critical Care Medicine , Hallym University Kangdong Sacred Heart Hospital , Seoul
| | - Yong Bum Park
- e Department of Pulmonary and Critical Care Medicine , Hallym University Kangdong Sacred Heart Hospital , Seoul
| | - Soo-Yoon Moon
- e Department of Pulmonary and Critical Care Medicine , Hallym University Kangdong Sacred Heart Hospital , Seoul
| | - Minkyung Oh
- f Department of Pharmacology and Clinical Trial Center , Inje University Busan Paik Hospital , Busan , Republic of Korea
| | - Yousang Ko
- b Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine , Busan Paik Hospital, Inje University College of Medicine , Busan ;,e Department of Pulmonary and Critical Care Medicine , Hallym University Kangdong Sacred Heart Hospital , Seoul
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