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Sharma K, Singh S, Sharma M, Batra N, Kaur V, Modi M, Sharma A, Ray P. Multi-targeted loop mediated amplification PCR for diagnosis of extrapulmonary tuberculosis. Indian J Tuberc 2020; 67:479-482. [PMID: 33077047 DOI: 10.1016/j.ijtb.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AIMS The present study was conceived to evaluate multi-targeted loop mediated amplification (MLAMP) for the rapid diagnosis of extrapulmonary tuberculosis (EPTB). METHODS AND RESULTS A total of 700 patients were included who were classified into 2 groups: Group 1 (n = 400) included a 100 culture confirmed EPTB patients and 300 culture negative, suspected EPTB patients. Group 2 (n = 300) included negative controls from non-tubercular patients. All samples were subjected to Ziehl-Neelsen microscopy, solid culture on Lowenstein Jensen media, Polymerase chain reaction (PCR) targeting IS6110 gene and LAMP targeting both IS6110 and MPB64 individually and as MLAMP. The overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the MLAMP assay were 12%, 25%, 72.5%, 80% and 86.6% respectively and the specificity of all the tests was 100%. CONCLUSION MLAMP is a rapid robust tool for the diagnosis of EPTB and utilizing two targets for M. tuberculosis can improve the overall sensitivity and increase the yield of detection from extrapulmonary samples. The rapidity, ease of performance and low cost make MLAMP an excellent alternative in low-income, resource limited settings.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nitya Batra
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varpreet Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
Culture remains the gold standard for tuberculosis (TB) diagnosis, and the mycobacteria growth indicator tube (MGIT), endorsed by the World Health Organization (WHO), is widely used. Further identification of a positive culture is done with the help of an immunochromatography assay, which often shows faint bands that are difficult to interpret. We analysed 125 BACTEC MGIT culture positive results, of which 11/16 (68.7%) of the doubtful assays, analysed by MGIT™ TBc Identification test (TBcId), were positive for Mycobacterium tuberculosis complex (MTBC), the remaining being non-tuberculous mycobacteria as determined by an in-house duplex polymerase chain reaction and line probe assay. Guidelines on faint or doubtful bands in immunochromatography assays are important so as not to overlook true-positive cases of TB.
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Affiliation(s)
- Chanchal Kumar
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Kamal Shrivastava
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Anupriya Singh
- Research Assistant, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Naresh Kumar Sharma
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Jitender Yadav
- Senior Technical Assistant, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Mandira Varma-Basil
- Professor, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
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Baikunje N, Behera D, Rajwanshi A, Sharma M, Sharma A, Sharma K. Comparative evaluation of loop-mediated isothermal amplification (LAMP) assay, GeneXpert MTB/Rif and multiplex PCR for the diagnosis of tubercular lymphadenitis in HIV-infected patients of North India. Mol Cell Probes 2019; 48:101459. [PMID: 31550519 DOI: 10.1016/j.mcp.2019.101459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tubercular lymphadenitis (TBLA) is one of the most common extrapulmonary manifestations of tuberculosis in patients with HIV. With several other pathological conditions presenting as lymphadenitis and lack of consensus regarding a gold standard test, the diagnosis of TBLA remains a challenge for the clinician. OBJECTIVES and design: In this study, we have assessed the potential of loop-mediated isothermal amplification (LAMP) test for the diagnosis of TBLA in HIV-infected patients. The study group included samples collected by fine needle aspiration (FNAC) of lymph nodes from 24 HIV-infected patients with TBLA. A composite reference standard was used to identify cases of TBLA based on clinical suspicion, results of cytology, AFB smear, MGIT culture, GeneXpert MTB/RIF, multiplex polymerase chain reaction (MPCR) and subsequently clinical response to antitubercular therapy. These tests were also carried out in 26 control samples of lymph node FNAC from HIV-infected patients with non-tubercular lymphadenitis. RESULTS LAMP assay was positive in 19/24 TBLA cases and yielded a sensitivity of 79.17% with 100% specificity. Cytology was suggestive in 18/24 (75%) TBLA cases. GeneXpert MTB/RIF assay correctly identified 16/24 TBLA cases, but the test did show one false positive result reducing its specificity. MPCR had the highest sensitivity of 91.67% as it correctly identified 22/24 cases and showed no false positive result. CONCLUSION The current study highlights the potential of LAMP test for the specific diagnosis of tubercular lymphadenitis in FNAC samples from HIV-infected patients, especially when cytology is either non-conclusive or non-available. Though MPCR had a higher sensitivity than LAMP assay, the added advantages of low cost, minimal technical expertise and simplicity of procedure make LAMP assay a suitable diagnostic test in resource-limited settings.
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Affiliation(s)
- N Baikunje
- Department of Pulmonary Medicine and Critical Care, PGIMER, Chandigarh, 160012, India
| | - D Behera
- Department of Pulmonary Medicine and Critical Care, PGIMER, Chandigarh, 160012, India
| | - A Rajwanshi
- Department of Cytology, PGIMER, Chandigarh, 160012, India
| | - M Sharma
- Department of Medical Microbiology, PGIMER, Chandigarh, 160012, India
| | - A Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, 160012, India
| | - K Sharma
- Department of Medical Microbiology, PGIMER, Chandigarh, 160012, India.
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Sharma K, Sharma M, Chaudhary L, Modi M, Goyal M, Sharma N, Sharma A, Jain A, Dhibar DP, Jain K, Khandelwal N, Ray P, Lal V, Salfinger M. Comparative evaluation of Xpert MTB/RIF assay with multiplex polymerase chain reaction for the diagnosis of tuberculous meningitis. Tuberculosis (Edinb) 2018; 113:38-42. [PMID: 30514512 DOI: 10.1016/j.tube.2018.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid and specific diagnosis of tuberculous meningitis (TBM) is of paramount importance to decrease morbidity and mortality. Therefore, the present study was undertaken to compare the efficacy of Xpert MTB/RIF assay (GXpert) and multiplex PCR (MPCR) using three targets (IS6110, MPB64 and protein B) for diagnosing tuberculous meningitis. METHODS GXpert and MPCR were performed on cerebrospinal fluid samples of 225 patients out of which 80 were culture-positive confirmed cases of TBM, 100 were 'suspected' cases of TBM and 45 were non-TBM controls. rpoB gene sequencing was done for diagnosing rifampicin (Rif) resistance in all positive cases. RESULTS GXpert and MPCR were positive in 91/180 (50.5%) and 157/180 (87.2%) confirmed or suspected TBM patients respectively. Both the tests were negative in all 45 controls. Rif resistance was detected in 14 cases by GXpert and in 13 cases by MPCR. Rif resistance was confirmed in 13 cases with rpoB gene sequencing. There was one case of false Rif resistance detected by GXpert which was Rif susceptible on rpoB gene sequencing. Cost of doing MPCR was less than USD1 whereas GXpert required USD10 per isolate. CONCLUSION MPCR has a higher sensitivity than GXpert for diagnosing TBM. MPCR is a robust and cost effective method for diagnosis of TBM in low-resource and high-endemic countries.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Megha Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Chaudhary
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anumiti Jain
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deba Prasad Dhibar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivel Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Max Salfinger
- Department of Medicine & Mycobacteriology Laboratory, National Jewish Health, Denver, CO, USA
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Sharma K, Sharma M, Batra N, Sharma A, Dhillon MS. Diagnostic potential of multi-targeted LAMP (loop-mediated isothermal amplification) for osteoarticular tuberculosis. J Orthop Res 2017; 35:361-365. [PMID: 27175946 DOI: 10.1002/jor.23293] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Received: 02/01/2016] [Accepted: 05/06/2016] [Indexed: 02/04/2023]
Abstract
Delay in diagnosing osteoarticular tuberculosis (OATB) contributes significantly to morbidity by causing disfiguration and neurological sequelae. The delay caused by conventional culture and the expertise and expense involved in other nucleic acid based tests, make LAMP (loop-mediated isothermal amplification) assay a favorable middle path. We evaluated LAMP assay using IS6110 and MPB64 for rapid diagnosis of OATB by comparing with IS6110 PCR and culture. LAMP assay was performed on 140 synovial fluid and pus samples (10 culture-positive proven cases, 80 culture-negative probable cases, and 50 negative controls) using three set of primer pairs each for IS6110 and MPB64. LAMP assay, using two-target approach, had an overall sensitivity and specificity of 90% and 100% in detecting OATB. Sensitivity of IS6110 PCR, IS6110 LAMP, and MPB64 LAMP was 80%, 100%, and 100%, respectively, for confirmed cases and 72.5%, 81.75%, and 86.25%, respectively, for probable cases. Six additional cases were picked using two-target approach. LAMP assay utilizing IS6110 and MPB64 is a cost-effective technique for an early and reliable diagnosis of OATB. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:361-365, 2017.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitya Batra
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lekhak SP, Sharma L, Rajbhandari R, Rajbhandari P, Shrestha R, Pant B. Evaluation of multiplex PCR using MPB64 and IS6110 primers for rapid diagnosis of tuberculous meningitis. Tuberculosis (Edinb) 2016; 100:1-4. [PMID: 27553404 DOI: 10.1016/j.tube.2016.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
Tuberculous meningitis (TBM) is one of those most serious manifestations of extra-pulmonary tuberculosis and prompt diagnosis and treatment is required for better clinical outcome. It is difficult to diagnose due to lack of rapid, sensitive, and specific tests. Newer methods, which are easy and reliable, are required to diagnose TBM at an early stage. Thus our aim was to evaluate the Multiplex polymerase chain reaction (PCR) technique, using primers directed against the insertion sequence IS6110 and MPB64 gene for the detection of Mycobacterium tuberculosis in Cerebrospinal fluid (CSF), for rapid diagnosis of TBM patients. 102 CSF samples were analyzed from patients suspected with TBM along with a control group of 10 patients having other neurological disorders. CSF sediments were analyzed individually for M. tuberculosis DNA by Multiplex PCR using two set of primers targeting insertion sequence IS6110 and gene MBp64, which is very specific for MTBC. Out of 37 patients diagnosed with TBM clinically, MPB64 PCR was positive in 22, IS6110 PCR was positive in 28, both PCR using Multiplex were positive in 34 and Microscopy was positive in one. Thus Sensitivity of MPB64 PCR, IS6110 PCR, Multiplex PCR and Microscopy were found to be 62.3%, 75.4%, 91.8% and 2.7% respectively. In non TBM group PCR was negative in all cases hence, the specificity was 100%. Multiplex PCR system using primers targeting IS6110 and MPB64, for the detection of M. tuberculosis DNA in CSF samples, has high sensitivity than any one of them alone, and could be used for the early detection of TBM in CSF samples.
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Affiliation(s)
- Sunil Prasad Lekhak
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal; Department of Microbiology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
| | - Laxmi Sharma
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Reema Rajbhandari
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pravesh Rajbhandari
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Resha Shrestha
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Basant Pant
- Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Raveendran R, Wattal C. Utility of multiplex real-time PCR in the diagnosis of extrapulmonary tuberculosis. Braz J Infect Dis 2016; 20:235-41. [PMID: 27020707 PMCID: PMC9425353 DOI: 10.1016/j.bjid.2016.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/27/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The diagnosis of extrapulmonary tuberculosis is still a challenge because of its pauci-bacillary nature. The aim of the study was to evaluate the role of a multiplex PCR assay in the diagnosis of extrapulmonary tuberculosis and to compare the efficiency of two targets, IS6110 and MPB64 to detect Mycobacterium tuberculosis. Methods 150 extrapulmonary samples (61 pus/aspirate, 46 tissue, 32 body fluids, and 11 urine) from clinically suspected cases of tuberculosis were included in the study. All the samples were subjected to direct fluorescent microscopy, TB culture (BacT/ALERT 3D, biomerieux, Durham, North Carolina, USA) and a Multiplexed Tandem PCR targeting two mycobacterial DNA sequences, IS6110 and MPB64. Master-Mix reagents and primers were prepared by AusDiagnostics Pvt. Ltd (Alexandria, New South Wales, Australia). The performance of the assay was assessed using a composite gold standard, which included clinical characteristics, microbiology smear as well as culture, histopathology, cytology, radiology, and response to antitubercular therapy. Results 20.3%, 23.6%, and 45.3% of specimens were positive by smear, culture, and PCR, respectively. The sensitivity and specificity of the multiplex PCR was 91.9% and 88.4%, respectively, using the composite gold standard. Positive and negative predictive values of the PCR were estimated as 85.1% and 93.8%, respectively. Higher positivity was observed with target IS6110 (44.6%) as compared to target MPB64 (18.9%). The sensitivities of IS6110 and MPB64 individual targets were 90.3% and 64.5%, respectively, and specificities were 88.4% and 97.7%, respectively. Conclusion PCR can play an important role in rapid and accurate diagnosis of extrapulmonary tuberculosis. IS6110 alone is an effective target in our part of the country.
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Affiliation(s)
- Reena Raveendran
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Wattal
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India.
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Sharma N, Sharma V, Singh PR, Sailwal S, Kushwaha RS, Singh RK, Nautiyal SC, Mishra P, Masood T, Singh RK. Diagnostic value of PCR in genitourinary tuberculosis. Indian J Clin Biochem 2012; 28:305-8. [PMID: 24426229 DOI: 10.1007/s12291-012-0279-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/03/2012] [Indexed: 11/27/2022]
Abstract
Genitourinary tuberculosis is a disease of the genitourinary system which includes the entire urinary tract and reproductive system. Genital tuberculosis is an important cause of female infertility, especially in developing nations like India. In the present study, a total of 257 clinical specimens comprising of endometrial biopsy (109), endometrial curetting (42), menstrual blood (8), semen (17), placenta (11) and urine (70) were collected from patients and subjected for PCR, Culture and AFB detection. The endometrial biopsy, endometrial curetting, menstrual blood, semen, placenta, urine showed 30.2, 45.2,12.5, 5.8, 27.2, 31.4 %, positivity rate for tuberculosis by PCR, 7.3, 9.5, 25.0, 0, 9, 8.5 % by culture and 1.8, 2.3, 0, 0, 0, 2.8 % respectively by AFB smear. Being a novel, rapid technique, PCR is the method of choice for rapid diagnosis and management of genitourinary tuberculosis shared with the other concerned tests. This study reveals that genital tuberculosis can occur in any age group, however, the majority of patients were from reproductive age (nearly 75 % of them were from 20-45 years of age) group.
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Affiliation(s)
- Narotam Sharma
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Veena Sharma
- Department of Bioscience and Biotechnology, Banasthali University, Banasthali, 304022 Rajasthan India
| | - Prem Raj Singh
- Department of Bioscience and Biotechnology, Banasthali University, Banasthali, 304022 Rajasthan India
| | - Shivani Sailwal
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Rajeev S Kushwaha
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Rajesh K Singh
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Satish C Nautiyal
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Pankaj Mishra
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India ; Department of Community Medicine, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - Tariq Masood
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
| | - R K Singh
- Molecular Research Laboratory, Department of Biochemistry, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Patel Nagar, Dehradun, 248001 Uttarakhand India
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Dil-Afroze, Sharma D, Dhobi GN, Shah S, Eachkoti R, Hussain I, Shah ZA, Siddiqi MA. Evaluation of polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous pleurisy. Indian J Clin Biochem 2012; 21:76-9. [PMID: 23105619 DOI: 10.1007/bf02912917] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pleural effusion is one of the commonest presentations of tuberculosis, the clinical manifestations being typically abrupt resembling bacterial pneumonia. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. Owing to these facts, tuberculous pleurisy as an extra-pulmonary disease poses a diagnostic dilemma. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in pleural fluid and are of limited use in diagnosis of tuberculous pleurisy. We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of tuberculous pleurisy by targeting the gene segment coding for MPB64 protein specific forMycobacterium tuberculosis. Based on the clinical criteria, 82 patients with lymphocytic exudative pleural effusion were included in the study. Patients were analyzed in two groups; one group consisting of 48 patients of tubercular pleural effusion confimed by various diagnostic procedures and another group of 34 patients comprising of non-tubercular pleural effusion. There were no false positive results by PCR and the specificity worked out to be 100%. Twenty two patients tested positive for Mantoux with a sensitivity of 45%. ZN-staining for AFB was found in samples from 15 patients (20% sensitivity). ADA was positive for 28 patients with a sensitivity of 53%. PCR was positive for 32/48 patients (67% sensitivity). Thus, PCR was found to be more sensitive than any other conventional method in diagnosis of clinically suspected tubercular pleurisy.
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Affiliation(s)
- Dil-Afroze
- Department of Immunology & Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, J&K-190011 Soura, India
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