RESUMO
BACKGROUND: Tuberculous pleuritis (TBP) is a common extrapulmonary tuberculosis that contributes to the tuberculosis burden. Xpert MTB/RIF assay is a promising method for rapid diagnosis of TBP. The diagnostic value of Xpert MTB/RIF assay in pleural tissue obtained via closed pleural biopsy among sputum acid-fast bacilli (AFB) smear-negative persons is not well studied. OBJECTIVES: To evaluate the diagnostic value of Xpert MTB/RIF assay on diagnosis of TB in pleural tissue obtained via blind closed pleural biopsy. METHODS: Closed pleural biopsy using Cope needle was performed on adult patients who presented with lymphocyte predominant exudative pleural effusion. Xpert MTB/RIF assay was performed in parallel to pathology and mycobacterial culture of the pleural tissue specimen to determine its sensitivity and specificity. Final clinical diagnosis of TBP was determined by improvement in 2-months follow-up of anti-tuberculous treatment. RESULTS: A total of 33 patients were included in the study. The median (interquartile range (IQR)) age was 27 (25 - 42) years. The sensitivity and specificity of Xpert MTB/RIF assay was 30% and 100% compared with Mycobacterium tuberculosis culture as the gold standard, and 20% and 95.7% compared with histopathology as the gold standard. CONCLUSION: Xpert MTB/RIF assay in pleural tissue obtained by closed pleural biopsy did not increase diagnostic yield, but it shortens time for diagnosis compared with conventional methods.
RESUMO
The pituitary glands of seven Boran cattle (Bos indicus), five infected with a clone of Trypanosoma congolense IL 1180 (ILNat 3.1) transmitted by Glossina morsitans centralis and two uninfected controls, were examined by light and electron microscopy 43 (experiment 2) or 56 (experiment 1) days after fly challenge. The three cattle used in the first experiment included a 15-month-old female (No. 1), a 24-month-old female (No. 2), and a 21-month-old male (No. 3) as a control. In the second experiment, four cattle were used: two females (Nos. 4, 5) and one male (No. 6), all between 15 and 24 months of age, and one female control (No. 7) of similar age. In all the infected animals, dilation of both the sinusoids and microvasculature was apparent, as was an increase in the thickness of the extracellular matrix between the pituitary lobules. Trypanosomes were found in the microvasculature of the adenohypophysis and neurohypophysis in all the infected animals. Focal degenerative changes were seen in the adenohypophyseal section of glands from the infected animals euthanatized 56 days post-infection. These degenerative structural changes were confined to the somatotrophic cells. The possible role that trypanosomes in the microvasculature may play in inducing pituitary damage and dysfunction is discussed.