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1.
Mikrobiyol Bul ; 53(4): 355-363, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709933

RESUMO

One of the most important steps for the control of tuberculosis is rapid and accurate detection of Mycobacterium tuberculosis in clinical samples. The early and accurate diagnosis of tuberculosis allows the initiation of the effective treatment regimen as early as possible. However the early diagnosis of tuberculosis can be achieved by the integration of molecular methods into the diagnostic algorithm of tuberculosis together with the gold standard culture methods. For this reason, molecular methods have become valuable diagnostic tools in routine diagnostic laboratories in recent years. The aim of this study was to determine the diagnostic efficacy of Anyplex MTB/NTM test (Seegene, South Korea) used for the molecular diagnosis of tuberculosis in routine molecular diagnostic laboratories. In addition to this aim, a preliminary evaluation of in-house polymerase chain reaction (PCR) primers that was designed to produce a kit as an alternative against imported commercial kits was performed. Ten thousand six hundred fifthy two clinical specimens that were collected from suspected tuberculosis cases in three years were included in the study. All samples were tested by microscopic examination after staining, culture and real-time PCR (Rt-PCR) methods. The smears were examined by microscope after staining with Kinyoun method for the existence of acid resistant bacilli. For culture, following the N-acetyl-L-sistein-sodium hydroxide homogenization and decontamination procedure, the samples were inoculated into the MGIT (Mycobacteria Growth Indicator Tube) tubes (Becton Dickinson, USA). Rt-PCR method was performed by using Anyplex MTB/NTM test. In the first stage of the study, the performance of the Anyplex MTB/NTM test was compared with the gold standard culture method. M.tuberculosis was isolated in 178 specimens out of 10.652 (1.7%). After the comparison with the gold standard culture method, the sensitivity and specificity of Anyplex MTB/NTM test was found to be 84% and 99% respectively in pulmonary samples, and 74% and 99% respectively in extrapulmonary samples. In the second stage of the study, PCR method with laboratory designed primers was applied to 100 culture positive samples. The PCR results of 98 samples were found to be in agreement with the culture, while M.tuberculosis DNA was not detected in two samples. As a result of the study it was concluded that Anyplex MTB/NTM test is a rapid, practical and reliable method that can be used in routine tuberculosis diagnosis. The high agreement between PCR method using the laboratory-designed primers and the PCR method used in routine practice will lighten the way for the development of national tuberculosis molecular diagnostic kits with a relevant cost. In this way, it will be possible to perform rapid diagnosis in a more cost-effective manner in routine diagnosis laboratories.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Reação em Cadeia da Polimerase em Tempo Real/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tuberculose/diagnóstico , Tuberculose/microbiologia
2.
Praxis (Bern 1994) ; 108(15): 1019-1026, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31771497

RESUMO

CME: Extrapulmonary Tuberculosis Abstract. While tuberculosis mostly manifests as pulmonary infection, a dissemination in any extrapulmonary organ is possible. Extrapulmonary tuberculosis mostly affects lymph nodes, pleura and bones. Patients with immunosuppressive conditions such as an HIV co-infection or immunosuppressive therapies like TNF-alpha-inhibitors have a higher risk of a dissemination of tuberculosis. Diagnosis of extrapulmonary tuberculosis is difficult, as microbiological testing mostly requires invasive procedures to obtain a sample for direct proof of tuberculosis by microscopy, culture, molecular methods (e.g. Xpert® MTB/RIF) or histology. Treatment follows guidelines of pulmonary tuberculosis with a two-month regimen consisting of four drugs (rifampicin, isoniazide, pyrazinamide and ethambuthol), followed by a four-month therapy with two drugs (rifampicin and isoniazide). Duration of therapy is extended in tuberculous meningitis to one year and in a skeletal dissemination up to six to nine months. Corticosteroids are recommended in cerebral and pericardial tuberculosis.


Assuntos
Antibióticos Antituberculose , Mycobacterium tuberculosis , Tuberculose , Antibióticos Antituberculose/uso terapêutico , Humanos , Rifampina , Sensibilidade e Especificidade , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
3.
Medicine (Baltimore) ; 98(42): e17416, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626097

RESUMO

This study aims to evaluate the clinical value of haptoglobin (Hp) and sCD163 testing for the differential diagnosis of pleural effusion, and investigate the correlation of Hp and sCD163 with the inflammatory response of the body.Pleural effusion samples were collected from 78 patients (38 tuberculous pleural effusions [TPE] and 40 malignant pleural effusions [MPE]). The concentrations of Hp and sCD163 in the pleural effusion were measured by enzyme-linked immunosorbent assay (ELISA).The concentrations of Hp and sCD163 were significantly higher in the TPE group than in the MPE group (P < .05). The sensitivity and specificity of the Hp test for the differential diagnosis of TPE and MPE was 82.4% and 86.1%, respectively (P < .01), while the cut off value was 779.05 ug/mL. Furthermore, the sensitivity and specificity of the sCD163 test for the differential diagnosis of TPE and MPE was 76.3% and 85.0%, respectively (P < .01), while the cut off value was 16,401.11 ng/mL. Moreover, the sensitivity and specificity of the combination of Hp and sCD163 tests for diagnosing TPE was 90.0% and 87.5%, respectively. Hp and IL-1ß, TNF-α, CRP and ESR were positively correlated in both the TPE group and MPE group (P < .05). Hp and sCD163 were positively correlated in the TPE group (r = 0.3735, P = .0209), but not in the MPE group (r = 0.22, P = .1684). However, there was no correlation between sCD163 and TNF-α, CRP and ESR in either the TPE group, or the MPE group (P > .05). Furthermore, sCD163 and IL-1ß were weakly correlated in the TPE group (r = 0.49, P = .0018), but these had no correlation in the MPE group (r = 0.068, P = .6767).Hp and sCD163 can be used as biological markers for the differential diagnosis of pleural effusion in clinic, and the level of Hp in pleural effusion may reflect the intensity of inflammation in the body to some extent.


Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Haptoglobinas/análise , Derrame Pleural Maligno/diagnóstico , Receptores de Superfície Celular/sangue , Tuberculose/diagnóstico , Idoso , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-1beta/sangue , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/sangue , Curva ROC , Sensibilidade e Especificidade , Fator de Necrose Tumoral alfa/sangue
4.
Pan Afr Med J ; 33: 158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565120

RESUMO

Introduction: While HIV care among tuberculosis (TB) patients is successfully implemented and monitored, it is not routinely reported among "presumptive TB patients without TB". The present study describes the ascertainment of HIV status and receipt of antiretroviral therapy (ART) and the associated factors among presumptive TB patients (with and without TB) in 35 public health facilities of Masvingo district of Zimbabwe from January to June 2017. Methods: This was an analysis of secondary programme data. We performed log binomial regression to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). Results: Of 1369 presumptive TB patients, 1181 (86%) were ascertained for HIV status (98% among those subsequently diagnosed with TB, 83% among non-TB). Of them, 748 (63%) were HIV positive, more among TB patients (69%) than those without TB (61%). Among HIV-positive patients, 475 (64%) received ART, significantly higher among TB patients (78%) compared to those without TB (57%). Patients without TB were significantly more likely to have non-ascertained for HIV status (aRR=2.4, 95% CI=1.4-5.0) and not receiving ART (aRR=1.8, 95% CI=1.6-2.0), compared to those with TB. Conclusion: We found high rates of HIV status ascertainment among presumptive TB patients. But, ART uptake was poor among "presumptive TB patients without TB", despite implementation of "test and treat" strategy in Zimbabwe. The programme should step up the monitoring of HIV status and ART receipt among presumptive TB patients, by introducing an indicator in the quarterly reports of the national TB programme.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Tuberculose/epidemiologia , Adolescente , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Análise de Regressão , Tuberculose/diagnóstico , Adulto Jovem , Zimbábue
5.
Internist (Berl) ; 60(11): 1155-1175, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31641790

RESUMO

Tuberculosis is a bacterial infectious disease that is usually transmitted by inhalation of droplets containing the bacteria. The World Health Organization (WHO) estimates that approximately 10 million patients were newly diagnosed with tuberculosis in 2017. Rapid diagnosis relies on a combination of imaging and microbiological, molecular, and, rarely, immunological tests. Genotypic methods enable early diagnosis and allow highly accurate prediction of drug resistance. Phenotypic (culture-based) methods are the diagnostic gold standard. Standard management of patients with pan drug-susceptible pulmonary tuberculosis includes a combination of rifampicin, isoniazid, ethambutol and pyrazinamide for 2 months followed by rifampicin and isoniazid for additional 4 months, which leads to cure rates of >80%. With individualized treatment schemes, similar cure rates can be achieved for patients with multidrug-resistant tuberculosis.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
7.
Artigo em Chinês | MEDLINE | ID: mdl-31594129

RESUMO

Objective: To evaluate the performence of GeneXpert MTB/RIF and BACTEC-MGIT 960 on detecting Mycobacterium tuberculosis and rifampicin resistance for pneumoconiosis-associated tuberculosis patients. Methods: The recruited 133 suspected active pneumoconiosis-associated tuberculosis hospitalized cases, morning sputum samples were collected to do modified L-J culture, conventional proportion method drug susceptibility test, GeneXpert MTB/RIF and BACTEC-MGIT 960. Analyze the sensitivity and specificity of the 133 sputum from patients, the positive rates of patients with tuberculosis in GeneXpert MTB/RIF test, BACTEC-MGIT 960 and modified L-J culture were 37.59%, 34.59% and 30.08% respectively. There was no significant difference among the three tests respectively (P>0.05) . According to the modified L-J culture, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting tuberculosis were 92.5% and 95.0% respectively, and specificity in rifampicin resistance were 86.0% and 91.4% respectively. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . According to conventional proportion method drug susceptibility test, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting rifampicin resistance were 90.0% and 100%, and specificity were 92.6% and 96.4%. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . Conclusion: The GeneXpert MTB/RIF has good performence of detecting tuberculosis and rifampicin resistance. It has good application value among pneumoconiosis-associated tuberculosis patients.


Assuntos
Farmacorresistência Bacteriana , Pneumoconiose/complicações , Pneumoconiose/microbiologia , Tuberculose/diagnóstico , Humanos , Mycobacterium tuberculosis , Rifampina , Sensibilidade e Especificidade , Escarro
8.
Lancet ; 394(10202): 967-978, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31526740

RESUMO

Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis.


Assuntos
Tuberculose/terapia , Criança , Busca de Comunicante/métodos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Manejo de Espécimes/métodos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Vacinas contra a Tuberculose , Vacinação
9.
Pneumologie ; 73(9): 516-522, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31533173

RESUMO

BACKGROUND: Big cities in Europe have the highest incidence rates of TB in otherwise low incidence settings. Understanding of the spatio-temporal patterns of TB incidence can support efforts for TB prevention and control in line with the End-TB Strategy of the WHO in such settings for low incidence settings. METHODS: Data from the municipal TB register of Cologne collected between 2006 and 2015 under the infection prevention legislation were retrieved, addresses geographically identified and all notified incident TB cases retrospectively analysed for their spatial and temporal distribution in this large German city using a geographic information system. RESULTS: During the analysed period 1,038 incident cases were reported, equivalent to an incidence rate of 10.03 cases per 100,000 inhabitants. Contagious pulmonary TB contributed 57 % of all cases. Distribution patterns changed over time with decreases in 37 and increases in 22 of the 77 urban sub-districts, three of which showing constant high rates of TB incidence. CONCLUSION: The study presents a complementary method to monitor the distribution and development of incident TB cases at a disaggregated level of urban sub-districts. Identification of areas with comparatively high incidence can support identification of clusters respectively their prevention and allow better planning for targeted local TB services.


Assuntos
Análise Espaço-Temporal , Tuberculose Pulmonar/epidemiologia , Tuberculose/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Geografia , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose Pulmonar/diagnóstico
10.
Pan Afr Med J ; 33: 150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558947

RESUMO

Even if tuberculosis is a major cause of morbidity and mortality, nasopharyngeal location is unusual and extremely rare. We report four new cases observed with short time interval suggesting a trend towards increased frequency. The diagnosis was confirmed by histological analysis after a biopsy. The evolution was favorable after anti tuberculosis chemotherapy. In the light of those observations and a review of the literature, we will discuss different characteristics of this disease and we will highlight the need of a systematic biopsy in order to confirm diagnosis and exclude undifferentiated carcinoma especially in endemic regions for both diseases.


Assuntos
Doenças Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Tuberculose/diagnóstico , Adolescente , Biópsia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico , Doenças Nasofaríngeas/microbiologia , Adulto Jovem
11.
J Assoc Physicians India ; 67(8): 31-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562713

RESUMO

Background: To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extra pulmonary specimens and to compare it with conventional techniques. Methods: A prospective study was conducted with the introduction of GeneXpert in a tertiary care hospital which relied on microscopy and culture for diagnosis of tuberculosis. All patients for whom geneXpert was ordered by the physician were included in the study. Samples which did not have accompanying microscopy or MGIT culture requests were excluded from the analysis of the results. Sensitivity and specificity of GeneXpert was calculated using liquid culture as the reference test. Results: Xpert MTB/RIF assay was performed on 742 samples of which 116 were positive for Mycobacterium tuberculosis. Rifampicin resistance was seen in 6 samples. The pulmonary samples showed a positivity rate of 16.8% while 17.1% of the extrapulmonary samples were positive by GeneXpert. A comparative analysis of microscopy, liquid culture and GeneXpert could be done for 88 samples. Of the 88 geneXpert positive samples, 42 were positive by smear microscopy and MGIT culture while 46 showed discordant results. Of these, 18 samples were positive by geneXpert but showed no growth in MGIT culture. 15 of these patients had undergone anti-tuberculous treatment (ATT) within the past 12 months. The sensitivity of geneXpert was 89.7% and specificity was 95.1% when compared to liquid culture as a gold standard. Sensitivity for extrapulmonary samples was 85.7% and specificity was 98.05%. Conclusion: To conclude, though GeneXpert detects tuberculosis within the shortest possible time, it still suffers from intermediate level sensitivity, which makes culture facilities relevant even in settings that offer an Xpert/Rif assay.


Assuntos
Bioensaio/métodos , Mycobacterium tuberculosis , Centros de Atenção Terciária , Tuberculose/diagnóstico , Farmacorresistência Bacteriana/genética , Humanos , Índia , Microscopia , Estudos Prospectivos , Rifampina , Sensibilidade e Especificidade , Escarro , Tuberculose/microbiologia
12.
Urologe A ; 58(10): 1219-1230, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31552438

RESUMO

In the context of refugee migrations infectious diseases are being more frequently diagnosed, which the responsible physicians as well as urologists have never seen before. This is due to the poorer health and hygiene conditions in the country of origin, during the flight and in the refugee camps. In Europe increasing incidences of tuberculosis, schistosomiasis and scabies have recently been observed. Tuberculosis and schistosomiasis are often accompanied by unspecific symptoms or can resemble normally encountered urological diseases. Due to the highly contagious nature of scabies, a screening of new arrivals is recommended. A timely differential diagnostic inclusion of these disease patterns is enormously important. Despite the reduction in the numbers of asylum applications in Germany, a higher number of unregistered migrants is generally assumed, who also elude the healthcare system and can therefore contribute to the spread of these rare infectious diseases.


Assuntos
Programas de Rastreamento/métodos , Refugiados , Migrantes , Tuberculose Urogenital/diagnóstico , Infecções Urinárias/diagnóstico , Diagnóstico Diferencial , Alemanha , Humanos , Infecções do Sistema Genital/diagnóstico , Esquistossomose/diagnóstico , Tuberculose/diagnóstico
13.
Pan Afr Med J ; 33: 110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489088

RESUMO

Introduction: The World Health Organization endorsed (2010) the use of Xpert MTB/RIF and countries are shifting from smear microscopy (smear)-based to Xpert MTB/RIF-based tuberculosis (TB) diagnostic algorithms. As with smear, sputum quality may predict the likelihood of obtaining a bacteriologically-confirmed TB when using Xpert MTB/RIF. Methods: From 08/12-11/2014, all people living with HIV were recruited at 22 clinics. For patients screened positive using the four TB symptoms their sputa were tested by Xpert MTB/RIF and smear. Laboratorians assessed and recorded sputum appearance and volume. The yield of bacteriologically-positive sputum evaluated using Xpert MTB/RIF and smear, likelihood-ratios were calculated. Results: Among 6,041 patients enrolled 2,296 were presumptive TB, 1,305 (56.8%) had > 1 sputa collected and 644/1,305 (49.3%) had both Xpert MTB/RIF and smear results. Since >1 sputa collected from 644 patients 954 sputa were tested by Xpert MTB/RIF and smear. Bacteriologically-positive sputum was two-fold higher with Xpert MTB/RIF 11.4% versus smear 5.3%, p < 0.001. Sputum appearance and quantity were not predictive of bacteriologically-positive results, except volume of 2ml to < 3ml, tested by Xpert MTB/RIF LR+= 1.26 (95% CI, 1.05-1.50). Conclusion: Xpert MTB/RIF test yield to bacteriologically-positive sputum was superior to smear. Sputum quality and quantity, however, were not consistently predictive of bacteriologically-positive results by Xpert MTB/RIF or smear.


Assuntos
Técnicas Bacteriológicas/métodos , Microscopia/métodos , Escarro/microbiologia , Tuberculose/diagnóstico , Adulto , Feminino , Seguimentos , Humanos , Masculino , Técnicas de Diagnóstico Molecular/métodos , Estudos Prospectivos , Tuberculose/epidemiologia
14.
PLoS One ; 14(9): 0221038, Sept. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1023322

RESUMO

BACKGROUND: Determine TB-LAM Ag (LAM) is a point of care test developed to diagnose tuberculosis (TB). The aim of this study was to evaluate the diagnostic performance of LAM in people living with HIV using Brazilian public health network algorithm for TB diagnosis. METHODS AND FINDINGS: A cross-sectional study design was used to enroll 199 adult patients in two sites in Rio de Janeiro and two in São Paulo. The study enrolled HIV-infected patients with CD4 counts ≤200 cells/mm3 (in the Alere PIMA CD4 assay at study screening), patients coughing for at least 2 weeks or presenting a chest radiography suggestive of TB. LAM, in conjunction with sputum smear microscopy or Xpert MTB/RIF (Xpert) as compared to Mycobacterium tuberculosis culture, which was used as a reference standard. TB prevalence was 24.6%. Overall accuracy of LAM was 79.9% (73.8%-84.9%), positive and negative predictive values were 62.2% (46.1%-75.9%) and 84% (77.5%-88.8%), respectively. The overall LAM sensitivity was 46.9% (33.7%-60.6%) and specificity was 90.7% (84.9%-94.4%). The best performance of LAM was observed among patients with CD4 counts ≤50 cells/mm3 (sensitivity = 70.4% and specificity = 85.9%). When 2 respiratory smears were used in conjunction with LAM, sensitivity increased 22%, as compared to just 2 smears. Furthermore, LAM when used in conjunction with two respiratory smears, was as sensitive as compared to a single one. However, no improvement in TB diagnosis occurred when LAM was used with Xpert as compared to Xpert alone. Among 14 LAM false positive tests, Non-Tuberculosis Mycobacteria were isolated in three cases. CONCLUSION: LAM is a point of care test that increased TB diagnosis in immunosuppressed HIV-infected patients when used in conjunction with smear microscopy, but not when used with Xpert in Brazilian public health network sites. Use of LAM test should be considered in settings where immunosuppressed HIV patients need rapid TB diagnosis


Assuntos
Humanos , Tuberculose/diagnóstico , Brasil , Infecções por HIV
15.
Rozhl Chir ; 98(7): 297-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398991

RESUMO

INTRODUCTION: Extrapulmonary tuberculosis can involve any organ or tissue. It is a rare disease in the Czech Republic with an incidence rate of 0.62 cases per 100.000 persons. It affects mostly immunocompromised patients. The most common sites include lymph nodes, the urogenital system, skin, joints, bones and serous epithelium - the peritoneum, pleura, and pericardium. Splenic involvement is rare. Mycobacterium is a slow growing intracellular parasite. The diagnostic process is very difficult; microbiological diagnosis is critical. CASE REPORT: An 84 years old female patient with subcapsular splenic rupture with no trauma history as a cause of anemia. Splenic abscess was diagnosed during surgical revision and splenectomy. Tuberculosis was suspected based on subsequent histological analysis, which was confirmed after nine weeks of peritoneal fluid culture. The surgical procedure and postoperative hospitalization were not associated with any complications. The patient was referred to the respiratory clinic for further treatment. CONCLUSION: The diagnosis of extrapulmonary tuberculosis including splenic localization should always be considered. A sample from the affected tissue or effusion must be collected in the case of unclear perioperative findings and sent for complete bacteriological testing, including mycobacterial culture. If a tuberculous splenic abscess is found, the therapeutic process should involve its complete drainage in combination with long-term anti-TB medication.


Assuntos
Abscesso , Esplenopatias , Ruptura Esplênica , Tuberculose , Abscesso/etiologia , Idoso de 80 Anos ou mais , República Tcheca , Feminino , Humanos , Esplenectomia , Esplenopatias/etiologia , Tuberculose/complicações , Tuberculose/diagnóstico
16.
Artigo em Chinês | MEDLINE | ID: mdl-31446712

RESUMO

Summary To study the clinical features, diagnosis and treatments of tuberculous otomastoiditis. One case is reported and literatures are reviewed. In this report, the specimen of the middle ear revealed the presence of acid fast bacilli(AFB), grew mycobacterium tuberculosis on a culture. Lung CT scans demonstrated tuberculosis. After anti-tuberculosis therapy, the symptoms disappeared and did not recur in 3 years. Hydrotympanum can be the early symptom of tuberculous otomastoiditis. When persistent otorrhea can not be improved by conventional therapy, tuberculous otomastoiditis should be considered as one of the differential diagnosis.


Assuntos
Mastoidite/diagnóstico , Otite Média com Derrame/etiologia , Tuberculose/diagnóstico , Orelha Média/microbiologia , Orelha Média/patologia , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Tomografia Computadorizada por Raios X
17.
Pan Afr Med J ; 33: 31, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384346

RESUMO

Tuberculosis (TB) is endemic in the Central African Republic (CAR) with an incidence rate of 391 per 100,000 population in 2015. This study aims to analyze current epidemiological and clinical features of TB at the Hôpital de l'Amitié in the Central African Republic. We conducted an analytic retrospective study of patients hospitalized in the Department of Medicine at the Hôpital de l'Amitié from 15 April 2010 to 14 October 2011. Data were collected using a questionnaire and then analyzed with Epi info software 3.5.3. Chi-square test was used to compare proportions, using a threshold significance level of 5%. The study included 220 patients, of whom 128 were women (58.18%). The average age of patients was 35.69± 10.65 years. In 42.70% of cases, patients had no professional activity. Prevalence of tuberculosis in hospital was 10.99%. On average, 12 cases of TB were recorded each month. Most common clinical signs included: chronic cough (71.81%), fever (96.82%), alteration of the general state (91.36%) and pulmonary condensation syndrome (63.64%). The diseases most commonly associated with tuberculosis were HIV/AIDS (73.36%), malaria (48.63%) and anemia (31.81%). The mean time between symptom onset and diagnosis was 37.65 days. Mortality rate was 18.63%. TB/HIV co-infection and neuromeningeal TB were associated with a high mortality rate (p < 0.05). Tuberculosis is a common disease in Bangui and it is often associated with HIV infection. Prognosis is poor in the case of neuromeningeal involvement. Prevention and routine monitoring in HIV infected patients may contribute to reduce the extent and severity of TB.


Assuntos
Infecções por HIV/epidemiologia , Hospitalização , Tuberculose Meníngea/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Anemia/epidemiologia , República Centro-Africana/epidemiologia , Coinfecção , Feminino , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose Meníngea/mortalidade , Adulto Jovem
18.
BMC Infect Dis ; 19(1): 682, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375068

RESUMO

BACKGROUND: Adolescents are a prime target group for tuberculosis (TB) vaccine trials that include prevention of infection (POI). The BCG vaccine is given at birth and does not prevent TB infection. TB infection, a critical endpoint for POI vaccine trials would need to be documented to estimate sample sizes in target populations. METHODS: Adolescents aged 12-18 years of age were enrolled in an area under continuous demographic surveillance. A tuberculin skin test (TST) survey was conducted as part of a study on TB prevalence and incidence. All adolescents got TSTs at enrolment and returned after 72 h for reading. A TST of ≥10 mm if HIV negative or ≥ 5 mm if HIV positive, was considered positive. RESULTS: Of 4808 adolescents returning for TST readings (96% of those enrolled), mean age was 14.4 (SD 1.9), 4518(94%) were enrolled in school and 21(0.4%) gave a previous history of tuberculosis. Among adolescents with TST reactivity, the mean TST induration was 13.2 mm (SD 5.4). The overall prevalence of latent TB infection was 1544/4808 (32.1, 95% CI 29.2-35.1) with a corresponding annual risk of TB infection (ARTI) of 2.6% (95% CI 2.2-3.1). Risk factors for a positive TST included being male (OR 1.3, 95% CI 1.2,1.5), history of having a household TB contact (OR 1.5, 95% CI 1.2,1.8), having a BCG scar (OR 1.5,95% CI 1.2,1.8), living in a rural area (OR 1.4, 95% CI 1.1,1.9), and being out of school (OR 1.8, 95% CI 1.4,2.3). CONCLUSION: We conclude that the high TB transmission rates we found in this study, suggest that adolescents in this region may be an appropriate target group for TB vaccine trials including TB vaccine trials aiming to prevent infection.


Assuntos
Tuberculose/epidemiologia , Adolescente , Vacina BCG/uso terapêutico , Criança , Feminino , Humanos , Quênia/epidemiologia , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Masculino , Mycobacterium tuberculosis/patogenicidade , Prevalência , Fatores de Risco , Instituições Acadêmicas , Teste Tuberculínico , Tuberculose/diagnóstico
19.
BMC Health Serv Res ; 19(1): 543, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375112

RESUMO

BACKGROUND: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program's implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers. METHODS: This research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers' TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation. RESULTS: From a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers' HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers' motivation, collaboration between stakeholders and external development partners' promotion of program implementation. CONCLUSION: In the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.


Assuntos
Infecções por HIV/diagnóstico , Tuberculose/diagnóstico , Adulto , Criança , Coinfecção , Aconselhamento , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Nepal/epidemiologia , Estudos Retrospectivos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
20.
BMC Infect Dis ; 19(1): 701, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395014

RESUMO

BACKGROUND: In recent years, studies on the diagnostic accuracy of in-house real-time PCR (hRT-PCR) assay for the detection of Mycobacterium tuberculosis (Mtb) have been reported with unignorable discrepancies. To assess the overall accuracy of the hRT-PCR assay for Mtb diagnosis in different samples for individuals with active pulmonary and extra-pulmonary Mtb infection, a systematic review and meta-analysis were performed. METHODS: The PUBMED, EMBASE, Web of Science, and Cochrane databases were searched up to June 2017 for eligible studies that estimated diagnostic sensitivity and specificity with the hRT-PCR assay in respiratory and non-respiratory samples in pulmonary and extra-pulmonary Mtb infection patients, with Mtb culture as the reference standard. Bivariate random effect models were used to provide pooled estimation of diagnostic accuracy. Further, subgroup and meta-regression analyses were performed to explore sources of heterogeneity. The risk of bias was assessed by the QUADAS-2 tool. RESULTS: Of the 3589 candidate studies, 18 eligible studies met our inclusion criteria. Compared to Mtb culture data, the pooled sensitivity and specificity were 0.96 and 0.92, respectively. The diagnostic odds ratio (DOR) was 192.96 (95% CI 68.46, 543.90), and the area under the summary ROC curve (AUC) was 0.9791. There was significant heterogeneity in sensitivity and specificity among the enrolled studies (p < 0.001). The studies with high-quality assessment and application of respiratory specimen were associated with better accuracy. CONCLUSIONS: In low-income/high-burden settings, our results suggested that the hRT-PCR assay could be a useful test for the diagnosis of TB with high sensitivity and specificity.


Assuntos
Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Tuberculose/diagnóstico , Humanos , Curva ROC , Sensibilidade e Especificidade , Tuberculose/genética , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/genética
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