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Extra Pulmonary Tuberculosis: A Diagnostic Dilemma

机译:肺外结核:诊断难题

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摘要

Tuberculosis remains a major public health problem globally, with India being one of the high burden countries. The common causative agent is Mycobacterium tuberculosis but in developing countries M. bovis is reported as a potential human pathogen. Almost 20% of all reported cases of tuberculosis are of extra pulmonary form of disease. Diagnosis of extra pulmonary tuberculosis (EPTB) is not always possible with conventional methods, due to the long time required and the paucibacillary nature of samples; hence the need of rapid molecular methods. A prospective study was conducted on 300 patients of EPTB over a period of 5 years. These patients were suspected cases of tubercular meningitis, tubercular ascites and tubercular lymphadenitis. Samples analyzed were cerebrospinal fluid, ascitic fluid and lymph node fine needle aspirate. A two step PCR targeting hup B gene was used. Clinical response to anti tubercular therapy (ATT) was taken as positive (gold standard). PCR for hup B gene was positive in 147 samples out of 155 ATT responders. Of these 85.71% were infected with M. tuberculosis, 9.52% with M. bovis alone and 4.76% showed co infection with both M.tb and M. bovis. The sensitivity and specificity of PCR was 90.32 and 94.48% respectively.
机译:结核病仍然是全球范围内的主要公共卫生问题,印度是负担最重的国家之一。常见的病原体是结核分枝杆菌,但是在发展中国家,牛分枝杆菌据报道是潜在的人类病原体。在所有报告的结核病例中,几乎有20%属于肺外疾病。由于所需时间长且样品的脓杆菌性质,常规方法并不总是能够诊断出肺外结核(EPTB)。因此需要快速的分子方法。在5年中对300例EPTB患者进行了前瞻性研究。这些患者被怀疑为结核性脑膜炎,结核性腹水和结核性淋巴结炎。分析的样品是脑脊液,腹水和淋巴结细针抽吸物。使用靶向hup B基因的两步PCR。对抗结核治疗(ATT)的临床反应为阳性(金标准)。 155个ATT应答者中的147个样本中hup B基因的PCR阳性。在这85.71%的人群中,结核分枝杆菌感染,仅牛分枝杆菌为9.52%,结核分枝杆菌和牛分枝杆菌均​​为4.76%。 PCR的敏感性和特异性分别为90.32和94.48%。

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