Extrapulmonary Tuberculosis- A Diagnostic Conundrum! | Chapter 01 | New Insights into Disease and Pathogen Research Vol. 2
Introduction:
Tuberculosis continues to be the ninth leading cause of death worldwide.
Pulmonary tuberculosis [PTB] being an infectious form of the disease receives
greater attention & significance; while, the silent forms of disease like
latent tuberculosis infection [LTBI] or extrapulmonary [EPTB] form of disease
remains as the most neglected ones for reasons well known. Exact data on the
disease burden from developing countries is missing due to the existing poor
reporting system by both the patient and health care services.
Aim: To know the burden of the
disease in a tertiary care hospital of India. To study the clinical trends in
the disease, and the utility of various diagnostic modalities in diagnosis of
the same. To identify the Mycobacterial species and perform drug susceptibility
test.
Materials and Methods: A cross
sectional study was carried out for a period of two years. A total of 147
samples were received and tested for extrapulmonary tuberculosis using a
combination of bacteriological, cytological, histological and biochemical
techniques to achieve proper diagnosis of EPTB.
Results: Bacteriologically, 26% of
the specimens were positive for EPTB. Mycobacterial culture positivity was
noted in 18%. Smear by Ziehl Nielsen stain was positive in 9%. Young adults and
females predominated the study group and positive cases. A combination of
culture media both solid and liquid maximized the yield of Mycobacteria. Lymph
node tuberculosis was found to be the predominant type followed by others.
Fifteen percent of the strains were found to be resistant to the first line
drugs used in treatment of tuberculosis. Cytology and biochemical findings were
found to be less specific in diagnosis of extrapulmonary tuberculosis. Rapid
immuno chromatographic test called MPT64 Antigen test was very useful for
presumptive identification of M.tb complex with reported sensitivity and
specificity of 99% and 100%.
Conclusion: Extra pulmonary
tuberculosis is seen in a substantial number of the symptomatic patients.
Hence, attention should be paid towards its proper and early diagnosis followed
by rational management, as if neglected may lead to associated complications
and sequalae. Use of combination of media and methods enhances the diagnostic
sensitivity. Further research is needed to evaluate specific reasons for why
the disease is more common in young adults and females. It is wiser to read
cytology and biochemical findings in light of bacteriological results as alone
they are less specific. Resistance is emerging to anti tuberculosis drugs even
in extra pulmonary form of disease. Hence the use of anti-tuberculosis drugs
has to be justified as per the laboratory results for drug susceptibility test.
Author(s) Details
Dr. Sarwat Fatima
Department of Microbiology,
Ayaan institute of Medical Sciences & Research Center, Moinabad, Telangana,
India.
N. M. Aleemuddin
Department of Pulmonology,
Deccan College of Medical Sciences, Hyderabad, India.
F. Fakeha
Department of Pathology,
Osmania Medical College, Hyderabad, India.
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