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Problems in laboratory diagnosis of tuberculosis
Joshi J,Sundaram P,Kamble R
Lung India , 2005,
Abstract: Setting : Department of Respiratory Medicine, B.Y.L. Nair Hospital, Mumbai, India. Objective : To study pre-treatment sputum smear, culture and drug susceptibility testing for mycobacterium tuberculosis in fresh cases of pulmonary tuberculosis, the extent of laboratory related problems and correlation of the laboratory results with clinical outcome. Design : This study is a prospective analysis of 57 cases of pulmonary tuberculosis that denied previous treatment with anti tuberculosis drugs. Cases with associated human immunodeficiency virus (HIV) infection and diabetes mellitus (DM) were excluded. Pre-treatment smear, culture and drug susceptibility were performed by standard culture techniques. Patients were treated with short course chemotherapy (SCC) on the basis of World Health Organisation (WHO) category I. Laboratory results were correlated with initial clinical data and treatment outcomes. Results : Of the 57 cases selected, there were 34 males and 23females, age range 18-65 years, mean age 27.86 years. Clinical data was lacking in 16 patients who defaulted on treatment and hence were excluded from the analysis. Of the 41 cases with complete data, 37 patients were declared cured (91.25%) while 4 patients failed on therapy (9.75%), 17/41 (41.46%) had laboratory results consistent with clinical data and treatment results whereas 24/41 (58.53%) had poor correlation between laboratory results, clinical data and treatment outcomes. The major laboratory related problems were: 1) Smear positive / culture negative (S+/C-) in 16/41 (39%) cases at the start of treatment; 2) HR pattern of resistance in 4/41 (9.75%) and R resistance 3/41 (7.31%) on initial culture susceptibility tests but response to SCC suggesting incorrect susceptibility results. Conclusions : Discrepant reports between clinical findings, laboratory reports and treatment outcomes were found in 58.53% cases. Treatment should not be decided only on the basis of the initial culture susceptibility testing to avoid unnecessary and toxic second line therapy. Improvement in standardisation and new reliable diagnostic techniques are required for management of TB.
Advances in the laboratory diagnosis of Mycobacterium tuberculosis  [cached]
Ani A
Annals of African Medicine , 2008,
Abstract: Mycobacterium tuberculosis (MTB), the agent of human tuberculosis remains a leading cause of mortality globally. Its resurgence during the last two decades is a reflection of its opportunistic relationship with HIV. The challenges associated with the disease are enormous and often debilitating. The role of clinical and research laboratories is central and significant in this regard as prompt and adequate diagnosis are key factors in the management and control of the disease.
Advances in the Laboratory Diagnosis of Mycobacterium Tuberculosis
AE Ani
Annals of African Medicine , 2008,
Abstract: Mycobacterium tuberculosis (MTB), the agent of human tuberculosis remains a leading cause of mortality globally. Its resurgence during the last two decades is a reflection of its opportunistic relationship with HIV. The challenges associated with the disease are enormous and often debilitating. The role of clinical and research laboratories is central and significant in this regard as prompt and adequate diagnosis are key factors in the management and control of the disease. Mycobactérie tuberculose, un agent de la tuberculose humaine est toujours une cause majeure des morts dans le monde. Cette maladie qui est resurgie dans les deux derniers siècles, a un grand rapport opportunistic avec le (HIV). La maladie est pleine de défis qui sont à la fois énorme et ennuyant. Dans cet égard, les laboratoires et les h pitaux jouent un r le central et significatif, car les ma tres mots dans le control et la ma trise de cette maladie c'est le diagnostic suffisant et prompt
LABORATORY METHODS FOR DIAGNOSIS OF TUBERCULOSIS- THE APPROACH AND CHALLENGES  [PDF]
Gupta A K
Pravara Medical Review , 2009,
Abstract: Tuberculosis (TB) remains a major global health problem, particularly in many of the developing countries including India. Some of the factors that have substantially contributed to the number of multi-drug resistant tuberculosis (MDR- TB) and extensively drug resistant tuberculosis (XDR- TB) cases both in general and among HIV infected persons are- the delay in the diagnosis as well as delayed determination in the drug susceptibility of the isolated organism. In the present article, an attempt has been made to review various techniques/methods available for the diagnosis of tuberculosis and their applications along with the advantages and disadvantages/ limitations.
An evaluation study of the sputum smear concentration technique for the laboratory diagnosis of pulmonary tuberculosis
H.L.F Kamga, P Weledji, N.P Fon, A.S Atah
African Journal of Clinical and Experimental Microbiology , 2011,
Abstract: The microbial diagnosis of Pulmonary Tuberculosis plays a key role in routine treatment and Tuberculosis control Programmes in developing countries. Many patients have presented with signs and symptoms of pulmonary tuberculosis, of which consecutive direct sputum smear microscopy have given negative results for Acid-Fast Bacilli (AFB). Microscopy of smears made directly from sputum has a low sensitivity and there is an urgent need for improved methods. This study was carried out at the Yaoundé University Teaching Hospital and is aimed at evaluating the sputum smear concentration technique in the laboratory diagnosis of pulmonary TB. Sputum samples were collected in screw-cap tight containers and evaluated by both the direct and concentrated methods. Microscopy of direct smears of sputum after liquefaction with 5% sodium hypochlorite (NaOCl) solution; and concentration of the organisms by centrifugation were compared and evaluated. Results showed an increase in sensitivity from 18.27% to 25% with a specificity of 90.95%. The tuberculosis prevalence was 25%. 13.33% belongs to the age range 20-40 years and 11.67% to the age range >40 years. The positive predictive value was 73%. We concluded that the use of sodium hypochlorite (NaOCl) in the concentration of acid-fast bacilli (AFB) in sputum significantly improves the laboratory diagnosis of pulmonary tuberculosis.
Diagnosis of tuberculosis: the experience at a specialized diagnostic laboratory
Anita Mashta, Pooja Mishra, Sonia Philipose, S Tamilzhalagan, Hanif Mahmud, Sangeeta Bhaskar, Pramod Upadhyay
Journal of Negative Results in BioMedicine , 2011, DOI: 10.1186/1477-5751-10-16
Abstract: None of the tests we evaluated can accurately detect the presence or absence of Mycobacterium tuberculosis in all the samples and smear microscopy was found to be the most reliable assay in this study.The PCR assay could detect down to 2 pg of H37Rv DNA. Sensitivity, specificity was 0.40, 0.60 and 0.19, 0.81 for smear positive (n = 228) and negative samples (n = 235) respectively. In the MODS assay, sensitivity, specificity of 0.48, 0.52 and 0.38, 0.76 was observed for smear positive and negative samples. Sputum smear microscopy had sensitivity of 0.77 and specificity of 0.70.Despite the availability of effective and inexpensive therapy, tuberculosis (TB) is one of the leading causes of death from an infectious disease. It is believed that the clinical management of TB is made more difficult by the lack of a simple and effective diagnostic test. Correct and timely diagnosis of TB is very important to achieve higher compliance with the treatment, reduce transmission and to reduce the development of drug resistance.Along with the emergence of evidence based diagnosis approaches [1], a number of new technologies have been introduced [2]. These include light-emitting diode (LED)-based fluorescence microscopy [3], automated liquid culture systems such as BacT/ALERT MP [4], interferon-gamma release assays [5], etc.Recently published meta-analysis and reviews make us to believe that the future of TB diagnosis is bright. On the other hand, WHO and other organizations such as FIND (Geneva) perpetually call proposals for the development of simple and cost effective tests for TB diagnosis. This suggests that the current scenario is far from satisfactory and not all the claims made by the researchers and companies regarding the sensitivity and specificity etc. of the TB diagnostic tests are valid in actual 'field conditions'.We carried out an evaluation of relatively new TB diagnosis technologies. In addition to the direct sputum microscopy, we performed nucleic acid detection
One Health concept for strengthening public health surveillance and response through Field Epidemiology and Laboratory Training in Ghana
Frederick Wurapa, Ebenezer Afari, Chima Ohuabunwo, Samuel Sackey, Christine Clerk, Simon Kwadje, Nathaniel Yebuah, Joseph Amankwa, George Amofah, Ebenezer Appiah-Denkyira
Pan African Medical Journal , 2011,
Abstract: The lack of highly trained field epidemiologists in the public health system in Ghana has been known since the 1970s when the Planning Unit was established in the Ghana Ministry of Health. When the Public Health School was started in 1994, the decision was taken to develop a 1 academic-year general MPH course. The persisting need for well-trained epidemiologists to support the public health surveillance, outbreak investigation and response system made the development of the Field Epidemiology and Laboratory Training Programme (FELTP) a national priority. The School of Public health and the Ministry of Health therefore requested the technical and financial assistance of the United States Centers for Disease Control and Prevention (CDC) in organizing the Programme. The collaboration started by organizing short courses in disease outbreak investigations and response for serving Ghana Health Service staff. The success of the short courses led to development of the FELTP. By October 2007, the new FELTP curriculum for the award of a Masters of Philosophy in Applied Epidemiology and Disease Control was approved by the Academic Board of the University of Ghana and the programme started that academic year. Since then five cohorts of 37 residents have been enrolled in the two tracks of the programme. They consist of 12 physicians, 12 veterinarians and 13 laboratory scientists. The first two cohorts of 13 residents have graduated. The third cohort of seven has submitted dissertations and is awaiting the results. The fourth cohort has started the second year of field placement while the fifth cohort has just started the first semester. The field activities of the graduates have included disease outbreak investigations and response, evaluation of disease surveillance systems at the national level and analysis of datasets on diseases at the regional level. The residents have made a total of 25 oral presentations and 39 poster presentations at various regional and global scientific conferences. The Ghana FELTP (GFELTP) has promoted the introduction of the One Health concept into FELTP. It hosted the first USAID–supported workshop in West Africa to further integrate and strengthen collaboration of the animal and human health sectors in the FETP model. GFELTP has also taken the lead in hosting the first AFENET Center for Training in Public Health Leadership and Management, through which the short course on Management for Improving Public Health Interventions was developed for AFENET member countries. The GFELTP pre-tested the Integrated Avian Influenza Outbreak and Pandemic Influenza course in preparation for introducing the materials into the curriculum of other FELTP in the network. The leadership positions to which the graduates of the program have been appointed in the human and animal Public Health Services, improvement in disease surveillance, outbreak investigation and response along with the testimony of the health authorities about their appreciation of
Haemophilia Laboratory diagnosis training and care in Rural communities in Sudan
Fathelrahman M. Hassan,Maria M. Satti
Russian Open Medical Journal , 2012,
Abstract: Sixty nine per cent of people with hemophilia symptoms in rural areas were accessed to laboratory diagnosis and care support in Sudan, where technical expertise and health care facilities was less than optimal. There were many reasons for the inadequate care of hemophilic patients: the perception of rarity of the disease; lacked of laboratory facilities to diagnose the disorder; lacked of understanding of the disorder by patients, their relatives, and even healthcare providers; poorly developed blood bank facilities; and lacked of adequate factor supply were just some examples. The Sudanese Hemophilia Care Association (SHCA) was attempted to address many of these issues by establishing hemophilia care programs and by educating and training healthcare practitioners so that a healthcare team could be organized that attempts to ameliorate these problems and provides treatment options. However, it was possible to manage hemophiliac’s patients with limited resources. Strategies for conserving factor concentrates were included education of doctors and patients, prenatal diagnosis, increasing the use of anti fibrinolytic agents, physiotherapy, the use of fibrin glue, and simple orthotics and prosthetic measures. An outreach program would be initiated to ensure that hemophilia care and diagnosis was available outside the capital city. Official recognition of hemophilia laboratory diagnosis and treatment centers and designated centers by the government could also be very beneficial in ensuring adequate care in rural areas in Sudan.
Population-Based Tuberculosis Disease Prevalence Survey in Ghana: The Role and Lessons Learnt from the Laboratory  [PDF]
Kennedy Kwasi Addo, Samuel Ofori Addo, Christian Bonsu, Ezekiel Mensah, Sarah Edusei, Prosper Dedzo, Michael Amo Omari, Samuel Kudzawu, Honesty Ganu, Samuel Kumah Atiadevie, Frank Adae Bonsu
Journal of Tuberculosis Research (JTR) , 2019, DOI: 10.4236/jtr.2019.72009
Abstract: Background: Bacteriologically-confirmed tuberculosis (TB) cases used in calculating TB prevalence in a country are obtained through laboratory examination of sputum specimens. Objective: This article describes laboratory processing of specimens, results overview, conclusions and key lessons learnt from the perspective of laboratory personnel involved in the conduct of TB disease prevalence survey in Ghana in 2013. Methods: Symptoms screening and Chest X-ray suggestive of TB were used to select participants who produced sputum to confirm TB cases using microscopy, culture and Xpert® MTB/RIF assay (GeneXpert). Results: A total of 15,935 single and paired sputum specimens were received from eligible participants. About half of Ziehl-Nielsen (129/263) and Auramine O (122/246) stained smear positives were scanty positive. Culture positivity rate for Mycobacterium tuberculosis complex was 266/14,994 (1.7%) and 100/15,179 (0.7%) in Mycobacterial Growth Indicator Tube (MGIT) and Lowenstein-Jensen (LJ) media respectively; while non-tuberculous mycobacterium was 294/14,994 (1.96%) and 167/15,179 (1.1%). Total contamination rates in MGIT (5.4%) were higher than in LJ (1.7%). Prevalence of smear positive TB and bacteriologically confirmed TB among adult population (≥15 years) was estimated at 111 (95% CI: 76 - 145) and 356 (95% CI: 288 - 425) per 100,000 population respectively. Conclusions and Lessons Learnt: Direct supervision of specimen collection by well-trained laboratory personnel, timely transportation of specimens from field to laboratory, prompt specimen processing and use of electronic data management systems are essential for a reliable TB disease prevalence survey data. More importantly, strengthening human and logistical capacity of the laboratory must be of utmost priority.
Comparative Efficacy of Different Laboratory Techniques Used in Diagnosis of Tuberculosis in Human Population  [PDF]
Tanzeela Talat,Bashir Mahmood Bhatti,M. Yaqoob
Journal of Medical Sciences , 2002,
Abstract: In order to test the efficacy of different laboratory techniques used in diagnosis of tuberculosis, 50 Tb cases along with 50 control cases in Faisalabad area were studied, using different laboratory tests. Mantoux`s test showed no correlation with hematological parameters. Acid fast test (AFB-Test) was routinely used in labs, but there was still chances of contamination of sputum sample with a typical mycobacteria, so increasing the chances of error in the results. Chest radiograph was also a specific technique to some extent but in case of small children and other lungs diseases, it became unreliable and confusing test. When a comparative evaluation was made between different diagnostic tests, polymerase chain reaction (PCR) proved to be a very sensitive, highly specific, qualitative and quantitative technique for the confirmation of pulmonary tuberculosis. However, there was no correlation of PCR results with other hematological findings. Hematological studies showed significantly high level of erythrocyte sedimentation rate (ESR) in Tb cases (64.3 38.2) (P<0.00) than in control cases (16.57 5.26) were significantly increased (72.5 39.9). Hemoglobin level (Hb) of Tb patients was significantly decreased (8.84 2.33) than in control cases (11.8 1.65). Total Leucocyte count (TLC) in Tb patients was significantly (P<0.000) higher (8882 1650) as compared to control cases (62134 1161.68). Differential leucocyte count (DLC) analysis of Tb cases in comparison with control cases showed significantly high (P<0.000), neutrophil count in Tb cases (69.4 4.69) as compared to control cases (60.04 5.15). Lymphocyte count in Tb cases was significantly decreased (P<0.000) (24.55 3.64) than in control cases (32.39 4.63) and eosinophil count in Tb cases was (2.16 1.34) and control cases (3.2 1.55) at probability level of (0.0004). Monocytes and basophil count was non-significantly different (P<0.1127; P<1.00) in Tb cases (3.7 1.72, 0.08 0.27) from control cases (4.38 2.55, 0.08 0.27). It may be concluded that PCR test is reliable, which may be employed in routine testing of Tb cases to safeguard against misdiagnosis.
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