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Efficacy of serum chitotriosidase activity in early treatment of patients with active tuberculosis and a negative sputum smear
Tasci C,Tapan S,Ozkaya S,Demirer E
Therapeutics and Clinical Risk Management , 2012,
Abstract: Canturk Tasci,1 Serkan Tapan,2 Sevket Ozkaya,3 Ersin Demirer,4 Omer Deniz,1 Arzu Balkan,1 Metin Ozkan,1 Ilker Inan,1 Ismail Kurt,2 Hayati Bilgic11Department of Pulmonary Diseases, 2Department of Biochemistry, Gulhane Medical Faculty, Ankara, 3Department of Pulmonary Medicine, Dr Suat Seren Education and Research Hospital for Chest Diseases and Thoracic Surgery, Izmir, 4Istanbul Gulhane Medical Faculty, Department of Pulmonary Diseases, Istanbul, TurkeyBackground: The results of sputum culture for Mycobacterium tuberculosis must be awaited in most cases, which delays the start of treatment in patients with sputum smear-negative pulmonary tuberculosis. We investigated whether plasma chitotriosidase activity is a strong marker for early diagnosis of tuberculosis in patients for whom a bacillus smear is negative and tuberculosis culture is positive.Methods: Clinical, radiological, and laboratory features were evaluated in 75 patients, 17 of whom were diagnosed as having active tuberculosis by negative acid-fast bacillus smear and positive culture, 38 as having sequel tuberculosis which was radiologically and microbiologically negative, and 20 who served as healthy controls. Serum chitotriosidase activity levels were measured in both cases and controls.Results: The mean age of the cases with active pulmonary tuberculosis, cases with sequel lesions, and controls was 23 ± 2.4 years, 22 ± 1.7 years, and 24 ± 2.1 years, respectively. Serum chitotriosidase levels were 68.05 ± 72.61 nmol/hour/mL in smear-negative, culture-positive pulmonary tuberculosis cases (Group A) and 29.73 ± 20.55 nmol/hour/mL in smear-negative, culture-negative sequel pulmonary tuberculosis cases (Group B). Serum chitotriosidase levels from patients in Group A were significantly higher than in Group B and Group C. There was no statistically significant difference in serum chitotriosidase levels between cases with sequel pulmonary tuberculosis (Group B, smear-negative, culture-negative) and healthy controls (Group C).Conclusion: In patients with active tuberculosis and a negative sputum smear for acid-fast bacillus, plasma chitotriosidase activity seems to be a strong marker for diagnosis of active disease which can be used while awaiting culture results.Keywords: pulmonary tuberculosis, serum chitotriosidase, diagnosis, antituberculous treatment, disease activity
Factors Influencing Sputum Conversion among Smear-Positive Pulmonary Tuberculosis Patients in Morocco  [PDF]
Khalid Bouti,Mohammed Aharmim,Karima Marc,Mouna Soualhi,Rachida Zahraoui,Jouda Benamor,Jamal Eddine Bourkadi,Ghali Iraqi
ISRN Pulmonology , 2013, DOI: 10.1155/2013/486507
Abstract: Background. Sputum smear-positive pulmonary tuberculosis patients expel infectious viable bacilli for a period following the commencement of treatment. Objective. To determine the time to sputum smear conversion and study the factors influencing it. Design. A prospective study was undertaken at our hospital in Rabat over a six-month period on a cohort of 119 sputum smear positive patients. Patients were followed up fortnightly. At each followup, specimens were collected and processed for microscopy using standard protocol. Results. 96.6% of our patients completed the study (4 deaths). Sputum conversion rate was 42% after two weeks, 73% after one month, and 95% after two months. Univariate and stepwise regression analysis showed that patients who had high smear grading, miliary, and bilateral radiologic lesions were more likely to undergo delayed sputum conversion ( ). Other factors were thought to influence sputum conversion but were not statistically proven in our study. Conclusion. Since viable bacilli continue to be expelled for up to two months, infection control measures should be maintained for such a time. Patients with high smear grading, miliary, and bilateral radiologic lesions need to be monitored more closely. 1. Introduction The World Health Organization (WHO) estimates that there are almost 13.7 milion people living with tuberculosis and that the disease kills more young people and adults than any other infectious disease in the world. In Morocco, the new cases of tuberculosis in 2008 were 27000, and the incidence was 82/100000 people. Patients in our health system receive intermittent therapy with multidrug regimen based on directly observed treatment, short-course (DOTS). Tuberculosis control aims to reduce the spread of the infection, and the most efficient method for preventing transmission is the identification and cure of infectious pulmonary tuberculosis patients [1]. Sputum smear-positive (SSP) pulmonary tuberculosis patients are the most significant source of infection for tuberculosis because, when they cough or sneeze, they expel droplet nuclei which carry infectious bacilli [2]. One untreated infectious tuberculosis patient is likely to infect 10 to 15 persons annually [3]. When SSP patients are initiated on multidrug antituberculosis treatment, there is a multifold reduction in bacillary load expelled in sputum [4]. Patients, who respond, are likely to become smear and culture negative during the course of treatment. However, viable bacilli continue to be expelled for a period of time, during which they may continue to spread
Efficacy of serum chitotriosidase activity in early treatment of patients with active tuberculosis and a negative sputum smear
Tasci C, Tapan S, Ozkaya S, Demirer E, Deniz O, Balkan A, Ozkan M, Inan I, Kurt I, Bilgic H
Therapeutics and Clinical Risk Management , 2012, DOI: http://dx.doi.org/10.2147/TCRM.S31752
Abstract: acy of serum chitotriosidase activity in early treatment of patients with active tuberculosis and a negative sputum smear Original Research (1120) Total Article Views Authors: Tasci C, Tapan S, Ozkaya S, Demirer E, Deniz O, Balkan A, Ozkan M, Inan I, Kurt I, Bilgic H Published Date August 2012 Volume 2012:8 Pages 369 - 372 DOI: http://dx.doi.org/10.2147/TCRM.S31752 Received: 13 March 2012 Accepted: 18 April 2012 Published: 27 August 2012 Canturk Tasci,1 Serkan Tapan,2 Sevket Ozkaya,3 Ersin Demirer,4 Omer Deniz,1 Arzu Balkan,1 Metin Ozkan,1 Ilker Inan,1 Ismail Kurt,2 Hayati Bilgic1 1Department of Pulmonary Diseases, 2Department of Biochemistry, Gulhane Medical Faculty, Ankara, 3Department of Pulmonary Medicine, Dr Suat Seren Education and Research Hospital for Chest Diseases and Thoracic Surgery, Izmir, 4Istanbul Gulhane Medical Faculty, Department of Pulmonary Diseases, Istanbul, Turkey Background: The results of sputum culture for Mycobacterium tuberculosis must be awaited in most cases, which delays the start of treatment in patients with sputum smear-negative pulmonary tuberculosis. We investigated whether plasma chitotriosidase activity is a strong marker for early diagnosis of tuberculosis in patients for whom a bacillus smear is negative and tuberculosis culture is positive. Methods: Clinical, radiological, and laboratory features were evaluated in 75 patients, 17 of whom were diagnosed as having active tuberculosis by negative acid-fast bacillus smear and positive culture, 38 as having sequel tuberculosis which was radiologically and microbiologically negative, and 20 who served as healthy controls. Serum chitotriosidase activity levels were measured in both cases and controls. Results: The mean age of the cases with active pulmonary tuberculosis, cases with sequel lesions, and controls was 23 ± 2.4 years, 22 ± 1.7 years, and 24 ± 2.1 years, respectively. Serum chitotriosidase levels were 68.05 ± 72.61 nmol/hour/mL in smear-negative, culture-positive pulmonary tuberculosis cases (Group A) and 29.73 ± 20.55 nmol/hour/mL in smear-negative, culture-negative sequel pulmonary tuberculosis cases (Group B). Serum chitotriosidase levels from patients in Group A were significantly higher than in Group B and Group C. There was no statistically significant difference in serum chitotriosidase levels between cases with sequel pulmonary tuberculosis (Group B, smear-negative, culture-negative) and healthy controls (Group C). Conclusion: In patients with active tuberculosis and a negative sputum smear for acid-fast bacillus, plasma chitotriosidase activity seems to be a strong marker for diagnosis of active disease which can be used while awaiting culture results.
Increase in the Number of Tuberculosis Cases Treated following Tuberculin Skin Testing in First-Year Schoolchildren in Madagascar  [PDF]
Rila Ratovoson, Voamalala Raharimanga, Niaina Rakotosamimanana, B. Ravaloson, Maherisosa Ratsitorahina, Rindra Randremanana, Herimanana Ramarokoto, Soatiana Rajatonirina, Voahangy Rasolofo, Vincent Richard
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095494
Abstract: Background Tuberculosis continues to cause unacceptably high levels of disease and death worldwide. Active preventive strategies are required to improve tuberculosis control and to increase the number of cases treated in developing countries. The aim of this study was to evaluate the utility of the tuberculin skin test (TST) in first-year schoolchildren as a means of increasing the number of tuberculosis cases detected through the screening of close contacts. Methods All members of the households of 90 schoolchildren assigned to three groups on the basis of TST category (≤5 mm, [5–15)mm, ≥15 mm) were screened for sputum smear-positive pulmonary tuberculosis. The percentage detection of tuberculosis in close contacts was compared between TST categories. Results We identified 433 close contacts of the 90 schoolchildren, who were then evaluated for tuberculosis. We identified 11 cases of pulmonary tuberculosis among the close contacts (7 already on treatment and 4 previously undiagnosed): 0 in TST category ≤5 mm, 3 in TST category [5–15) mm and 8 in TST category ≥15 mm). This approach increased the detection of tuberculosis cases by a factor of 1.6 in first-year schoolchildren of the TST ≥5 mm group. Conclusion TST in first-year schoolchildren is a potentially effective method for improving the detection of tuberculosis in close contacts.
Radiologic Manifestations of Patients with Smear Positive Pulmonary Tuberculosis in Zabol
Masoud Sajadi Nassab
Iranian Journal of Radiology , 2009,
Abstract: "nIntroduction:Tuberculosis (TB) is one of the most important causes of mortality in the world. If not treated, this disease will kill 50 – 65% of the patients in five years. Chest X ray has an important role in the diagnosis of TB. Diagnosis of this disease and starting the appropriate treatment interrupts tuberculosis transmission by rendering patients noninfectious. In this study, we evaluated the radiologic manifestations of patients with smear positive pulmonary tuberculosis in Zabol. "nMaterials and Methods: In this cross–sectional study, 325 patients with smear positive pulmonary tuberculosis from March 2004 to March 2005 were evaluated. Data were collected and analyzed using SPSS ver 15 software. "nResults: Of 325 patients with a smear positive pulmonary tuberculosis, 116 (35.7%) were male and 209 (64.3%) were female. The left upper lobe was the most frequent site involved 175 (53.8%) and the second was the right upper lobe 134 (41.2%). The most frequently observed pulmonary involved form was bronchopneumonia 242 (74.4%). Patchy consolidation was detected in 99 (30.4%) patients. Cavitary lesions and pleural effusion were observed in 68 (20.9%) and 35 (10.7%) patients, respectively. In 8 cases (2.4%) the CXR was normal. After six months treatment, the CXR of the patients were evaluated. In 90 (27.7%) patients CXRs were resolved entirely. In 169 (52%) cases CXRs were resolved slightly and in 66 (20.3%) patients, CXR did not show any changes. "nConclusion: Tuberculosis, one of the oldest diseases known to affect humans, is a major cause of death worldwide. HIV infection and other immunodeficiency states increase the prevalence of TB. It is one of the most important infectious diseases in Afghanistan (in the east border of Iran) and immigration of Afghans causes TB to become a health problem. Pulmonary TB has different radiological manifestations and CXR has an important role in the diagnosis of TB. Consolidation, cavitations and other radiological manifestations especially in the upper lobes help the diagnosis of TB. This disease is one of the most important differential diagnoses of these changes.
Granulomatous lesions of the skin  [PDF]
K Gautam,RR Pai,S Bhat
Journal of Pathology of Nepal , 2011, DOI: 10.3126/jpn.v1i2.5397
Abstract: Background: Granulomatous skin lesions often present as a diagnostic challenge to dermatopathologists due to various modes of presentation and identical histological picture produced by several causes. The aim of the study was to study different granulomatous skin lesions and to determine the relative frequency, the level of clinicopathologic concordance and to compare our results with those of other workers. Materials and Methods : A retrospective analysis of skin biopsies received over a period of two years from January 2007 to December 2008; was performed, and cases of granulomatous dermatitis reported on histopathological examination were reviewed along with special stains. Results: Out of a total of 1590 skin biopsies 106 (6.67%) cases were found to have a granulomatous reaction. It was common in males (63.21%) with most occurring in the fourth to fifth decades. Majority of cases (79 cases, 74.5%) were categorized as infectious granulomatous lesions with predominance of leprosy (63 cases, 79.7%) followed by tuberculosis (6 cases, 7.6%). An overall clinicopathologic concordance was seen in 97% of cases of leprosy. Conclusion: In this study leprosy is the most common cause of granulomatous skin lesions. It can be concluded that histopathology plays an important role in classification of leprosy, and in diagnosis and management of a variety of granulomatous skin diseases. Special stains play a supportive role in infectious granulomas. Keywords: Granulomatous skin lesion; Leprosy; Skin biopsy DOI: http://dx.doi.org/10.3126/jpn.v1i2.5397 JPN 2011; 1(2): 81-86
Re-Assessing Tuberculin Skin Test (TST) for the Diagnosis of Tuberculosis (TB) among African Migrants in Western Europe and USA  [PDF]
Kebede C. Shero, Mengistu Legesse, Girmay Medhin, Mulugeta Belay, Gunnar Bjune, Fekadu Abebe
Journal of Tuberculosis Research (JTR) , 2014, DOI: 10.4236/jtr.2014.21002
Abstract: Background: Tuberculin skin test (TST)—is widely used for screening tuberculosis TB in migrants from high endemic countries of Africa and Asia. However, the cut-off point for clinical TB and Mtb infection is not well established in TB endemic countries of sub-Saharan Africa. In this study we compared the size of TST induration in smear positive pulmonary TB (PTB) patients, their house-hold contacts and community controls in high endemic setting in Ethiopia. Methods: In a health facility-based cross-sectional study, smear positive PTB patients were recruited. Their household contacts traced, and community controls were recruited from neighbourhoods. Sputum sample collected from patients were examined using smear microscopy. Participants were also tested by TST and QuantiFERON? -TB Gold In–Tube test (QFTGIT). Results: From a total of 224 study participants, skin test induration data were available for 48 PTB patients, 88 household contacts and 75 community controls. All 48 patients, 64 (72.2%) of the household contacts and 35 (46.7%) of the community controls had skin test induration ≥ 10 mm. Moreover, 44 (91.7%) PTB patients, 58 (65.9%) of the household contacts and 26 (34.7%) of the community controls had skin test induration ≥ 15 mm, respectively. The mean size of TST induration was significantly higher in TB patients (18.1mm) compared to that of household contacts (13.6 mm) and community controls (7.9 mm) (p< 0.001). Conclusion: Skin test induration ≥ 15 mm seems to be optimal for suspecting active TB and recommending chest X-ray for migrants from Ethiopia, and other sub-Saharan countries, while skin test induration ≥ 10 mm seems optimal to suggest Mtb infection
Frequency of Infectious Skin Lesions in Kidney Transplant Recipients  [cached]
Masoomeh Alimagham,Saeed Amini-Afshar,Siamak Farahmand,Aydin Pour-Kazemi
Urology Journal , 2005,
Abstract: Introduction: This study was performed to evaluate the frequency of skin lesions in kidney transplant recipients. Materials and Methods: A total of 681 kidney transplant recipients were followed at Shaheed Labbafinejad transplant center in Tehran, Iran. Skin lesions were evaluated, and diagnoses were made clinically and confirmed by lesion smear, tissue biopsy, tissue culture, and serologic examinations, as indicated. Results: Skin lesions were found in 54 patients (7.9%), and their frequencies were as follows: dermatomal herpes zoster (18 patients, 2.6%, 13 men and 5 women), herpes simplex infection of face and lips (15 patients, 2.2%, 5 men and 10 women), chickenpox (6 patients, 0.9%, 5 men and 1 woman), Kaposi's sarcoma (5 patients, 0.7%, 3 men and 2 women), warts (4 women, 2 of whom had genital warts), pyoderma gangrenosum (1 man, 0.14%), multiple fungal abscesses of the leg (1 man, 0.14%), mucormycosis (1 man, 0.14%), and molluscum contagiosum (1 man, 0.14%). Moreover, 2 women (0.3%) had generalized herpes simplex lesions. Conclusion: Frequencies of herpes zoster (3.5%), herpes simplex (2.5%), and human papillomavirus (0.6%) infections in our kidney transplant recipients were low. We recommend that all kidney transplant candidates be evaluated and immunized for herpes zoster virus before transplantation, all herpetic-form lesions of these patients be reported to physicians (even mild lesions), and finally, that all human papillomavirus lesions be diagnosed and treated promptly to prevent more serious lesions such as malignancies.
Immunopathology of skin lesions
Khan Nazoora,Maheshwari Veena,Trivedi Indu,Kalam Abul
Indian Journal of Dermatology, Venereology and Leprology , 2001,
Abstract: A study was conducted on 130 patients suffering from skin lesions which included psoriasis, lichen planus, DLE, pemphigus, vitiligo and alopecia areata. Forty age-and-sex-matched healthy individuals served as control. Serum IgG, IgM, and circulating immune complexes (CIC) were estimated. Significant increase in serum IgG (1937.2 ± 1030.43 mg%) and IgM (232.12 ± 136.98 mg%) was observed in all the skin lesions when compared with controls except in lichen planus where they were significantly lowered, values being 580.61± 77.35 mg% and 66.88 ± 6.59mg% respectively. CIC levels were significantly raised (P<0.00 1) in various skin lesions (40.49±23.29) when compared with controls (17.68± 3.21), but no significance was observed in lichen planus( 17.72 ± 4.28). Serum IgG, IgM and CIC were statistically significantly altered depending on the extent of the lesion and lowered significantly to almost normal values following treatment, thereby confirming the role of immunity in the pathogenesis of these skin disorders.
"Comparative Study Of The Profiles Of Th1 And Th2 Cytokines In Patients With Sputum Smear- Positive Pulmonary Tuberculosis And PPD–Positive Healthy Persons And Their Changes During Treatment "
M. Hajiabdolbaghi,A.A. Amirzargar,M. Khaledi,F. Khosravi
Tehran University Medical Journal , 2006,
Abstract: Background and Aim: The better understanding of immunopathologic mechanism of tuberculosis (TB) is necessary for the production of new vaccines and adjunctive immunomodulator drugs. Intended to this object, the following study including the measurement of serum concentrations of Th1 (Interferon (IFN)-y and interkeukin (IL)-2 and Th2 cytokines(IL-4AND IL-10 ) in patients with sputum smear-positive pulmonary TB and comparisons of them with PPpositive healthy persons, was designed. Materials and Methods: The HIV-negative patients that had sputum smear-positive pulmonary TB as defined WHO criteria and hospitalized in the infectious diseases ward of Imam Khomeini hospital or referred to health care centers in the south of Tehran, were included in the study. The PPD-positive healthy persons who were close contacts with pulmonary TB patients, were considered as control group. Results: In this research 34 active pulmonary TB patients (including17men and 17 woman)and 23 healthy persons with PPD skin test results or = 10mm (including 12men and 11 woman) were studied. The mean ages of the patients and the healthy persons were 73 and 41 years and 74 and 27 years, respectively. The mean serum IFN-Y concentration was significantly higher in TB patients but the mean serum IL-2 IL-4and IL-10 concentrations were significantly higher in healthy persons. The com parison of the mean serum levels of these cytokines before and during treatment (about 2 months after starting treatment) showed that the amounts of IFN-y and IL4 were increased and the amounts of IL2 and IL-10 were decreased but only the changes of IL-10 were statistically significant. There were no effect on the cytokine changes before and during treatment by age and gender of the patients. Conclusion: The results of the study of serum Th1 and Th2 cytokines in pulmonary TB patients were different in comparison with the results of the studies of peripheral blood mononuclear cells (PBMCs) stimulated with M.tuberculosis antigens. SO, the simultaneous measurement of them in serum, pleural fluid, BAL fluid and the medium culture of PBMCs stimulated with the antigens is recommended.
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