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PubMed1995

Direct detection of Mycobacterium tuberculosis complex in respiratory specimens by Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test and Roche Amplicor Mycobacterium Tuberculosis Test.

Two hundred and fifty-six sputum, bronchoalveolar lavage, and bronchial and tracheal aspirate specimens from 243 patients were tested for the presence of Mycobacterium tuberculosis complex by auramine fluorochrome staining, rRNA target amplification (Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test [AMTD]), and PCR (Roche Amplicor Mycobacterium Tuberculosis Test [Amplicor PCR]. The results were compared with those of conventional Löwenstein-Jensen tube culture and BACTEC radiometric liquid culture. A total of 26 specimens from 18 patients were culture positive for M. tuberculosis. In addition, seven specimens were positive by staining and by culture for other Mycobacterium species but negative by nucleic acid amplification methods and were not included in the comparison. When compared with that for culture, the sensitivities of the techniques were as follows: for staining, 80.8%; for Gen-Probe AMTD, 84.6%; and for Roche Amplicor PCR, 84.6%. The specificities were 99.1, 98.7, and 99.1%, respectively. After resolution of discrepant results by review of the patients' clinical data, 29 specimens from 21 patients were considered positive, and the overall sensitivities, specificities, and positive and negative predictive values were 89.7, 100, 100, and 98.7% for culture; 75.9, 99.5, 95.7, and 96.9% for staining; 86.2, 100, 100, and 98.2% for Gen-Probe AMTD; and 82.8, 100, 100, and 97.9% for Roche Amplicor PCR, respectively. It is concluded that both nucleic acid amplification methods are rapid, sensitive, and specific methods for the detection of M. tuberculosis in respiratory specimens.

Bacteriological Techniques↗
PubMed1996

Surveillance of tuberculosis in Europe. Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting on tuberculosis cases.

Consensus-based recommendations have been developed by a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) on uniform reporting of tuberculosis surveillance data in the countries of Europe. A uniform case definition and a minimum set of variables for reporting on each case have been agreed which, when collated on a national basis, will allow comparison of the epidemiology of tuberculosis in different European countries. The Working Group recommends that the case definition includes "definite" cases, where the diagnosis has been confirmed by culture (or supported by microscopy findings in countries where diagnostic culture facilities are not available), and "other than definite cases" based on a clinical diagnosis of tuberculosis combined with the intention to treat with a full course of antituberculosis therapy. Both "definite" and "other than definite" cases should be notified by physicians and, in addition, laboratories should be required to report "definite" cases. The minimum set of variables to be collected on each case of tuberculosis should include: date of starting treatment, place of residence, date of birth, gender, and country of origin, to characterize the patient. Recommended disease-specific variables include: site of disease, bacteriological status (microscopy and culture), and history of previous antituberculosis chemotherapy. The minimum set of variables should be collated on all patients and should be as complete as possible. Additional variables may be collected for individual, local or national purposes, but, in general, completeness of reporting on cases is likely to be better if the information requested is kept to a minimum. Timely reporting of cases is essential for appropriate public health action. Cases should be reported to the health authority at the local and/or regional level within 1 week of starting treatment. Individual-case based information should be reported to the national level by the local or regional level. Feedback to reporters is essential. At the national level, preliminary quarterly reports should be produced and final reports should be published annually.

Data Collection↗
PubMed2002

[Sensitivity of microscopy for detection of mycobacterium tuberculosis and MOTT (mycobacteria other than tuberculosis) on the basis of analysis 22.218 clinical materials submitted in 1998-2001 to the Department of Microbiology in National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland].

The results of 22.218 respiratory specimens sent to our laboratory were studied to determine the sensitivity of the Ziehl-Neelsen (Z-N) stain and microscopy-fluorescence method for detection of M.tbc and MOTT. There were no AIDS patients among analyzed cases. Smears were positive for acid fast bacilli (AFB) 60.0% (480 of 800) of specimens growing M. tuberculosis and 25.1% (219 of 872) of specimens growing the six common species of MOTT. Smear positivity by species was 28.1% (141 of 502) for M. kansasii, 29.4% (43 of 146) for MAIC, 28.7% (35 of 122) for M. xenopi. No smear was positive for M. gordone (43 cultures), M. fortuitum (33 cultures), M. scrofulaceum (26 cultures). The rate of nonculturable mycobacteria on L-J medium was 0.2%; mean rate of contamination was 4.6%. We also analyzed the relation between the number of AFB seen on the smear and time of the growth of M. tuberculosis and relation between abundance of the culture growth and AFB seen on smears. These study suggest that the sensitivity of microscopy for Mycobacterium tuberculosis is comparable with the data of others authors. Sensitivity of microscopy is lower in MOTT detection than for M.tbc (p < 0.001). Time of growth and abundance of the M. tuberculosis cultures were adequate to AFB seen in microscopy.

Bacteriological Techniques↗
PubMed1986

[Rare abdominal manifestations of tuberculosis: isolated splenic tuberculosis and peritoneal tuberculosis].

Two patients with rare localizations of extrapulmonary tuberculosis are presented. In a 55-year-old man admitted with septic fever and a low neutrophil count, ultrasonography of the spleen revealed splenomegaly with numerous hypodense foci. Fine needle biopsy of one of the foci disclosed tuberculosis. Persistent splenogenic neutropenia and thrombocytopenia, despite tuberculostatic therapy, required splenectomy which confirmed the initial diagnosis. At laparotomy no other abdominal foci of tuberculosis were found. In a second 57-year-old man admitted for ascites and weight loss, a biopsy specimen of the liver showed normal liver parenchyma but, by chance, peritoneal tuberculosis. Tuberculostatic therapy brought about cure.

Biopsy↗
PubMed1998

Chemotherapy of tuberculosis in Hong Kong: a consensus statement The Tuberculosis Control Coordinating Committee (Department of Health) and the Tuberculosis Subcommittee of the Coordinating Committee in Internal Medicine (Hospital Authority), Hong Kong.

This consensus statement is prepared primarily as a concise reference for tuberculosis chemotherapy in Hong Kong. Treatment should be tailored to patients individually, expert advice should be sought when necessary, and 'directly observed treatment' should be used where possible. A 6-month regimen is recommended as the initial treatment of uncomplicated pulmonary tuberculosis and a 9-month regimen is recommended for retreatment. Patients with disease that is resistant to isoniazid or rifampicin may require modified regimens. Multidrug-resistant tuberculosis should be managed in specialised centres, using multiple drugs as guided by in vitro susceptibility tests. Recommended regimens to treat extrapulmonary tuberculosis are based on limited current evidence, although shorter regimens may be acceptable when better evidence emerges. A longer duration of treatment is required for diabetic, immuno-compromised, or silicotic patients. During pregnancy, streptomycin should be avoided; the safety profiles of second-line drugs have not yet been ascertained. Hepatotoxic drugs should be used with caution in patients with liver dysfunction, and extra caution and dosage reductions are required if streptomycin and ethambutol are used in patients with renal impairment.

Journal Article↗
PubMed2000

Comparison of enhanced Mycobacterium tuberculosis amplified direct test with COBAS AMPLICOR Mycobacterium tuberculosis assay for direct detection of Mycobacterium tuberculosis complex in respiratory and extrapulmonary specimens.

The new Roche COBAS AMPLICOR Mycobacterium tuberculosis Assay was compared to the Gen-Probe enhanced Mycobacterium tuberculosis Amplified Direct Test (AMTDII). A total of 486 specimens (296 respiratory and 190 extrapulmonary) collected from 323 patients were tested in parallel with both assays. Results were compared with those of acid-fast staining and culture, setting the combination of culture and clinical diagnosis as the "gold standard." After resolution of discrepant results, the sensitivity, specificity, and positive and negative predictive values for AMTDII were 85.7, 100, 100, and 90.4% for respiratory specimens and 82.9, 100, 100, and 95. 5% for extrapulmonary specimens, respectively. The corresponding values for AMPLICOR were 94.2, 100, 100, and 96.6% for respiratory specimens and 85, 100, 100, and 96.1% for extrapulmonary specimens, respectively. No significant differences were observed between the results of both assays or, within each one, between respiratory and extrapulmonary specimens. The difference between AMTDII and AMPLICOR sensitivities was related to the presence of inhibitory samples, which the former assay, lacking an internal amplification control (IAC), could not detect. The overall inhibition rate for the AMPLICOR assay was 3.9% (19 specimens). It is concluded that, although both amplification assays proved to be rapid and specific for the detection of M. tuberculosis complex in clinical samples, AMPLICOR, by a completely automated amplification and detection procedure, was shown to be particularly feasible for a routine laboratory setting. Finally, AMTDII is potentially an excellent diagnostic technique for both respiratory and extrapulmonary specimens, provided that an IAC is included with the assay.

Biopsy↗
PubMed1998

Comparative evaluation of the new gen-probe Mycobacterium tuberculosis amplified direct test and the semiautomated abbott LCx Mycobacterium tuberculosis assay for direct detection of Mycobacterium tuberculosis complex in respiratory and extrapulmonary specimens.

Two commercial assays that detect Mycobacterium tuberculosis complex (MTB) in clinical specimens by rRNA target amplification (AMTDII) and ligase chain reaction (LCx) were evaluated. The tests were applied to 457 respiratory (n = 273) and extrapulmonary (n = 184) specimens collected from 357 patients. The results were compared with those of acid-fast staining and culture. The combination of culture and clinical diagnosis was considered to be the "gold standard." Seventy specimens were from patients with pulmonary tuberculosis and 28 specimens were from patients with extrapulmonary tuberculosis. After resolution of discrepant results, the overall sensitivities, specificities, and positive and negative predictive values for respiratory specimens were 92.8, 99.4, 98.5, and 97%, respectively, for AMTDII and 75.7, 98.8, 96.4, and 90.5%, respectively, for LCx. With extrapulmonary specimens, the overall sensitivities, specificities, and positive and negative predictive values were 78.6, 99.3, 95.6, and 96.2%, respectively, for AMTDII and 53.6, 99.3, 93.7, and 92.1%, respectively, for LCx. The level of agreement between AMTDII and LCx assay results was 78.2%. We conclude that although both nucleic acid amplification methods are rapid and specific for the detection of MTB in clinical specimens, AMTDII is significantly more sensitive than LCx with both respiratory (P = 0.005) and extrapulmonary (P = 0.048) specimens.

Bronchi↗
PubMed1998

Standardized tuberculosis treatment outcome monitoring in Europe. Recommendations of a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting by cohort analysis of treatment outcome in tuberculosis patients.

Consensus-based recommendations have been developed by a Working Group of the World Health Organisation (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) on uniform reporting of tuberculosis (TB) treatment outcome data in countries in Europe. The main purpose of treatment monitoring is to find out how many of the potential infectious TB patients notified were declared cured at the end of treatment. Following the uniform case definitions as defined in 1996, emphasis is placed on cohort analysis of definite cases of pulmonary TB. The Working Group recommends using a minimal set of six mutually exclusive categories of treatment outcome: cure, treatment completed, failure, death, treatment interrupted, and transfer out. More detailed subsets may be chosen. Treatment outcome is expressed as a percentage of the total number of cases notified. Analysis should be separate for new and retreatment cases. Treatment outcome data have to be collected at the local level and passed on to regional and national authorities on an ongoing basis. Evaluation of treatment results becomes, preferably, an inbuilt component of national monitoring of programme performance. Because of the long duration of treatment, it is recommended that analysis is carried out in the first quarter of the calendar year that follows a full year after the last patient was enrolled. Feedback is essential. Treatment outcome results should become an inseparable part of the annual report on tuberculosis.

Cohort Studies↗
PubMed1993

[A survey of the initial course of tuberculosis chemotherapy under compulsory hospitalization on the basis of the revised Tuberculosis Prevention Law--report of the 32nd C series of controlled trials of chemotherapy--Cooperative Study Unit of Chemotherapy of Tuberculosis of the National Sanatoria in Japan].

We studied 2247 patients with pulmonary tuberculosis who were hospitalized for the initial course of chemotherapy under the provision of the revised Tuberculosis Prevention Law issued by Japanese Ministry of Welfare. The results were as follows. 1) There were more males than females with a ratio of 2.6: 1. 2) There were two peaks in their ages, 20s and 60s. 3) The average admission periods were 5.2 +/- 2.7 months for men and 5.1 +/- 2.8 months for women. 4) The average compulsory admission periods were 6.8 +/- 2.5 months for men and 6.4 +/- 2.3 months for women, so that the actual admission periods were shorter in the majority of the patients. 5) The sputum cultures were converted negative in three months in about 80 percent of the patients who were smear and/or culture positive on admission. 6) The appearance rate of INH-resistant and RFP-resistant strains were 2% and 1.4% respectively. 7) Most of the death from tuberculosis was observed in the early stages of admission. 8) With regards to the cost, there seemed to be no difference whether treated under the new or the old provisions. 9) The newly approved extension of the admission periods for those who had complications such as diabetes mellitus or pneumoconiosis and those who had INH and/or RFP positive bacilli seemed to be appropriate.

Adult↗
PubMed1981

Hemagglutination tests for tuberculosis with mycobacterial glycolipid antigens. Results in patients with active pulmonary tuberculosis before and during chemotherapy and in healthy tuberculosis contacts.

Hemagglutination tests using three serologically active mycobacterial glycolipids as antigens were carried out on serum specimens from patients with pulmonary tuberculosis and from healthy family contacts of patients with tuberculosis in Singapore. A positive response to any of the three antigens was found in 82.5% of 211 patients with newly diagnosed disease and in 21% of 100 contacts. The much higher proportion of positive results in the contacts than in other groups of healthy subjects previously reported might have been due to subclinical infection with tubercle bacilli or with other environmental mycobacteria. The use of rules derived from discriminant analysis improved discrimination between patients and contacts, so that a positive result was obtained in 72% of patients and 5% of contacts. Serial positive titers during 1 yr of chemotherapy showed an initial slight increase during the first month and then a slow decrease, although conversion from a serologically positive result to a negative result was uncommon. The occurrence of widely variable patterns of response to the three antigens in different patients emphasizes the importance of using a battery of tests, each with a separate antigen.

Adolescent↗
PubMed1995

Screening for tuberculosis and tuberculosis infection in high-risk populations. Recommendations of the Advisory Council for the Elimination of Tuberculosis.

This report from the Advisory Council for the Elimination of Tuberculosis updates and replaces previous recommendations for screening for tuberculosis (TB) and TB infection among high-risk populations. {MMWR 1990;39(No. RR-8):1-7}. In particular, these recommendations a) emphasize that screening for TB infection should not be given preference over high priority TB prevention and control activities, especially identifying and completely treating all persons who have active TB as well as conducting prompt, effective contact investigation; b) provide more detailed recommendations for screening specific high-risk groups; c) provide a detailed description of the tuberculin skin test; and d) revise CDC's previous recommendations regarding anergy testing. This report is for public health policymakers, administrators, program directors and managers as well as health-care providers and others who provide care or services to persons at increased risk for TB infection and disease.

Adolescent↗
PubMed2005

Tuberculosis bacteriology--priorities and indications in high prevalence countries: position of the technical staff of the Tuberculosis Division of the International Union Against Tuberculosis and Lung Disease.

Smear microscopy for acid-fast bacilli (AFB) remains the first priority for national tuberculosis programmes (NTPs) in high-prevalence countries. No other established technique offers the same advantages of accuracy, speed, appropriateness and accessibility. Its sensitivity may be reduced in HIV-positive cases or because of technical deficiencies, and it lacks specificity for viable bacilli in follow-up examinations. Its main problem is that it is tedious, necessitating an effective external quality assessment (EQA) system following international guidelines. Operational research is needed to optimise the staining he place of sputum concentration o define t and fluorescence microscopy, to challenge difficult and obsolete strategies and to streamline procedures. Culture is much more difficult to set up and is usually impossible to decentralise. Because of its lower yield and higher costs, its efficiency for case detection in NTPs will lag well behind that in industrialised countries. The technique should only be used as a preliminary to drug susceptibility testing (DST). DST should not be developed to the detriment of the AFB microscopy network and its EQA. It should be used mainly for monitoring drug resistance. Continuous monitoring of resistance in a representative sample of isolates from first-line failure and relapse cases may be more efficient and more accurate than periodic surveys among new cases, and can be used to identify MDR-TB, whose treatment should be standardised, because of considerable risk of error in the laboratory. A specialist service offering molecular techniques may be useful for exceptional cases, but it has no place in the routine work of NTPs.

Bacteriological Techniques↗
PubMed2006

Guidance for National Tuberculosis Programmes on the management of tuberculosis in children. Chapter 1: introduction and diagnosis of tuberculosis in children.

About one million children develop tuberculosis (TB) annually worldwide, accounting for about 11% of all TB cases. Children with TB differ from adults in their immunological and pathophysiological response in ways that may have important implications for the prevention, diagnosis and treatment of TB in children. There is an urgent need to improve the diagnosis and management of children with TB, and the prevention of TB in children, by ensuring their inclusion under the implementation of the Stop TB strategy by National TB Programmes. Critical areas for further research include a better understanding of the epidemiology of childhood TB, vaccine development, the development of better diagnostic techniques, new drug development, and the optimal formulations and dosing of first- and second-line TB drugs in children. Specifically regarding the diagnosis of TB in children, this relies on a careful and thorough assessment of all the evidence derived from a careful history, clinical examination and relevant investigations, e.g., tuberculin skin test, chest radiograph and sputum smear microscopy. Although bacteriological confirmation of TB is not always possible, it should be sought whenever possible, e.g., by sputum microscopy in children with suspected pulmonary TB who are old enough to produce a sputum sample. A trial of treatment with TB medications is not generally recommended as a method to diagnose TB in children. New, improved diagnostic tests are urgently needed.

Child↗