MyMedR

Rapid detection of Mycobacterium tuberculosis in clinical samples by multiplex polymerase chain reaction (mPCR)

Tang TH, Ahmed SA, Musa M, Zainuddin ZF

World J Microbiol Biotechnol, 2013 Dec;29(12):2389-95.

PMID: 23807412 DOI: 10.1007/s11274-013-1407-0

Although the multi-copy and specific element IS6110 provides a good target for the detection of Mycobacterium tuberculosis complex by PCR techniques, the emergence of IS6110-negative strains suggested that false negative may occur if IS6110 alone is used as the target for detection. In this report, a multiplex polymerase chain reaction (mPCR) system was developed using primers derived from the insertion sequence IS6110 and an IS-like elements designated as B9 (GenBank accession no. U78639.1) to overcome the problem of detecting negative or low copy IS6110 containing strains of M. tuberculosis. The mPCR was evaluated using 346 clinical samples which included 283 sputum, 19 bronchial wash, 18 pleural fluid, 9 urine, 7 CSF, 6 pus, and 4 gastric lavage samples. Our results showed that the sensitivity (93.1 %) and specificity (89.6 %) of the mPCR system exceeds that of the conventional method of microscopy and culture. The mPCR assay provides an efficient strategy to detect and identify M. tuberculosis from clinical samples and enables prompt diagnosis when rapid identification of infecting mycobacteria is necessary.

Matched MeSH terms: Tuberculosis/diagnosis

DNA markers for tuberculosis diagnosis

Chin KL, Sarmiento ME, Norazmi MN, Acosta A

Tuberculosis (Edinb), 2018 12;113:139-152.

PMID: 30514496 DOI: 10.1016/j.tube.2018.09.008

Tuberculosis (TB), caused by Mycobacterium tuberculosis complex (MTBC), is an infectious disease with more than 10.4 million cases and 1.7 million deaths reported worldwide in 2016. The classical methods for detection and differentiation of mycobacteria are: acid-fast microscopy (Ziehl-Neelsen staining), culture, and biochemical methods. However, the microbial phenotypic characterization is time-consuming and laborious. Thus, fast, easy, and sensitive nucleic acid amplification tests (NAATs) have been developed based on specific DNA markers, which are commercially available for TB diagnosis. Despite these developments, the disease remains uncontrollable. The identification and differentiation among MTBC members with the use of NAATs remains challenging due, among other factors, to the high degree of homology within the members and mutations, which hinders the identification of specific target sequences in the genome with potential impact in the diagnosis and treatment outcomes. In silico methods provide predictive identification of many new target genes/fragments/regions that can specifically be used to identify species/strains, which have not been fully explored. This review focused on DNA markers useful for MTBC detection, species identification and antibiotic resistance determination. The use of DNA targets with new technological approaches will help to develop NAATs applicable to all levels of the health system, mainly in low resource areas, which urgently need customized methods to their specific conditions.

Matched MeSH terms: Tuberculosis/diagnosis*

Post mortem computed tomography (PMCT) guided lung biopsy: A preliminary case report

Abdul Hadi D, Mansharan Kaur CS, Effat O, Siew SF

Trop Biomed, 2019 Dec 01;36(4):850-854.

PMID: 33597457

Tuberculosis (TB) is a highly infectious disease on the rise caused by the organism Mycobacterium tuberculosis and health care workers working in emergency departments, medical wards and autopsy rooms are in danger of contacting this disease. We present a case of a 42 year old man found dead under a pedestrian bridge with no medical history available. Post mortem computed tomography showed multiple cavities involving upper lobes of both lungs and areas of consolidation in both lung fields raising the suspicion of pulmonary tuberculosis. This was followed by a computed tomography guided lung biopsy and a limited conventional autopsy done in situ in a special high risk autopsy suite with appropriate ventilation. This case highlights the importance of cross sectional imaging which can be coupled with image guided biopsy in cases of infectious disease to reduce the risk of transmission to health care workers.

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia

Margolis B, Al-Darraji HA, Wickersham JA, Kamarulzaman A, Altice FL

Int J Tuberc Lung Dis, 2013 Dec;17(12):1538-44.

PMID: 24200265 DOI: 10.5588/ijtld.13.0193

There are currently no routine screening procedures for active tuberculosis (TB) or latent tuberculous infection (LTBI) in Malaysian prisons.

Matched MeSH terms: Latent Tuberculosis/diagnosis

Serial testing of Malaysian health care workers with QuantiFERON®-TB Gold In-Tube

Rafiza S, Rampal KG

Int J Tuberc Lung Dis, 2012 Feb;16(2):163-8.

PMID: 22236915 DOI: 10.5588/ijtld.11.0364

BACKGROUND: Serial testing for tuberculosis (TB) exposure has been advocated among health care workers (HCWs) at risk of nosocomial infection.
OBJECTIVE: To determine the incidence and factors associated with TB infection among selected HCWs in Malaysia and to determine interferon-gamma response in serial testing.
DESIGN: A cohort of 769 HCWs were retested after 1 year using QuantiFERON®-TB Gold In-Tube. Incidence of TB infection was determined among HCWs who previously tested negative. Conversion and reversion rates using several definitions were explored.
RESULTS: Incidence of TB infection was 9.9 per 100 workers per year (95%CI 7.9-12.3). Working in the Emergency Department (ED; RR 2.18, 95%CI 1.07-4.43) was significantly associated with risk of TB infection. Reversion and conversion occurred frequently, with 46.7% reversion among HCWs with baseline interferon-gamma (IFN-γ) levels of 0.35-0.70 international units (IU)/ml, and 23.8% conversion among HCWs with baseline IFN-γ levels of 0.20-0.34 IU/ml.
CONCLUSIONS: TB infection control measures need to be strengthened, particularly in the ED, as the incidence of TB was high. Conversion and reversion rates in serial testing were high, and further studies are needed to facilitate its interpretation.

Matched MeSH terms: Tuberculosis/diagnosis

A prospective study of mycobacterial viability in refrigerated, unpreserved sputum batched for up to 8 weeks

Rashid Ali MR, Parameswaran U, William T, Bird E, Wilkes CS, Lee WK, et al.

Int J Tuberc Lung Dis, 2015 May;19(5):620-1.

PMID: 25868033 DOI: 10.5588/ijtld.14.0938

Matched MeSH terms: Tuberculosis/diagnosis

Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia

Liam CK, Lim KH, Srinivas P, Poi PJ

Int J Tuberc Lung Dis, 1998 Oct;2(10):818-23.

PMID: 9783529

University Hospital, Kuala Lumpur, Malaysia.

Matched MeSH terms: Tuberculosis/diagnosis

Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis

Lange B, Khan P, Kalmambetova G, Al-Darraji HA, Alland D, Antonenka U, et al.

Int J Tuberc Lung Dis, 2017 05 01;21(5):493-502.

PMID: 28399963 DOI: 10.5588/ijtld.16.0702

SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.

DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.

RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87). Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.

CONCLUSION: Xpert CT values and smear status were strongly associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.

Matched MeSH terms: Tuberculosis/diagnosis*

Tuberculosis in HIV/AIDS patients: a Malaysian experience

Nissapatorn V, Kuppusamy I, Sim BL, Quek KF, Khairul Anuar A

Southeast Asian J. Trop. Med. Public Health, 2005 Jul;36(4):946-53.

PMID: 16295550

This retrospective study was conducted at the National Tuberculosis Center (NTBC) where 252 HIV-positive patients coexisting with tuberculosis (TB/HIV) were examined. We found that patients with pulmonary (PTB) and extrapulmonary tuberculosis (EPT) had similar mean age. A higher sex ratio between male to female (10.7:1) was observed in patients with PTB. The other characteristics of patients with pulmonary and extrapulmonary tuberculosis were not statistically different from each other. Cough (88%) and hemoptysis were the most common presenting symptoms, significantly related to patients with PTB. Lymphadenopathy (33.5%) was the most common sign in patients with EPT. The majority of patients with pulmonary and extrapulmonary tuberculosis had CD4 cell counts of less than 200 cells/mm3 (range 0-1,179 with a median of 57 cells/mm3). Lung (89%) and miliary (55.6%) forms were the most frequent disease locations in patients with PTB and EPT, respectively. A higher percentage of patients with PTB (42%) were treated successfully with short-course (6 months) therapy, whereas in patients with EPT (43%) needed a longer period (9 months) for successful treatment. Of the patients who defaulted treatment, a higher proportion (87%) had PTB. No MDR-TB or relapse cases were found in this study.

Matched MeSH terms: Tuberculosis/diagnosis*

Fasciolopsiasis: a first case report from Malaysia

Rohela M, Jamaiah I, Menon J, Rachel J

Southeast Asian J. Trop. Med. Public Health, 2005 Mar;36(2):456-8.

PMID: 15916055

Fasciolopsiasis is a disease caused by the largest intestinal fluke, Fasciolopsis buski. The disease is endemic in the Far East and Southeast Asia. Human acquires the infection after eating raw freshwater plants contaminated with the infective metacercariae. There has been no report of fasciolopsiasis either in man or in animal in Malaysia. We are reporting the first case of fasciolopsiasis in Malaysia in a 39-year-old female farmer, a native of Sabah (East Malaysia). This patient complained of cough and fever for a duration of two weeks, associated with loss of appetite and loss of weight. She had no history of traveling overseas. Physical examination showed pallor, multiple cervical and inguinal lymph nodes and hepatosplenomegaly. Laboratory investigations showed that she had iron deficiency anemia. There was leukocytosis and a raised ESR. Lymph node biopsy revealed a caseating granuloma. Stool examination was positive for the eggs of Fasciolopsis buski. The eggs measure 140 x 72.5 microm and are operculated. In this case, the patient did not present with symptoms suggestive of any intestinal parasitic infections. Detection of Fasciolopsis buski eggs in the stool was an incidental finding. She was diagnosed as a case of disseminated tuberculosis with fasciolopsiasis and was treated with antituberculosis drugs and praziquantel, respectively.

Matched MeSH terms: Tuberculosis/diagnosis

Fulltext Tuberculosis or systemic lupus erythematosus? A diagnostic and therapeutic dilemma

Mohd A, Goh EM, Chow SK, Looi LM, Yeap SS

Southeast Asian J. Trop. Med. Public Health, 2003 Jun;34(2):361-4.

PMID: 12971563

The diagnosis of patients with fever of unknown origin (FUO) is often problematic because the range of possible differential diagnoses is broad. We report on a case in which a patient presented with FUO and was subsequently found to have both a collagen vascular disease and an intercurrent infection. Treatment for the collagen vascular disease with corticosteroids exacerbated the intercurrent infection. The problems in the diagnosis and management of such cases are discussed.

Matched MeSH terms: Tuberculosis/diagnosis*

Infections in post-tsunami victims

Othman N, Ismail IH, Yip R, Zainuddin Z, Kasim SM, Isa R, et al.

Pediatr Infect Dis J, 2007 Oct;26(10):960-1.

PMID: 17901807 DOI: 10.1097/INF.0b013e3181257234

Two tsunami survivors from Banda Acheh, Sumatra, presented with pyrexia of unknown origin and a nonresolving left-sided empyema, respectively. Both children had mixed infections of tuberculosis and melioidosis; Salmonella typhi was also present in the second patient. Mixed infections are common late sequela complications in post-tsunami victims.

Matched MeSH terms: Tuberculosis/diagnosis*

Congenital Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis

Osowicki J, Wang S, McKenzie C, Marshall C, Gard J, Ke Juin W, et al.

Pediatr Infect Dis J, 2016 Jan;35(1):108-10.

PMID: 26398869 DOI: 10.1097/INF.0000000000000932

We present the case of a male infant with congenital tuberculosis in a nonendemic setting complicated by hemophagocytic lymphohistiocytosis, who was treated successfully with antituberculous therapy and corticosteroids. We review the pediatric literature concerning the unusual association of these 2 rare conditions.

Matched MeSH terms: Tuberculosis/diagnosis

Fulltext Tuberculosis of gallbladder with candidiasis, a rare entity

Leong BD, Chan KW, Ramu P, Kumar VM, Chuah JA

Med J Malaysia, 2011 Jun;66(2):146-7.

PMID: 22106698 MyJurnal

Gallbladder tuberculosis (GT) is an extremely rare condition. This is thought to be due to the protective property of bile against the infection. Clinical and radiological diagnosis of GT is difficult. We describe a case of GT who initially presented to us with jaundice, a right hypochondrial mass and computed tomographic findings suggestive of gallbladder empyema. Diagnosis was made from histopathological examination of the resected gallbladder which revealed epitheloid granulomas with caseating necrosis and presence of Langhan's giant cells. From a literature search and to the best of our knowledge, this is the first GT to be reported in South East Asia.

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Influence of co-morbidity in the interpretation of tuberculin skin reactivity in multi-ethnic adult patients with tuberculosis

Loh LC, Chan SK, Ch'ng KI, Tan LZ, Vijayasingham P, Thayaparan T

Med J Malaysia, 2005 Oct;60(4):426-31.

PMID: 16570703

In the Malaysian setting of multi-ethnicity and high BCG coverage, interpretation of Tuberculin Skin Testing (TST) may be difficult. Between January 2001 and December 2003, a retrospective study on all adult patients with documented TST results treated for tuberculosis (TB) in chest clinics of two government hospitals was conducted to determine the reliability of TST and factors affecting its interpretation. One hundred and three patients [mean age (SD): 43 (17); male: 67%] were eligible for data collection: 72% and 57% of patients had positive TST results based on cut-off points of 10mm and 15mm respectively. The only significant univariate association with TST results was the severity of co-morbidity. A patient with co-morbidity score of 3 defined as those with any cancer, end-stage renal or liver disease, or HIV disease, was more likely to have a negative TST results [10mm cut-off point: Odd Ratio (95% CI) 6.6 (1.82 to 24.35), p = 0.003; 15mm cut-off point: 4.8 (1.21 to 18.95), p = 0.012]. A TST reading of 10mm had a higher sensitivity than 15mm as the cut-off point in diagnosing TB infection. Considering all possible confounding factors like ethnicity, prior BCG vaccination and TB burden in the population, severity of co-morbidity remains strongly predictive of a negative TST. Caution should be exercised in interpreting TST in these patients.
Study site: Chest clinic, Hospital Seremban, Hospital Kuala Pilah, Negeri Sembilan, Malaysia

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Tuberculin reactivity and subsequent development of tuberculosis in a cohort of student nurses

Jeyakumar D

Med J Malaysia, 1999 Dec;54(4):492-5.

PMID: 11072468

This retrospective study documents a strong correlation between tuberculin reactivity and the subsequent development of active tuberculosis in student nurses. 12% of the 25 student nurses with tuberculin reactions above 20 mm developed tuberculosis over a period of 2 years, compared to only 0.3% of the 341 student nurses with reactions of 20 mm or less. The implications of these findings for preventive therapy are discussed.

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Tuberculous infection

Ch'ng EC, Hooi LN, Halimah Y, Syed J

Med J Malaysia, 1997 Mar;52(1):91-3.

PMID: 10968062

A female patient presenting with post-prandial epigastric pain and weight loss was diagnosed to have oesophageal tuberculosis by endoscopic biopsy. She responded well to standard anti-tuberculosis treatment.

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Clinical significance of Mantoux test in Malaysian patients

Yaacob I, Ahmad Z

Med J Malaysia, 1990 Sep;45(3):231-4.

PMID: 2152084

The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.
Study site: outpatients, inpatients; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Tuberculous encephalopathy in Sabah children

Ng LF

Med J Malaysia, 1985 Dec;40(4):289-93.

PMID: 3842728

A series of 18 cases of tuberculous encephalopathy (TBE) in children studied between June 1983 and October 1984 at Queen Elizabeth Hospital, Kota Kinabalu is presented. The data suggest that: the incidence is not as rare as previously thought; the occurrence of TBE is related to the absence of BCG vaccination; the presentation is often late; laboratory data, although helpful is not often confirmatory; early treatment is the key to better outcome; the clinical picture should outweigh laboratory diagnosis in the initial assessment and management.

Matched MeSH terms: Tuberculosis/diagnosis*

Fulltext Guinea pig inoculation versus culture in the diagnosis of tuberculosis

Cheong YM, Jegathesan M

Med J Malaysia, 1983 Dec;38(4):350.

PMID: 6443797

Matched MeSH terms: Tuberculosis/diagnosis*

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