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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/71/845/642-1
View Volume: https://doi.org/10.9734/bpi/nidpr/v2

Cytology Services Utilisation Pattern in North-Central Nigeria | Chapter 13 | Current Trends in Medicine and Medical Research Vol. 3

Introduction: Cytology  is  a  simple,  fast,  low  cost,  minimally  invasive  and  sensitive  technique  for evaluating  cells  sampled  from  lesions  in  the  body. Cytology  also  has  the  peculiar  advantages  of minimal invasiveness, low cost and speed. It is an aspect of pathology service at its fledgling stage in most institutions in sub-Saharan African countries.

Aims: This  study  examined  the  pattern  of  the  cytology  samples  received  in  the  laboratory  of  a relatively new tertiary hospital in north-central Nigeria.

Materials and  Methods: Three years archival slides and records of cytology samples were retrieved and analysed.

Results: Cytology specimens were 775 (27.5%) of 2,823 samples  accessioned during the  period. Most  of  the  samples  were  cervical  smears  constituting  436  (56.3%)  and  an  annual  rate  of  218 samples  per  year.  This  was  followed  by  134  (17.3%)  breast  fine  needle  aspiration  (FNA)  with  an annual rate of 67 samples per year. The 48 (6.2%) lymph nodes FNA samples had an annual rate of 24 samples per year. Soft tissue and thyroidmasses were 40 (5.2%) and 37 (4.8%), respectively. The sites of other less commonly requested cytology samples in this study included the liver, nose, eyes, testes, urine and peritoneal fluids. The patients’ age ranged from 14 months to 80 years.

Conclusions: This  study  shows  a  still  very  low  utilisation  of  cytology  services  in  management  of patients.  There  remains  the  need  of  developing  diagnostic  cytology  services  in  Nigeria,  taking advantage of its low cost, accuracy and timeliness as a simple, yet highly useful diagnostic tool in a resource deficient environment. In the north –central region of Nigeria, cytology is still grossly under-utilized  as  a  diagnostic  tool  in  the  management  of  patients.  Although  mostly  employed  in  routine cervical cancer screening, other patients need to benefit more from this simple, minimally invasive, cheap, highly sensitive and accurate investigative modality.

Author(s) Details

Raymond Akpobome Vhriterhire

Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Joseph Aondowase Orkuma

Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Joseph Aondowase Ngbea

Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Barnabas Agaba Eke

Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Godwin T. A. Jombo

Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Amali Adekwu

Department of Human Physiology, University ofJos, Jos, Plateau State, Nigeria.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/42/178/326-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v3