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Does Normal Chest X ray in Patients with Chronic Cough Exclude Pulmonary tuberculosis?

Authors: Mohammad Yahya Abdulrazaq --- Abdulla Janger Minshed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 130-133
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Tuberculosis is the second infection in causing deaths from infectious agent in the world, currently in Iraq approximately 67% of new cases of Tuberculosis involve the lung only ,cough is the most common symptom of pulmonary Tuberculosis , pulmonary Tuberculosis nearly always causes detectable abnormalities on chest film, but still atypical or absent radiologic findings can occur.OBJECTIVE:This study was designed to determine whether in patients with chronic cough normal chest X ray exclude pulmonary tuberculosis.PATIENTS AND METHODS:One hundred seventy two patients attending the respiratory clinic, complaining from chronic cough and they are suspected cases of tuberculosis, were enrolled in this study. A full medical history and physical examination was done then a chest X ray was ordered, for those with normal chest X ray finding (seventy seven patients), sputum smear for acid fast bacilli (AFB) ordered .RESULTS:47 females (61%), 30 males (39%) with chronic cough with females to male ratio = 1.56/1.The age ranged between 17-67, with mean age of 37.16 years. The age of males ranged between 18-67 and the mean was 39.32 years, the age of females ranged between 17-66 and the mean was 34.93 years. X ray finding were negative in all the patients. Positive AFB in sputum smear examination by microscopy was found in only one patient but with ENT examination it was proved to be a case of laryngeal tuberculosis not pulmonary tuberculosis.CONCLUSION:Normal chest x ray in patients with chronic cough excludes pulmonary tuberculosis


Article
GeneXpert MTB/RIF Assay – A Major Milestone for Diagnosing Mycobacterium tuberculosis and Rifampicin-Resistant Cases in Pulmonary and Extrapulmonary Specimens

Author: Shatha Thanoon Ahmed
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2019 Volume: 16 Issue: 4 Pages: 297-301
Publisher: Babylon University جامعة بابل

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Abstract

Background and Objective: Tuberculosis (TB) is an endemic disease in Iraq. Many methods are available to diagnose pulmonary andextrapulmonary TB (EPTB). The most traditional test is the sputum smear for acid‑fast bacilli (AFB). However, it is well known for itslow sensitivity and specificity. On the other hand, culturing AFB although considered the gold standard for detecting Mycobacteriumtuberculosis (MTB), yet it takes long time to confirm or exclude the presence of TB. The WHO has recommended the use of a gene‑basedmolecular technique called GeneXpert (GX) MTB/rifampicin (RIF) for rapid and accurate detection of MTB in pulmonary andextrapulmonary (EPTB) sites. GX is a quick, fully automated system that can be easily used with minimal training. The objective of thisstudy was to evaluate the accuracy of the GX test for diagnosing MTB in pulmonary and extrapulmonary sites in Kurdistan/Iraq that isconsidered as an endemic area for TB, as well as testing the ability of this technique to identify the resistant strains of these bacilli to first‑lineanti‑TB treatment. Methodology: A total of 925 (504 males and 421 females) patients attended the TB center in Erbil/Iraq from August 2015to August 2017. These patients were clinically diagnosed or suspected to have TB. Two sputum samples were collected from each patientand subjected to AFB smear staining. The other portions of the sputum were examined by GX assay, and a number of cases were grown onthe Lowenstein–Jensen media. For extrapulmonary fluid samples, the same tests were done. Results: Seven hundred and forty‑three werepulmonary samples, and the remaining 182 cases were extrapulmonary specimens (cerebrospinal fluid, peritoneal aspirate, pleural fluid,urine, and blood). Of these, 575 had their AFB smears done which was positive for in 184 (32%) and negative in 391 (68%) cases. On theother hand, real‑time polymerase chain reaction using GX technology was positive in 228 (39.65%) while negative in 347 (60.34%) cases.The sensitivity and specificity of the GeneX versus AFB smear considering culture as a gold standard were 94.9% and 80.1%, respectively.In addition, GX technique revealed that about 20 (14.3%) of positive MTB cases were resistant to RIF therapy. Conclusion: The currentstudy displayed the real significance of using GX test in diagnosing MTB in pulmonary and extrapulmonary specimens to save time andto avoid unnecessary anti‑TB treatment.

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