Introduction
Obstructive sleep apnea (OSA) is a common disorder that is characterised by recurrent respiratory disturbances during night time sleep resulting from upper airways obstruction 1 . Sleep fragmentation, which is typical of OSA, results in
India is presently one of the high burden countries for tuberculosis and accounts for 23% of global TB burden with 2.2 million patients. Of these reported cases in India around 20% are of Extra Pulmonary Tuberculosis (EPTB).Pleural effusion due to TB is currently the second common location for EPTB next to TB lymphadenitis . The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. The present study was done to determine the role of ADA and CBNAAT both being rapid and non-invasive diagnostic methods for early detection of tuberculous pleuritis, which is essential for treatment initiation, improved patient outcome and for more effective public health intervention. Materials and Methods: An observational study was done on 100 patients presenting with clinicoradiological picture suggestive of pleural effusion, either admitted or attending OPD of Department of Pulmonary Medicine from Nov 2017 to Nov 2019 at GGH, Kakinada. Results: Out of 100 exudative pleural effusions in study, male predominance with 80% of males and 20% females. Lymphocyte predominance is 74%, sputum AFB was positive in 6 cases. With ADA cut off as 40IU/L, 70 cases had an ADA > 40IU/L out of which 64 were tubercular, and 6 were malignant effusions .ADA has a sensitivity of 94% and specificity of 60%.Pleural fluid CBNAAT was positive in 30 cases, out of which 2 cases had an ADA < 40 IU/L .All are rifampicin sensitive. The sensitivity of CBNAAT is 40% and specificity 82%.There is a positive correlation between the lymphocyte predominance with ADA and CBNAAT with P<0.05%. Conclusion: Estimation of ADA in pleural fluid is a simple, rapid, and less expensive laboratory investigation where the diagnosis is uncertain. The sensitivity of ADA, when combined with lymphocytepredominant exudates, helps to diagnose tubercular effusions. The role of CBNAAT in diagnosing pleural TB is limited due to its poor sensitivity.
Tuberculosis is a global health burden still causing large mortality and morbidity. According to WHO’s 2018 Global TB Report two main routes for reducing TB incidence and death are- diagnosis and treatment. The main challenging issue with TB is to obtain a rapid and accurate diagnosis for initiating early treatment. Sometimes patient with active pulmonary tuberculosis fail to produce adequate sputum resulting in increase of false-negatives. Sputum-smear negative pulmonary tuberculosis is highly infectious and remains a diagnostic challenge. Fiber-optic bronchoscopy is an important tool for early detection and confirmation of sputum smear-negative and sputum-scarce PTB as it provides high-quality biological samples like bronchoalveolar lavage (BAL) fluid. The aim of the present study was to evaluate role of in Gene Xpert MTB/RIF on bronchoscopic specimens in sputum smear negative patients with suspicion of PTB. A prospective observational study was done on 100 patients with clinical suspicion of PTB who either have a negative sputum smear microscopy or unable to produce qualitative sputum attending outpatient and admitted in Pulmonology department, Government General Hospital, Kakinada.Out of 100 patients, 47 were diagnosed and confirmed as pulmonary tuberculosis of which bronchial specimens smear positive were 5(10.6%),bronchial specimens smear negative but CBNAAT positive were 42(89.3%). At last as CBNAAT has dual diagnostic advantage of detecting rifampicin resistance, about 5 cases were detected as rifampicin resistance. CBNAAT/RIF assay on BAL specimen provides an accurate diagnosis of PTB in patients with sputum smear negative results or those who cannot expectorate sputum and superior to sputum smears in detecting rifampicin resistance.
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