IntroductionIsolated primary tubercular abscess is one of the rare forms of extrapulmonary tuberculosis. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.Case presentationA 30-year-old man, of Asian origin, developed a hepatic tubercular abscess which was not associated with any pulmonary or gastrointestinal tract foci of tuberculosis. An ultrasonogram of the abdomen showed an abscess in the right lobe of his liver which was initially diagnosed as an amoebic liver abscess. Subsequently, the pus from the lesion yielded Mycobacterium tuberculosis using the BACTEC TB 460 instrument and Mycobacterium tuberculosis deoxyribonucleic acid by polymerase chain reaction. The patient was started on systemic antitubercular therapy to which he responded favorably.ConclusionThis report emphasizes the fact that, although a tuberculous liver abscess is a very rare entity, it should be included in the differential diagnosis of unknown hepatic mass lesions.
Following the endorsement of the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, USA) by the World Health Organization (WHO) in 2010, Viet Nam’s National Tuberculosis Control Program (NTP) began using GeneXpert instruments in NTP laboratories. In 2013, Viet Nam’s NTP implemented an Xpert MTB/RIF external quality assurance (EQA) program in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the Foundation for Innovative New Diagnostics (FIND). Proficiency-testing (PT) panels comprising five dried tube specimens (DTS) were sent to participating sites approximately twice a year from October 2013 to July 2016. The number of enrolled laboratories increased from 22 to 39 during the study period. Testing accuracy was assessed by comparing reported and expected results; percentage scores were assigned; and feedback reports were provided to sites. On-site evaluation (OSE) was conducted for underperforming laboratories. The results from the first five rounds demonstrate the positive impact of PT and targeted OSE visits on testing quality. On average, for every additional round of feedback, the odds of achieving PT scores of ≥80% increased 2.04-fold (95% confidence interval, 1.39- to 3.00-fold). Future work will include scaling up PT to all sites and maintaining the performance of participating laboratories while developing local panel production capacity.
Objectives Early diagnosis of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) is a priority for Viet Nam’s National TB Control Programme. In many laboratories, quality systems are weak; few have attained accreditation. We implemented a structured training and mentoring program for TB laboratories and measured impact on quality. Methods Six TB culture laboratories implemented the Strengthening TB Laboratory Management Towards Accreditation (TB SLMTA) program, consisting of three training workshops and on-site mentoring between workshops to support improvement projects. Periodic audits, using standardized checklists, monitored laboratories’ progress toward accreditation readiness. Results At baseline, all six laboratories achieved a zero-star level. At exit, five laboratories attained three stars and another one star. Overall checklist scores increased by 44.2% on average, from 29.8% to 74.0%; improvements occurred across all quality system essentials. Conclusions The program led to improved quality systems. Sites should be monitored to ensure sustainability of improvements and country capacity expanded for national scaleup.
The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance. Case reportA 62-year-old male who had worked in a tuberculosis (TB) laboratory for the past 25 years in a small district in Uttar Pradesh, India, presented with multiple ulcerations on the glans penis for the last 2 years. He initially noticed a small painful raised lesion, which ulcerated and started to discharge pus, but he had no other local or systemic complaints. He was a widower and denied having had any sexual partner for 10 years. On examination, he had multiple superficial ulcers on the prepuce and glans penis. The edges of the ulcers were undermined, but the ulcers did not perforate deeply into the urethra (Fig. 1). The inguinal lymph nodes were not palpable. Systemic examination did not reveal any significant finding. His haemogram showed a raised erythrocyte sedimentation rate (42 mm in the first hour). Venereal disease research laboratory and human immunodeficiency virus serology were non-reactive. Chest X-ray and ultrasound of his abdomen were normal. Urine samples were normal on routine microscopy, and sterile on routine bacterial and mycobacterial cultures. Direct smear microscopy of the pus revealed a heavy load of acid-fast bacilli (3+). Serology for mycobacterial A60 antigen (ELISA) was strongly positive (840 U dl 21 ). The patient then received a full course of first line antitubercular treatment (ATT); however, the ulcers did not heal. A direct smear was again obtained from the ulcer after this first ATT course, and cultures for Mycobacterium tuberculosis were also set up on LJ medium and in vials of BACTEC 12B liquid medium. Direct microscopy of the pus again showed a heavy load of acidfast bacilli (3+), and cultures were positive for M. tuberculosis both on LJ medium and in BACTEC liquid medium. Routine bacterial culture was sterile. Drug sensitivity tests were performed with the BACTEC 460 TB system. These revealed resistance to the first line drugs rifampicin and isoniazid. The patient was then treated with a second line antitubercular drug regimen according to the Revised National TB Control Programme protocol for multidrug-resistant TB. He responded favourably, and after 3 months the ulcers had started to heal. DiscussionThe genitourinary tract is the most common site for extrapulmonary TB (Lenk & Schroeder, 2001). However, penile TB is extre...
Rapid diagnosis of tuberculous meningitis (TBM) is crucial as the disease outcome depends on the stage at which the treatment is initiated. The reliability of the available tests has not been established; thus, the present study was conducted to evaluate the conventional diagnostic tests as compared to the newer methods. Cerebrospinal fluid was collected from 100 children, and analyzed for various biochemical and cytological tests. The samples were subjected to Ziehl-Neelsen (Z-N) staining, Lowenstein-Jensen (L-J) culture, BACTEC culture and polymerase chain reaction (PCR). Twenty-two patients could be identified as definitive TBM based on the demonstration of Mycobacterium tuberculosis by BACTEC culture and PCR. Of these 22 cases, Z-N staining was positive in only two and L-J culture in six cases. Both the BACTEC culture and PCR had 100% agreement in the diagnosis of TBM. However, BACTEC culture could be a better diagnostic test as drug sensitivity can also be performed by this method.
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