Extrapulmonary tuberculosis in China: a national survey

Li, Tao; Yan, Xiangyu; Du, Xin; Huang, Fei; Wang, Ni; Ni, Ni; Ren, Ji-Hong; Zhao, Yanlin; Jia, Zhongwei

doi:10.1016/j.ijid.2022.12.005

Cited by 26 publications

(28 citation statements)

References 33 publications

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“…TBP is amongst the top two most common subtypes of EPTB, but its reported prevalence varies with geographical location, methodology of review (analysis of diagnostic coding or manual review of clinical registry), and definition of disease (microbiologically proven or based on clinical diagnosis). Prevalence of TBP ranged widely from 2.2 to 31.4% of all TB cases and from 9.2 to 67.0% among all EPTB patients [2,3,5–12,13 ▪▪ ,14–17] (Table 1). In a Chinese registry containing 472,920 TBP patients, there was an annual increase in the incidence of TBP from 0.4 to 3.3 per 100 000 population between 2005 and 2018 [18 ▪ ].…”

Section: The Latest Global Burden Of Tuberculous Pleuritismentioning

confidence: 99%

Tuberculous pleuritis: clinical presentations and diagnostic challenges

Chan,

Lee

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Tuberculous pleuritis (TBP) is one of the most common types of extrapulmonary tuberculosis. We highlight the latest epidemiology of TBP, the heterogeneity of its presentation and the performance of different diagnostic strategies. Recent findings There are differential trends in the incidences of TBP worldwide. Its incidence increased in China but decreased in the United States in the past decade. The presentation of TBP is heterogeneous regarding clinical symptoms, radiological findings and pleural fluid analysis results. Conventional microbiological tests have low sensitivities to diagnose TBP. Recent research focused on various diagnostic tools with better yield. The sensitivity of nucleic acid amplification tests (NAAT) in pleural fluid, including the latest generation of PCR and sequencing-based techniques for detecting tuberculosis, remains suboptimal. Various pleural fluid biomarkers have been explored, but there is a lack of consensus on their clinical utility and cutoff levels. Summary The heterogeneity of clinical presentation poses obstacles to diagnosing TBP. Further development of diagnostic tools, including more robust NAAT and biomarkers with additional validation, is needed before incorporation into routine clinical practice.

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Section: The Latest Global Burden Of Tuberculous Pleuritismentioning

confidence: 99%

Tuberculous pleuritis: clinical presentations and diagnostic challenges

Chan,

Lee

2024

Current Opinion in Pulmonary Medicine

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“…It has been reported that the rate of laboratory-confirmed positivity is approximately 1%. 9 Although the acid-fast staining is quick and effective in diagnosing TB, it has a false negative rate of 30%–65%, which makes TB often missed. 8 A timely and accurate diagnosis of MTBC is urgently needed for TB-IAI to facilitate faster and more targeted treatment.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Role of Metagenomic Next-Generation Sequencing in Tubercular Orthopedic Implant-Associated Infection

Wang,

et al. 2024

IDR

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The diagnosis of tubercular orthopedic implant-associated infection (TB-IAI) is challenging. This study evaluated the value of metagenomic next-generation sequencing (mNGS) for the diagnosis of TB-IAI and developed a standardized diagnostic procedure for TB-IAI. Methods:The records of all patients with TB-IAI diagnosed and treated at our institution between December 2018 and September 2022 were retrospectively reviewed. Patient demographic characteristics, medical history, laboratory test, microbial culture, histopathology, and mNGS results, and time to diagnosis were recorded. The diagnostic efficiency of mNGS for TB-IAI was assessed by comparing the results and diagnostic time with that of other diagnostic modalities. Results: Ten patients were included in the analysis, including eight with prosthetic joint infections and two with fracture-related infections. The mNGS positivity rate was 100% (10/10), which was higher than that of TB-antibody (11%, 1/9), real-time quantitative polymerase chain reaction (22%, 2/9), T-SPOT.TB (25%, 2/8), purified protein derivative (50%, 4/8), microbial culture (50%, 5/10), and histopathology (20%, 2/10). mNGS shortened the time to diagnosis of TB-IAI. A standardized diagnostic procedure for TB-IAI was developed based on the findings. Conclusion: mNGS is useful for the diagnosis of TB-IAI. mNGS is recommended in cases where it is difficult to identify a pathogen using routine diagnostic tests. The standardized diagnostic procedure might improve TB-IAI diagnosis. Importance: TB-IAI is a rare infection, which occurs after orthopedic surgery and hard to diagnose microbiologically. mNGS is a new detection technique not yet discussed in current literature as a means for TB-IAI diagnostics. Here we describe a cohort of patients with TB-IAI diagnosed by mNGS show high efficiency of mNGS for detection of this pathology and present a clinical algorithm supplementing conventional methods for TB-IAI assessment.

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“…As per the Global TB Report 2020, EPTB constituted 16% of the 7.5 million notified TB cases in 2019, ranging from 8% in the Western Pacific Region to 24% in the Eastern Mediterranean Region ( WHO, 2020 ). In China, EPTB accounted for approximately 24% of TB cases, with a maximum of 33% in the western region ( Li et al., 2022 ). In the context of WHO’s End TB Strategy, timely diagnosis and treatment of EPTB is a challenge we have to face.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of extrapulmonary tuberculosis by ultrasound-guided biopsy: A retrospective comparison study

Shi

et al. 2023

Front. Cell. Infect. Microbiol.

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ObjectiveTo compare the diagnostic performance of laboratory assays on the ultrasound-guided core needle biopsy samples for diagnosis of extra-pulmonary tuberculosis (EPTB) in HIV-positive and HIV-negative patients.MethodsA total of 217 patients suspected to have EPTB underwent lesion biopsy from 2017 to 2020. Results of laboratory tests on the biopsy and non-biopsy samples were collected with clinical data for retrospective analysis of test utility. The calculated diagnostic accuracy of the tests was stratified according to the specimen types and HIV status.ResultsThe cohort contained 118 patients with a final positive diagnosis of extrapulmonary tuberculosis (EPTB group, 54.4%) and 99 finally diagnosed as without TB (non-EPTB group, 45.6%). The risk factor for EPTB was HIV co-infection (OR 2.22, 95% CI 1.17-4.28, p = 0.014). In biopsy samples, GeneXpert (Xpert) showed higher sensitivity (96.6% [91.6-98.7], p < 0.0001) than culture (56.1% [47.0-64.9]). Regardless of HIV status, Xpert had the highest sensitivity (>95%) and specificity (nearly 100%) of any methods. In non-biopsy samples, only T-SPOT.TB (T-SPOT) showed higher sensitivity than culture (90.9% [62.3-99.5] vs 35.3% [17.3-58.7], p = 0.0037). Furthermore, the sensitivities of Xpert were lower in non-biopsy samples (60.0% [23.1-92.9], p = 0.022) than in biopsy samples (100% [86.7-100]). Even in smear-negative biopsy samples, Xpert still had higher sensitivity than culture and retained high specificity (100% [95.7-100]).ConclusionSuperior performance of Xpert in diagnosing EPTB was observed regardless of HIV status and specimen types. Nevertheless, the biopsy samples still substantially facilitated the accurate diagnosis of extrapulmonary tuberculosis.

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Extrapulmonary tuberculosis in China: a national survey

Cited by 26 publications

References 33 publications

Tuberculous pleuritis: clinical presentations and diagnostic challenges

Tuberculous pleuritis: clinical presentations and diagnostic challenges

Diagnostic Role of Metagenomic Next-Generation Sequencing in Tubercular Orthopedic Implant-Associated Infection

Diagnosis of extrapulmonary tuberculosis by ultrasound-guided biopsy: A retrospective comparison study

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