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R M, Kanchana K, Shankar A, J K. An Unusual Case of Tuberculous Tenosynovitis of the Hand. Cureus 2024; 16:e63081. [PMID: 39055437 PMCID: PMC11272143 DOI: 10.7759/cureus.63081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Infectious tuberculous tenosynovitis (TS) is an unusual occurrence in the forearm, wrist, or hand. Here we report a case of tuberculous TS of the wrist in a 26-year-old male with no comorbidities. The patient presented with a nonhealing ulcer on the palmar aspect of the proximal part of the left little finger with restricted mobility. There were no other symptoms to confirm the existence of an active tuberculosis infection in this patient. This case report helps broaden our knowledge about the different presentations of tuberculous TS in a patient with no history of exposure to tuberculosis.
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Affiliation(s)
- Manimaran R
- Plastic Surgery, Sree Balaji Medical College & Hospital, Chennai, IND
| | - Koppolu Kanchana
- Plastic Surgery, Sree Balaji Medical College & Hospital, Chennai, IND
| | - Aiswerya Shankar
- General Surgery, Sree Balaji Medical College & Hospital, Chennai, IND
| | - Karthick J
- Plastic and Reconstructive Surgery, Sree Balaji Medical College & Hospital, Chennai, IND
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Zhang M, Hu X, Lei S, Jia J, Kang X. Trends and prospects in spinal tuberculosis research: a future-oriented approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4246-4258. [PMID: 37115281 DOI: 10.1007/s00586-023-07728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Tuberculosis is one of the oldest diseases in human history, and spinal tuberculosis (STB) is the most common form of extrapulmonary tuberculosis. A large number of research has been conducted in this field. However, there has been no bibliometric analysis performed in recent years in STB. The aim of this study was to analyze trends and hotspots in research on STB. METHODS Publications regarding STB between 1980 and 2022 were extracted from the Web of Science database. CiteSpace (V5.7.R2) and VOSviewer (1.6.10) were used to perform global analyses of the number of publications, countries, institutions, authors, journals, keywords, and cited references. RESULTS A total of 1262 articles were published between 1980 and 2022. We observed rapid growth in the number of publications since 2010. Spine had the highest number of publications (47, 3.7%). Zhang HQ and Wang XY were key researchers. The Central South University published the most papers (90, 7.1%). China was the leading contributor in this field with 459 publications and 29 H-index. National partnerships are dominated by the USA, and there is a lack of active cooperation between other countries and authors. CONCLUSION research on STB has achieved great progress, with an increasing number of publications since 2010. Surgical treatment and debridement are current research hots pots, and diagnosis, drug resistance, and kyphosis are likely research frontiers. Cooperation between countries and authors needs to be further strengthened.
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Affiliation(s)
- Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuchang Hu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Shuanhu Lei
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Jingwen Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuewen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China.
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China.
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Xu T, Lai Q, Qu N, Zhang B, Qi Q. Diagnostic Values of Peripheral Blood T-Cell Spot Test for Tuberculosis (T-SPOT.TB) for Spinal Tuberculosis. Surg Infect (Larchmt) 2023. [PMID: 37437114 DOI: 10.1089/sur.2023.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Background: The T-cell spot test for tuberculosis (T-SPOT.TB) with false positives and false negatives exists in the diagnosis of spinal infection. The objective of this study was to increase the diagnostic value precision and specificity of T-SPOT.TB in the identification of spinal tuberculosis (TB). Patients and Methods: Fifty-two patients suspected of having spinal TB from April 2020 to December 2021 were included, and all patients received T-SPOT.TB tests and surgical treatment. The composite reference standard was used to diagnose spinal TB. The T-SPOT.TB values were compared according to whether spinal TB was diagnosed, and the optimal cutoff values of diagnosis was determined by receiver operating characteristic (ROC) curve analysis. Results: All patients were followed up for at least one year. The sensitivity, specificity, positive predictive value, and negative predictive value of the T-SPOT.TB test in assisting the diagnosis of spinal TB were 91.67%, 71.43%, 73.33%, and 90.9%, respectively. We determined that the values of early secreted antigen target 6 (ESAT-6) antigen and culture filter protein 10 (CFP-10) antigen were determined to be diagnostic for spinal tuberculosis, with areas under the curve equal to 0.776 and 0.852, respectively; the cutoff values for the diagnosis of ESAT-6 antigen and CFP-10 antigen were calculated as 40.5 spot forming cells (SFCs) per 106 peripheral blood mononuclear cells (PBMCs) and 26.5 SFCs/106 PBMCs, respectively. Follow-up for all patients was 12 months, and in this period, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), visual analog scale (VAS) score, and Oswestry Dysfunction Index (ODI%) were different between groups (p < 0.05). Conclusions: The T-SPOT.TB test is considered a milestone discovery in the diagnosis of TB; there are still many false-positive samples, but the diagnostic specificity was improved in the study, allowing spinal infections to be treated accurately and in a timely manner.
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Affiliation(s)
- Tiantian Xu
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qi Lai
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ning Qu
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qihua Qi
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Zheng M, Wang Y, Ying X, Zhang P, Liu F, Zheng Q. Clinical utility of tuberculosis RNA in the rapid diagnosis of bone and joint tuberculosis. Diagn Microbiol Infect Dis 2023; 106:115941. [PMID: 37030282 DOI: 10.1016/j.diagmicrobio.2023.115941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of tuberculosis RNA (TB-RNA) for the rapid diagnosis of bone and joint tuberculosis (BJTB). METHODS We conducted a retrospective study to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of TB-RNA and acid-fast bacillus (AFB) smear against the final clinical diagnosis. RESULTS A total of 268 patients were included. The overall sensitivity, specificity, PPV, NPV, and AUC of AFB smear for BJTB were 0.7%, 100.0%, 100.0%, 49.3%, and 0.50, respectively, whereas those of TB-RNA were 59.6%, 100.0%, 100.0%, 70.6%, and 0.80, respectively; for cases of confirmed (culture-positive) BJTB, these values were 82.8%, 99.4%, 99.7%, 89.2%, and 0.91, respectively. CONCLUSIONS The diagnostic accuracy of TB-RNA in the rapid diagnosis of BJTB was relatively good, especially in culture-positive BJTB. The use of TB-RNA could be an effective technique for the rapid diagnosis of BJTB.
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Affiliation(s)
- Mingfeng Zheng
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China.
| | - Yifan Wang
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China
| | - Xiaozhang Ying
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China
| | - Peng Zhang
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China
| | - Fei Liu
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China
| | - Qi Zheng
- Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Hangzhou, Zhejiang, China
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Ren C, Tang J, Xia L. Interferon gamma release assays for diagnosis of osteoarticular tuberculosis: A systematic review and meta-analysis. PLoS One 2022; 17:e0269234. [PMID: 35771875 PMCID: PMC9246147 DOI: 10.1371/journal.pone.0269234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although the Interferon Gamma Release Assays (IGRA) is often used to identify latent tuberculosis, it also plays a crucial role in diagnosing active extrapulmonary tuberculosis. Some studies have assessed the use of IGRA as a biomarker for osteoarticular tuberculosis (OATB), which is elevated following TB infection. Still, conclusive results about its effectiveness have not been reported. Method We searched PubMed, Embase, and Cochran databases. We obtained literature related to the diagnosis of OATB by IGRA, and the retrieval period was from the establishment of the database to June 2021. The bivariate random effect model was used to summarize the sensitivity, specificity, and accuracy of other indicators in diagnosing OATB by IGRA, and the forest plot and receiver operating characteristic (ROC) curve were used for testing. Results We included seven studies involving 643 subjects in diagnosing OATB by IGRA. The comprehensive sensitivity and specificity were 0.84 (95% CI, 0.70–0.92) and 0.78 (95% CI, 0.66–0.87), respectively. The area under the curve (AUC) was 0.87. Conclusion In blood samples, the diagnostic accuracy of IGRAS is poor in patients with suspected OAT. We conclude that IGRA may not be appropriate for patients with OATB.
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Affiliation(s)
- Chunnian Ren
- Department of Cardiothoracic Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
- * E-mail: (LX); (JT)
| | - Liangfeng Xia
- Department of Cardiothoracic Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- * E-mail: (LX); (JT)
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Khan A, Singh R, Sharma S, Singh V, Sheoran A, Soni A, Dhull V, Gill PS, Yadav A, Chaudhary D, Gupta MC, Mehta PK. Diagnosis of osteoarticular tuberculosis by immuno-PCR assay based on mycobacterial antigen 85 complex detection. Lett Appl Microbiol 2021; 74:17-26. [PMID: 34592012 DOI: 10.1111/lam.13567] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023]
Abstract
Diagnosis of osteoarticular tuberculosis (OATB) exhibits serious challenges owing to paucibacillary nature of specimens and localization of disease at sites that are difficult to access. We recently developed indirect immuno-PCR (I-PCR) and real-time I-PCR (RT-I-PCR) assays for the detection of mycobacterial antigen 85 complex (Ag85) in OATB patients. Detection limits for the purified Ag85 protein were found to be 1 and 41 fg ml-1 by I-PCR and RT-I-PCR, respectively, which were at least 105 -fold lower than respective ELISA. While spiking synovial fluids of non-TB control subjects with the purified Ag85 protein, LODs of 100 and 120 fg ml-1 were obtained by I-PCR and RT-I-PCR, respectively, thus demonstrating the sample matrix effect. Sensitivities of 87·5 and 70·5% were observed in bodily fluids of confirmed (n = 8) and clinically suspected (n = 51) OATB cases, respectively, by I-PCR, with a specificity of 93·9% (n = 33). Markedly, the sensitivities obtained by I-PCR/RT-I-PCR were significantly higher (P < 0·05-0·01) than ELISA and GeneXpert assay (n = 30). However, no substantial difference in sensitivity was observed between the I-PCR and RT-I-PCR assays. After further improving the accuracy of I-PCR, this test may lead to development of an attractive diagnostic kit.
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Affiliation(s)
- A Khan
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
| | - R Singh
- Department of Orthopaedics, University of Health Sciences (UHS), Rohtak, India
| | - S Sharma
- Department of Microbiology, UHS, Rohtak, India
| | - V Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A Sheoran
- Department of Statistics, Ramanujan College, University of Delhi, New Delhi, India
| | - A Soni
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India.,Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, India
| | - V Dhull
- Department of Biotechnology Engineering, University Institute of Engineering & Technology, MDU, Rohtak, India
| | - P S Gill
- Department of Microbiology, UHS, Rohtak, India
| | - A Yadav
- Department of Microbiology, UHS, Rohtak, India
| | - D Chaudhary
- Pulmonary and Critical Care Medicine, UHS, Rohtak, India
| | - M C Gupta
- Department of Pharmacology, UHS, Rohtak, India
| | - P K Mehta
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
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Li X, Wang J, Yang Z, Song Q. Diagnostic values of peripheral blood T-cell spot of tuberculosis assay (T-SPOT.TB) and magnetic resonance imaging for osteoarticular tuberculosis: a case-control study. Aging (Albany NY) 2021; 13:9693-9703. [PMID: 33744856 PMCID: PMC8064225 DOI: 10.18632/aging.202720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Early diagnosis of osteoarticular tuberculosis helps improve patients' outcomes, but little is known about the accuracy of noninvasive diagnostic methods. This case-control study aimed to assess the diagnostic value of peripheral blood T-cell spot of tuberculosis assay (T-SPOT.TB) and magnetic resonance imaging (MRI). METHODS Patients suspected with osteoarticular tuberculosis were retrospectively included and diagnosed according to the composite reference standard. T-SPOT.TB was used to detect the number of cells secreting Interferon gamma. Diagnostic performance of T-SPOT.TB and MRI alone and combined were evaluated. RESULTS Among the suspected patients, 92 had osteoarticular tuberculosis and 137 non- osteoarticular tuberculosis. T-SPOT.TB assay alone had a higher sensitivity (0.73 vs. 0.60) but a lower specificity (0.69 vs. 0.91 P>0.05) in diagnosing osteoarticular tuberculosis. Combined serial test showed a sensitivity and specificity 0.47, 0.97, respectively, whereas combined parallel test showed a sensitivity and specificity of 0.86, 0.65, respectively. Specificity was higher in the combined serial test than in the T-SPOT.TB assay (P=0.007) or MRI alone (P < 0.001). Furthermore, sensitivity was higher in the combined parallel test than in the T-SPOT.TB assay (P < 0.001) or MRI alone (P < 0.001). CONCLUSIONS Combined blood T-cell spot of tuberculosis assay and osteoarticular MRI have higher sensitivity and specificity for noninvasive osteoarticular tuberculosis diagnosis, compared with either method alone.
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Affiliation(s)
- Xiaoliang Li
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Junli Wang
- Department of Cardiopulmonary Function, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Zhigang Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Qiongzhu Song
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
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Zhou Z, Zheng Y, Wang L. Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis using tissue specimens. Int J Infect Dis 2021; 105:224-229. [PMID: 33582371 DOI: 10.1016/j.ijid.2021.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis (BJTB) using tissue specimens, and to compare the diagnostic accuracy of different types of tissue specimens. METHODS This study involved 242 patients admitted with suspected BJTB between May 2018 and March 2020. The Xpert MTB/RIF assay was performed on surgically excised tissue. Diagnostic accuracy of the Xpert MTB/RIF assay was evaluated by culture, histopathology and a composite reference standard (CRS). RESULTS One hundred and seventy-five patients were excluded (91 based on the exclusion criteria, and 84 as pus specimens were used instead of tissue specimens). Of the 67 patients enrolled, 14 were confirmed as BJTB, 20 as probable BJTB, 11 as possible BJTB, and 22 as non-BJTB. Using culture as the reference standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) of the Xpert MTB/RIF assay were 92.9% (88.2-97.6%), 62.3% (56.1-68.5%), 39.4% (33.2-45.6%), 97.1% (92.3-100.0%), 2.464 (1.077-3.851), 0.114 (0.025-0.203) and 0.776 (0.654-0.897), respectively. When histopathology was used as the reference standard, the Xpert MTB/RIF assay had sensitivity, specificity, PPV, NPV, PLR, NLR and AUC of 79.3% (73.5-85.1%), 73.7% (67.8-79.6%), 69.7% (63.8-75.6%), 82.4% (76.5-88.3%), 3.015 (1.184-4.846), 0.281 (0.141-0.421) and 0.765 (0.646-0.884), respectively. Sensitivity, specificity, PPV, NPV, PLR, NLR and AUC obtained when using CRS as the reference were 73.3% (67.9-78.7%), 100.0% (100.0-100.0%), 100.0% (100.0-100.0%), 64.7% (58.5-70.9%), +∞, 0.267 (0.129-0.405) and 0.867 (0.781-0.952), respectively. Tissue samples were classified, and the positive rate of the Xpert MTB/RIF assay for BJTB using granulation tissue specimens was found to be significantly higher than that for caseous necrotic tissue, sequestrum and other necrotic connective tissues (P < 0.05). CONCLUSION The Xpert MTB/RIF assay showed high sensitivity and specificity for the diagnosis of BJTB from tissue specimens.
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Affiliation(s)
- Zibo Zhou
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, PR China.
| | - Yan Zheng
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, PR China
| | - Leiming Wang
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, PR China
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Kohli M, Schiller I, Dendukuri N, Yao M, Dheda K, Denkinger CM, Schumacher SG, Steingart KR. Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2021; 1:CD012768. [PMID: 33448348 PMCID: PMC8078545 DOI: 10.1002/14651858.cd012768.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Xpert MTB/RIF Ultra (Xpert Ultra) and Xpert MTB/RIF are World Health Organization (WHO)-recommended rapid nucleic acid amplification tests (NAATs) widely used for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum. To extend our previous review on extrapulmonary tuberculosis (Kohli 2018), we performed this update to inform updated WHO policy (WHO Consolidated Guidelines (Module 3) 2020). OBJECTIVES To estimate diagnostic accuracy of Xpert Ultra and Xpert MTB/RIF for extrapulmonary tuberculosis and rifampicin resistance in adults with presumptive extrapulmonary tuberculosis. SEARCH METHODS Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, 2 August 2019 and 28 January 2020 (Xpert Ultra studies), without language restriction. SELECTION CRITERIA Cross-sectional and cohort studies using non-respiratory specimens. Forms of extrapulmonary tuberculosis: tuberculous meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, disseminated tuberculosis. Reference standards were culture and a study-defined composite reference standard (tuberculosis detection); phenotypic drug susceptibility testing and line probe assays (rifampicin resistance detection). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias and applicability using QUADAS-2. For tuberculosis detection, we performed separate analyses by specimen type and reference standard using the bivariate model to estimate pooled sensitivity and specificity with 95% credible intervals (CrIs). We applied a latent class meta-analysis model to three forms of extrapulmonary tuberculosis. We assessed certainty of evidence using GRADE. MAIN RESULTS 69 studies: 67 evaluated Xpert MTB/RIF and 11 evaluated Xpert Ultra, of which nine evaluated both tests. Most studies were conducted in China, India, South Africa, and Uganda. Overall, risk of bias was low for patient selection, index test, and flow and timing domains, and low (49%) or unclear (43%) for the reference standard domain. Applicability for the patient selection domain was unclear for most studies because we were unsure of the clinical settings. Cerebrospinal fluid Xpert Ultra (6 studies) Xpert Ultra pooled sensitivity and specificity (95% CrI) against culture were 89.4% (79.1 to 95.6) (89 participants; low-certainty evidence) and 91.2% (83.2 to 95.7) (386 participants; moderate-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 168 would be Xpert Ultra-positive: of these, 79 (47%) would not have tuberculosis (false-positives) and 832 would be Xpert Ultra-negative: of these, 11 (1%) would have tuberculosis (false-negatives). Xpert MTB/RIF (30 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 71.1% (62.8 to 79.1) (571 participants; moderate-certainty evidence) and 96.9% (95.4 to 98.0) (2824 participants; high-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 99 would be Xpert MTB/RIF-positive: of these, 28 (28%) would not have tuberculosis; and 901 would be Xpert MTB/RIF-negative: of these, 29 (3%) would have tuberculosis. Pleural fluid Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity against culture were 75.0% (58.0 to 86.4) (158 participants; very low-certainty evidence) and 87.0% (63.1 to 97.9) (240 participants; very low-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 192 would be Xpert Ultra-positive: of these, 117 (61%) would not have tuberculosis; and 808 would be Xpert Ultra-negative: of these, 25 (3%) would have tuberculosis. Xpert MTB/RIF (25 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 49.5% (39.8 to 59.9) (644 participants; low-certainty evidence) and 98.9% (97.6 to 99.7) (2421 participants; high-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 60 would be Xpert MTB/RIF-positive: of these, 10 (17%) would not have tuberculosis; and 940 would be Xpert MTB/RIF-negative: of these, 50 (5%) would have tuberculosis. Lymph node aspirate Xpert Ultra (1 study) Xpert Ultra sensitivity and specificity (95% confidence interval) against composite reference standard were 70% (51 to 85) (30 participants; very low-certainty evidence) and 100% (92 to 100) (43 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 70 would be Xpert Ultra-positive and 0 (0%) would not have tuberculosis; 930 would be Xpert Ultra-negative and 30 (3%) would have tuberculosis. Xpert MTB/RIF (4 studies) Xpert MTB/RIF pooled sensitivity and specificity against composite reference standard were 81.6% (61.9 to 93.3) (377 participants; low-certainty evidence) and 96.4% (91.3 to 98.6) (302 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 118 would be Xpert MTB/RIF-positive and 37 (31%) would not have tuberculosis; 882 would be Xpert MTB/RIF-negative and 19 (2%) would have tuberculosis. In lymph node aspirate, Xpert MTB/RIF pooled specificity against culture was 86.2% (78.0 to 92.3), lower than that against a composite reference standard. Using the latent class model, Xpert MTB/RIF pooled specificity was 99.5% (99.1 to 99.7), similar to that observed with a composite reference standard. Rifampicin resistance Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity were 100.0% (95.1 to 100.0), (24 participants; low-certainty evidence) and 100.0% (99.0 to 100.0) (105 participants; moderate-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 100 would be Xpert Ultra-positive (resistant): of these, zero (0%) would not have rifampicin resistance; and 900 would be Xpert Ultra-negative (susceptible): of these, zero (0%) would have rifampicin resistance. Xpert MTB/RIF (19 studies) Xpert MTB/RIF pooled sensitivity and specificity were 96.5% (91.9 to 98.8) (148 participants; high-certainty evidence) and 99.1% (98.0 to 99.7) (822 participants; high-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 105 would be Xpert MTB/RIF-positive (resistant): of these, 8 (8%) would not have rifampicin resistance; and 895 would be Xpert MTB/RIF-negative (susceptible): of these, 3 (0.3%) would have rifampicin resistance. AUTHORS' CONCLUSIONS Xpert Ultra and Xpert MTB/RIF may be helpful in diagnosing extrapulmonary tuberculosis. Sensitivity varies across different extrapulmonary specimens: while for most specimens specificity is high, the tests rarely yield a positive result for people without tuberculosis. For tuberculous meningitis, Xpert Ultra had higher sensitivity and lower specificity than Xpert MTB/RIF against culture. Xpert Ultra and Xpert MTB/RIF had similar sensitivity and specificity for rifampicin resistance. Future research should acknowledge the concern associated with culture as a reference standard in paucibacillary specimens and consider ways to address this limitation.
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MESH Headings
- Adult
- Antibiotics, Antitubercular/therapeutic use
- Bias
- Drug Resistance, Bacterial
- False Negative Reactions
- False Positive Reactions
- Humans
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/isolation & purification
- Nucleic Acid Amplification Techniques/methods
- Nucleic Acid Amplification Techniques/statistics & numerical data
- Reagent Kits, Diagnostic
- Rifampin/therapeutic use
- Sensitivity and Specificity
- Tuberculosis/cerebrospinal fluid
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis, Lymph Node/cerebrospinal fluid
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/drug therapy
- Tuberculosis, Multidrug-Resistant/cerebrospinal fluid
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Pleural/cerebrospinal fluid
- Tuberculosis, Pleural/diagnosis
- Tuberculosis, Pleural/drug therapy
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Affiliation(s)
- Mikashmi Kohli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Mandy Yao
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Keertan Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia M Denkinger
- FIND, Geneva , Switzerland
- Division of Tropical Medicine, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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10
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Wang D, Sun X, Zhang C, Fang X, Huang Z, Zheng Q, Zhang W. Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature. Orthop Surg 2020; 12:1900-1912. [PMID: 33145983 PMCID: PMC7767691 DOI: 10.1111/os.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). METHODS Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. RESULTS In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. CONCLUSIONS Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.
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Affiliation(s)
- Du Wang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xiao‐tang Sun
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Chao‐fan Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xin‐yu Fang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zi‐da Huang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Qing‐cong Zheng
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Wen‐ming Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
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11
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Mansour O, Moussa MK, Khalaf Z, Zreik H, Bou Raad R. Tuberculous Extensor Tenosynovitis Presenting as Huge Mass on the Dorsum of the Hand. Cureus 2020; 12:e10236. [PMID: 33042677 PMCID: PMC7535947 DOI: 10.7759/cureus.10236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infectious tuberculous tenosynovitis (TS) of the extensor tendons of the wrist is an exceptional location of musculoskeletal tuberculosis. We present a case of tuberculous extensor TS in a 52-year-old diabetic male patient presenting as a huge mass on the dorsum of the hand, in the absence of other pulmonary or extrapulmonary manifestation of tuberculosis. This report increases physicians’ vigilance when dealing with patients with risk factors of tuberculosis, allowing early diagnosis and optimal treatment.
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Affiliation(s)
- Oussama Mansour
- Orthopedics and Traumatology, Al Zahraa Hospital, University Medical Center, Beirut, LBN
| | - Mohamad K Moussa
- Orthopedic Surgery, Lebanese University Faculty of Medical Science, Beirut, LBN
| | - Zaynab Khalaf
- Endocrinology, Diabetes and Metabolism, Lebanese University Faculty of Medical Science, Beirut, LBN
| | - Hussein Zreik
- Orthopaedics and Trauma, Al Zahraa Hospital, University Medical Center, Beirut, LBN
| | - Ryan Bou Raad
- Orthopaedics and Traumatology, Lebanese University Faculty of Medicine, Beirut, LBN
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12
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Chen X, Jia X, Lei H, Wen X, Hao Y, Ma Y, Ye J, Wang C, Gao J. Screening and identification of serum biomarkers of osteoarticular tuberculosis based on mass spectrometry. J Clin Lab Anal 2020; 34:e23297. [PMID: 32162728 PMCID: PMC7370717 DOI: 10.1002/jcla.23297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In view of the current difficulty of clinically diagnosing osteoarticular tuberculosis, our aim was to use mass spectrometry to establish diagnostic models and to screen and identify serum proteins which could serve as potential diagnostic biomarkers for early detection of osteoarticular tuberculosis. METHODS Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to select an osteoarticular tuberculosis-specific serum peptide profile and establish diagnostic models. Further, liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to identify potential serum biomarkers that could be used for auxiliary diagnosis of osteoarticular tuberculosis, and then clinical serum samples were used to verify these biomarkers by enzyme-linked immunosorbent assay (ELISA). RESULTS We established four diagnostic models that can distinguish osteoarticular tuberculosis from rheumatoid arthritis, ankylosing spondylitis, osteoarticular infections, and healthy adults. The models were osteoarticular tuberculosis-rheumatoid arthritis, osteoarticular tuberculosis-ankylosing spondylitis, osteoarticular tuberculosis-osteoarticular infections, and osteoarticular tuberculosis-healthy adult, and their accuracy was 76.78%, 79.02%, 83.77%, and 88.16%, respectively. Next, we selected and identified 18 proteins, including complement factor H-related protein 1 (CFHR1) and complement factor H-related protein 2 (CFHR2), which were upregulated in the tuberculosis group only. CONCLUSIONS We successfully established four diagnostic models involving osteoarticular tuberculosis, rheumatoid arthritis, ankylosing spondylitis, osteoarticular infections, and healthy adults. Furthermore, we found that CFHR1 and CFHR2 may be two valuable auxiliary diagnostic indicators for osteoarticular tuberculosis. These results provide reference values for rapid and accurate diagnosis of osteoarticular tuberculosis.
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Affiliation(s)
- Ximeng Chen
- Center of Clinical Laboratory Medicine, The 1st Medical Center of PLA General Hospital, Beijing, China.,School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
| | - Xingwang Jia
- Center of Clinical Laboratory Medicine, The 1st Medical Center of PLA General Hospital, Beijing, China
| | - Hong Lei
- Department of Clinical Laboratory Medicine, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Xinyu Wen
- Center of Clinical Laboratory Medicine, The 1st Medical Center of PLA General Hospital, Beijing, China
| | - Yanfei Hao
- Department of Clinical Laboratory Medicine, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Yating Ma
- School of Medicine, Nankai University, Tianjin, China
| | - Jingyun Ye
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
| | - Chengbin Wang
- Center of Clinical Laboratory Medicine, The 1st Medical Center of PLA General Hospital, Beijing, China
| | - Jimin Gao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
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13
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Zhou Z, Zheng Y, Wang L. A comparative study on the value of Xpert MTB/RIF and T-SPOT.TB tests in the diagnosis of bone and joint tuberculosis. Clin Chim Acta 2020; 500:115-119. [DOI: 10.1016/j.cca.2019.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/09/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
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14
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Shen Y, Yu G, Zhong F, Kong X. Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis. PLoS One 2019; 14:e0221427. [PMID: 31437232 PMCID: PMC6705841 DOI: 10.1371/journal.pone.0221427] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background This study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis. Methods We searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression. Results Nineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77–84) and 99% (95% CI, 97–100) compared to the CRS, respectively, and 96% (95% CI, 90–98) and 85% (95% CI, 57–96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76–86) and 99% (95% CI, 95–100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76–90) and 98% (95% CI, 94–99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens. Conclusions Xpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.
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Affiliation(s)
- Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Guocan Yu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Fangming Zhong
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Xiaohua Kong
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
- * E-mail:
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15
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Yin L, Tang Y, Pan A, Yang L, Zhu X, Liu Y. The application of IL-10 and TNF-α in expressed prostatic secretions and prostatic exosomal protein in urine in the diagnosis of patients with chronic prostatitis. Medicine (Baltimore) 2019; 98:e16848. [PMID: 31415412 PMCID: PMC6831336 DOI: 10.1097/md.0000000000016848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the expression of tumor necrosis factor alpha (TNF-α) and interleukin-10 (IL-10) in expressed prostatic secretions (EPSs) of patients with chronic prostatitis (CP) and the expression of prostatic exosomal protein (PSEP) in urine, and to evaluate its correlation with the condition. METHODS Urine samples from 310 patients with CP (101 National Institutes of Health [NIH] II, 112 NIH IIIa, and 97 NIH IIIb, classified according to the US National Institutes of Health) and 110 control group subjects were collected. The samples were tested for PSEP by enzyme-linked immunosorbent assay (ELISA). At the same time, EPSs in 60 patients from 310 patients with CP and 20 control group subjects were collected. The levels of IL-10 and TNF-α in the collected samples that EPS were determined by double antibody sandwich ELISA. SPSS 23.0 statistical software was used for statistical analysis of the measured data. RESULTS The level of PSEP in patients with CP was significantly higher than that in the control group (P < .001). The levels of TNF-α and IL-10 in the EPS of patients with NIH II and NIH IIIa CP were higher than those of the patients with NIH IIIb and the control group (P < .001). There was a positive correlation between PSEP and IL-10 and TNF-α, while TNF-α and IL-10 were also positively correlated. CONCLUSION PSEP, TNF-α, and IL-10 may serve as a basis for the classification diagnosis of CP. Their combination can provide more accurate diagnostic information for clinical CP typing.
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Affiliation(s)
- Lianli Yin
- Department of Clinical Laboratory, Nanning Second People's Hospital, The Third Affiliated Hospital of Guangxi Medical University
| | - Yinghua Tang
- Department of Clinical Laboratory, Guangxi Hospital Of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine
| | - Aiping Pan
- Department of Clinical Laboratory, Guangxi Hospital Of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine
| | - Lan Yang
- Department of Clinical Laboratory, Nanning Second People's Hospital, The Third Affiliated Hospital of Guangxi Medical University
| | - Xu Zhu
- Department of Clinical Laboratory, Nanning Second People's Hospital, The Third Affiliated Hospital of Guangxi Medical University
| | - Yonggang Liu
- Department of Urology, Nanning Second People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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16
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Chen G, Wu Y, Yu D, Li R, Luo W, Ma G, Zhang C. Isoniazid-loaded chitosan/carbon nanotubes microspheres promote secondary wound healing of bone tuberculosis. J Biomater Appl 2018; 33:989-996. [PMID: 30509120 DOI: 10.1177/0885328218814988] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor blood circulation makes it difficult for antitubercular drugs to achieve effective bactericidal concentration at tuberculose focus. The residual Mycobacterium tuberculosis around surgical wound would multiply, resulting in nonunion or sinus formation. Carbon nanotubes have strong tissue penetration and can cross many kinds of physiological barriers. Here, we constructed a chitosan/carbon nanotubes nanoparticles to control slow release of isoniazid. Transmission electron microscopy and nanoparticle tracking and analysis results showed that the diameter of chitosan/carbon nanotubes nanoparticles was between 150 and 250 nm. Chitosan/carbon nanotubes nanoparticles significantly prolonged the release time of isoniazid, and the release rate was more uniform, no sudden release was observed. In vitro experiments showed that chitosan/carbon nanotubes nanoparticles did not destroy biological function of isoniazid, but could reduce its cytotoxicity and inflammation. We further constructed animal model of tuberculous ulcer. The results showed that isoniazid/chitosan/carbon nanotubes nanoparticles promoted the healing of tuberculosis ulcer. Compared with isoniazid group and isoniazid/carbon nanotubes group, the area of wounds decreased by 94.6% and 89.8%, respectively. Immunohistochemistry showed that CD3+ and CD4+ T cell number decreased significantly in isoniazid/chitosan/carbon nanotubes group. In conclusion, we constructed a kind of isoniazid/chitosan/carbon nanotubes nanoparticles, which can significantly promote the healing of tuberculosis ulcer. Our study provided an effective way for the treatment of secondary wound healing of bone tuberculosis.
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Affiliation(s)
- Gangquan Chen
- 1 Department of burn, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yaling Wu
- 2 Nursing faculty, Jiangxi Health Vocational college, Nanchang 330006, China
| | - Dongping Yu
- 1 Department of burn, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Rubing Li
- 1 Department of burn, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Wenyuan Luo
- 3 Department of orthopedics, Gansu Provincial People's Hospital, Lanzhou, Gansu Province, China
| | - Guifu Ma
- 3 Department of orthopedics, Gansu Provincial People's Hospital, Lanzhou, Gansu Province, China
| | - Chao Zhang
- 1 Department of burn, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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17
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Tang Y, Yin L, Tang S, Zhang H, Lan J. Application of molecular, microbiological, and immunological tests for the diagnosis of bone and joint tuberculosis. J Clin Lab Anal 2018; 32:e22260. [PMID: 28543876 PMCID: PMC6816924 DOI: 10.1002/jcla.22260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/18/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To evaluate the application of interferon gamma release assay (IGRA), rifampicin resistant real-time fluorescence quantitative PCR technique Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF), and the levels of TNF-α and TGF-β in the diagnosis of bone and joint tuberculosis. METHODS Eighty-six patients with bone and joint tuberculosis, diagnosed by pathology or microbiology, were examined by Xpert MTB/RIF and IGRA (T-SPOT. TB) for Mycobacterium tuberculosis infection, and the TNF-α and TGF-β levels of the patients were measured. RESULTS The sensitivity of IGRA in diagnosing bone and joint tuberculosis was 81.4%; Xpert MTB/RIF's sensitivity was 70.9%. The combined sensitivity of the two methods was 91.9%. The combined detection sensitivity of the two methods was higher than individual IGRA or Xpert MTB/RIF detection sensitivity. The TNF-α and TGF-β levels in bone and joint tuberculosis patients were higher than those in the control group. CONCLUSION Xpert MTB/RIF, IGRA, TNF-α, and TGF-βs expression have value in the rapid diagnosis of bone and joint tuberculosis, and the sensitivity and accuracy of bone and joint tuberculosis diagnosis by combining them can improve it.
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Affiliation(s)
- Yinghua Tang
- Department of Clinical LaboratoryLiuzhou traditional Chinese Medical Hospitalthe Third Affiliated Hospital of Guangxi University of traditional Chinese MedicineLiuzhouGuangxiChina
| | - Lianli Yin
- Department of Clinical LaboratoryLiuzhou traditional Chinese Medical Hospitalthe Third Affiliated Hospital of Guangxi University of traditional Chinese MedicineLiuzhouGuangxiChina
| | - Shifu Tang
- Department of Clinical LaboratoryLiuzhou traditional Chinese Medical Hospitalthe Third Affiliated Hospital of Guangxi University of traditional Chinese MedicineLiuzhouGuangxiChina
| | - Hongyu Zhang
- Department of Clinical LaboratoryLiuzhou traditional Chinese Medical Hospitalthe Third Affiliated Hospital of Guangxi University of traditional Chinese MedicineLiuzhouGuangxiChina
| | - Jihui Lan
- Department of Laboratory ScienceGuangxi Tuberculosis Prevention and Treatment Centerthe Longtan Hospital of Guangxi Zhuang Autonomous RegionLiuzhouGuangxiChina
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