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Salazar MP, da Costa Lima Suassuna Monteiro JF, Veloso Carvalho-Silva WH, Nunes Diniz GT, Werkhauser RP, Lapa Montenegro LM, Schindler HC. Development and evaluation of a single-tube nested PCR with colorimetric assay for Mycobacterium tuberculosis detection. Biotechniques 2024; 76:235-244. [PMID: 38602382 DOI: 10.2144/btn-2023-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
Molecular techniques have revolutionized tuberculosis (TB) diagnosis by offering a faster and more sensitive approach, detecting Mycobacterium tuberculosis (Mtb) DNA directly from samples. Single-tube nested PCR (STNPCR) combines two PCR reactions with separate oligonucleotide sets in a single tube. Moreover, colorimetric methods in PCR products have been studied for pathogen detection. Thus, this study aimed to establish a novel system based on colorimetric STNPCR for Mtb detection using microtiter plates with IS6110-amplified fragments. The results showed a general colorimetric STNPCR detection limit of 1 pg/μl. Its general sensitivity and specificity were 76.62 and 60.53%, respectively, with kappa index agreement of 0.166.
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Affiliation(s)
- Marcela Pereira Salazar
- Laboratory of Immunoepidemiology, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
- Contributed equally to this work and are considered as co-first authors
| | - Juliana Figueiredo da Costa Lima Suassuna Monteiro
- Laboratory of Immunoepidemiology, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
- Contributed equally to this work and are considered as co-first authors
| | | | - George Tadeu Nunes Diniz
- Laboratory of Quantitative Methods, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
| | - Roberto Pereira Werkhauser
- Laboratory of Immunoepidemiology, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
| | - Lílian Maria Lapa Montenegro
- Laboratory of Immunoepidemiology, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
| | - Haiana Charifker Schindler
- Laboratory of Immunoepidemiology, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Pernambuco, 50740-465, Brazil
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Gupta D, Kaushal M, Jain S. Epithelioid cell granulomas in urine cytology smears: A diagnostic approach. Cytojournal 2022; 19:34. [PMID: 35673699 PMCID: PMC9168401 DOI: 10.25259/cytojournal_82_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/01/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepika Gupta
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
| | - Manju Kaushal
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
| | - Swasti Jain
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
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Shekar P A, Patel H, Dumra A, Reddy D, Shivakumar KS, Satish Kumar P. Presentation, management and outcomes of pediatric urogenital tuberculosis: 20 years' experience from a tertiary center. J Pediatr Urol 2021; 17:546.e1-546.e8. [PMID: 33931319 DOI: 10.1016/j.jpurol.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberculosis is a rarity nowadays. In developing countries, childhood pulmonary tuberculosis is still a major issue and hence, UGTB is not an uncommon diagnosis in younger children and adolescents in these countries. Considering this dearth of data on childhood UGTB, we retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery. OBJECTIVE To analyze the clinical presentation, management strategies and outcomes of pediatric UGTB managed in a tertiary care center. MATERIALS AND METHODS Case records of children and adolescents ≤18 years diagnosed with UGTB during the period July 1998 to June 2018 at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied. RESULTS There were 41 children and adolescents (M: F = 22:19) identified, with a mean age of 14.8 ± 3.9 years who fulfilled the inclusion criteria. The most common presentation was flank pain and irritative storage symptoms. Mycobacterium tuberculosis was identified on urinary examination in only 17 (41.5%) cases. Six patients were lost to follow up after initial diagnosis. A total of 45 procedures (35 primary and 10 secondary) were performed in 35 children. Initial diversion in the form of PCN and DJS were done in 11 and 12 patients respectively, of which 8 were managed with stenting alone. Surgical management was done mostly in the form of nephrectomy (15), nephrectomy along with reconstruction (5) and reconstruction only (6). On univariate analysis, factors associated with nephrectomy were poor initial function and nephrostomy as initial diversion. Overall median follow-up was 25 (IQR 15.5-74.25) months. During follow up, chronic renal failure developed in nearly 53.8% of patients who underwent major reconstruction. CONCLUSIONS Urogenital tuberculosis presents with a wide spectrum of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of minimally invasive diversions and surgery (both ablative and reconstructive) achieve satisfactory results in the majority of cases. Children undergoing major surgical reconstruction in particular need to be followed up rigorously and counselled about possibility of development of renal failure.
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Affiliation(s)
- Ashwin Shekar P
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Hardik Patel
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Anuj Dumra
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Dinesh Reddy
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - K S Shivakumar
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - P Satish Kumar
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
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Naeem M, Zulfiqar M, Siddiqui MA, Shetty AS, Haq A, Varela C, Siegel C, Menias CO. Imaging Manifestations of Genitourinary Tuberculosis. Radiographics 2021; 41:1123-1143. [PMID: 34048278 DOI: 10.1148/rg.2021200154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB are protean and can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB. In addition, contiguous extension from the urinary tract and sexual transmission are described as sources of genital TB. Genitourinary TB can be indolent and results in nonspecific signs and symptoms; thus, imaging has a vital role in the working diagnosis for these cases. Classic uroradiologic signs of genitourinary TB are primarily described from the era of intravenous urography and conventional radiography. Now, CT, CT urography, MRI, and US are used in the diagnosis and management. Familiarity with the imaging features of genitourinary TB may help guide the diagnosis and, in turn, lead to timely management. US has a vital role in the evaluation of scrotal and female genital TB. MRI offers superior soft-tissue contrast resolution and excellent depiction of anatomic detail. The various imaging manifestations of genitourinary TB are highlighted. ©RSNA, 2021.
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Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Mohammed Azfar Siddiqui
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Adeel Haq
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cristian Varela
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cary Siegel
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
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Kamra E, Mehta PK. Current updates in diagnosis of male urogenital tuberculosis. Expert Rev Anti Infect Ther 2021; 19:1175-1190. [PMID: 33688791 DOI: 10.1080/14787210.2021.1902305] [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] [Indexed: 02/07/2023]
Abstract
Introduction: Urogenital tuberculosis (UGTB) is a common manifestation of extrapulmonary TB (EPTB), which affects both men and women in a ratio of 2:1. Similar to other EPTB types, diagnosis of UGTB is quite challenging owing to atypical clinical presentation and paucibacillary nature of specimens. This review is primarily focused on the current updates developed in the diagnosis of male UGTB.Area covered: Smear/culture, imaging, histopathology, and interferon-γ release assays are the main modalities employed for detecting male UGTB cases. Moreover, we described the utility of nucleic acid amplification tests (NAATs), including loop-mediated isothermal amplification, PCR, nested-PCR, and GeneXpert (MTB/RIF) assays. The possibility of using other novel modalities, such as immuno-PCR (I-PCR), aptamer-linked immobilized sorbent assay (ALISA), and identification of circulating cell-free DNA (cfDNA) by NAATs were also discussed.Expert opinion: The current methods used for the diagnosis of male UGTB are not adequate. Therefore, the latest molecular/immunological tools, i.e. Xpert Ultra, Truenat MTBTM, I-PCR, ALISA, and cfDNA detection employed for the diagnosis of other EPTB forms and pulmonary TB may also be exploited for UGTB diagnosis. Reliable and timely diagnosis of male UGTB may initiate an early start of anti-tubercular therapy that would reduce infertility and other complications associated with disease.
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Affiliation(s)
- Ekta Kamra
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
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Kardani AK, Subandiyah K. Genitourinary tuberculosis in 2-year-old indonesian boy with malnutrition: A rare case. Urol Case Rep 2020; 33:101365. [PMID: 33102064 PMCID: PMC7573958 DOI: 10.1016/j.eucr.2020.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Genitourinary tuberculosis is a primary target of hematogenous infections and is the most common site of extra-pulmonary tuberculosis. A 2-year-old Indonesian boy with genitourinary tuberculosis with family history of tuberculosis. Radiological work-ups show pulmonary miliary tuberculosis, complication of hydronephrosis and ureteral kinking. Centrifuge-urine smear shows acid-resistant bacillus. Anthropometric measured was similar a 1-years-2-months-old boy. The biological activity of tuberculosis can only be assessed by cultivating mycobacteria. The patient was treated with anti-tuberculosis regiments and shows improvement on clinical presentation. He received nutritional intake based on the WHO formula (F75, F100, F135). This patient should undergo reconstructive surgery but refuse.
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Affiliation(s)
- Astrid Kristina Kardani
- Nephrology Division, Department of Pediatric, Faculty of Medicine, Universitas Brawijaya - Dr. Saiful Anwar General Hospital, Malang, 65111, Indonesia
| | - Krisni Subandiyah
- Nephrology Division, Department of Pediatric, Faculty of Medicine, Universitas Brawijaya - Dr. Saiful Anwar General Hospital, Malang, 65111, Indonesia
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7
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Rajvanshi N, Paul V, Verma PK, Mammen K. Gross hematuria: A rare presentation of disseminated tuberculosis. Indian J Tuberc 2020; 67:564-566. [PMID: 33077059 DOI: 10.1016/j.ijtb.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Vinod Paul
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Prashant Kumar Verma
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Kim Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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8
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Challenges in urogenital tuberculosis. World J Urol 2019; 38:89-94. [DOI: 10.1007/s00345-019-02767-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
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10
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Affiliation(s)
- Joseph A McBride
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Alexander J Lepak
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Gurpreet Dhaliwal
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Sanjay Saint
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Nasia Safdar
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
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Ye Y, Hu X, Shi Y, Zhou J, Zhou Y, Song X, Xie Y, Lu X, Wang L, Ying B, Chen X. Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China: A Cross-sectional Study. Medicine (Baltimore) 2016; 95:e3537. [PMID: 27175652 PMCID: PMC4902494 DOI: 10.1097/md.0000000000003537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the epidemiology, clinical features, and drug-resistance profile of urinary tuberculosis (UTB) in south-western China to improve UTB diagnostics.After the screening of 1036 cases of suspected UTB, 193 patients with UTB were enrolled during 2009 to 2014. Urine samples were collected for routine urinalysis, smear, tuberculosis DNA (TB-DNA) detection, and drug-resistant analysis, whereas blood samples were collected for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and renal function evaluation. Clinical features (such as symptoms and outcome) and imageology results (such as B ultrasonic, computerized tomography, intravenous pyelography, and renography) were also collected and analyzed to investigate the epidemiology, clinical features, and drug-resistance profile.The most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed. The positive rate for TB-DNA was 66.3%. The positive rate for culture was 13.1% and for smear it was 9.8%. The abnormal outcome rates of the computerized tomography, ultrasonography, intravenous pyelography, and the nephrogram were 76.9%, 70.1%, 29.8%, and 37.0%, respectively. The total rate of drug-resistant TB (resistant to at least 1 drug) was 39.7%, of which 20.7% was multidrug-resistance TB. The most prevalent mutation sites were katG S315T1, rpoB S531L, and gyrA D94G.We observed a serious epidemic of drug-resistant UTB and a substantial number of new UTB cases with multidrug resistance TB. Molecular diagnostics is crucial in the definite diagnosis of UTB, and our finding is a supplement and further confirmation of polymerase chain reaction usage for TB diagnosis. We recommend real-time polymerase chain reaction for TB-DNA identification instead of culture, and GenoType tests (MTBDRplus and MTBDRsl assay) for drug resistance as routine assays for patients with suspected UTB.
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MESH Headings
- Adult
- Antitubercular Agents/pharmacology
- Blood Sedimentation
- C-Reactive Protein/analysis
- China
- Cross-Sectional Studies
- DNA, Bacterial/urine
- Drug Resistance, Multiple, Bacterial
- Female
- Hematuria/microbiology
- Humans
- Kidney Function Tests
- Low Back Pain/microbiology
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Proteinuria/microbiology
- Tuberculosis, Multidrug-Resistant/complications
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/metabolism
- Tuberculosis, Renal/complications
- Tuberculosis, Renal/diagnosis
- Tuberculosis, Renal/drug therapy
- Tuberculosis, Renal/metabolism
- Urinary Tract Infections/microbiology
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Affiliation(s)
- Yuanxin Ye
- From the Department of Laboratory Medicine (YY, XH, JZ, YZ, XS, YX, XL, LW, BY), West China Hospital, Sichuan University, Sichuan Province; Department of Nephrology (YS); and Department of Tuberculosis (XC), West China Hospital, Sichuan University, Chengdu, The People's Republic of China
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Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A. Urinary tuberculosis: a cohort of 79 adult cases. Ren Fail 2015; 37:1157-63. [PMID: 26123266 DOI: 10.3109/0886022x.2015.1057460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.
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Affiliation(s)
- Mehmet Riza Altiparmak
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Sinan Trabulus
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Ilker Inanc Balkan
- b Department of Infectious Diseases , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Serkan Feyyaz Yalin
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Nazim Denizli
- c Department of Internal Medicine, Division of Nephrology , Haydarpasa Training and Research Hospital , Istanbul , Turkey
| | - Gonul Aslan
- d Department of Clinical Microbiology, Medical Faculty , Mersin University , Mersin , Turkey
| | - Hasan Erdal Doruk
- e Department of Urology, Medical Faculty , Mersin University , Mersin , Turkey
| | - Aynur Engin
- f Department of Infectious Diseases, Medical Faculty , Cumhuriyet University , Sivas , Turkey
| | - Recep Tekin
- g Department of Infectious Diseases, Medical Faculty , Dicle University , Diyarbakir , Turkey
| | - Serhat Birengel
- h Department of Infectious Diseases, Medical Faculty , Ankara University , Ankara , Turkey
| | - Birsen Durmaz Cetin
- i Department of Infectious Diseases, Medical Faculty , Koc University , Istanbul , Turkey
| | - Ferhat Arslan
- j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and
| | - Vedat Turhan
- k GATA Haydarpasa Training and Research Hospital , Istanbul , Turkey
| | - Ali Mert
- j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and
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Dezemon Z, Muvunyi CM, Jacob O. Staining techniques for detection of acid fast bacilli: what hope does fluorescein-diacetate (FDA) vitality staining technique represent for the monitoring of tuberculosis treatment in resource limited settings. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2055-0901-1-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dezemon Z, Muvunyi CM, Jacob O. Staining techniques for detection of acid fast bacilli: what hope does fluorescein-diacetate (FDA) vitality staining technique represent for the monitoring of tuberculosis treatment in resource limited settings. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2057-4711-1-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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