Comparative Diagnostic of Cervical Tuberculous Lymphadenitis: PCR is a Fast, Efficient, and Improved Diagnostic Approach

Methods

The study included 100 clinically suspected cases of TBLN. Fine needle aspirate (FNA) samples were processed for cytology staining and cultured on LJ & BACTEC 12B media. The biochemical tests were performed to identify the isolates at the species level. Additionally, for PCR, DNA was extracted and used for the diagnosis and identification of mycobacterial species.

Results

Patients ranged from 2 to 45 years with a mean age of 24.96 ± 9.10 years. Out of 100 patients, 73% had clinical symptoms of weight loss, followed by fever (72%), anorexia (66%), and night sweats (58%). 24% of patients were found to be smear-positive after Ziehl-Neelsen (ZN) staining and statistically highly significant with PCR. On LJ medium 34% and on BACTEC radiometric 45% of samples were smearing positive. Overall, 48% of cases were PCR-positive for TBLN. When compared with culture, the sensitivity and specificity of PCR were 93.75% and 100%, respectively, which are higher than cytology. The true positive predictive value (PPV) and negative predictive value (NPV) were 83.3% and 61.5%, respectively.

Conclusion

This study suggests that PCR is a rapid, sensitive, and specific tool for correct diagnosis of TBLN cases as compared to staining and culture which lead to the early and proper management of mycobacterial diseases.

Comparative Evaluation of Two Antibiotic Pastes for Root Canal Disinfection

Aim and objective

To compare the efficacy of triple antibiotic paste (TAP) and double antibiotic paste (DAP) for root canal disinfection during revascularization of immature pulpless teeth.

Materials and methods

A sample of 20 immature teeth in subjects aged 8–13 years was selected for a revascularization procedure. The teeth were randomly distributed in two groups corresponding to the medicament received—TAP group (n = 10) and DAP group (n = 10). Microbial samples were collected using dry paper points at the beginning of treatment and thereafter every 3 weeks till sterile reading was obtained. Microbial samples were then sent to the microbiological lab for identification.

Results

A variety of opportunistic microbes were detected in samples obtained before placement of medicaments with no significant difference between the two medicament groups. The efficacy of TAP to eliminate microbes was lower in comparison to DAP after 3 weeks of placement of medicaments, whereas it was found to be more efficacious in comparison to DAP after 6 weeks and no significant difference (p> 0.05) was observed between the two groups.

Conclusion

Immature permanent teeth with pulp necrosis can achieve complete root development with regenerative endodontic technique. The use of antibiotic pastes including TAP and DAP can help achieve a successful outcome with thorough decontamination of the root canal.

How to cite this article

Goswami M, Baveja CP, Bhushan U, et al. Comparative Evaluation of Two Antibiotic Pastes for Root Canal Disinfection. Int J Clin Pediatr Dent 2022;15(S-1):S12-S17.

Rare case of meningitis due to an emerging pathogen Chryseobacterium indologenes

Chryseobacterium indologenes is a non-glucose fermenting Gram-negative bacteria widely distributed in nature. It has been found to cause a variety of infections like nosocomial pneumonia, bacteremia and wound infections usually in immunosuppressed patients and those with indwelling devices. The organism is resistant to a significant number of the commonly prescribed broad spectrum antibiotics. We report a rare case of meningitis due to C. indologenes in a patient diagnosed with medulloblastoma and hydrocephalus with an external ventricular drain in situ. The patient was successfully treated with trimethoprim/sulfamethoxazole combination and external ventricular drain replacement as shown by subsequent sterile cultures.

Microbiological evaluation of clinically suspected cases of tubercular lymphadenopathy by cytology, culture, and smear microscopy - A hospital-based study from Northern India

Introduction:

Over the past few years, the incidence of extrapulmonary tuberculosis (EPTB), particularly of tubercular lymphadenitis (TBLN), is on the rise. TBLN, which contributes to 20–40% of EPTB cases, often poses a diagnostic and therapeutic challenge for clinicians more so in resource-constrained settings where laboratory confirmation is not available. In this study, we aimed to study if fine-needle aspiration cytology (FNAC) combined with Ziehl–Neelsen (ZN) staining and mycobacterial culture could improve the diagnostic accuracy in patients clinically suspected of TBLN.

Materials and Methods:

This cross-sectional study involved 120 patients (>12 years of age), clinically suspected of peripheral TBLN. Direct examination of the samples with ZN staining and culture on Lowenstein–Jensen (LJ) slants and Bactec MGIT 960 vials (MGIT 960 medium) was performed on previously collected fine-needle aspirates.

Results:

Out of total 120 patients included in study, 43.3% were males and 56.7% were females. Maximum numbers of cases were observed in age group 13–21 (56%). On ZN staining, 21.7% samples were found positive, whereas FNAC findings were suggestive of tuberculosis (TB) in 455 patients. Culture on LJ media showed 33.3% samples to be positive, whereas Bactec MGIT 960 system showed positivity of 35%. Out of 54 samples suggestive of TB on FNAC, only 30 (55.6%) were found positive on Bactec culture. Also out of 66 samples which were not suggestive of TB in FNAC, 12 (18.2%) were found positive in Bactec culture.

Conclusion:

Accurate diagnosis of TBLN requires a multifaceted approach involving microbiology, pathology, radiology, and clinical presentation of the disease. FNAC and ZN staining along with the culture can result in better diagnostic yield and will be helpful in reducing the burden of TB.

Statistical analysis of microbiological diagnostic tests

No study in medical science is complete without application of the statistical principles. Incorrect application of statistical tests causes incorrect interpretation of the study results obtained through hard work. Yet statistics remains one of the most neglected and loathed areas, probably due to the lack of understanding of the basic principles. In microbiology, rapid progress is being made in the field of diagnostic test, and a huge number of studies being conducted are related to the evaluation of these tests. Therefore, a good knowledge of statistical principles will aid a microbiologist to plan, conduct and interpret the result. The initial part of this review discusses the study designs, types of variables, principles of sampling, calculation of sample size, types of errors and power of the study. Subsequently, description of the performance characteristics of a diagnostic test, receiver operator characteristic curve and tests of significance are explained. Lack of a perfect gold standard test against which our test is being compared can hamper the study results; thus, it becomes essential to apply the remedial measures described here. Rapid computerisation has made statistical calculations much simpler, obviating the need for the routine researcher to rote learn the derivations and apply the complex formulae. Thus, greater focus has been laid on developing an understanding of principles. Finally, it should be kept in mind that a diagnostic test may show exemplary statistical results, yet it may not be useful in the routine laboratory or in the field; thus, its operational characteristics are as important as the statistical results.

Association of interleukin-2, -4 and -10 with dengue severity

BACKGROUND

Dengue is an arboviral disease caused by four distinct serotypes of dengue virus. The pathogenesis of dengue is not very clearly understood. Various pro- and anti-inflammatory cytokines are involved in the immune pathogenesis of dengue. Interleukin (IL)-2/IL-2 receptor interaction is supposed to play a protective role, while IL-4 acts as pro-inflammatory whereas IL-10 acts as anti-inflammatory cytokines. So far, not much information is available regarding the established role of these cytokines with dengue infection and severity.

AIMS

our study aimed to show the association of IL-2, -4, and -10 with severity of dengue infection.

SETTINGS AND DESIGN

This was a cross-sectional study.

MATERIALS AND METHODS

The study was conducted in the year 2015; 150 blood samples from suspected dengue cases were confirmed for dengue and then with an equal number of healthy control samples were tested for cytokines levels (IL-2, -4, and -10) by ELISA. Severity of the dengue infection was determined on the basis of clinical manifestations based on the WHO criteria.

STATISTICAL ANALYSIS

for statistical analysis, SPSS version 21 (IBM, New York, United States) was used.

RESULTS

Out of 150 samples, 56 samples came to be dengue positive. Thirty-eight (67.85%) cases were classified as nonsevere dengue and 18 (32.15%) were severe dengue. The serum levels of IL-4 and -10 were significantly raised in severe dengue cases as compared to nonsevere dengue cases. No significant association was observed between serum IL-2 levels and the severity of dengue.

CONCLUSION

IL-4 and -10 levels can be used as marker of severe dengue and help in early preparedness to start the treatment in the line of severe dengue.

Drug susceptibility of Mycobacterium tuberculosis in patients with AIDS at a tertiary care hospital in northern India

The study was done to determine the anti-tuberculosis drug resistance patterns of Mycobacterium tuberculosis (MTB) in AIDS patients. Fifty antiretroviral drug naïve new AIDS patients with clinical evidence of pulmonary tuberculosis and no previous history of tuberculosis were recruited. Baseline CD4 counts and plasma viral loads (PVL) were measured by flow cytometry and RT-PCR, respectively. Sputum samples were obtained from each patient and subjected to Ziehl-Neelsen staining and cultured on Lowenstein-Jensen medium and using the BACTEC 460 system (B460). Antimicrobial susceptibilities were tested in all isolates using the B460 gystem. The occurrence of MTB was found to be more common with a PVL>4 log10 copies/ml (odds ratio: 4.6). Of 15 MTB isolates, 8 (53.3%) had single drug resistance, 4 (26.7%) had multidrug resistance (MDR) and 1 (6.7%) had resistance to three drugs (non-MDR). Two isolates (13.3%) were sensitive to all the four drugs. Resistance to first line anti-tuberculosis drugs was found to be higher among AIDS patients with MTB.

Primary tubercular liver abscess in an immunocompetent adult: a case report

INTRODUCTION

Isolated primary tubercular abscess is one of the rare forms of extrapulmonary tuberculosis. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.

CASE PRESENTATION

A 30-year-old man, of Asian origin, developed a hepatic tubercular abscess which was not associated with any pulmonary or gastrointestinal tract foci of tuberculosis. An ultrasonogram of the abdomen showed an abscess in the right lobe of his liver which was initially diagnosed as an amoebic liver abscess. Subsequently, the pus from the lesion yielded Mycobacterium tuberculosis using the BACTEC TB 460 instrument and Mycobacterium tuberculosis deoxyribonucleic acid by polymerase chain reaction. The patient was started on systemic antitubercular therapy to which he responded favorably.

CONCLUSION

This report emphasizes the fact that, although a tuberculous liver abscess is a very rare entity, it should be included in the differential diagnosis of unknown hepatic mass lesions.

Newer methods over the conventional diagnostic tests for tuberculous meningitis: do they really help?

Rapid diagnosis of tuberculous meningitis (TBM) is crucial as the disease outcome depends on the stage at which the treatment is initiated. The reliability of the available tests has not been established; thus, the present study was conducted to evaluate the conventional diagnostic tests as compared to the newer methods. Cerebrospinal fluid was collected from 100 children, and analyzed for various biochemical and cytological tests. The samples were subjected to Ziehl-Neelsen (Z-N) staining, Lowenstein-Jensen (L-J) culture, BACTEC culture and polymerase chain reaction (PCR). Twenty-two patients could be identified as definitive TBM based on the demonstration of Mycobacterium tuberculosis by BACTEC culture and PCR. Of these 22 cases, Z-N staining was positive in only two and L-J culture in six cases. Both the BACTEC culture and PCR had 100% agreement in the diagnosis of TBM. However, BACTEC culture could be a better diagnostic test as drug sensitivity can also be performed by this method.

Drug-resistant genital tuberculosis of the penis in a human immunodeficiency virus non-reactive individual

The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance.

Diagnostic utility of ELISA test using antigen A60 in suspected cases of tuberculous meningitis in paediatric age group

The aim of the study was evaluation of the utility of ELISA test using antigen A60 for rapid diagnosis of tuberculous menigitis (TBM) in paediatric age group. ELISA test based on mycrobacterial antigen A60 (Anda biological, France) was used to estimate specific IgM and IgG antibodies in the sera and CSF of 20 suspected cases of TBM which were selected on the basis of numerous parameters and were smear negative on concentrated smear of CSF. Sera of 20 Montoux negative healthy children was taken as control by detecting IgM and IgG antibodies to A60 antigen. Response to anti-tubercular treatment was observed in all the suspected cases of TBM. This study showed that specificity for diagnosis of TBM by detecting IgM and IgG antibodies in sera was 90% and 80% respectively. Sensitivity of the test by detecting IgM and IgG antibodies in sera was 85% and 80% respectively with positive predictive value of 89.47% for IgM antibody and 80% for IgG antibody. In CSF IgM and IgG antibodies were found in 75% and 60% cases respectively. Both were positive only in 60% of cases. It is concluded from this study that 80-85% cases of TBM in paediatric age group have eigher IgM or IgG antibodies in sera whereas 60-75% have antibodies in CSF.

Bacteriological study of drinking water during epidemic of cholera in Delhi

Sixty drinking water samples collected from various sources in different areas of Delhi during epidemic of cholera and gastroenteritis were analysed for bacteriological standards. Only 27 (45 per cent) samples were found to be satisfactory for human consumption. Remaining thirty-three (55 per cent) samples showed presence of coliform organisms with MPN value ranging from 10 to 1800+ per 100 ml. Among these positive samples, 31 (93.9 per cent) samples contained faecal coli. Twenty out of thirty (66.6 per cent) Hand pump, 9 out of 21 (42.8 per cent) Taps 2 out of 4 (50 per cent) Tube well and 2 out of 5 (40 per cent) of miscellaneous sources showed contamination with coliform organisms.