Title: To Study the Comparative yield of Zn Staining v/s CBNAAT (Gene Xpert) in Clinically Diagnosed cases of Tubercular Pleural Effusion
Authors: Jain G, Jain VK, Mishra M, Maan L, Garg A, Bhardwaj G
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.166
Abstract
Background: India accounts for a quarter of global TB burden in which 15-20% are extra-pulmonary TB. Tubercular pleural effusion is the most common extra pulmonary TB after Tubercular lymphadenitis. Tubercular effusion remains mostly undiagnosed due to pauci-bacillary nature. Early detection of Tuberculosis and Drug Resistance is the priority in diagnosis for early disease management and reduce morbidity. Molecular biological tests specially CBNAAT is one of the important method for early and rapid diagnosis of mycobacterium tuberculosis in specimen/tissue having pauci-bacillary nature with good sensitivity and specificity.
Materials and Methods: This is a retrospective study conducted in Department of Respiratory Medicine, MGMCH Jaipur in 150 patients of clinically diagnosed cases of tubercular pleural effusion between August 2016 to July 2018. In addition to detailed clinical history/examination and radio imagine Pleural fluid for routine Biochemical examination reports evaluated for protein, sugar ADA and cell cytology, suspecting tubercular in nature were taken in our study. In all these cases AFB by ZN staining and CBNAAT done and comparative reports evaluated.
Results: A total of 150 cases of clinically diagnosed tubercular pleural effusion, MTB was Detected by ZN staining in 11(7.33%) and CBNAAT in 38(25.33%) cases. CBNAAT yield was significantly more as compare with ZN Staining. Among 38 cases who were positive for CBNAAT only 11 cases were positive for ZN Staining showing poor yield of ZN Staining.
Conclusion: CBNAAT is newly emerging and highly sensitive and specific technique for early and rapid diagnosis of Tubercular Pleural effusion including resistant pattern of Rifampicin in view of MDR as compared to ZN staining.
Keywords: MTB,CBNAAT, ZN staining, MDR, ADA.
References
- Procel JM. Tuberculous pleural effusion. Lung 2009;187:263-70.
- World Health Organization;2017. Global Tubeculosis Report 2017.
- TrajmanA et al. Novel tests for diagnosing tuberculosis pleural effusion: What works and what does not? EurRespir J.2008;31:1098-106.
- Chakravarty S, Sen MK, Tyagi JS (2005) Diagnosis of extra pulmonary tuberculosis by smear, culture, and PCR using universal sample processing technology. J ClinMicrobiol 43(9): 4357-4362.
- Sahn SA et al. Can tuberculous pleural effusion be diagnosed by pleural fluid analysis alone?Int J Tuberc Lung Dise.2013;17:787-93.
- TB CARE I. International Standards for Tuberculosis Care, 3rd edition. 2014. Available at URL: istcweb.org.
- Boehme CC. "Rapid molecular detection of tuberculosis and rifampin resistance". N Engl J Med.2010; 363:1005-1015.
- Light RW. Update on tuberculous pleural effusion. Res-pirology,2010;15:451– 8.
- Koegelenberg CF, Bolliger CT, Theron J etal. Direct comparison of the diagnostic yield of ultrasound assisted Abram and Tru-cut needle biopsies for pleural tuberculosis. Thorax, 2010; 65: 857 – 62.
- Parikh P, Odhwani J, Ganagajalia C. Study of 100 cases of pleural effusion with reference to diagnostic approach. Int J Adv Med 2016;3:328-331.
- Arya Shashikant et al. A Study of Clincoetiological Profile of Patients with Pleural Effusion. IOSR Journal of Dental and Medical Sciences Jan 2017;16(1):23-27
- Ferreiro L, San José E, Valdés L (2014). "Tuberculous pleural effusion.". Arch Bronconeumol.50(10): 435–43.
- Ferrer. Pleural tuberculosis. EurRespir J.1997;10:942-947
- Valdés L, Alvarez D, San José E, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998;158:2017-21.
- Mahim Mittal, Ritesh Kumar. Int J Res Med Sci.2017;7:2952-2955.
- Ahmad N S, Sana khan, Aneeqa Shamshad Butt. Rapid detection of Mycobacterium tuberculosis and Rifampicin Resistance in extra pulmonary samples using Gene Xpert MTB/RIF assay. IOSR Journal of Dental and Medical Sciences 11/2014; 13(11):2279- 861.DOI: 10.9790/0853-131145053.
- ShuklaA et al.Role of gene Xpert MTB/ RIF assay in diagnosis of Tubercular Pleural Effusion.Int. J. Curr. Res. Med. Sci. (2017). 3(5): 105-110.
- Pravin KN and Choursai E, Use of Gene XPERT Assay for Diagnosis of Tuberculosis From Body Fluid Specimens, a 2 Year Study. J Microbiol Biotechnol, 2016, 1(1):000105.