An Assessment of Relevance of Sputum Sample Examination in Patients with Tuberculous Pleural Effusion

Background: Utility of chest-X ray findings as a reference diagnostic modality in cases of tubercular pleural effusion is well acknowledged. In advent of increasing reports, regarding the absence of visible lung lesions among patients suffering with tubercular pleural effusion, reliability on radiographic findings alone is questionable. In this context, need for a more reliable diagnostic tool in addressing this diagnostic challenge arises. Aim: The present study was undertaken to evaluate the relevance and utility of sputum specimen and adenosine deaminase (ADA) level examination in patients with tubercular pleural effusion, having no visible lesions on radiological examination. Materials and methods Methods: A total 81 cases of suspected tubercular pleural effusion were selected from the inpatient wards of a tertiary care hospital, over a period of eight months (May to December, 2013). Sputum and pleural fluid specimens from all these patients were collected for microbiological investigations such as smear microscopy using Ziehl-Neelsen and Auramine-O staining, mycobacterial culture using conventional method. ADA level was also tested from all pleural fluid specimens. Results: Of the 81 cases, culture positivity from sputum specimens was observed among 13 (16.1%), smear positivity from sputum specimens (3, 3.7%) and smear and culture positivity from pleural fluid specimens (1, 1.23%) cases. High levels of ADA, ranging from 115 IU/L to 203 IU/L were observed among (8, 22.2%) subjects. Conclusion: Our study findings suggest the reliability of smear examination and culture from sputum specimens over pleural fluids specimens and also high sensitivity of ADA as a biomarker in the diagnosis of tubercular pleural effusion.Keywords: Tuberculous pleural effusion, Mycobacterium tuberculosis, Diagnosis, Adenosine deaminase (ADA

Rhabdomyoma of larynx – A diagnaostic dilemma

AbstractIntroductionRhabdomyomas of the head and neck are unusual. Extracardiac rhabdomyoma is a rare benign tumor of striated muscle origin that is found in adults and children. We report a case of rhabdomyoma of the larynx, which presented a diagnostic dilemma.Case reportWe report an uncommon case of a 50-year-old man, who presented with change in voice for two years. Endoscopic examination of the larynx revealed a smooth mass covered by intact mucosa involving the right aryepiglottic fold and a false vocal cord with restricted right vocal cord mobility. Biopsy from the lesion revealed a diagnosis of squamous cell carcinoma. The patient underwent total laryngectomy. To our surprise, histologic examination and immunohistochemical diagnosis proved it to be rhabdomyoma of the adult type with no evidence of malignancy.DiscussionMost extracardiac rhabdomyomas arise from the pharyngeal constrictor muscles, the floor of the mouth, or the base of the tongue. Rarely, rhabdomyomas may arise from the larynx. Histologic and immunohistochemical analysis is essential for diagnosis. Treatment of rhabdomyoma consists primarily of complete excision with preservation of the surrounding tissues.ConclusionOur case demonstrates various differential diagnoses possible in laryngeal neoplasms. It also shows that immunocytochemistry plays an important role in differential diagnosis

A comparative study of laser posterior cordotomy and vocal cord lateralization

AbstractIntroductionThe treatment of bilateral vocal cord paralysis continues to be a challenge to the otolaryngologist, head and neck surgeon even today. Numerous surgical procedures have been proposed to improve the patient’s airway insufficiency without leaving the patient with a breathy, weak voice or an incompetent larynx. In this study we compared the outcome of laser posterior cordotomy and vocal cord lateralization in a group of bilateral abductor palsy patients.MethodRetrospective as well as a prospective study of 25 patients was carried out. The total of 25 patients was divided into 2 groups, group 1 consisted of 15 patients who underwent vocal cord lateralization with SUTUPAK suture and group 2 consisted of 10 patients who underwent laser assisted posterior partial cordotomy.ResultsThyroidectomy was the commonest cause for bilateral vocal fold paralysis i.e. 80% (20) of cases. Patients who underwent laser posterior cordotomy had 100% successful decannulation rate as compared to 92.8% for vocal cord lateralization patients. Comparison between pre and post operative voice assessment data by WILCOXON SIGNED RANKS test revealed that excepting the parameter of fluctuations/s in F0, all other parameters were statistically not significant.ConclusionLaser cordotomy is a superior, reliable and viable alternative to the other lateralization procedures for bilateral vocal fold paralysis

Diagnostic Performance of Xpert MTB /RIF in Comparison with LED Fluorescence Microscopy and Culture in Suspected Cases of Pulmonary Tuberculosis

GeneXpert MTB/RIF assay (GeneXpert) is relatively new technology in India and it is important to generate data on its efficacy for diagnosis of Tuberculosis. Thus; present study was undertaken to compare the diagnostic performance of GeneXpert for diagnosis of pulmonary tuberculosis (PTB) in comparison with Auramine O staining based Light Emitting Diode- Fluorescence Microscopy (LED-FM) considering culture as gold standard. A total of 662 (451 BAL, 211 Sputum) respiratory samples obtained from patients suspected of PTB were tested for smear microscopy and GeneXpert assay and were compared with culture results. Rifampicin resistance was compared with Genotype MTBDR plus assay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of the assays were calculated using SPSS version 22. On comparing with culture the sensitivity, specificity, PPV and NPV of GeneXpert MTB/RIF was found to be 97.25%, 98.54%, 96.20% and 98.95% respectively whereas sensitivity, specificity, PPV and NPV of smear microscopy was found to be 73.08%, 100%, 100% and 90.74% respectively. Rifampicin resistance was detected in 11 (1.66%) samples by GeneXpert. Five (0.75%) samples among them were found to be MDR whereas one sample showed false positive result for rifampicin resistant when compared by Genotype MTBDR plus assay. GeneXpert MTB/RIF assay offers much higher sensitivity as compared to Auramine O staining based LED-FM and seems to be a promising tool for TB diagnosis. Further longitudinal studies are required to evaluate the potential of this assay at primary health care settings and diagnosis of Extrapulmonary TB

Role of Bleach Concentration Method for Detection of Acid-fast Bacilli (AFB) in Sputum using Conventional Ziehl-Neelsen (ZN) Staining Technique

Sputum microscopy is the most important tool for the detection of Mycobacterium tuberculosis in peripheral laboratories. Sodium hypochlorite concentration technique prior to sputum microscopy may improve the detection of AFB bacilli over direct Ziehl Neelsen’s staining method. A prospective study was conducted at Kasturba Medical College, Manipal. Consecutive sputum samples were collected for 3 months. ZN stained smears were made directly of fresh specimens and of specimens that were processed with 3.5% sodium hypochlorite (NaOCl), from each patient. Then, ZN stained smears were observed under light microscopy. A total of 239 samples were collected. The yield of positive smears with ZN staining after NaOCl centrifugation was higher than that with microscopy after direct ZN stain. The percentage increase yield of ZN staining after NaOCl centrifugation over direct ZN staining was 3.3% (8/239). Bleach centrifugation can help in increasing the yield of positivity in sputum smear

Same Day Sputum Microscopy for Screening of Pulmonary Tuberculosis: its Accuracy and Usefulness in Comparison with Conventional Method

Sputum microscopy is the primary diagnostic tool for screening pulmonary tuberculosis (PTB) suspects in TB prevalent countries. Our study had evaluated the ‘front loading’ or ‘same day’ sputum microscopy feasibility to screen clinically suspected PTB cases, in comparison to standard method of smear microscopy. In this hospital based cross-sectional study, three sputum specimens i.e., two consecutive spot samples collected in one hour interval on the first day of visit and a single sputum sample was collected on the next day early morning from 312 randomly selected adults suspected for PTB. Sputum samples were cultured on Lowenstein-Jensen (LJ) medium and stained by auramine O method and examined under LED-fluorescence microscopy. Out of 312 presumptive PTB patients, 43 (13.8%) were smear-positive by front loading method and 46 (14.7%) by standard method respectively. Considering LJ media culture as the gold standard test, the sensitivity was 83.7% and 89.8% respectively for front loading and the standard sputum microscopy and specificity was 99.2% by both methods. The statistical difference was insignificant between two methods of sputum microscopy (p-value > 0.05 by McNemar’s test). In health care settings of high burden countries same day sputum microscopy could be an acceptable method to screen the suspects of pulmonary tuberculosis and complete the diagnosis procedure on the first day of visit, which will decrease patients’ drop-out from the diagnostic procedure and initiate treatments as soon as possible

Honey as an Antimicrobial Agent Against Pseudomonas Aeruginosa Isolated from Infected Wounds

Background: As natural products garner attention in the medical field due to emergence of antibiotic resistant strains of bacteria, honey is valued for its antibacterial activity. Objective: Fifty strains of Pseudomonas aeruginosa isolated from infected wounds were evaluated for their antibacterial action using honey in comparison with different antibiotics and Dettol. Methodology and Results: All the strains were found to be sensitive to honey at a minimum inhibitory concentration of 20% in comparison with Dettol at 10% using agar dilution method. In the second step, the time kill assay was performed on five isolates of P. aeruginosa to demonstrate the bactericidal activity of honey at different dilutions of honey ranging from 20% to 100% at regular time intervals. All the isolates of P. aeruginosa tested were killed in 12-24 h depending on the dilutions of the honey tested. Thus, honey could prevent the growth of P. aeruginosa even if it was diluted by deionized water by fivefolds in vitro. Honey had almost uniform bactericidal activity against P. aeruginosa irrespective of their susceptibility to different classes of antibiotics. Conclusion: Honey which is a natural, non-toxic, and an inexpensive product has activity against the P. aeruginosa isolated from infected wounds may make it an alternative topical choice in the treatment of wound infections

Evaluating Different Counter Stains in Fluorescent Staining Technique for Detecting Acid Fast Bacilli: Best Amongst The Better

Tuberculosis is a global emergency needing an early and accurate diagnosis for management and control. Smear microscopy is a rapid diagnostic method for detecting acid fast bacilli (AFB) and improvising this method would contribute in better detection rates. The present study compares the efficacy of various counter stains used in Auramine O staining method in examining sputum smears under fluorescence microscope. This was a prospective study conducted in the Department of Microbiology from January to March, 2017. 102 sputum specimens were collected during this period from patients clinically suspected with pulmonary tuberculosis. Five smears were prepared from each specimen, where each smear was stained with Auramine O staining technique using five different counter stains, 0.1% potassium permanganate, 0.1% methylene blue, 0.1% toluidine blue, 0.1% malachite green and undiluted blue ink. Among the 102 sputum specimens, 50(49.01%), 50(49.01%), 49(48.03%), 44(43.13%) and 48(47.05%) smears showed positive results using potassium permanganate, methylene blue, toluidine blue, malachite green and blue ink respectively. On comparing the degree of fluorescence exhibited by debris in these smears, using potassium permanganate, methylene blue, toluidine blue, malachite green and blue ink, fluorescence was observed in 22(21.6%), 11(10.8%), 46(45.1%), 0(0%) and 31(30.4%) smears respectively. When the counter stains were analyzed, there was a statistically significant difference for debris getting fluoresced (p<0.001). In conclusion, methylene blue as a counter stain has almost equivalent effect compared to routinely used potassium permanganate. It has shown to have the best sensitivity and specificity, reduced debris fluorescence and better contrast in appreciating AFB