采用抗酸杆菌涂片、分枝杆菌培养及Xpert MTB/RIF检测法诊断终末期肾衰竭和非终末期肾衰竭患者的结核性腹膜炎。
Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure.
作者信息
Misra Richa, Kar Mitra, Mohindra Samir, Gupta Amit
机构信息
Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
出版信息
Access Microbiol. 2022 Aug 11;4(8):acmi000414. doi: 10.1099/acmi.0.000414. eCollection 2022.
INTRODUCTION
Diagnosis of tuberculous peritonitis (TBP) requires a high index of suspicion.
HYPOTHESIS /GAP STATEMENT: Information about the diagnostic features of TBP among patients with end-stage renal failure (ESRF) from India is limited.
AIM
To assess the utility of the Gene Xpert MTB/RIF assay in the diagnosis of TBP in patients with end-stage renal failure (ESRF), compared with those without ESRF.
METHODOLOGY
This prospective observational single centre cohort study was performed at a tertiary care centre in Northern India. Ascitic fluid and/or whole continuous ambulatory peritoneal dialysis (CAPD) bag with effluent from 300 clinically suspected cases of TBP were included in the study. Diagnosis was based on detection of on smear, Xpert MTB/RIF assay and/or culture. Cell counting was done in a Neubauer chamber. Cell predominance was seen by Giemsa stain. Line probe assay (LPA) for drug susceptibility testing was performed on all positive cultures.
RESULTS
TBP was diagnosed in 168 cases. Diabetes mellitus was a significant risk factor for developing TBP in patients with ESRF ( value<0.01). Lymphocytic predominance was seen in 21 patients without ESRF ( value 0.033) while majority of the patients in both groups had neutrophils in their ascitic and peritoneal fluids (138/168; value 0.033). We recovered 15 cases of laboratory diagnosed TBP (11 without ESRF and four with ESRF). Microscopy was positive in two cases while ten isolates were recovered on culture. The Xpert MTB/RIF assay was positive in seven ascitic fluid samples out of which three were rifampicin resistant. All these were patients without renal failure ( value 0.010). Eight culture positive samples tested by the line probe assay did not detect any resistance to either rifampicin or isoniazid.
CONCLUSION
The GeneXpert MTB/RIF assay has a limited value in the diagnosis of TBP in patients with ESRF.
引言
结核性腹膜炎（TBP）的诊断需要高度的怀疑指数。
假设/差距陈述：来自印度的终末期肾衰竭（ESRF）患者中关于TBP诊断特征的信息有限。
目的
与非终末期肾衰竭患者相比，评估Gene Xpert MTB/RIF检测在终末期肾衰竭（ESRF）患者TBP诊断中的效用。
方法
这项前瞻性观察性单中心队列研究在印度北部的一家三级医疗中心进行。研究纳入了300例临床疑似TBP病例的腹水和/或带有流出液的全持续性非卧床腹膜透析（CAPD）袋。诊断基于涂片、Xpert MTB/RIF检测和/或培养结果。在Neubauer计数板中进行细胞计数。通过吉姆萨染色观察细胞优势情况。对所有阳性培养物进行药物敏感性检测的线性探针分析（LPA）。
结果
168例被诊断为TBP。糖尿病是ESRF患者发生TBP的一个重要危险因素（P值<0.01）。21例非ESRF患者出现淋巴细胞优势（P值0.033），而两组中的大多数患者腹水和腹膜液中以中性粒细胞为主（138/168；P值0.033）。我们确诊了15例实验室诊断的TBP（11例非ESRF患者和4例ESRF患者）。显微镜检查2例呈阳性，培养分离出10株菌株。Xpert MTB/RIF检测在7份腹水样本中呈阳性，其中3份对利福平耐药。所有这些均为无肾衰竭患者（P值0.010）。通过线性探针分析检测的8份培养阳性样本未检测到对利福平或异烟肼的任何耐药性。
结论
GeneXpert MTB/RIF检测在ESRF患者TBP诊断中的价值有限。
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