Joshi Priyanka, Singh Krishna G, Patidar Vishal, Gupta Vikas
Pulmonary Medicine, Mahaveer Institute of Medical Sciences and Research, Bhopal, IND.
Respiratory Medicine, Chirayu Medical College and Hospital, Bhopal, IND.
Cureus. 2024 Aug 17;16(8):e67062. doi: 10.7759/cureus.67062. eCollection 2024 Aug.
Background Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, predominantly affecting the lungs (pulmonary TB) and is a significant public health challenge in India. The study aims to analyze demographic, radiological, and clinical subgroups of pulmonary TB cases, examine the relationship between smear acid-fast bacillus (AFB examination) and cartridge-based nucleic acid amplification test (CBNAAT), evaluate CBNAAT sensitivity for Mycobacterium tuberculosis (MTB) in new and previously treated patients, and determine the proportion of rifampicin resistance. Methods This hospital-based prospective study was conducted among patients diagnosed with pulmonary TB at the Respiratory Medicine Department of a Government Hospital over 16 months (August 2019 to December 2020). The study included 150 diagnosed TB cases (new and previously treated). Data collection encompassed demographic details, clinical symptoms, comorbidities, radiological findings (chest X-ray), and microbiological results (smear AFB examination, CBNAAT). Sputum samples were subjected to Ziehl-Neelsen staining and CBNAAT for MTB detection and rifampicin resistance testing. Statistical analysis was performed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY, USA). Results Of the 150 patients, 69.3% were male, and 48% were aged 21-40 years. The majority had a BMI of 18.5-24.9 kg/m² (50%) and resided in urban areas (63.3%). Common symptoms included cough (95.3%), fever (80%), and weight loss (74%). Cavitary lesions on chest X-ray were observed in 84% of patients. Smear microscopy detected MTB in 72.7% of cases, while CBNAAT detected MTB in 94% of cases. CBNAAT sensitivity for smear-positive and smear-negative samples was 93.97% and 94.12%, respectively. Rifampicin resistance was found in 3% of new cases and 6% of previously treated cases. The sensitivity of smear microscopy was 77.33%, and the sensitivity of CBNAAT was 94%. Conclusion The study underscores the high burden of pulmonary TB and the utility of CBNAAT in detecting MTB and rifampicin resistance, particularly in smear-negative samples. The findings highlight the necessity of universal drug susceptibility testing (DST) for effective TB management and the importance of addressing drug resistance to improve treatment outcomes.
结核病（TB）是由结核分枝杆菌引起的一种传染病，主要影响肺部（肺结核），在印度是一项重大的公共卫生挑战。本研究旨在分析肺结核病例的人口统计学、放射学和临床亚组，研究涂片抗酸杆菌（AFB检查）与基于 cartridge 的核酸扩增试验（CBNAAT）之间的关系，评估 CBNAAT 对新患者和既往治疗患者中结核分枝杆菌（MTB）的敏感性，并确定利福平耐药的比例。方法：本基于医院的前瞻性研究在一家政府医院呼吸内科对诊断为肺结核的患者中进行，为期 16 个月（2019 年 8 月至 2020 年 12 月）。该研究纳入了 150 例确诊的结核病例（新病例和既往治疗病例）。数据收集包括人口统计学细节、临床症状、合并症、放射学检查结果（胸部 X 光）和微生物学结果（涂片 AFB 检查、CBNAAT）。痰液样本进行萋-尼氏染色和 CBNAAT 以检测 MTB 并进行利福平耐药检测。使用 IBM SPSS Statistics 21.0 版本（美国纽约州阿蒙克市 IBM 公司）进行统计分析。结果：150 例患者中，69.3%为男性，48%年龄在 21 - 40 岁之间。大多数患者的体重指数（BMI）为 18.5 - 24.9 kg/m²（50%），居住在城市地区（63.3%）。常见症状包括咳嗽（95.3%）、发热（80%）和体重减轻（74%）。84%的患者胸部 X 光检查发现有空洞性病变。涂片显微镜检查在 72.7%的病例中检测到 MTB，而 CBNAAT 在 94%的病例中检测到 MTB。CBNAAT 对涂片阳性和涂片阴性样本的敏感性分别为 93.97%和 94.12%。新病例中 3%和既往治疗病例中 6%发现利福平耐药。涂片显微镜检查的敏感性为 77.33%，CBNAAT 的敏感性为 94%。结论：该研究强调了肺结核的高负担以及 CBNAAT 在检测 MTB 和利福平耐药方面的实用性，特别是在涂片阴性样本中。研究结果突出了进行普遍药物敏感性试验（DST）以有效管理结核病的必要性，以及应对耐药性以改善治疗效果的重要性。
