Gastrointestinal Tuberculosis in Patients With Pulmonary Tuberculosis

Proven or suspected intestinal tuberculosis was diagnosed in23(46 per cent) of 50 patients with smear-positive, cavitatlngpulmonary tuberculosis. The diagnosis was regarded as provenin patients and suspected in the remaining nine. The frequencyof proven gastrointestinal disease increased with the severityof the pulmonary tuberculosis. Small intestinal disease wasencountered in only two patients. Small mucosal lesions in thecaecum were the most commonly detected pathological features.Colonoscopy was of particular value in establishing the diagnosis,which could not be predicted from the patients' abdominal signsor gastrointestinal symptoms.     

Patients in whom active tuberculosis was diagnosed after admission to a Japanese university hospital from 2005 through 2007

To identify problems in early diagnosis of tuberculosis and to design countermeasures against the disease, we examined the status of active tuberculosis among patients admitted to a university hospital that did not have an isolation ward for tuberculosis. Between 2005 and 2007, we analyzed demographic characteristics, disease type, chest radiologic findings, and the process leading to diagnosis. Active tuberculosis was diagnosed after admission in 55 patients (34 males and 21 females): pulmonary tuberculosis, 26; tuberculous pleuritis, 13; tuberculous meningitis, 6; miliary tuberculosis, 4; tuberculous pericarditis, 3; lymph-node tuberculosis, 2; and tracheal and bronchial tuberculosis, 1. Although radiographic examinations provided abundant information, chest radiography showed normal findings in 7 patients (12.7%). Computed tomographic scanning was useful for detailed evaluation of abnormalities. Twenty patients (36.4%) were given diagnoses at departments other than ours (Department of Pulmonary Medicine). Numbers of days between hospital admission and diagnosis of tuberculosis (50th percentile/80th percentile) were 8.0/37.8 for miliary tuberculosis, 8.0/8.0 for tracheal and bronchial tuberculosis, 7.5/17.8 for tuberculous pleuritis, 7.0/8.8 for tuberculous pericarditis, 6.0/15.6 for pulmonary tuberculosis, 3.5/4.4 for lymph-node tuberculosis, and 1/1 for tuberculous meningitis. Early diagnosis of tuberculosis requires adherence to the following precautions. Tuberculosis should be suspected in any patient with respiratory symptoms. Sputum tests for acid-fast bacteria should be performed at least three times initially. If findings on chest X-ray films are equivocal, high-resolution computed tomography should be performed to confirm details of shadows and to detect minimal pulmonary shadows or cavitary lesions. Physicians from all specialties should be repeatedly informed about the risk of tuberculosis and should include tuberculosis in the differential diagnosis in patients suspected to have pulmonary diseases.     

Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease

BACKGROUND AND STUDY AIMS: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. PATIENTS AND METHODS: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up. RESULTS: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %). CONCLUSIONS: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.     

Development and evaluation of multiplex PCR in rapid diagnosis of abdominal tuberculosis

The clinical features of abdominal tuberculosis (TB) are non-specific and establishing a diagnosis remains a challenge. A delay in diagnosis is likely to increase the morbidity in these patients. We developed a multiplex polymerase chain reaction (PCR) using 16SrRNA, IS6110, and devR, and evaluated it in comparison with other conventional tests in clinical suspects of abdominal TB. A total of 183 patients with clinical suspicion of abdominal TB (96 patients with intestinal TB and 87 with peritoneal TB) were enrolled for the study. Endoscopic or intraoperative biopsies were collected from patients suspected of intestinal TB and ascitic fluid was collected from patients with a suspicion of peritoneal TB. Of the intestinal tuberculosis group, there were 40 confirmed cases and 56 controls, while of the peritoneal tuberculosis group there were 37 confirmed cases and 50 controls. Multiplex PCR showed a high sensitivity and specificity in both the intestinal TB and peritoneal TB groups. When combined with histopathology, multiplex PCR could detect 97.5% of all the cases in the intestinal tuberculosis group, while in combination adenosine deaminase levels (ADA) in cases of peritoneal tuberculosis it increased the specificity of diagnosis of peritoneal tuberculosis to 95%. In combination with histopathology in suspected intestinal TB cases, and ADA testing in suspected peritoneal TB cases, it can be used as a highly sensitive, specific, and rapid diagnostic tool with the ability to supplement the limitations of other diagnostic modalities.     

结核感染T细胞检测在菌阴性肺结核诊断中的应用价值

目的评估结核感染T细胞检测在菌阴性肺结核的诊断价值。方法纳入包括菌阴性肺结核病患者145例、非结核肺部疾病患者45例共190例。所有研究对象进行结核感染T细胞检测,计算灵敏度、特异度、阳性预测值、阴性预测值等指标。结果结核感染T细胞检测对菌阴性肺结核诊断的灵敏度为85.5%,特异度为84.4%,阳性预测值为94.7%,阴性预测值为64.4%。不同年龄段间比较差异无统计学意义(P0.05)。结论结核感染T细胞检测有较高的阳性预测值,适用于菌阴性肺结核病的临床辅助诊断。     

结核分枝杆菌检测方法临床应用的对比研究

目的用涂片、聚合酶链反应(PCR)法检测结核分枝杆菌,探讨其临床应用价值。方法对169例临床确诊的肺结核患者、可疑肺结核患者和非结核患者痰标本用涂片、PCR两种方法进行检测,对结果进行对比分析。结果 169例痰标本中,痰涂片检查阳性率为7.1%(12/169),PCR检测阳性率为32.54%(55/169);痰涂片、PCR法检测42例临床确诊的肺结核患者痰标本阳性率分别为11.9%(5/42)、57.1%(24/42);检测82例临床可疑肺结核患者痰标本阳性率分别为8.54%(7/82)、37.8%(31/82)。比较两种方法的阳性检测率,差异有统计学意义(χ2=19.729,P<0.01),检测45例非结核患者痰标本,涂片及PCR检测均为阴性。结论 PCR法检测结核分枝杆菌具有较高的敏感性和特异性,可作为临床结核病检测诊断的有效方法之一。     

结核杆菌蛋白芯片检测对活动性肺结核的诊断价值

目的评价结核杆菌蛋白芯片对肺结核的诊断价值及其影响因素。方法对痰涂片阳性肺结核病患者结核杆菌蛋白芯片和胸部CT扫描结果进行对比,分析肺结核病变范围和类型等因素对结核杆菌蛋白芯片检测的影响。结果结核杆菌蛋白芯片阳性率72.0%,CT诊断阳性率为90.0%,两种方法同时检测阳性率达到96.0%;多个肺野肺结核的结核杆菌蛋白芯片阳性率高于单个肺野(P0.05),有基础疾病较无基础疾病检出率低(P0.01)。结论病变范围及基础疾病影响结核杆菌蛋白芯片的阳性率,胸部CT扫描联合结核杆菌蛋白芯片检测可以提高肺结核的诊断率。     

低剂量螺旋CT在肺结核中的诊断价值

目的:探讨低剂量螺旋CT在肺结核诊断中的应用价值。材料与方法:采用东芝公司Active 16排螺旋CT对98例胸部DR平片怀疑肺结核的患者进行常规剂量螺旋CT扫描,同时对病变部位行低剂量螺旋CT扫描。所得图像由3名从事影像诊断工作主治医师以上的医生进行判读,分别就肺结核在螺旋CT上的主要征象进行逐一判定,最后做出定性诊断。结果:98例胸部DR平片怀疑肺结核患者,最后通过查痰、活检或肺结核菌阴性确诊的肺结核患者有80例。对以上确诊的80例肺结核患者的两种扫描方式所得图像进行判定,低剂量螺旋CT与常规CT在肺结核征象的检出率差异无统计学意义(P0.05)。结论:低剂量螺旋CT大幅度降低患者的辐射剂量,能获得常规剂量CT扫描相同的诊断效果,在肺结核的诊断中具有临床应用价值。     

Effect of a publicly funded tuberculosis service on the diagnosis of tuberculosis at a teaching hospital

The speed and accuracy of diagnosis of tuberculosis on general medical teaching services were retrospectively compared to that on a designated publicly funded tuberculosis service and to recent discouraging reports in the literature. The diagnosis was confirmed in all patients on the designated service and in 78.8% of patients not on the designated service within one week. No patient was discharged undiagnosed. Acid-fast smears done by the hospital laboratory showed a sensitivity of 82.5% and a specificity of 98.4%. Radiologic reports indicated the presence of tuberculosis or cavities in 85% of chest x-ray films in patients with pulmonary disease. These results may indicate that a publicly funded tuberculosis service, by providing emphasis on tuberculosis, allows more rapid and accurate diagnosis of tuberculosis in all patients. The impact of such training on future health care delivery should be recognized when decisions regarding allocation of public funds are made.     

Intestinal tuberculosis in AIDS

The radiological appearance of intestinal tuberculosis (IT) in six patients with AIDS is presented. Involvement of the ileocecal segment (five cases), cecum (four cases), and duodenum (one case) was seen on computed tomographic (CT) or barium studies. There were no significant differences in radiological manifestations of IT among patients with or without AIDS, but all six patients had an advanced stage of their disease at the time of diagnosis.     

Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis

We investigated the diagnostic value of induced sputum (IS) and bronchial lavage (BL) specimens in patients with suspected pulmonary tuberculosis who had negative spontaneous sputum specimens or who were unable to produce sputum spontaneously. IS specimens and BL specimens obtained using flexible fibreoptic bronchoscopy from 55 patients were evaluated for the presence of acid-fast bacilli (AFB) and cultured for Mycobacterium tuberculosis. Positive results were found with IS smear in 23 patients, BL smear in 26 patients, and IS or BL culture in 42 patients. Culture of BL specimens had a higher sensitivity than IS or BL smears or culture of IS specimens. The highest sensitivity rate was obtained with a positive BL or IS culture (86%). For early diagnosis (a positive IS or BL smear), the sensitivity was 57%. IS has a higher sensitivity rate than spontaneous sputum for the detection of tuberculosis, and fibreoptic bronchoscopy is useful for the early diagnosis of tuberculosis when AFB are not detected in spontaneous or induced sputum specimens.     

Sonographic findings of intestinal tuberculosis

Sonograms in 41 patients with intestinal tuberculosis were analyzed. The sonographic findings of intestinal tuberculosis were thickening of the wall in the ileum, cecum, or ascending colon (or in more than one of these). We detected the wall thickening in 38 cases by sonography (detection rate, 93%). The ileum was the most frequent site of involvement. The patterns of bowel wall thickening were diffuse in 30 cases and focal in eight cases and were concentric in 28 cases and eccentric in six cases. The associated findings were ascites, lymphadenopathy, omental cake, and cecal spasm in order of decreasing frequency. The sonographic findings are not specific for the diagnosis of intestinal tuberculosis, but when noted in the appropriate clinical situation would be of great help in the diagnosis of intestinal tuberculosis.     

肺结核病人PPD皮试与ELISPOT结果的相关性分析

[目的]研究肺结核病人酶联免疫斑点技术(ELISPOT)和结核菌素纯蛋白衍生物(PPD)皮试结果的相关性.[方法]24例痰结核菌培养阳性肺结核病人,38例临床疑似肺结核病人,取外周血分离获取单个核细胞(PBMCs)后行ELISPOT试验.[结果]痰结核菌培养阳性肺结核组与临床疑似肺结核组PPD皮试阳性率相似;痰结核菌培养阳性肺结核组的ELISPOT阳性率高于临床疑似肺结核组;ELISPOT斑点数与PPD皮试反应程度之间缺乏相关性.[结论]ELISPOT的诊断特异性高于PPD皮试.     

分子信标荧光探针检测结核分枝杆菌的临床应用

目的:探讨分子信标荧光探针检测结核分枝杆菌的临床应用价值。方法:应用设置内参照的分子信标荧光探针检测178例肺结核标本,并与痰涂片和培养结果进行比较。结果:肺结核组分子信标荧光探针阳性率显著高于痰涂片和培养,检出率分别为56.2%(100/178),34.8%(62/178)、34.8%(62/178)。结论:分子信标荧光探针具有较高的灵敏度和特异度,对结核病的辅助诊断有一定的临床意义。     

Measurement of tuberculostearic acid in sputa, pleural effusions, and bronchial washings. A clinical evaluation for diagnosis of pulmonary tuberculosis

Gas chromatography/mass spectrometry combined with selected ion monitoring was used to measure tuberculostearic acid (TSA), in sputum, pleural effusion, and bronchial washing. The detection limit corresponded to the amount of TSA eluted from as low as 10(3) tubercle bacilli. Sputa were collected from 169 patients with active pulmonary tuberculosis, 35 clinically suspected to be active, 53 with obsolete pulmonary tuberculosis, and 160 with pulmonary diseases other than tuberculosis. TSA was positive in 90% of the patients with active pulmonary tuberculosis (152/169) and 71% of the clinically suspected cases (25/35), respectively. In contrast, less than 10% of the patients with obsolete tuberculosis or other pulmonary diseases had a positive TSA. Pleural effusions and bronchial washings were also collected from patients with active tuberculosis and from those with other diseases, as the controls. TSA in pleural effusions and bronchial washings was detected in 24 of 32 patients and 15 of 22 patients with active tuberculosis, respectively. In those with pulmonary diseases other than tuberculosis, only 8.7% of pleural effusion (4/46) and 4.3% of bronchial washing samples (3/69) showed a positive TSA. Therefore, the measurement of TSA is useful as a rapid and sensitive method for diagnosing pulmonary tuberculosis.     

肺结核合并肺部感染患者病原菌分布及内毒素、钙结合蛋白检测的临床意义

目的 分析肺结核合并肺部感染患者病原菌分布及内毒素(LSP)、钙结合蛋白(S100A9)检测的临床意义.方法 选取2017年1月至2020年6月我院收治肺结核患者216例,根据有无合并肺部感染分为感染组与未感染组.分析肺结核患者肺部感染及病原菌分布情况,对比感染组与未感染组LSP、S100A9蛋白、降钙素原、C反应蛋白...     

寡核苷酸法检测结核病患者血清IgG抗体的临床应用评价

目的评价结核分枝杆菌IgG抗体寡核苷酸酶联免疫法在结核病血清学诊断中的临床应用价值。方法对285例结核病[菌阳肺结核（涂片阳性/培养阳性）124例,菌阴肺结核（涂片、培养均为阴性）161例]、38例非结核病的其他呼吸系统疾病患者及49名健康志愿者同步进行抗酸杆菌涂片、培养及结核分枝杆菌IgG抗体寡核苷酸酶联免疫法检测。结果结核分枝杆菌IgG抗体寡核苷酸酶联免疫法诊断菌阳肺结核的敏感性为67.7%（84/124）,诊断菌阴肺结核的敏感性为33.5%（54/161）,诊断结核病的总体敏感性为48.4%（138/285）,总体特异性为92.0%（80/87）,其中在非结核病的其他呼吸系统疾病患者中的特异性为86.8%（33/38）,在健康志愿者中的特异性为95.9%（47/49）。结论结核分枝杆菌IgG抗体寡核苷酸酶联免疫法有极高的特异性和一定的敏感性,可用于结核分枝杆菌IgG抗体的血清学检测,能为临床诊断提供可靠的参考依据。     

经皮低剂量CT引导下肺穿刺诊断肺结核3例分析

目的增加小儿疑似肺结核的确诊依据。方法回顾分析3例经皮低剂量CT引导下肺穿刺诊断肺结核患儿的临床资料,对其临床、影像、肺穿刺组织病理学特点进行总结。结果3例患儿均有不同程度的发热、咳嗽、消瘦、乏力,PPD试验及痰涂片均阴性,临床疑似但不能明确诊断为肺结核,经皮低剂量CT引导下肺穿刺明确诊断为肺结核。结论临床上疑似肺结核,诊断困难时可以考虑经皮低剂量CT引导下肺穿刺,以明确诊断。     

TB-DNA、T-SPOT.TB和TB-Ab平行检测在肺结核诊断中的应用价值

目的评价结核分枝杆菌脱氧核糖核酸(TB-DNA)检测、结核感染T细胞酶联免疫斑点试验(T-SPOT.TB)和结核抗体(TB-Ab)检测3种方法在肺结核诊断中的应用价值。方法收集2019年1-12月商洛某三甲医院收治的245例疑似肺结核患者的一般资料,根据最终诊断结果分为肺结核患者组(试验组)和非结核病患者组(对照组)。比较TB-DNA、TB-Ab和T-SPOT.TB 3种方法平行检测结果在两组中的差异,并分析TB-DNA、TB-Ab和T-SPOT.TB在肺结核诊断中的应用价值。结果试验组的TB-DNA、T-SPOT.TB和TB-Ab的阳性率均高于对照组,差异均有统计学意义(P<0.05)。运用受试者工作特征曲线(ROC曲线)分析,T-SPOT.TB抗原A、T-SPOT.TB抗原B、TB-DNA、TB-Ab的ROC曲线下面积分别是0.908、0.881、0.677、0.649。这3种方法在肺结核诊断中以TB-DNA的特异度(97.14%)最高,T-SPOT.TB的灵敏度(89.14%)最高。T-SPOT.TB的诊断符合率高于TB-DNA和TB-Ab,差异均有统计学意义(P<0.05),TB-DNA和TB-Ab的诊断符合率差异无统计学意义(P>0.05)。联合检测可以提高灵敏度,T-SPOT.TB联合TB-DNA具有最高的诊断符合率。结论T-SPOT.TB具有较高的灵敏度、特异度和诊断符合率,在肺结核诊断中具有较高价值,科学地选择组合项目检测可以提高诊断符合率。     

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large chalky and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.