A diagnostic study on tuberculosis pleurisy in Iraq by different diagnostic methods

العناوين الأخرى

دراسة تشخيصية لمرض سائل الجنب في العراق بطرائق تشخيصية المختلفة

مقدم أطروحة جامعية

al-Umayri, Lara Ghali Abd Ali

مشرف أطروحة جامعية

Mankhi, Ahmad Asmir
Salih, Duha Sad

الجامعة

جامعة بغداد

الكلية

كلية العلوم

القسم الأكاديمي

قسم علوم الحياة

دولة الجامعة

العراق

الدرجة العلمية

ماجستير

تاريخ الدرجة العلمية

2013

الملخص الإنجليزي

This study involved the detection of extrapulmonary tuberculosis in pleural fluid locally, there are no or little studies about this subject.

The study included the molecular diagnosis by using Gene Xpert MTB/RIF assay for the detection of Mycobacterium tuberculosis from 70 pleural fluid specimens, in addition to using the conventional bacteriological tests which include smear microscopy by Ziehl-Neelsen stain, solid culture media which include Lowenstein-Jensen (L.J) medium and Stone Brink (S.B) medium, liquid culture medium which include Middle brook7H9 media by BACTEC system.

Susceptibility test of isolated mycobacteria to first line anti-TB drugs (Rifampin, Isoniazid, Ethambutol and Streptomycin) were done by using conventional method (proportion method) and liquid medium method by BACTEC system, biochemical identification of isolated mycobacteria were also done by using niacin, nitrate strips, the differential media which includes Thiophyne-2- Carboxylic acid Hydrazine (TCH) and Para Nitro Benzoic acid (PNB).

Furthermore, the study included the biochemical analysis of pleural fluid specimens includes total protein, sugar, lactate dehydrogenase (LDH), adenosine deaminase (ADA).

As a result, eleven specimens (15.71%) with significance differences (P<0.01) were positively detected by Gene Xpert assay while all specimens were negative by smear microscopy and two specimens (2.86%) were positive by solid and liquid culture media with significance differences (P<0.01).

The isolates also showed susceptibility to all four anti-TB drugs by using proportion method.

All isolates which were positively detected by Gene Xpert system showed sensitivity for rifampicin.

And isolated mycobacteria were Mycobacterium tuberculosis according to the biochemical identification tests as well as for the isolates which were positively detected by Gene Xpert assay, since it is specific for MTB.

II The mean ± S.D of protein concentration in pleural fluid was higher in TPE patients (8.80 ± 3.08 g/dl) than it's concentration in non-TPE patients (7.61 ± 4.12 g/dl) with no significance differences, as well as LDH concentration was (3366.58 ± 983.6 U/L) in TPE patients and (3024.12 ± 889.15U/L) in non-TPE patients with no significance differences and ADA activity was higher in the TPE patients (226.05 ± 58.47 U/L) than (153.06 ± 74.04 U/L) in non-TPE too with significance differences (P<0.05).

Whereas glucose was the unique parameter with lower concentration in TPE patients than non-TPE patients (27.23 ± 4.81 mg/dl) and (199.80 ± 18.51 mg/dl) respectively with significance differences (P<0.05).

As a conclusion, the comparison between the different diagnostic method used in the present study which includes smear microscopy, solid & liquid cultures and the molecular diagnosis via Gene Xpert system showed that the Gene Xpert assay could be considered more helpful for the diagnosis of TPE since the pleural fluid specimens are paucibacillary in nature with a high sensitivity and specificity coupled with its speed, simplicity and this technique is a useful tool for the diagnosis of tuberculous pleural effusion.

The combination of the two parameters, protein level > 5 g/dl and glucose level < 60 mg /dl might be diagnostic importance for tuberculous pleural effusion and the higher the level of ADA, the greater the chance of the patient having TB while the lower the level the lesser the chance of the patient having TB.

LDH measurement is a sensitive, but rather non-specific inflammatory marker.

The storage time and temperature can be potential factors of errors in biochemical analysis of pleural fluid

التخصصات الرئيسية

علم الحيوان
الطب البشري

الموضوعات

• الأمراض
• العراق
• التشخيص

عدد الصفحات

103

قائمة المحتويات

• APA
• MLA
• AMA

لغة النص

الإنجليزية

نوع البيانات

رسائل جامعية

رقم السجل

BIM-598023