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Diagnosis of Tuberculosis

Current concepts
Dr A D Deshpande
MD (Micro) , MD (Patho)

WHO
Int. Std. of TB
Care
Std. of TB Care
in India
RNTCP

India (25%)

India = 1500
deaths / day because
of Tuberculosis

Disea
se

60 days

Diagnos
is

New

Robert Koch

My name is

Koch

World TB day
March

24

March 24 1882 --
Dr Robert Koch discovered
TB bacillus

Lab Diagnosis
of Tuberculosis

Microbiology Tests
Sputum for ZN stain
Culture
PCR based Tests

Sputum for ZN stain


2 Samples
( Sensitivity)

LED
microscope
Fluorescent
microscope

Sputum for ZN stain

Culture
LJ
Medium

BACTEC
MGIT

Culture - BACTEC MGIT


Results :
42 days

15 days

Most Sensitive Test


Antibiotic Sensitivity for full 13 drugs
Sample to be sent in Saline

PCR Based
Tests

LINE PROBE ASSAY PCR REC BY


RNTCP
OTHER PCR TESTS DONE BY LABS LIKE
RANBAXY AND METROPOLICE
( ALL THESE METHOD NOT
VALIDATED BY WHO )

PCR based Tests


WHO endorsed Test,
2010

Gene Xpert
- Fast (90 mins)
- Easy to perform
- Genotypic Drug
Resistance (Rif)
- Dead Bacteria can
give Test positive

Extra pulmonary TB
Lymphnode Pus
CSF
Synovial fluid
Endometrial tissue
Pleural fluid
Any Pus

First do smear for


ZN stain
BACTEC MGIT
Culture
& Sensitivity
Gene Xpert

Cost - Subsidized Rates ~ IPAQT


(Initiative for promoting Affordable & Quality tests)

Gene Xpert : 2000 Rs


Line probe Assay (for Sputum
Positive samples
Only Via RNTCP) : 1600 Rs
BACTEC MGIT Culture : 900 Rs

Serum
for TB

IgG , IgM

by Govt. of
India

7 June
2012

TB is a Notifiable
Disease

Dont send
patients
Blood to
Diagnose TB

Tuberculin Test
(Mantoux Test)

Not recommended in Adults b


RNTCP
Useful in Children

Tuberculin Test in Vitro = TB Gold


Same are IGRA & Quantiferon
tests

NOT RECOMMENDED IN
ADULTS

TB GOLD is NOT Gold

Latent TB
Child contacts
All Immunosuppressed HIV Patients
In US

Diagnosis of Tuberculosis in
Pathology

FNAC

Histopatholog
y

Take Home Message


>15 Days Productive cough /
Doubtful Radiological finding Sputum for ZN stain

Culture (BACTEC MGIT) - Most


Sensitive
Gene Xpert Fast
No role of Tuberculin Test in
Adults
Blood is not a sample, Serology is
Banned

Thank you

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