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Tuberculosis Diagnosis

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Diagnosis of Tuberculosis in India, Current concepts, which tests to perform

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Tuberculosis Diagnosis

  1. 1. Diagnosis of Tuberculosis Current concepts Dr A D Deshpande MD (Micro) , MD (Patho)
  2. 2. WHO Int. Std. of TB Care Std. of TB Care in India RNTCP
  3. 3. India (25%)
  4. 4. India = 1500 deaths / day because of Tuberculosis
  5. 5. DiagnosisDisease  60 days  15 New cases
  6. 6. Robert Koch
  7. 7. My name is Koch
  8. 8. World TB day 24 March March 24 1882 -- Dr Robert Koch discovered TB bacillus
  9. 9. Lab Diagnosis of Tuberculosis
  10. 10. Microbiology Tests  Sputum for ZN stain  Culture  PCR based Tests
  11. 11. Sputum for ZN stain 2 Samples ( Sensitivity) • LED microscope • Fluorescent microscope
  12. 12. Sputum for ZN stain
  13. 13. Culture L J Medium BACTEC MGIT
  14. 14. Culture - BACTEC MGIT Results : 15 days 42 days Most Sensitive Test Antibiotic Sensitivity for full 13 drugs Sample to be sent in Saline
  15. 15. • 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
  16. 16. PCR based Tests Gene Xpert - Fast (90 mins) - Easy to perform - Genotypic Drug Resistance (Rif) - Dead Bacteria can give Test positive WHO endorsed Test, 2010
  17. 17. Extra pulmonary TB Lymphnode – Pus CSF Synovial fluid Endometrial tissue Pleural fluid Any Pus •BACTEC MGIT Culture & Sensitivity • Gene Xpert First do smear for ZN stain
  18. 18. 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
  19. 19. Serum IgG , IgM for TB by Govt. of India
  20. 20. 7 June 2012
  21. 21. Don’t send patients Blood to Diagnose TB
  22. 22. • Not recommended in Adults by RNTCP • Useful in Children Tuberculin Test (Mantoux Test)
  23. 23. Tuberculin Test in Vitro = TB Gold Same are IGRA & Quantiferon tests NOT RECOMMENDED IN ADULTS NOT
  24. 24. Latent TB • Child contacts • All Immunosuppressed – HIV Patients • In US
  25. 25. Diagnosis of Tuberculosis in Pathology FNAC Histopathology
  26. 26.  >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
  27. 27. Thank you

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