Background: Drug-resistant tuberculosis (DR-TB) is the most exigent and calamitous challenge encountered in treatment of TB. Extra pulmonary (EP) DR-TB poses a complex diagnostic and therapeutic challenge owing to myriad of presentations and paucibacillary nature. Data available on this subset is limited. We studied the prevalence of EPDR-TB cases among the total DR-TB cases visiting our Programmatic management of Drug-Resistant TB (PMDT) site. We also studied the demographic and microbiological profile of these cases and analyzed the prevalence of pre-extensively drug-resistant TB (pre XDR-TB) and extensively drug-resistant TB (XDR-TB) among patients of EPDR-TB in pre Bdq era. Results: Of the 1086 DR-TB patients, 64 (5.89%) were cases of EPDR-TB. Seven out of 64 (10.93%) were primary EPDR-TB. The site wise distribution of cases was 34 (53.125%) lymph node DR-TB, 18 (28.125%) pleural DR-TB, 9 (14.0625%) spinal DR-TB/paraspinal abscess/psoas abscess, 1 case (1.5625%) each of abdominal DR-TB, sternal and gluteal abscess. On the basis of the second-line drug susceptibility testing (DST), patients were grouped into: (1) multidrug-resistant TB (MDR-TB), (2) MDR-TB with fluoroquinolone (FQ) resistance {pre XDR XDR-TB (FQ)}, (3) MDR-TB with second-line injectable (SLI) resistance {pre XDR XDR-TB (SLI)}, (4) XDR-TB. Of the 64 patients, 43 (67.185%) had MDR-TB, 19 (29.687%) had preXDR-TB (FQ), none had preXDR-TB (SLI) and 2 (3.125%) had XDR-TB. Gastro esophageal reflux disease (GERD) was the most common comorbidity seen in 26 (40.6%) patients, followed by anemia in 5 (7.8%), psychiatry problems 5 (7.8%), hypertension in 3 (4.6%), renal disorders in 2 (3.1%) while thyroid disorder, HIV and thalassemia in 1 each (1.5%). Conclusion: EPDR-TB forms a small but significant proportion of total DR-TB. Lymph node DR-TB is its most common subclass. Our study emphasises the momentousness and essentiality of baseline DST to FQ and SLI in patients of DR-TB. This enables an appropriate modification of therapy at baseline itself to better the treatment outcomes. We observed a strikingly high proportion of preXDR-TB (FQ) in our study group.

A BSTRACT Background: Tuberculosis (TB) is still a global health issue. While the lungs are the most commonly affected, infections can also affect other organs. Because of the rise in immunocompromised hosts, the number of opportunistic infections has skyrocketed. In instances of aspergilloma and chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB) is the most usually linked condition. Material and Methods: The current cross-sectional study was conducted on 42 study participants from January 2018 to June 2019. Results: Aspergilloma was observed in two participants (4.8%) of the study population. Candida growth was observed in five participants (11.9%) of the study population on sputum fungal culture. Aspergillus growth and Candida growth was observed in three (7.1%) and two (4.8%) participants of the study population, respectively, on bronchoalveolar lavage (BAL) fungal culture. Aspergillus IgG antibody was positive in four particpants (9.5%) of study population. Out of the 42 participants, four were diagnosed with CPA. Conclusion: Since CPA and PTB patients present similar symptoms, it is virtually impossible to distinguish between the two unless serological test is performed. There has been a significant burden of patients with CPA, especially in post tuberculosis fibro-cavitation. CPA patients requires long-term anti-fungal therapy; hence an improved case detection should be undertaken.

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Introduction: Tuberculosis (TB) of the lung is an infectious disease caused by Mycobacterium tuberculosis, which is an aerobic, acid-fast, Gram-positive bacillus. India has the world's highest number of TB cases, accounting for one-fourth of all TB cases. For efficient treatment of pulmonary TB, microbiological diagnosis is the mainstay. Acid-fast bacillus (AFB) smear-negative patients could account for 31% of new cases. After multiple negative induced-sputum smear tests, we conducted this study to observe whether cartridge-based nucleic acid amplification test (CBNAAT) provides an additional and early diagnostic yield for undiagnosed cases of pulmonary TB. Objectives and Goals: The purpose of this study was to observe if CBNAAT could be used to diagnose pulmonary TB early in patients who had TB clinically and radiologically but negative for sputum direct smear. Materials and Methods: At our institute, 82 patients were involved in an observational study for assessing the utility of CBNAAT in the early confirmation of TB in individuals who had an X-ray chest that is indicative of PTB, but a negative sputum smear for AFB. Our hospital's department of respiratory medicine was the site of the current clinical study. Results: The patients were mostly between the ages of 31 and 40 years, with a male majority. Cough was the most common symptom in 72 (88%) patients. In 30 patients, the sputum CBNAAT test was positive (36.5%). All 82 instances were given a bronchoalveolar lavage (BAL). In 46 (56%) patients, BAL CBNAAT was positive. In 12 (15%) cases, bronchial brushings tested positive for AFB on smear examination. Caseating epithelioid granuloma was seen in 4 (14%) patients after a transbronchial lung biopsy. Conclusion: In individuals with strong indication of pulmonary TB, sputum CBNAAT and BAL CBNAAT provide a higher bacteriological confirmation of diagnosis.