Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:6.2.1.7 (BAL)
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This initial report on the use of PCR in diagnosis of TB was based on a group of 180 patients observed in the AIDS Diagnosis and Therapy Center in Warsaw. Out of 6 patients with positive results of PCR assay for MTB, five had positive AFB smears in induced sputum or BAL, two had positive MTB cultures. Five of them were treated with tuberculostatic drugs with clinical improvement and had negative sputum PCR MTB results after several weeks. Additional 11 patients with AFB positive sputum or BAL smears and negative PCR MTB were observed. None of them developed pulmonary tuberculosis, and none of them was confirmed by culture as MTB infection. The results presented in this paper confirm high specificity and sensitivity of polymerase chain reaction (PCR) as an fast diagnostic test very useful in the clinical settings of AIDS. With the increase of collected material further evaluation will be continued.
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PMID:[Initial assessment of the use of polymerase chain reaction (PCR) in diagnosis of tuberculosis among patients of the Center for Diagnosis and Treatment of AIDS]. 913 97

Miliary tuberculosis (TB), is a fatal form of disseminated TB characterized by tiny tubercles evident on gross pathology similar to innumerable millet seeds in size and appearance. Global HIV/AIDS pandemic and increasing use of immunosuppressive drugs have altered the epidemiology of miliary TB. Keeping in mind its protean manifestations, clinicians should have a low threshold for suspecting miliary TB. Careful physical examination should focus on identifying organ system involvement early, particularly TB meningitis, as this has therapeutic significance. Fundus examination for detecting choroid tubercles can help in early diagnosis as their presence is pathognomonic of miliary TB. Imaging modalities help in recognizing the miliary pattern, define the extent of organ system involvement and facilitate image guided fine-needle aspiration cytology or biopsy from various organ sites. Sputum or BAL fluid examination, pleural, pericardial, peritoneal fluid and cerebrospinal fluid studies, fine needle aspiration cytology or biopsy of the lymph nodes, needle biopsy of the liver, bone marrow aspiration and biopsy, testing of body fluids must be carried out. GeneXpert MTB/RIF, line probe assay, mycobacterial culture and drug-susceptibility testing must be carried out as appropriate and feasible. Treatment of miliary TB should be started at the earliest as this can be life saving. Response to first-line anti-TB drugs is good. Screening and monitoring for complications like acute respiratory distress syndrome (ARDS), adverse drug reactions like drug-induced liver injury, drug-drug interactions, especially in patients co-infected with HIV/AIDS, are warranted. Sparse data are available from randomized controlled trials regarding optimum regimen and duration of anti-TB treatment.
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PMID:Miliary tuberculosis: A new look at an old foe. 3172 81