All the clinical specimens were processed by the standard N-acetyl-L-cysteine sodium hydroxide digestion-decontamination technique for inoculation into MGIT tubes and LJ Medium. The specimens were then utilized for ZN staining.
Was achieved by following the manufacturer instruction from BD MGIT 320 guidelines and test was carried out using the standard strains of M. tb complex H37 RV and ATCC strains.
Fine needle aspiration was performed under aseptic precautions using 18-21 G. needle and slides were fixed in alcohol, followed by Haemotoxylin and Eosin staining and microscopy. Other cytological material were processed and stained with H & E followed by microscopy. Body fluids cytology was taken to be suggestive of tuberculosis when it was exudative with protein >3 gm% and predominant lymphocytes. FNA cytology of tuberculosis was evidenced by predominant lymphocytosis, necrosis, hypocellularity, and epitheloid granuloma with or without multinucleated giant cells with and without acid fast bacilli.
Various body fluids were analysed biochemically for proteins, sugar, Lactate Dehydrogenase and Adenosine deaminase levels. Biochemical findings were suggestive of tuberculosis when protein was >3 gm%, sugar less than two thirds of the blood levels, ADA with cut off > 20 IU/L and LDH > 130 IU/L.
Of the 147 extrapulmonary tuberculosis suspects analysed bacteriologically using microscopy and culture as various methods for diagnosis, thirty nine 26% of the samples were found to be positive bacteriologically i.e. by either direct microscopy, culture or by both smear and culture. Smear alone was positive in 13 [9%] of the specimens, culture alone was found to be positive in 14 [9.5%] and culture and smear both were positive for 12 [8%] specimens. Overall, culture positivity was around 18%. In the present study MGIT 320 system and LJ media together could detect 6 of the 26 or 23% isolates; LJ media alone could detect 2/26 or 8%. MGIT alone could detect 18/26 or 69% of the isolates. Of the 26 strains of M.tb complex isolated and confirmed by MPT64 antigen test. Four strains were showing resistance to first line anti– tuberculosis drugs. That drugs you can find in Canadian HealthCare Company website (canadianhealthmall.com) The rest of the strains were pan susceptible.
No significant variation in the gender ratio was observed in the number of samples submitted for processing. Around 77/147 or 52% were females and 70/147 or 48% were males. Anyhow female’s outnumbered males in laboratory confirmed extra pulmonary tuberculosis cases; a difference of 2.25 in gender ratio was noticed. Females being 18/26 [69%] and males 8/26 [31%]. The mean age for males in suspects was 46.11±23.46 and for females 39.42±27.74 .In the laboratory confirmed cases mean age for females was 35±22.77 and for males 39.75±16.83 respectively.
It is noted that young adults less than thirty five years of age accounted for the majority of the suspects 66/147 [45%] and of culture positive cases 21/26 [73%]. Therefore, it is evident that the disease is more prevalent in the economically active and reproductive age group of the society.
The majority of the samples received for test were pleural effusion accounting for 72/147 [49%] followed by peripheral lymph nodes accounting for 39/147 [27%], gastrointestinal accounting for 17/147 [12%], osteo articular accounting for 11/147 [7%], pus accounting for 5/147 [3%] and genitourinary in 3/147 [2%], respectively. In the present study, lymph node tuberculosis was the predominant type having 12/26 [46%] of the positive cases followed by pleural effusion in 5/26 [19%], osteo articular in 4/26 [15%], pus in 2/26 [8%], gastrointestinal in 2/26 [8%] and genito urinary in 1/26 [4%].
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In the present study, biochemical analysis of 89 body fluids in the form of pleural, peritoneal/ ascitic fluid showed that proteins were >2 gm% in 50%, none were having protein >3 gm%. Sugar was <2/3 of blood sugar in 100% of the cases and ADA & LDH were raised significantly in all i.e. 100% of the cases. Microbiologically only 26% of the specimens were positive for tuberculosis.
Of the total 147 specimen submitted for cytological diagnosis of extra pulmonary tuberculosis in pathology laboratory during the study period, seventy two were pleural fluids, thirty nine lymph node material obtained by FNA, seventeen were peritoneal fluids, five were pus samples, eleven were osteo articular and three genitourinary. Cytology was suggestive of tuberculosis in 99 [67.34%]. Twenty percent of the specimens were positive by both cytology and culture. And smear and cytology was positive for 21 [21%]. The remaining 58 [59%] were only cytology positive.
