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

1. Diagnosis of Tuberculosis
Current concepts
Dr A D Deshpande
MD (Micro) , MD (Patho)

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

3. India (25%)

5. India = 1500 deaths / day
because of Tuberculosis

6. DiagnosisDisease
 60 days 
15 New cases

7. Robert Koch

8. My name is Koch

9. World TB day 24 March
March 24 1882 --
Dr Robert Koch discovered TB bacillus

10. Lab Diagnosis of
Tuberculosis

11. Microbiology Tests
 Sputum for ZN stain
 Culture
 PCR based Tests

12. Sputum for ZN stain
2 Samples
( Sensitivity)
• LED microscope
• Fluorescent
microscope

13. Sputum for ZN stain

14. Culture
L J Medium BACTEC MGIT

15. Culture - BACTEC MGIT
Results : 15 days 42 days
Most Sensitive Test
Antibiotic Sensitivity for full 13 drugs
Sample to be sent in Saline

16. • 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

17. 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

18. 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

19. 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

21. Serum IgG , IgM for TB
by Govt. of India

22. 7 June 2012

26. Don’t send
patients Blood to
Diagnose TB

27. • Not recommended in Adults by RNTCP
• Useful in Children
Tuberculin Test (Mantoux Test)

28. Tuberculin Test in Vitro = TB Gold
Same are IGRA & Quantiferon
tests
NOT RECOMMENDED IN ADULTS
NOT

29. Latent TB
• Child contacts
• All Immunosuppressed – HIV Patients
• In US

30. Diagnosis of Tuberculosis in Pathology
FNAC Histopathology

31.  >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

32. Thank you