European Journal of Molecular & Clinical Medicine

Background: Mycobacterium tuberculosis complex is the causative organism of tuberculosis, it is a major health problem throughout the world. In developing countries like India, almost 25% of adult deaths which are avoidable are caused by it.
Around 22-61% of Cases have smear negative but culture positive state where clinical profile and radiological lesions suggest diagnosis of pulmonary tuberculosis, then initiation of anti-tubercular drugs is not advisable without meticulous search for tubercular bacilli.
Gold standard for diagnosis of tuberculosis is culture of sputum, but it takes long time( 45 days ) to perform.
Aim: Evaluation of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis.
Methodology: In our observational, cross sectional study done in the Department of Respiratory Medicine, NIMS involving all the patients attending indoor and outdoor services in one year period from January 2019 to June 2020, we tried to access the diagnostic yield of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis. Then the Broncholaveolar Lavage (BAL)  fluid  specimen  was  sent  for  smear  for  AFB, CBNAAT and  BACTEC  culture  for  Mycobacterium tuberculosis.
Result: In this study, pulmonary infiltrate (54.2 %) was most common radiological finding in their chest x-ray, followed by cavity (31.2%). 17 patients had nodular shadow (8.9%) and only 11 patients had miliary pattern (5.7%). Out of 190 cases, 156 patients had unilateral involvement of lung (82.2%) and only 34 cases had bilateral involvement (17.8%). Most of the patients had right upper zone (58.4%)  involvement followed by left upper zone (12.2%) with involvement of lower lung field in only 4.2%.
Conclusion: To conclude bronchoalveolar lavage obtained by fiber optic bronchoscopy is a relatively safe and useful procedure for diagnosis of suspected pulmonary tuberculosis cases when smears of these patients does not reveal mycobacterium tuberculosis.

Mutations in embB306 are the most common polymorphisms linked with ethambutol
(EMB) resistance, accounting for 40-60% of EMB resistant tuberculosis clinical cases
(TB). The current investigation looked for further mutations linked with EMB
resistance in the embB, embC, embA, and Rv3806c (ubiA) genes in 29 EMB resistant
and 29 EMB susceptible clinical isolates of M. tuberculosis from 360 TB patients.DNA
sequencing was used to screen for polymorphisms in the entire ubiA gene, mutational
hotspot regions of embB, embC, and the upstream region of embA, and the results were
correlated with minimum inhibitory concentrations (MIC) of EMB. The most common
polymorphism in ubiA was at codon 149 (GAA to GAC), which was found in 5/29
(17.2%) resistant isolates and 7/29 (24%) susceptible isolates. Mutations in embB were
most common at codon 306 (ATG to ATC/GTG), and were found only in EMB resistant
isolates (20/29; 69%).Mutations in the upstream region of embA at -8, -11, -12, and -60
codons were also found in EMB resistant organisms (8/29; 27.5 percent), with 6/8 (75
percent) occurring in isolates with an EMB MIC of 16 g/ml. Although no
polymorphisms in ubiA were found to be related with EMB resistance, polymorphisms
upstream of embA may contribute to high levels of EMB resistance.

Interferon Gamma Release Assays (IGRAs) were developed for the indirect or immunologic diagnosis of tuberculosis infection; however, they have also been used to assist in difficult to diagnose cases of tuberculosis disease in adults, and to a lesser extent, in children, especially in those under 5 years old. Interferon-gamma release assay (IGRA)-positive rates and false-positive rates among the five age groups examined. Both rates were significantly different among age groups (all p-values <0.001). p-values were obtained by chi-square tests for trend. Interferon-gamma release assay (IGRA)-positive rates among the four anatomic types of uveitis and between patients with and without retinal vasculitis. The IGRA-positive rates were significantly different among the four anatomic groups (p = 0.001). Patients with retinal vasculitis had higher positive IGRA rate (p < 0.001) than those without retinal vasculitis. p-values were obtained using chi-square tests.

Hepatotoxicity is an emerging medical problem. It has multiple etiological factors but most common reason is chronic treatment with certain drugs during the cure of numerous life threatening diseases. Antitubercular drugs are the leading cause of injury or damage to liver. So this is a challenging task to prevent the drug induced hepatotoxicity during tuberculosis treatment. Generally it results into interruption of treatment and cause re-emergence of this disease. This review article highlights the different mechanisms of anti-tubercular drug induced hepatotoxicity, its incidence and clinical management.

Tuberculosis is a matter of concern for all countries. Tuberculosis (TB) remains one of the major global health threats leading to morbidity and mortality. One in three persons across the world representing 2–3 billion individuals are known to be infected with Mycobacterium Tuberculosis (M. Tuberculosis) of which 5–15% are likely to develop active TB disease during their lifetime.Information of the pattern of drug resistant among the tuberculosis is crucial in developing countries. Therefore, this study aims to assess the drug resistance pattern of Mycobacterium tuberculosis isolates and associated factors among the patients. This study selected 934 culture-positive sputum samples referred to the National Reference Laboratory of the Research Institute for Pulmonology in Thanjavur from January 2015 to January 2018 were analysed; 40% of these samples were obtained from Tb Sanatorium, Sengipattipatients (hospitalized in `Sengipatti) and 60% from other regions (hospitalized in Minsk and other regions) equal to patient’s population in the regions.All 934 cases were subjected to a drug-resistance test. The anti-microbial drug susceptibility tests (DST) were performed using the WHO standard conventional proportional method. The Preferable First Line Drugs were INH 1mcg/ml, RIF40 mcg/ml, Ethambutol (EMB) 2 mcg/ml, and Streptomycin (SM) 10 mcg/ml on slants with the H37Rv strain of MTB as the positive control. Furthermore, MDR isolates were tested for resistance to fluoroquinolones and three injectable drugs (Amikacin 8 mcg/ml, Kanamycin 30 mcg/ml, and Capreomycin 8mcg/ml) for detection of XDR isolates.