Detection of Tuberculosis in Plwha- A Study of Yield by Microscopy and Cbnaat With Cd4 Correlation

BACKGROUNDTuberculosis (TB) related deaths are rising in the world and in 2013 the mortality was reported as 36 million deaths in Patients Living with HIV and AIDS (PLWHA), because of lack of proper diagnosis at the apt time.So an urgent need to implement newer diagnostic modalities with the Light Emitting Diode Fluorescent Microscopy (LED-FM) 1 and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) for the detection of MTB, especially in highly HIV prevalent areas. 2 In this study, we are analysing by the above two methods in the detection of AFB in Ziehl-Neelsen (ZN) Smear -ve suspected Pulmonary TB (PTB), MTB in Extrapulmonary TB (EPTB) in PLWHA, CD4 count correlation by CBNAAT and LED-FM and identify Rifampicin Resistance by CBNAAT in HIV +ve patients.Aims and Objectives-1.To compare the detection of AFB by CBNAAT and LED-FM in ZN Smear -ve suspected PTB and MTP in EPTB of PLWHA.2. To compare the CD4 count correlation by CBNAAT and LED-FM and to identify Rifampicin Resistance by CBNAAT in HIV +ve patients.MATERIALS AND METHODS This descriptive study was conducted in MGM Govt.Tertiary Care Hospital attached to KAPV Govt.Medical College, Trichy from January 2015 to April 2016.Totally, 130 PLWHA who were attending the Medical OPD, Chest Medicine OPD, STD Clinic and ART Centre with signs and symptoms of PTB and EPTB were selected.All the patients were subjected to chest x-ray, ZN smear examination, pleural fluid analyses, Fine Needle Aspiration Cytology (FNAC) of lymph node for the detection of MTP in PLWHA, CD4 count correlation and Rifampicin Resistance in HIV +ve patients by these methods. RESULTSIn this study of 130 patients, HIV was +ve in 65 and HIV was -ve in 65, of which ZN smear -ve suspected PTB was 80 and EPTB was 50 patients.Of the 80 PLWHA of ZN smear -ve suspected PTB, CBNAAT was +ve in 49 (61.25%) and CBNAAT was -ve in 31 (38.75%) and LED-FM was +ve in 17 (21.25%)and LED-FM was -ve in 63 (78.75%).Of the 30 PLWHA's, FNAC specimens of TB Lymphadenitis LED-FM was +ve in 12 (40%) and was -ve in 18 (60%) and CBNAAT was +ve in 20 (66.66%) and was -ve in 10 (33.33%).Of the 20 PLWHA of suspected TB pleural effusion, CBNAAT was +ve in 5 (25%) and was -ve in 15 (75%) and LED-FM was +ve in 3 (15%) and was -ve in 17 (85%).Of the 65 HIV +ve, CBNAAT was +ve in 34 (52.3%) more than LED-FM +ve in 14 (21.3%)based on CD4 count levels.More MTP was detected by both CBNAAT vs. LED-FM (28 vs. 10) with CD4 count of 100 -350 cells/ µL and next with CD4 count < 100 cells/ µL 19 vs. 6.Of the 49 (61.3%)CBNAAT +ve of 80 PLWHA Rifampicin Resistance was found only in 3 (6.12%)patients. CONCLUSIONIn this study of the 130 PLWHA, CBNAAT +ve was higher than LED-FM +ve in the 80 ZN smear -ve suspected PTB, 30 TB lymphadenitis and 20 TB pleural effusion samples, i.e. 49 (61.25%)> 17 (21.25%),20 (66.66%) > 12 (40%), 5 (25%) > 3 (15%) respectively in the ratio of 2.88, 1.66, 1.66 times in CBNAAT +ve vs. LED-FM +ve.Of the 65 HIV +ve cases, CBNAAT was +ve in 34 (52.3%)than LED-FM +ve in 14 (21.3%)cases based on CD4 counts.Both CBNAAT +ve and LED-FM +ve were high with CD4 count < 350 cells/ mL and less with CD4 count > 350 cells/mL.Of the 49 (61.3%)CBNAAT +ve ZN smear -ve suspected PTB of PLWHA Rifampicin Resistance was found only in 3 (6.12%).