Document Type : Original Article

Authors

1 Associate Professor, Molecular Pathology Research Center, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Researcher, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Professor, Molecular Pathology Research Center, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Associate Professor, Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Background: Tuberculosis has been detected in some extra pulmonary ecological niches. Although extra pulmonary tuberculosis (EPTB) is less frequent than Pulmonary Tuberculosis (PTB), its incidence has increased worldwide. The aim of this study was to investigate the presence of EPTB and MDR-EXPT in Formalin-fixed, paraffin-embedded tissue blocks among different samples in Kermanshah, Iran.
Methods: Among all the suspected tuberculosis cases referred to the pathology laboratories, 116 patients were included based on the diagnosis of the infectious disease specialist. DNA were extracted from formalin-fixed, paraffin-embedded tissue blocks using genomics extraction G-spin Total DNA Extraction kit and the presence of EPTB was examined by TB Resistant Modual Isoniazid, Rifampicin kit.
Results: The frequency of EPTB in the paraffin-embedded block samples was 32% (37 cases), and lymph nodes had the highest frequency (44.5%) followed by Pleural fluid, breast and CSF with the frequencies of 34.6%, 33% and 27% respectively.
Conclusions: In the present study we found a high and increasing frequency of EPTB in paraffin- embedded blocks of the participants and it is one of the highest frequencies reported around the world. Since EPTB cases constitute a large number of TB burden, serious attention of public health organizations is recommended.
 

Keywords

1.           Jiao WW, Mokrousov I, Sun GZ, Li M, Liu JW, Narvskaya O, et al. Molecular characteristics of rifampin and isoniazid resistant Mycobacterium tuberculosis strains from Beijing, China. Chin Med J 2007; 120:814-9.
2.           Chang B, Wu AW, Hansel NN, Diette GB. Quality of life in tuberculosis: a review of the English language literature. Qual Life Res 2004; 13 (10):1633-42.
3.           Darvishpour Kakhki A, Masjedi MR. Factors Associated with Health-Related Quality of Life in Tuberculosis Patients Referred to the National Research Institute of Tuberculosis and Lung Disease in Tehran. Tuberc Respir Dis 2015; 78 (4):309-14.
4.           Jagielski T, van Ingen J, Rastogi N, Dziadek J, Mazur PK, Bielecki J. Current methods in the molecular typing of Mycobacterium tuberculosis and other mycobacteria. Biomed Res Int 2014:Article ID. 645802.
5.           Lenk S, Schroeder J. Genitourinary tuberculosis. Curr Opin Urol 2001; 11(1):93-8.
6.           ZamanK. Tuberculosis: a global health problem. J Health Popul Nutr 2010; 28 (2):111-3.
7.           Maher D CP, Spinaci S, Harries A. Treatment oftuberculosis: guidelines for national programmes, Geneva: World Health Organization. 2010; 1997.
8.           Shahrezaei M, Maracy MR, Farid F. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011. Int J Prev Med 2015; 6:91.
9.           Fair E, Hopewell PC, Pai M. International Standards for Tuberculosis Care: revisiting the cornerstones of tuberculosis care and control. Expert Rev Anti Infect Ther 2007; 5(1):61-5.
10.        The World Health Organization. Global Tuberculosis Report. Geneva, Switzerland. http://www.who.int/tb/publications/global_report/en/, 2014.
11.        Ganguly J, Ray S, Nandi S, Halder S, Kundu S, Mandal A. A study to evaluate pattern of rifampicin resistance in cases of sputum positive pulmonary tuberculosis. J of Evolution of Med and Dent Sci. 2015; 4:4762-8.
12.        Fite E, Fenandez Figueras MT, Prats R, Vaquero M, Morera J. High prevalence of Mycobacterium tuberculosis DNA in biopsies from sarcoidosis patients from Catalonia, Spain. Respiration 2016; 73:14-5.
13.        Ardeleanue C, Andrei F, ceausa M, Ene D, Mihai M, Butur G, et al. Cellurar immune response in atypical tuberculosis diagnosed by PCR in paraffin embedded material. Rom J Morphol EmbryoL 2004; 45:63-72.
14.        Purohit M, Mustafa T. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need. J Clin Diagn Res 2015; 9(4):EE01-6.
15.        Chakravorty S, Sen MK, Tyagi JS. Diagnosis of extrapulmonary tuberculosis by smear, culture, and PCR using universal sample processing technology. J Clin Microbiol 2005 ; 43(9):4357-62.

16.        Mikhailovich V, Lapa S, Gryadunov D, Sobolev A, Strizhkov B, Chernyh N, et al. Identification of Rifampin-Resistant Mycobacterium tuberculosis Strains by Hybridization, PCR, and Ligase Detection Reaction on Oligonucleotide Microchips. J Clin Microbiol 2001; 39(7):2531-2540.

17.        Fanning A. Tuberculosis: 6. Extrapulmonary disease. CMAJ 1999; 160 (11):1597-603.
18.        Ong A, Creasman J, Hopewell PC, Gonzalez LC, Wong M, Jasmer RM, et al.A molecular epidemiological assessment of extrapulmonary tuberculosis in San Francisco.Clin Infect Dis 2004; 38 (1):25–31.
19.        Gomes T, Reis-Santos B, Bertolde A, Johnson J L, Riley LW, Maciel EL. Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model. BMC Infect Dis 2014; 14:9.
20.        Rish JA, Eisenach KD, Cave MD, Reddy MV, Gangadharam PR, Bates JH. Polymerase chain reaction detection of Mycobacterium tuberculosis in formalinfixed tissue. Am J Respir Crit Care Med 1996; 153:1419–1423.
21.        Li JY, Lo ST, Ng CS. Molecular detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli. Diagn Mol Pathol 2000; 9 (2):67–74.
22.        Mazza-Stalder J, Nicod L, Janssens JP. Janssens, Extrapulmonary tuberculosis. Rev Mal Respir 2012; 29 (4):566-78.
23.        Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P. Extrapulmonary tuberculosis: epidemiology and risk factors, Enferm Infecc Microbiol Clin 2011; 29 (7):502-9.
24.        Rafiee S, Sedaghat M, Anvari R, Hesam H, Nosrati H, Estiri A, et al. Smear positive pulmonary tuberculosis in Golestan province.18th National Congress on Tuberculosis, Sanandaj-Iran. 2007: 5.
25.       Moarref M, Khasii K, Atashbar A. TB epidemiologic picture in Kermanshah at 2005.18th National Congress on Tuberculosis, Sanandaj-Iran. 2007; 82.
26.        Arora VK, Gupra R. Trends of extrapulmonary tuberculosis under revised national tuberculosis control programme: A study from south Delhi, Indian. J Tuberc 2006; 53:77-83.
27.        Secretariat of Health Surveillance. Epidemiological bulletin: special tuberculosis. Brasil: Secretariat of Health Surveillance. Portuguese, 2012 (Cited 1st November, 2014).Availablefrom: http://www.saude.rs.gov.br/upload/1337634001_TuberculoseBoletim%20Epidemio.pdf.
28.        World Health Organization. Tuberculosis countries profiles. Geneva: World Health Organization. 2012 (Cited 1st November, 2014). Available from: http://apps.who.int/iris/bitstream/10665/75938/1/ 9789241564502_eng.pdf.
29.        Solovic I, Jonsson J, Korzeniewska Kosela M, Chiotan DI, Pace-Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. EuroSurveill2013; 18 (12):pii:20432.
30.        Liefooghe R, Michiels N, Habib S, Moran MB, De Muynck A. Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan. Soc Sci Med 1995; 41(12):1685-92.
31.        French CE, Antoine D, Gelb D, Jones JA, Gilbert RL, Watson JM Tuberculosis in non-UK-born persons, England and Wales, 2001-2003. Int J Tuberc Lung Dis 2007; 11(5):577-84.
32.        Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 2009; 49(9):1350-7.
33.        Chander V, Raina S.K, Bhardwaj AK, Kashyap S, Gupta AK, Sood A. Clinico-epidemiological profile of extra pulmonary tuberculosis: a report from a high prevalence state of Northern India. Public Health Res 2012; 2(6):185-9.
34.        Gunal S, Yang Z, Agarwal M, Koroglu M, Arici ZK, Durmaz R. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007. BMC Public Health 2011; 11:154.
35.        Kulchavenya E, Zhukova I, Kholtobin D. Kholtobin, Spectrum of urogenital tuberculosis. J Infect Chemother 2013; 19(5):880-3.
36.        Gurung R, Bhattacharya SK, Pradhan B, Gurung S, Singh YI. Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extrapulmonary tuberculosis. 2010; 8(1):57–61.
37.        Sachdeva R, Gadre DV, Talwar V.Characterization and drug susceptibility patterns of extrapulmonary mycobacterial isolates. Indian J Med Res 2002; 115:1025.
38.        Lin JN, Lai CH, Chen YH, Lee SS, Tsai SS, Huang CK, et al. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuberc Lung Dis 2009;13(5):620-5.
39. Iseman M.D. A clinician’s guide to tuberculosis. Philadelphia, Lippincott Williams & Wilkins, 2001;22;322-323
 
1.           Jiao WW, Mokrousov I, Sun GZ, Li M, Liu JW, Narvskaya O, et al. Molecular characteristics of rifampin and isoniazid resistant Mycobacterium tuberculosis strains from Beijing, China. Chin Med J 2007; 120:814-9.
2.           Chang B, Wu AW, Hansel NN, Diette GB. Quality of life in tuberculosis: a review of the English language literature. Qual Life Res 2004; 13 (10):1633-42.
3.           Darvishpour Kakhki A, Masjedi MR. Factors Associated with Health-Related Quality of Life in Tuberculosis Patients Referred to the National Research Institute of Tuberculosis and Lung Disease in Tehran. Tuberc Respir Dis 2015; 78 (4):309-14.
4.           Jagielski T, van Ingen J, Rastogi N, Dziadek J, Mazur PK, Bielecki J. Current methods in the molecular typing of Mycobacterium tuberculosis and other mycobacteria. Biomed Res Int 2014:Article ID. 645802.
5.           Lenk S, Schroeder J. Genitourinary tuberculosis. Curr Opin Urol 2001; 11(1):93-8.
6.           ZamanK. Tuberculosis: a global health problem. J Health Popul Nutr 2010; 28 (2):111-3.
7.           Maher D CP, Spinaci S, Harries A. Treatment oftuberculosis: guidelines for national programmes, Geneva: World Health Organization. 2010; 1997.
8.           Shahrezaei M, Maracy MR, Farid F. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011. Int J Prev Med 2015; 6:91.
9.           Fair E, Hopewell PC, Pai M. International Standards for Tuberculosis Care: revisiting the cornerstones of tuberculosis care and control. Expert Rev Anti Infect Ther 2007; 5(1):61-5.
10.        The World Health Organization. Global Tuberculosis Report. Geneva, Switzerland. http://www.who.int/tb/publications/global_report/en/, 2014.
11.        Ganguly J, Ray S, Nandi S, Halder S, Kundu S, Mandal A. A study to evaluate pattern of rifampicin resistance in cases of sputum positive pulmonary tuberculosis. J of Evolution of Med and Dent Sci. 2015; 4:4762-8.
12.        Fite E, Fenandez Figueras MT, Prats R, Vaquero M, Morera J. High prevalence of Mycobacterium tuberculosis DNA in biopsies from sarcoidosis patients from Catalonia, Spain. Respiration 2016; 73:14-5.
13.        Ardeleanue C, Andrei F, ceausa M, Ene D, Mihai M, Butur G, et al. Cellurar immune response in atypical tuberculosis diagnosed by PCR in paraffin embedded material. Rom J Morphol EmbryoL 2004; 45:63-72.
14.        Purohit M, Mustafa T. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need. J Clin Diagn Res 2015; 9(4):EE01-6.
15.        Chakravorty S, Sen MK, Tyagi JS. Diagnosis of extrapulmonary tuberculosis by smear, culture, and PCR using universal sample processing technology. J Clin Microbiol 2005 ; 43(9):4357-62.

16.        Mikhailovich V, Lapa S, Gryadunov D, Sobolev A, Strizhkov B, Chernyh N, et al. Identification of Rifampin-Resistant Mycobacterium tuberculosis Strains by Hybridization, PCR, and Ligase Detection Reaction on Oligonucleotide Microchips. J Clin Microbiol 2001; 39(7):2531-2540.

17.        Fanning A. Tuberculosis: 6. Extrapulmonary disease. CMAJ 1999; 160 (11):1597-603.
18.        Ong A, Creasman J, Hopewell PC, Gonzalez LC, Wong M, Jasmer RM, et al.A molecular epidemiological assessment of extrapulmonary tuberculosis in San Francisco.Clin Infect Dis 2004; 38 (1):25–31.
19.        Gomes T, Reis-Santos B, Bertolde A, Johnson J L, Riley LW, Maciel EL. Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model. BMC Infect Dis 2014; 14:9.
20.        Rish JA, Eisenach KD, Cave MD, Reddy MV, Gangadharam PR, Bates JH. Polymerase chain reaction detection of Mycobacterium tuberculosis in formalinfixed tissue. Am J Respir Crit Care Med 1996; 153:1419–1423.
21.        Li JY, Lo ST, Ng CS. Molecular detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli. Diagn Mol Pathol 2000; 9 (2):67–74.
22.        Mazza-Stalder J, Nicod L, Janssens JP. Janssens, Extrapulmonary tuberculosis. Rev Mal Respir 2012; 29 (4):566-78.
23.        Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P. Extrapulmonary tuberculosis: epidemiology and risk factors, Enferm Infecc Microbiol Clin 2011; 29 (7):502-9.
24.        Rafiee S, Sedaghat M, Anvari R, Hesam H, Nosrati H, Estiri A, et al. Smear positive pulmonary tuberculosis in Golestan province.18th National Congress on Tuberculosis, Sanandaj-Iran. 2007: 5.
25.       Moarref M, Khasii K, Atashbar A. TB epidemiologic picture in Kermanshah at 2005.18th National Congress on Tuberculosis, Sanandaj-Iran. 2007; 82.
26.        Arora VK, Gupra R. Trends of extrapulmonary tuberculosis under revised national tuberculosis control programme: A study from south Delhi, Indian. J Tuberc 2006; 53:77-83.
27.        Secretariat of Health Surveillance. Epidemiological bulletin: special tuberculosis. Brasil: Secretariat of Health Surveillance. Portuguese, 2012 (Cited 1st November, 2014).Availablefrom: http://www.saude.rs.gov.br/upload/1337634001_TuberculoseBoletim%20Epidemio.pdf.
28.        World Health Organization. Tuberculosis countries profiles. Geneva: World Health Organization. 2012 (Cited 1st November, 2014). Available from: http://apps.who.int/iris/bitstream/10665/75938/1/ 9789241564502_eng.pdf.
29.        Solovic I, Jonsson J, Korzeniewska Kosela M, Chiotan DI, Pace-Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. EuroSurveill2013; 18 (12):pii:20432.
30.        Liefooghe R, Michiels N, Habib S, Moran MB, De Muynck A. Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan. Soc Sci Med 1995; 41(12):1685-92.
31.        French CE, Antoine D, Gelb D, Jones JA, Gilbert RL, Watson JM Tuberculosis in non-UK-born persons, England and Wales, 2001-2003. Int J Tuberc Lung Dis 2007; 11(5):577-84.
32.        Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 2009; 49(9):1350-7.
33.        Chander V, Raina S.K, Bhardwaj AK, Kashyap S, Gupta AK, Sood A. Clinico-epidemiological profile of extra pulmonary tuberculosis: a report from a high prevalence state of Northern India. Public Health Res 2012; 2(6):185-9.
34.        Gunal S, Yang Z, Agarwal M, Koroglu M, Arici ZK, Durmaz R. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007. BMC Public Health 2011; 11:154.
35.        Kulchavenya E, Zhukova I, Kholtobin D. Kholtobin, Spectrum of urogenital tuberculosis. J Infect Chemother 2013; 19(5):880-3.
36.        Gurung R, Bhattacharya SK, Pradhan B, Gurung S, Singh YI. Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extrapulmonary tuberculosis. 2010; 8(1):57–61.
37.        Sachdeva R, Gadre DV, Talwar V.Characterization and drug susceptibility patterns of extrapulmonary mycobacterial isolates. Indian J Med Res 2002; 115:1025.
38.        Lin JN, Lai CH, Chen YH, Lee SS, Tsai SS, Huang CK, et al. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuberc Lung Dis 2009;13(5):620-5.
Iseman M.D. A clinician’s guide to tuberculosis. Philadelphia, Lippincott Williams & Wilkins, 2001;22;322-323