MDR-TB Treatment & Prevention

Hello everybody

I am working in one of the Satelite centre where we treat and manage MDR TB
patients. One of our healthcare workers was recently diagnosed TB pleural
effusion , on the day of pleural effusion tapping the Doctor decided to
sent the fluid for culture and DST in the meantime the client was started
on the firstline TB treatment because was never been on TB treatment before
but is working in MDR TB wards.

Last week the results came back as having Rifampicin resistant and now
another sputum has been sent for further test . We still rely on the
culture which takes six weeks and DST almost 2 months

Thanks to everybody
Khaya Mlandu

--
*The Co-INFECT Study Team, South Africa
Johns Hopkins University School of Nursing,*
* in collaboration with MRC/Pretoria*
/ www.son.jhmi.edu

POC test is a good suggestion really . And pleural effusion is quite
common. The important thing is we were putting them on a 3 drug regimen
till 2010. It was a national policy at the time.

If xpertTB rif is available, sensitivity is good for EP samples.
Unfortunately pleural fluid is not a good sample for TB diagnosis due to
the very low load of bacilli.

Daniela Maria Cirillo, MD PhD
Head of Emerging Pathogens Unit
TB Supranational Reference laboratory
San Raffaele Scientific Institute
San Gabriele Building
Via Olgettina 58
20132 Milano , Italy
Ph +390226437947
Assistant Mrs G Graziano

Mr D registered as MDR patient at one of the MDR treatment site. After three months on conversion patient was discharged, patient defaulted and now it is five month without treatment. All efforts to retrieve patient has failed should we ask local police bring the patient to treatment site for DST and treatment

Dear Claudia,
It`s really actual question, especially for us because in my department many patients with pleural effusion from the region are concentrated. According to our about one year experience of usage rapid POC in the diagnostic such events we consider Xpert very sensitive and specifical and in case of positive result we start DOT
before receiving culture, biopsy, biochemical analysis cell count. Although finally we estimate all diagnostic information for the whole to make sure our right about diagnose.
Thanks for raising this interesting question.
Vladimir Skornyakov. Russia

-----Original Message-----
From: GHDonline (Claudia Denkinger) [mailto:]
Sent: Sunday, July 29, 2012 1:56 AM
To: vladimir skornyakov
Subject: [MDR-TB Treatment & Prevention] POC test for Pleural TB

Claudia Denkinger added a new discussion to the MDR-TB Treatment & Prevention community.

Title: POC test for Pleural TB

Discussion contents:
"Hello everybody,

I know this post does not perfectly fit under this category but I was hoping for the experience of people who are working in TB around the globe.

Consider the development of a rapid point-of care (POC) test for pleural TB on pleural fluid.
If the test was highly sensitive it could be used at a peripheral health ...

Dear Claudia,
It`s really actual question, especially for us because in my department many patients with pleural effusion from the region are concentrated. According to our about one year experience of usage rapid POC in the diagnostic such events we consider Xpert very sensitive and specifical and in case of positive result we start DOT
before receiving culture, biopsy, biochemical analysis cell count. Although finally we estimate all diagnostic information for the whole to make sure our right about diagnose.
Thanks for raising this interesting question.
Vladimir Skornyakov. Russia

-----Original Message-----
From: GHDonline (Claudia Denkinger) [mailto:]
Sent: Sunday, July 29, 2012 1:56 AM
To: vladimir skornyakov
Subject: [MDR-TB Treatment & Prevention] POC test for Pleural TB

Claudia Denkinger added a new discussion to the MDR-TB Treatment & Prevention community.

Title: POC test for Pleural TB

Discussion contents:
"Hello everybody,

I know this post does not perfectly fit under this category but I was hoping for the experience of people who are working in TB around the globe.

Consider the development of a rapid point-of care (POC) test for pleural TB on pleural fluid.
If the test was highly sensitive it could be used at a peripheral health clinic and if negative the patient could be referred on to a higher level of care for further workup. However do you consider a test like this being a feasible test in a health clinic (thoracentesis required)?

One could also consider such a rapid POC test in a district hospital. However, given that biochemical analysis and cell count/differential would likely be available at that level of care, the additive value of the test in respect to sensitivity might be limited. Do you think a very specific test would be helpful in that context to avoid unnecessary treatment (possibly while awaiting culture or biopsy results)?

Thank you for your opinion.
Claudia"

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It doesnt work most of the times in my current experience
1) Fluid amount is so less in the pleural space
2) Paucity of bacilli inthe pleural fluid
Thanks


On 8/24/12, GHDonline (vladimir skornyakov) <> wrote:
> vladimir skornyakov replied to the discussion "POC test for Pleural TB" in
> the MDR-TB Treatment & Prevention community.
>
> Reply contents:
> "Dear Claudia,
> It`s really actual question, especially for us because in my department many
> patients with pleural effusion from the region are concentrated. According
> to our about one year experience of usage rapid POC in the diagnostic such
> events we consider Xpert very sensitive and specifical and in case of
> positive result we start DOT
> before receiving culture, biopsy, biochemical analysis cell count. Although
> finally we estimate all diagnostic information for the whole to make sure
> our right about diagnose.
> Thanks for raising this interesting question.
> Vladimir Skornyakov. Russia
>
> -----Original Message-----
> From: GHDonline (Claudia Denkinger) [mailto:]
> Sent: Sunday, July 29, 2012 1:56 AM
> To: vladimir skornyakov
> Subject: [MDR-TB Treatment & Prevention] POC test for Pleural TB
>
> Claudia Denkinger added a new discussion to the MDR-TB Treatment &
> Prevention community.
>
> Title: POC test for Pleural TB
>
> Discussion contents:
> "Hello ...

It doesnt work most of the times in my current experience
1) Fluid amount is so less in the pleural space
2) Paucity of bacilli inthe pleural fluid
Thanks


On 8/24/12, GHDonline (vladimir skornyakov) <> wrote:
> vladimir skornyakov replied to the discussion "POC test for Pleural TB" in
> the MDR-TB Treatment & Prevention community.
>
> Reply contents:
> "Dear Claudia,
> It`s really actual question, especially for us because in my department many
> patients with pleural effusion from the region are concentrated. According
> to our about one year experience of usage rapid POC in the diagnostic such
> events we consider Xpert very sensitive and specifical and in case of
> positive result we start DOT
> before receiving culture, biopsy, biochemical analysis cell count. Although
> finally we estimate all diagnostic information for the whole to make sure
> our right about diagnose.
> Thanks for raising this interesting question.
> Vladimir Skornyakov. Russia
>
> -----Original Message-----
> From: GHDonline (Claudia Denkinger) [mailto:]
> Sent: Sunday, July 29, 2012 1:56 AM
> To: vladimir skornyakov
> Subject: [MDR-TB Treatment & Prevention] POC test for Pleural TB
>
> Claudia Denkinger added a new discussion to the MDR-TB Treatment &
> Prevention community.
>
> Title: POC test for Pleural TB
>
> Discussion contents:
> "Hello everybody,
>
> I know this post does not perfectly fit under this category but I was hoping
> for the experience of people who are working in TB around the globe.
>
> Consider the development of a rapid point-of care (POC) test for pleural TB
> on pleural fluid.
> If the test was highly sensitive it could be used at a peripheral health
> clinic and if negative the patient could be referred on to a higher level of
> care for further workup. However do you consider a test like this being a
> feasible test in a health clinic (thoracentesis required)?
>
> One could also consider such a rapid POC test in a district hospital.
> However, given that biochemical analysis and cell count/differential would
> likely be available at that level of care, the additive value of the test in
> respect to sensitivity might be limited. Do you think a very specific test
> would be helpful in that context to avoid unnecessary treatment (possibly
> while awaiting culture or biopsy results)?
>
> Thank you for your opinion.
> Claudia"
>
> --
> View this post online:
> <http://www.ghdonline.org/drtb/discussion/poc-test-for-pleural-tb/?id=16488826...>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/vladimir-skornyakov/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <http://www.ghdonline.org/drtb/discussion/poc-test-for-pleural-tb/#reply-5480-...>
>
> Unsubscribe or change your email notification settings:
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>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline.
>

Fully agree: pleural fluid is not a good diagnostic specimen, the
paucibacillarity affects the performance of Xpert as well
Daniela Maria Cirillo, MD PhD
Head of Emerging Pathogens Unit
TB Supranational Reference laboratory
San Raffaele Scientific Institute
San Gabriele Building
Via Olgettina 58
20132 Milano , Italy
Ph +390226437947
Assistant Mrs G Graziano






On 8/24/12 3:18 PM, "GHDonline (Dr Shanta Ghatak)" <>
wrote:

Dr Shanta Ghatak replied to the discussion "POC test for Pleural TB" in
the MDR-TB Treatment & Prevention community.

Reply contents:
"It doesnt work most of the times in my current experience
1) Fluid amount is so less in the pleural space
2) Paucity of bacilli inthe pleural fluid
Thanks


On 8/24/12, GHDonline (vladimir skornyakov) <> wrote:
> vladimir skornyakov replied to the discussion "POC test for Pleural TB"
>in
> the MDR-TB Treatment & Prevention community.
>
> Reply contents:
> "Dear Claudia,
> It`s really actual question, especially for us because in my department
>many
> patients with pleural effusion from the region are concentrated.
>According
> to our about one year experience of usage rapid POC in the diagnostic
>such
> events we consider Xpert very sensitive and specifical and in case ...

Fully agree: pleural fluid is not a good diagnostic specimen, the
paucibacillarity affects the performance of Xpert as well
Daniela Maria Cirillo, MD PhD
Head of Emerging Pathogens Unit
TB Supranational Reference laboratory
San Raffaele Scientific Institute
San Gabriele Building
Via Olgettina 58
20132 Milano , Italy
Ph +390226437947
Assistant Mrs G Graziano






On 8/24/12 3:18 PM, "GHDonline (Dr Shanta Ghatak)" <>
wrote:

Dr Shanta Ghatak replied to the discussion "POC test for Pleural TB" in
the MDR-TB Treatment & Prevention community.

Reply contents:
"It doesnt work most of the times in my current experience
1) Fluid amount is so less in the pleural space
2) Paucity of bacilli inthe pleural fluid
Thanks


On 8/24/12, GHDonline (vladimir skornyakov) <> wrote:
> vladimir skornyakov replied to the discussion "POC test for Pleural TB"
>in
> the MDR-TB Treatment & Prevention community.
>
> Reply contents:
> "Dear Claudia,
> It`s really actual question, especially for us because in my department
>many
> patients with pleural effusion from the region are concentrated.
>According
> to our about one year experience of usage rapid POC in the diagnostic
>such
> events we consider Xpert very sensitive and specifical and in case of
> positive result we start DOT
> before receiving culture, biopsy, biochemical analysis cell count.
>Although
> finally we estimate all diagnostic information for the whole to make sure
> our right about diagnose.
> Thanks for raising this interesting question.
> Vladimir Skornyakov. Russia
>
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> -----Original Message-----
> From: GHDonline (Claudia Denkinger) [mailto:]
> Sent: Sunday, July 29, 2012 1:56 AM
> To: vladimir skornyakov
> Subject: [MDR-TB Treatment & Prevention] POC test for Pleural TB
>
> Claudia Denkinger added a new discussion to the MDR-TB Treatment &
> Prevention community.
>
> Title: POC test for Pleural TB
>
> Discussion contents:
> "Hello everybody,
>
> I know this post does not perfectly fit under this category but I was
>hoping
> for the experience of people who are working in TB around the globe.
>
> Consider the development of a rapid point-of care (POC) test for pleural
>TB
> on pleural fluid.
> If the test was highly sensitive it could be used at a peripheral health
> clinic and if negative the patient could be referred on to a higher
>level of
> care for further workup. However do you consider a test like this being a
> feasible test in a health clinic (thoracentesis required)?
>
> One could also consider such a rapid POC test in a district hospital.
> However, given that biochemical analysis and cell count/differential
>would
> likely be available at that level of care, the additive value of the
>test in
> respect to sensitivity might be limited. Do you think a very specific
>test
> would be helpful in that context to avoid unnecessary treatment (possibly
> while awaiting culture or biopsy results)?
>
> Thank you for your opinion.
> Claudia"
>
> --
> View this post online:
>
><http://www.ghdonline.org/drtb/discussion/poc-test-for-pleural-tb/?id=1648
>8826&format=text&type=instant>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/vladimir-skornyakov/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail;
>it
> will be shared with all community members and posted as is. Files cannot
>be
> added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
>
><http://www.ghdonline.org/drtb/discussion/poc-test-for-pleural-tb/#reply-5
>480-2?id=14778177&format=text&type=instant>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/dr-shanta-ghatak/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail;
>it
> will be shared with all community members and posted as is. Files cannot
>be
> added via email attachment and must be uploaded directly to GHDonline.
>"

--
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