about 48 hours to get our nucleic acid amplification test done, and that was positive for MTB. And yesterday, I found out that the cultures were positive. He had a QFT that’s just a hair above the cut point for a TB infection and that was on February 23rd. 79 So, I don't have a discussion about extra-pulmonary TB and a previously gouty foot, but I think there are issues that have been raised by this case. One of them is that TB is not mentioned by our pathologist at all, even when caseating granuloma are noted. And these cases are not referred to Epidemiology. The clinicians were not called by the pathologist. I have no idea what Podiatry saw in this biopsy, or didn’t see in the biopsy, or didn’t recognize the significance. There is not a single note on the chart from them regarding pathology. And I also think that no other clinician found out about this because these reports were now buried in a tremendous morass of clinical data that is piling up in our electronic systems, and I think as time goes by, none of us is going to have any of our information readily available. Multiple clinicians fail to find or note the report. And then finally, even in a center where we see a lot of TB, spinal fluid was obtained and pleural fluid was obtained but not sent for mycobacterial cultures. So, I'll open this up to questions or comments. Slide 80 Alfred thanks Dana. Any comments or questions from the audience before we open it up to the whole panel? Would you conjecture to tell us how you think the organism got to the toe? Dana Kissner: We were talking that before, because I felt that was an hour-long talk. You know, my suspicion is that he had gout all along. But I'm not really sure about that. It’s really hard to say. And then somehow or other, he had an open wound, and I suspected he could have caught this as a wound infection, which is really unusual, or he really did have a source, you know, a focus of extra-pulmonary TB that flared up his gout.
about 48 hours to get our nucleic acid amplification test done, and that was positive for MTB. And yesterday, I found out that the cultures were positive. He had a QFT that’s just a hair above the cut point for a TB infection and that was on February 23rd. 79 So, I don't have a discussion about extra-pulmonary TB and a previously gouty foot, but I think there are issues that have been raised by this case. One of them is that TB is not mentioned by our pathologist at all, even when caseating granuloma are noted. And these cases are not referred to Epidemiology. The clinicians were not called by the pathologist. I have no idea what Podiatry saw in this biopsy, or didn’t see in the biopsy, or didn’t recognize the significance. There is not a single note on the chart from them regarding pathology. And I also think that no other clinician found out about this because these reports were now buried in a tremendous morass of clinical data that is piling up in our electronic systems, and I think as time goes by, none of us is going to have any of our information readily available. Multiple clinicians fail to find or note the report. And then finally, even in a center where we see a lot of TB, spinal fluid was obtained and pleural fluid was obtained but not sent for mycobacterial cultures. So, I'll open this up to questions or comments. Slide 80 Alfred thanks Dana. Any comments or questions from the audience before we open it up to the whole panel? Would you conjecture to tell us how you think the organism got to the toe? Dana Kissner: We were talking that before, because I felt that was an hour-long talk. You know, my suspicion is that he had gout all along. But I'm not really sure about that. It’s really hard to say. And then somehow or other, he had an open wound, and I suspected he could have caught this as a wound infection, which is really unusual, or he really did have a source, you know, a focus of extra-pulmonary TB that flared up his gout.
Transcript_E-P%20TB%20Webinar.docx