A Flare of Granulomatosis with Polyangiitis or Reactivation of Pulmonary Tuberculosis? A diagnostic Dilemma

Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear

High-resolution CT findings of pulmonary tuberculosis in liver transplant patients

Background: The adrenal gland is not spared from the involvement by tuberculosis. One of the recognized causes of adrenal insufficiency (AI) is tuberculosis. AI, mostly at the subclinical level, is common in persons with pulmonary tuberculosis (PTB) infection, occurring in about 23% of patients. Coinfection with PTB and human immunodeficiency virus (HIV) may compromise adrenocortical function and produce significant adrenocortical insufficiency. Objective: To determine if coinfection with tuberculosis and HIV have a compound effect on adrenocortical function in persons with HIV and PTB coinfection. Materials and Methods: Persons with sputum-positive PTB, treatment naive, who met our inclusion criteria, were selected. All the recruited patients were screened for HIV and those positive for HIV infection had confirmatory test. A baseline blood samples for cortisol, fasting plasma glucose, full blood count, and electrolytes were collected between 8.00 h and 9.00 h immediately before administration of adrenocorticotropic hormone (ACTH). The persons received an intravenous bolus injection of 1 μg ACTH (Alliance Pharmaceuticals Ltd., Chippenham, Wiltshire SN15 2BB) and blood sample was drawn for cortisol level at 30 min. Results: Forty-four people with PTB infection and forty people with PTB and HIV coinfection met the inclusion criteria of the study. The adrenal response to 1 μg ACTH stimulation in participants with PTB and PTB and HIV coinfection showed that the mean basal cortisol level in the 2 groups was not statistically significant; however, 30-min post-ACTH stimulation cortisol level was 630.84 ± 372.17 and 980.36 ± 344.82 nmol/L (P < 0.001) and increment was 367.79 ± 334.87 and 740.77 ± 317.97 nmol/L (P < 0.001), respectively. Fourteen persons (31.8%) with PTB has subnormal adrenal response to ACTH stimulation while only 2 (5%) persons with PTB and HIV coinfection has subnormal response. Conclusion: AI, at subclinical level, was less frequent in those with PTB and HIV co-infection.

BackgroundPapua New Guinea (PNG) has a tuberculosis (TB) case notification rate of 333 cases per 100,000 population in 2016 and is one of the 14 countries classified by the World Health Organization (WHO) as “high-burden” for TB, multi-drug-resistant TB (MDR-TB), and TB/HIV. HIV epidemic is mixed with a higher prevalence among key populations, female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW).MethodsWe conducted a cross-sectional HIV biobehavioral survey (BBS) using respondent-driven sampling method among FSW, MSM, and TGW in Port Moresby, Lae, and Mt. Hagen (2016–2017). As part of the study, participants were screened for the four symptoms suggestive of TB infection using the WHO TB screening algorithm. Sputum and venous whole blood samples were collected and tested for pulmonary TB and HIV infection, respectively. Pulmonary TB testing was performed using GeneXpert®MTB/RIF molecular point-of-care test, and HIV testing was done following the PNG national HIV testing algorithm. All data discussed are weighted unless otherwise mentioned.ResultsAmong FSW, 72.6%, 52.0%, and 52.9% in Port Moresby, Lae, and Mt. Hagen, respectively, experienced at least one symptom suggestive of TB infection. Among MSM and TGW, 69% and 52.6% in Port Moresby and Lae, respectively, experienced at least one symptom suggestive of TB infection. Based on GeneXpert®MTB/RIF results, the estimated TB prevalence rate among FSW was 1200, 700, and 200 per 100,000 in Port Moresby, Lae, and Mt. Hagen, respectively. Among MSM and TGW, the estimated TB prevalence rate was 1000 and 1200 per 100,000 in Port Moresby and Lae, respectively. Co-prevalence of TB/HIV among FSW was 0.1% in Port Moresby and 0.2% in Lae. There were no co-prevalent cases among FSW in Mt. Hagen or among MSM and TGW in Port Moresby and Lae.ConclusionsKey populations have a higher estimated rate of pulmonary TB than the national rate of pulmonary and extra-pulmonary TB combined. This showed that screening key populations for TB should be integrated into HIV programs regardless of HIV status in PNG’s national TB response.

Systemic lupus erythematosus with diffuse alveolar hemorrhage.

ABSTRACTPulmonary tuberculosis (PTB) and diabetes mellitus (DM) are common chronic diseases that threaten human health. Patients with DM are susceptible to PTB, an important factor that aggravates the complications of diabetes. However, the molecular regulatory mechanism underlying the susceptibility of patients with DM to PTB infection remains unknown. In this study, healthy subjects, patients with primary PTB, and patients with primary PTB complicated by DM were recruited according to inclusion and exclusion criteria. Peripheral whole blood was collected, and alteration profiles and potential molecular mechanisms were further analyzed using integrated bioinformatics analysis of metabolomics and transcriptomics. Transcriptional data revealed that lipocalin 2 (LCN2), defensin alpha 1 (DEFA1), peptidoglycan recognition protein 1 (PGLYRP1), and integrin subunit alpha 2b (ITGA2B) were significantly upregulated, while chloride intracellular channel 3 (CLIC3) was significantly downregulated in the group with PTB and DM (PTB_DM) in contrast to the healthy control (HC) group. Additionally, the interleukin 17 (IL-17), phosphatidylinositol 3-kinase (PI3K)-AKT, and peroxisome proliferator-activated receptor (PPAR) signaling pathways are important for PTB infection and regulation of PTB-complicated diabetes. Metabolomic data showed that glycerophospholipid metabolism, carbon metabolism, and fat digestion and absorption processes were enriched in the differential metabolic analysis. Finally, integrated analysis of both metabolomic and transcriptomic data indicated that the NOTCH1/JAK/STAT signaling pathway is important in PTB complicated by DM. In conclusion, PTB infection altered the transcriptional and metabolic profiles of patients with DM. Metabolomic and transcriptomic changes were highly correlated in PTB patients with DM. Peripheral metabolite levels may be used as biomarkers for PTB management in patients with DM.IMPORTANCE The comorbidity of diabetes mellitus (DM) significantly increases the risk of tuberculosis infection and adverse tuberculosis treatment outcomes. Most previous studies have focused on the relationship between the effect of blood glucose control and the outcome of antituberculosis treatment in pulmonary tuberculosis (PTB) with DM (PTB_DM); however, early prediction and the underlying molecular mechanism of susceptibility to PTB infection in patients with DM remain unclear. In this study, transcriptome sequencing and untargeted metabolomics were performed to elucidate the key molecules and signaling pathways involved in PTB infection and the susceptibility of patients with diabetes to PTB. Our findings contribute to the development of vital diagnostic biomarkers for PTB or PTB_DM and provide a comprehensive understanding of molecular regulation during disease progression.

Diffuse alveolar hemorrhage (DAH) has been rarely reported with pulmonary infections and even rarer with pulmonary tuberculosis (PTB). We hereby report the case of a 31-year-old male, a known case of ankylosing spondylitis, who presented with clinical and radiological features consistent with DAH. Initial partial improvement with steroids was followed by a microbiological diagnosis of tuberculosis (TB). Starting of antituberculous treatment was followed by complete clinical improvement. This leads to a thought-provoking possible association between the two pathologies, DAH and PTB, if any.

Introducción: La hemorragia alveolar difusa (HAD) sigue siendo una complicación pulmonar poco frecuente del lupus eritematoso sistémico (LES), pero potencialmente mortal me parece que así quedaría mejor. Objetivo: presentar las características clínicas, tratamiento y la evolución de dos pacientes con LES con hemorragia alveolar y nefritis lúpica asociada como forma de debut del LES material y método: serie de dos casos de pacientes con diagnóstico de LES con hemorragia alveolar difusa como forma de debut del LES, internadas en el Departamento de Medicina Interna del Hospital Nacional de Itaugua en el periodo 2007-2018. Resultados: de 500 pacientes con LES en seguimiento, 2 mujeres presentaron hemorragia alveolar como forma de debut del LES (0,4%), edad media 22 años ± 4,2., tiempo de enfermedad media de 60 días ± 42,4. Ambas pacientes presentaron disnea, fiebre, hemoptisis, disminución de la Hb, infiltrado pulmonar bilateral en la Radiografía de tórax, nefritis, insuficiencia respiratoria aguda, asistencia respiratoria mecánica (ARM). Solo una paciente se realizó biopsia renal, NL clase 3/C. Así mismo las dos pacientes recibieron pulsos de metilprednisolona 1g/d/3 días, seguidas de ciclofosfamida, con buena respuesta al tratamiento en una paciente y un óbito en la otra paciente. Comentario: Ambas debutaron con HAD, presentaron nefropatía asociada y necesidad de asistencia respiratoria mecánica. El óbito se presentó en la paciente con nefropatía e insuficiencia renal aguda.

Opiates drug users are at much higher risk of developing tuberculosis (TB) infection than general population. We conducted this study to determine the susceptibility for pulmonary and latent TB infection in opiates drug users. In this cross-sectional study, all opiates drug users referred to drop-in centers, methadone maintenance clinics, and harm-reduction facilities affiliated with Shiraz University of Medical Sciences in southern Iran were screened for pulmonary and latent TB infection. The participation rate of opiate drug users was 87.66% (263 of 300). Mean age was 37.37 ± 8.33 (range, 20-65) years. Two hundred twenty-six (85.93%) were male and 197 (74.90%) were injection drug users (IDUs). One hundred sixty-three (61.97%) had TB-related symptoms. Culture for TB was positive in 3 patients (1.14%) (2 non-IDUs and 1 IDU). Two patients (0.76%) showed acid-fast bacilli in the direct sputum smear. Eighty-five of 244 patients (34.83%) had a 5- to 10-mm induration in the skin TB test. Twenty-nine of 223 patients (13%) had abnormal findings from chest x-ray films. The prevalence of smear-positive pulmonary TB in opiate drug users is more than 100 times in the general population in Iran. Therefore, active and appropriate screening to detect pulmonary TB infection should be integrated into routine activities at all harm-reduction facilities for drug users, irrespective of their route of drug use or human immunodeficiency virus status, in this country.

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS SECONDARY TO DISSEMINATED HISTOPLASMOSIS PRESENTING AS DIFFUSE ALVEOLAR HEMORRHAGE IN A 32-YEAR-OLD WOMAN

Pulmonary tuberculosis (TB) is an infection disease caused by Mycobacterium tuberculosis. Pulmonary TB remain a major health problem and the most common cause of death in the world especially in developing countries. Pulmonary TB infection could cause clinical manifestation, which is haematology disorders like anemia. Many studies has reported anemia as a common complication in patients with pulmonary TB. This research aims to determine haemoglobin levels and erythrocytes index of patients with pulmonary TB at RSUD Dr. M. Haulussy Ambon in the periods from January 2017 - April 2018. This research uses a descriptive study by using medical records of patients with pulmonary TB. Among 65 patients with pulmonary TB, number of patients with anemia are 44 cases (67,7%) and 21 cases (32,3%) are not anemia. Pulmonary TB with anemia most suffered by male as much 24 cases (72,7%). The age group suffered most is 18-30 years old as much 23 cases (69,7%), but the age group suffered most according to percentage is 51-60 years old as much 80%. The most common types of anemia is hipocromic micrositer as much 23 cases (52,3%). Haemoglobin levels in patients with pulmonary TB are found most below the normal value or anemia and the most common types of anemia is hipocromic micrositer. Needs to be done more research on the analysis of the relation between anemia with pulmonary TB.&#x0D; Keywords: pulmonary tuberculosis, haemoglobin, erythrocytes index

Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage and has an unknown etiology and pathogenesis. The clinical presentations of IPH include dyspnea, anemia, and hemoptysis. Chest radiography often reveals diffuse ground glass and ill-defined opacities. Herein, we report a patient with iron-deficiency anemia. The patient had progressive dyspnea, recurrent hemoptysis, hemolytic anemia and alveolar opacities on chest film that were difficult to differentiate from other types of pneumonitis. We excluded autoimmune disease, coagulopathy, renal disease, and pulmonary infection. The pathology report from the transbronchial biopsy revealed hemosiderin-laden macrophages. Intravenous prednisolone was useful in alleviating the symptoms.

Computed tomography of children with pulmonary Mycobacterium tuberculosis infection

Background:Developing countries have a high burden of Tuberculosis (TB); although it is considered as a disease of the past in most developed countries. The end TB strategy was predicted to stabilize or drop the incidence of TB. However, the rising of the prevalence of immune-related diseases like Diabetes Mellitus (DM) are challenging the TB control strategy in high TB burden region. The objective of this study was to determine the prevalence and associated factors of pulmonary tuberculosis in DM patients attending Adare Hospital, south Ethiopia.Methods:A cross-sectional study was carried out on 207 randomly selected diabetic patients at the Adare hospital. A structured pre-tested questionnaire was used during the data collection from participants. Sputum concentration technique followed by Ziehl-Neelsen staining method was used to examine pulmonary tuberculosis. Logistic regression analysis was used to assess the association between various variables and pulmonary tuberculosis. Odds ratios and 95% CI were computed to determine the strength and presence of the association.Results:The prevalence of pulmonary tuberculosis among diabetics was 5.3% [95% CI: (2.2, 8.4)]. Diabetic patients who were underweight [AOR = 9.94, 95% CI: (1.51-80.89)], had more than 10 years duration with DM [AOR = 7.03 95% CI: (1.357, 73.6)], Alcohol drinking habit [AOR = 12.49, 95% CI: (3.28, 77.94)], and history of contact with TB [AOR = 5.35, 95% CI: (1.1-39.12)] were the factors positively associated with pulmonary TB infection while being HIV seronegative had a negative association with pulmonary TB infection [AOR =0.074, 95% CI: (0.001-0.29)].Conclusion:High proportion of pulmonary TB was observed in diabetic patients as compared to the national estimated prevalence of TB in the total population. Duration of patient with DM, being underweight, alcohol consumption habit, and contact history with TB were positively associated with pulmonary TB infection while being HIV seronegative had a negative association with the infection in diabetic patients.

Kidney involvement in ANCA-associated vasculitis is common (64%–85%) and associated with high morbidity and mortality. Despite recent advances in therapy, a significant number of patients still progress to kidney failure or death. As such, therapies that improve kidney outcomes have been pursued