Comorbidity: alobar holoprosencephaly and pulmonary tuberculosis in a child (a case report)

Aim: to demonstrate the features of detection and diagnosis of latent tuberculosis infection and pulmonary tuberculosis in children from household contacts based on own clinical observation. Materials and methods. A clinical case of own observation of pulmonary tuberculosis and latent tuberculosis infection in children from household contacts who were treated in the paediatric department of the clinical base of the Phthysiatry and Pulmonology Department of Zaporizhzhia State Medical and Pharmaceutical University on Public Non-Profit Enterprise of the “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology” of Zaporizhzhia Regional Council. Results. Children from household contacts were examined at ages: 8 months, 2, 3, 5 and 7 years, after their mother was diagnosed with tuberculosis (TB). All children showed an increase in tuberculin skin test, at the X-ray of the thoracic cavity organs (TCO) no changes were detected in any child. Taking into account the age of the children and their constant residence with the index patient, a decision was made to conduct an additional examination using CT scan of the TCO. Thus, three children were diagnosed with pulmonary tuberculosis – primary tuberculosis complex, and two were infected. After receiving the results of the culture test in the gastric lavage, the youngest child was found MBT, which was resistant to first-line drugs, namely isoniazid and rifampicin, which required a treatment regimen adjustment. It should be noted that the youngest girl, who was not vaccinated, had the most widespread process in the lungs compared to other children. Conclusions. Monitoring and screening of children who have been in contact with the index patient within the household maximises the detection of additional cases of latent tuberculosis infection and pulmonary TB. The most at-risk groups are those who not vaccinated with BCG vaccine and children under 5 years of age. Early detection and timely prescription of anti-TB therapy is the key not only to effective treatment, but also to preventing the transmission of TB infection.

The HIV/AIDS pandemic has led to a rise in the incidence of tuberculosis and an epidemic of co-infection in many developing countries. Treatment of Mycobacterium tuberculosis in persons with HIV infection presents several challenges to the clinician particularly in resource-poor countries. As will be discussed in this paper diagnosis of latent tuberculosis relies on tuberculin skin testing which has poor sensitivity and reproducibility in immunocompromised patients. The World Health Organization (WHO) recommends treatment of active tuberculosis as the primary means of global tuberculosis control. In practice treatment of active tuberculosis typically requires that a symptomatic patient self-report to a health service for evaluation and management. Even if this approach to tuberculosis control were sufficient many logistic and clinical problems remain involving tuberculosis diagnosis and therapy in the patient with HIV/AIDS. Recognizing the significant clinical and public health challenges surrounding the treatment of tuberculosis in patients with HIV infection this paper will address a number of issues relevant to the care of co-infected patients. These include current guidelines for the treatment of active tuberculosis as well as the diagnosis and treatment of latent tuberculosis in HIV-positive patients. The paper concludes with a discussion of promising new drugs for tuberculosis treatment. (excerpt)

An Outbreak of Tuberculosis Among Adults With Mental Illness

The aim of this study was to compare the expression of peripheral blood T cell subsets, soluble interleukin-2 receptor (sIL-2R) and interferon-gamma (IFN-γ) in patients with retreatment pulmonary tuberculosis, initial treatment pulmonary and extra-pulmonary tuberculosis, and therefore to explore the cellular immune changes and the significance among different types and severity of tuberculosis. A total of 170 patients with tuberculosis in Pulmonary Hospital of Shanghai from December 2009 to January 2011, including 98 males and 72 females, aged from 16 to 70 years (average 40 years), were included in this study. The patients were divided into retreatment pulmonary tuberculosis group (47 cases), initial treatment pulmonary tuberculosis group (62 cases) and initial treatment extra-pulmonary tuberculosis group (61 cases). Furthermore, the 109 patients with pulmonary tuberculosis were divided into different subgroups according to cavity formation and the lung fields involved: patients without lung cavity (52 cases) vs those with lung cavity (57 cases), patients with involvement of 1 - 2 lung fields (48 cases), vs 3 - 4 lung fields (26 cases) and 5 - 6 lung fields (35 cases). Peripheral blood T cell subsets (by flow cytometry doubled-labeled antibody), sIL-2R and IFN-γ (by ELISA) were determined in 170 patients. Differences between means of 2 groups were tested by t test, differences among multiple groups were tested by analysis of variance (ANOVA), and multiple comparisons among multiple groups were tested by LSD-t test or χ² test. Linear regression equation was used to analyze the correlations. The levels of peripheral blood CD₄/CD₈ in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis patients were significantly lower than that in initial treatment pulmonary tuberculosis patients, [(1.7 ± 0.7), (1.6 ± 0.7) and (2.0 ± 0.7) respectively (F = 4.380, P < 0.05)]. The levels of serum sIL-2R in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [(224 ± 89) pmol/L, (209 ± 98) pmol/L, (167 ± 73) pmol/L, (F = 6.402, P < 0.01)]. The levels of serum IFN-γ in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [(37 ± 23) ng/L, (37 ± 24) ng/L, (29 ± 16) ng/L, (F = 2.799, P < 0.05)]. The levels of peripheral blood CD₄/CD₈ in initial treatment and retreatment cavity pulmonary tuberculosis patients were lower than that in pulmonary tuberculosis patients without cavity, but the results of sIL-2R and IFN-γ were the opposite [(1.7 ± 0.6) vs (2.0 ± 0.8), (214 ± 93) pmol/L vs (167 ± 68) pmol/L and (38 ± 22) ng/L vs (27 ± 14) ng/L, t = -2.813 to 3.076, P < 0.05 or P < 0.01]. The level of serum sIL-2R was negatively correlated with peripheral blood CD₄/CD₈ level in all the patients (r = -0.380, P < 0.01). Patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis had lower cellular immune function as compared to those with initial treatment pulmonary tuberculosis, and the cellular immune function was significantly correlated with the extent and cavity formation of pulmonary lesions.

Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children.

Mycobacterium tuberculosis Infections in Solid Organ Transplantation

BACKGROUND. Quarantine measures regarding the coronavirus disease (COVID-19) pandemic, initiated in early 2020, and subsequently large-scale hostilities in Ukraine, led to a decrease in the detection of tuberculosis (TB) patients and an increase in mortality from this disease. Particular attention needs to be paid to the peculiarities of the course of pulmonary TB against the background of a coronavirus infection, which may be due to both the features of the impact of SARS-CoV-2 and the features of the immunological status of patients with pulmonary TB with preserved sensitivity to antimycobacterial drugs (DSTB) and with drug resistance. OBJECTIVE. To investigate the dynamics of the course of pathological changes in the lungs in patients with pulmonary TB against the background of coronavirus infection by analyzing the data of computed tomography (CT) of the chest organs. MATERIALS AND METHODS. Establishing the diagnosis and treatment of pulmonary TB were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 530. The diagnosis of COVID-19 was established in patients who were treated for pulmonary TB in accordance with the current protocols for the treatment of the coronavirus infection. All patients underwent dynamic CT of the chest organs was performed on the Aquilion TSX-101A scanner (Toshiba, Japan). RESULTS AND DISCUSSION. Clinical, laboratory and X-ray data of patients with pulmonary TB and COVID-19 were analyzed in dynamics. It has been established that with timely diagnosis and adequate treatment of DSTB of the lungs, viral pneumonia (COVID-19) does not complicate the course of the TB process. The period of the course of COVID-19 is characterized by the continuation of the positive dynamics of the TB process. In patients with TB with multiple drug resistance, viral pneumonia (COVID-19) does not cause serious complications, but the period of the course of COVID-19 is characterized by the absence of positive dynamics of the TB process. With untreated pulmonary TB on the background of viral pneumonia (COVID-19), the disease can become severe and end in death. CONCLUSIONS. CT of the chest organs in patients with pulmonary TB against the background of COVID-19 is highly informative in monitoring the pathological process, detecting complications and evaluating the effectiveness of treatment.

Aim. To analyze the features of the simultaneous course of pulmonary aspergillosis and multidrug-resistant pulmonary tuberculosis (MDR-TB) on the background of type 1 diabetes mellitus, on the example of a clinical case of our practice. Materials and methods. Clinical case of our practice of simultaneous pulmonary aspergillosis and MDR-TB on the background of type 1 diabetes mellitus in a patient, who was treated in Pulmonary tuberculosis department No. 2 of clinical base of Phthisiatry and Pulmonology Department of Zaporizhzhia State Medical University at Communal Non-Commercial Enterprise of the “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthisiatry and Pulmonology” of Zaporizhzhia Regional Council. Results. In the presented clinical case, the patient had been suffering from diabetes mellitus for 8 years and had been receiving insulin therapy for all these years. One year before the TB disease, he had contact with an index patient, but he categorically refused a course of preventive chemotherapy. Also, the patient did not make a comparison X-ray TCO after 6 months, as a contact person. MDR-TB and aspergilloma of the left lung of the patient were diagnosed simultaneously on the background of severe condition with decompensated form of type 1 diabetes mellitus, severe intoxication syndrome and inflammatory process, massive hemoptysis. Aspergilloma of the left lung was diagnosed using X-ray TCO and cultural examination of bronchial aspirate for Aspergillus, which was not difficult to diagnose. Diagnosis of MDR-TB was also not difficult, because the patient had MBT, which contributed to the timely and correct appointment of antimycobacterial therapy. Surgery for aspergilloma of the left lung was contraindicated, as the type 1 diabetes was in decompensation. Persistent hyperglycemia remained, despite the fact of antifungal therapy and constant correction of insulin therapy prescribed for the patient. Endocarditis quickly developed in the patient, which was the reason of patient’s death. Conclusions. The decompensated form of type 1 diabetes mellitus caused persistent hyperglycemia, which was the reason of immune disorders and this made the patient’s body susceptible to bacterial (MDR-TB) and fungal (aspergillosis) infections, which led to the development of the complication of endocarditis and death. A big mistake in his case, was a categorical refusal by the patient to receive a course of preventive chemotherapy, as a contact person with an index patient. In view of this, in the presence of type 1 diabetes, the patient should have not neglected it. And as a result, the patient had a MDR-TB, one year after. At the same time, the patient did not make a comparison X-ray TCO, after 6 months, as a contact person, which was a possible reason for the missing of early diagnosis of pulmonary aspergilloma. That’s why, a correct treatment of type 1 diabetes mellitus and timely preventive radiological examination of the thoracic cavity organs are especially important, as the diabetes mellitus is the most common premorbid background for TB and aspergillosis.

Excerpt No drug having been thus far found in the treatment of tuberculosis which kills all tubercle bacilli, the objectives of drug treatment in this disease still fall short of the eradication of...

Tuberculosis (TB) treatment success rates are high in China, but there are still a considerable number of cases who have unfavourable treatment outcomes (UTO). We aimed to determine the proportion of TB patients with UTO and to assess whether baseline characteristics that included glycaemic status [normal fasting blood glucose (FBG), transient hyperglycaemia and diabetes mellitus (DM)] and vitamin D status were associated with UTO. Prospective cohort study conducted between November 2015 and July 2016 at six clinics within routine TB services in Jilin province, where persons with TB were consecutively recruited. Data analysis was performed using the chi-squared test and multivariate logistic regression. Of the306 recruited TB patients, 96 (31.4%) had smear-positive pulmonary TB, 187 (61.1%) had smear-negative pulmonary TB and 23 (7.5%) had extrapulmonary TB (EPTB). Of these, 95 (31.1%) had normal blood glucose, 83 (27.1%) had transient hyperglycaemia and 128 (41.8%) had DM. 227 (74.2%) patients had vitamin D deficiency/severe deficiency. There were 125 (40.8%) patients with UTO of whom the majority were lost to follow-up (57.6%) or not evaluated (28.8%). UTO was significantly associated with smear-negative pulmonary TB (P=0.009), EPTB (P<0.001) and DM (P=0.007). The proportion of TB patients with UTO increased with smear-negative pulmonary TB, EPTB and DM. TB programmes need to pay more attention to these issues and ensure intensive patient support to those at risk and early detection of DM.

Background : Tuberculosis (TB) is a widespread health problem in the world, including Indonesia. TB infects a wide range of ages, including the elderly. The factors of mortality and morbidity due to TB in Indonesia are caused by inadequate drug using, comorbid disease, and Multi Drug Resistant (MDR) TB. History of symptoms and sign also proper diagnosis are expected to reduce the time delay of TB treatment resulting in lower morbidity. Objective : To determine the difference pattern of clinical pulmonary and extra-pulmonary TB in adult and geriatric patients. Methods : The study design was descriptive analytic. Sample was 225-patient medical records from Dr.Kariadi Hospital Semarang since January until December 2013. Data was described using drawings and tables. Tables used chi-square test to determine differences of variable. Results : 225 samples consisted of 155 patients with pulmonary TB patients (121 adults and 35 elderly), extra pulmonary TB patients 69 (62 adults and 7 elderly). Most symptom of pulmonary TB was shortness of breath (p=0.016) and extra pulmonary TB was weight loss. Results of blood tests found anemia (51.92% pulmonary TB, 42.03% extra pulmonary TB )and lymphopenia (25.00% pulmonary TB, 24.64% extra pulmonary TB). Results of sputum smear tests on pulmonary TB was acid-resistant bacteria (+), while on the extrapulmonary TB was acid-resistant bacteria (-). The thorax x-ray was found radiopaque spots (34.62% of pulmonary TB patients, 1.45% extra pulmonary TB patients). Most comorbid disease with pulmonary TB was another lung disease( 49% of elderly). Length of hospitalization of pulmonary tuberculosis patients was 6-10 days and extra pulmonary TB was more than 15 days. Most complications were hemoptysis and septic shock. Conclusion : The results of this study have almost the same results with the research that has been done before.

A series of studies on the interventional diagnosis and treatment of tuberculosis(TB)were carried out by domestic and foreign researchers in 2023. The combination of minimally invasive interventional procedures with endoscopes, guidance, material acquisition techniques by multiple ways and multichannel and highly accurate laboratory testing techniques is becoming more and more widely practiced clinically, which has played an important role in the accurate diagnosis of problematic TB. Diagnostic procedures for pulmonary TB, tracheobronchial TB, mediastinal lymphatic TB and extrapulmonary TB included conventional flexible bronchoscopy and specific types of bronchoscopy(ultrathin bronchoscopy and endobronchial ultrasound), transbronchial needle aspiration biopsy, endobronchial ultrasound and virtual bronchoscopic navigation system-guided forceps biopsy, thoracoscopic cryobiopsy of pleura, percutaneous biopsy, and so on. The time to diagnosis has been significantly reduced and the diagnostic efficacy has been improved by the clinical specimen detection using either Gene Xpert MTB/RIF, Ultra, loop-mediated isothermal amplification, metagenomic next-generation sequencing, or nanopore sequencing, etc. Interventional therapy was focused on the following diseases: pulmonary TB with massive hemoptysis, tracheobronchial TB, pleural TB and TB-related fistulas. Interventional treatment of tracheobronchial TB mainly included the application of rigid bronchoscopy, bronchoscopic cold and thermal ablation treatment, endoscopic clamp, dilatations of narrow airway with balloon and stent placement, etc. The interventional treatment of pulmonary TB complicated by massive hemoptysis included endovascular embolization, coated stent placement, etc. Interventional treatment of pleural TB involved the application of thoracoscopy, endoscopic forceps, the implantation of stent and other occlusive devices and the closure of fistulas with autologous fat transplantation. In this article, we reviewed the progress of interventional diagnosis and treatment of TB by the search of published literatures from October 2022 to September 2023.

Objective. To study the relationship between tobacco smoking and the development of COPD and pulmonary tuberculosis. Material and methods. The analysis of domestic and foreign databases for the period from 2003 to 2024, including PubMed, MedLine, eLibrary.ru. The following keywords were used in the literature search: «tuberculosis», «smoking», «tobacco», «COPD», «functional lung disorders». Results. The most important factor in the development and progression of COPD is long-term exposure to harmful particles, gases, as well as tobacco smoking and infectious diseases, including tuberculosis. Meanwhile, tobacco consumption is a significant factor in the development of not only COPD, but also an active tuberculosis process. It is worth saying that smoking patients with pulmonary tuberculosis have low results of treatment, which leads to the progression of the tuberculosis process and relapses in the future. Also, a large number of studies indicate a wide prevalence of functional lung disorders in the development of pulmonary tuberculosis and active tobacco consumption. In this connection, it can be concluded that the development and course of pulmonary tuberculosis and COPD are closely interrelated, including in the presence of tobacco smoking, and may be associated not only with the development of functional lung disorders, but also with the onset of cardiovascular pathology. Conclusion. Significant problems in global health are the increase in the incidence of COPD and pulmonary tuberculosis. Smoking is one of the main factors in the development and more severe course of both COPD and pulmonary tuberculosis. An urgent area is the development and implementation of anti-smoking measures to eliminate tobacco dependence among patients with COPD and pulmonary tuberculosis.

We aimed to describe the risk factors of airway involvement and to investigate the contribution of bronchoscopy in the bacteriologic diagnosis of tuberculosis. Airway involvement was more often present in patients with resistance to tuberculosis therapy than in the patients having bronchoscopy performed at initial presentation. Addition of bronchoalveolar lavage to the diagnostic workup increased the mycobacteriologic yield statistically.

Current Concepts in the Management of Tuberculosis