Acid-fast Research Articles

Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt.

Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity. This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion. A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established. A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients. Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Cytomorphological findings in confirmed cases of tubercular lymphadenitis.

Tuberculosis (TB) remains a major health problem, especially in the developing countries. Fine-needle aspiration cytology is the first line of investigation for tubercular lymphadenitis as it is easy to perform, less invasive, quick, and economical. The typical cytopathological features of tuberculosis TB include epithelioid cell granulomas with Langhans giant cells and caseous necrosis. The present study aimed to evaluate the cytomorphological features of newly diagnosed cases of tubercular lymphadenitis confirmed by GeneXpert. This was a retrospective study in which all fine-needle aspirates from newly diagnosed cases of tubercular lymphadenitis confirmed by GeneXpert over a 1-year period from July 2022 to July 2023 were included in the study. The May-Grunwald-Giemsa stained smears from these aspirates were categorized into three patterns-epithelioid cell granulomas with necrosis, epithelioid granulomas without necrosis, and necrosis only. The granulomas were further categorized into well-formed, ill--formed, and splintered. The background of the aspirate which included a reactive lymphoid background, lymphocytes, eosinophils, and neutrophils was tabulated for all the cases. Out of the three cytomorphological patterns, epithelioid granulomas with necrosis were the most predominant (67.5%), followed by necrosis only (20.8%) and granulomas without necrosis (11.6%). An acid-fast bacilli (AFB) positivity of 53.3% (64 cases) was seen on the Ziehl-Neelsen stain. Well-composed, poorly formed, and splintered granulomas were seen in 55 (57.9%), 42 (44.2%), and 21 (22.1%) cases, respectively. Neutrophils were the most common background population (42, 35%) followed by lymphocytes (36, 30%). Reactive lymphoid cells and eosinophils were seen in 12 (10%) and 3 (2.5%) cases, respectively. Fine-needle aspiration cytology is a rapid inexpensive minimally invasive test for tubercular lymphadenitis as epithelioid cell granulomas along with caseous necrosis are highly suggestive of TB. However, manual acid-fast AFB detection has a low sensitivity as is illustrated in the present study where only AFBwas demonstrated in only 53.3% of cases.

Diagnostic Challenge: A case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

Introduction: Breast tuberculosis is a rare form of extra pulmonary tuberculosis with its primary form considered even rarer. Case presentation: A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary breast tuberculosis, necessitating anti-tubercular therapy. Clinical discussion: Breast tuberculosis, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, Persistent symptoms despite treatment should prompt consideration of breast tuberculosis in TB endemic regions. Conclusion: Primary Breast Tuberculosis might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.

Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India.

Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, thehematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.

Utility of CBNAAT (GeneXpert MTB/RIF assay) in rapid diagnosis of extrapulmonary tuberculosis in a hepatobiliary tertiary center

Objectives Newer diagnostic techniques like cartridge-based nucleic acid amplification techniques (CB NAAT) need to be evaluated for extrapulmonary tuberculosis (EPTB), as being a paucibacillary condition, it is often underdiagnosed with conventional methods. We conducted this study to assess the utility of CB NAAT (GeneXpert MTB/RIF assay) in rapid diagnosis of extrapulmonary tuberculosis. Material and Methods Liver disease patients admitted from June 2019 to June 2020 were investigated for EPTB based on clinical and radiological suspicion. EPTB was diagnosed based on one of the following: (i) histological evidence of caseating granulomas; (ii) smear positivity for acid-fast bacilli; (iii) CB NAAT (GeneXpert MTB/RIF assay, Cepheid, USA). Results A total of 290 EPTB specimens received in the laboratory were included. The extrapulmonary samples that were received included body fluids (n = 143) which included pleural fluid, ascitic fluid, drain fluids, and pus aspirates, followed by biopsies (n = 82), lymph nodes (n = 43), urine (n = 19), and CSF (n = 3). GeneXpert MTB/RIF assay was positive in 10.3% (n = 30) samples, whereas negative in 89.7% (n = 260) samples. The overall sensitivity of GeneXpert MTB/RIF assay was 61.36% (95% CI 46.62%–74.28%), specificity 89.29% (95% CI 72.8%–96.29%), positive predictive value (PPV) 90% (95% CI 74.38%–96.54%), and negative predictive value (NPV) 59.52% (95% CI 44.49%–72.96%). Conclusion The GeneXpert MTB/RIF assay is a valuable tool for extrapulmonary tuberculosis. In addition to other tests like smear, culture GeneXpert MTB/RIF assay helps in the confirmation of diagnosis. Rapid diagnosis of tuberculosis with overall good sensitivity and specificity makes it a beneficial test.

Duration of Effective Tuberculosis Treatment, not Acid-Fast Bacilli (AFB) Smear Status, as the Determinant for Deisolation in Community Settings.

Duration of Effective Tuberculosis Treatment, not Acid-Fast Bacilli (AFB) Smear Status, as the Determinant for Deisolation in Community Settings.

Prevalence of pulmonary tuberculosis and HIV infections and risk factors associated to tuberculosis in detained persons in Antananarivo, Madagascar

The incidence rate of tuberculosis in prisons is estimated to be 8 times greater than that in the general population in Madagascar. Our objectives were to estimate the prevalence of pulmonary tuberculosis and HIV infection among prisoners and to identify risk factors associated with tuberculosis. We conducted a cross-sectional study at the central prison of Antananarivo from March to July 2021. Individual male and female inmates aged ≥ 13 years who had lived in the prison for at least three months prior to the study period were included as participants. Acid-fast bacilli detection by microscopy and/or culture, an intradermal tuberculin test, a chest X-ray, and a rapid diagnostic orientation test for HIV were performed. Among 748 participants, 4 (0.5%) were confirmed to have pulmonary tuberculosis. Overall, 14 (1.9%) patients had “confirmed” or “probable” tuberculosis [0.90–2.84, 95% CI]. The proportion of participants with latent tuberculosis infection was 69.6% (517/743) based on a positive tuberculin test without clinical symptoms or radiography images indicating tuberculosis. Out of 745 HIV screening tests, three showed reactive results (0.4%). Age (OR = 4.4, 95% CI [1.4–14.0]) and prior tuberculosis treatment (or episodes) were found to be associated with confirmed and probable tuberculosis.

A Rare Case of Tuberculous Constrictive Pericarditis Due to Disseminated Tuberculosis with Response to Anti-tuberculosis Chemotherapy and Steroids in a Developed City State

A 27-year-old man presented with a 1-week history of atypical chest pain and sinus tachycardia. His physical examination was unremarkable. His resting ECG showed sinus tachycardia with widespread T-wave inversion. His initial blood tests show mildly raised troponin T and inflammatory markers and marked raised D-dimer. A CT pulmonary angiogram was performed to exclude pulmonary embolism but incidentally revealed an anterior mediastinal mass. A transthoracic echocardiogram and cardiac MRI showed features of constrictive pericarditis. A video-assisted thoracoscopic surgical biopsy of the anterior mediastinal mass showed thymic tissue with necrotising granulomatous inflammation and an acid-fast bacilli culture was positive to tuberculosis infection. The patient was started on anti-tuberculosis chemotherapy and a 6-week tapering course of oral steroids. A repeat cardiac MRI performed after 6 weeks of treatment showed a significant response to treatment with resolution of constrictive physiology.

Detection of Mycobacterium tuberculosis using Acid-Fast Bacilli (AFB) Test among Subjects in Rivers State of Nigeria

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is a significant public health concern in Nigeria, with varying prevalence across different regions. This study aimed to assess the prevalence of MTB infection and its association with socio-demographic variables in Rivers State, Nigeria. The study involved 392 participants from three local government areas (LGAs): Eleme, Obio/Akpor, and PHALGA. The Acid Fast Bacilli test was used to detect MTB in sputum samples. Socio-demographic data, including age, sex, marital status, education, and occupation, were collected using a structured questionnaire. A stratified random sampling method was employed. Statistical analysis involved descriptive statistics, Mann-Whitney U, and Kruskal-Wallis tests. The overall prevalence of Mycobacterium tuberculosis infection was 0.8%. Analysis of socio-demographic variables revealed no significant associations with infection rates, as indicated by non-significant p-values of (p=0.266), (p=0.832), (p=0.730), (p=0.673), (p=0.925) for age, sex, education, occupation, and marital status respectively. The study challenges traditional assumptions about demographic vulnerability. This research provides critical insights into the epidemiology of TB in Rivers State. The low prevalence suggests improved healthcare access and awareness. However, larger, more representative studies with advanced diagnostic methods are recommended for a comprehensive understanding and targeted interventions for TB control in Rivers State.

Combining Artificial Intelligence and Simplified Image Processing for the Automatic Detection of Mycobacterium tuberculosis in Acid-fast Stain : A Cross-institute Training and Validation Study.

Tuberculosis (TB) poses a significant health threat in Taiwan, necessitating efficient detection methods. Traditional screening for acid-fast positive bacilli in acid-fast stain is time-consuming and prone to human error due to staining artifacts. To address this, we present an automated TB detection platform leveraging deep learning and image processing. Whole slide images from 2 hospitals were collected and processed on a high-performance system. The system utilizes an image processing technique to highlight red, rod-like regions and a modified EfficientNet model for binary classification of TB-positive regions. Our approach achieves a 97% accuracy in tile-based TB image classification, with minimal loss during the image processing step. By setting a 0.99 threshold, false positives are significantly reduced, resulting in a 94% detection rate when assisting pathologists, compared with 68% without artificial intelligence assistance. Notably, our system efficiently identifies artifacts and contaminants, addressing challenges in digital slide interpretation. Cross-hospital validation demonstrates the system's adaptability. The proposed artificial intelligence-assisted pipeline improves both detection rates and time efficiency, making it a promising tool for routine pathology work in TB detection.

Beyond Symptoms: Radiologic identification of asymptomatic Mycobacterium avium complex pulmonary infections

BackgroundAlthough international nontuberculous mycobacterial pulmonary disease (NTM-PD) guidelines highlight symptom presence at diagnosis, the clinical characteristics of asymptomatic Mycobacterium avium complex pulmonary infection (MAC-PI) patients remain understudied. We clarified the clinical characteristics and course of asymptomatic MAC-PI patients. MethodsWe retrospectively analyzed 200 consecutive patients with MAC-PIs and adequate available data who newly met the microbiological and radiological criteria for NTM-PD at Fukujuji Hospital from January 2018 to June 2020. We compared the clinical characteristics and course of asymptomatic patients with symptomatic patients and evaluated factors influencing treatment initiation through multivariate analysis. Results111 patients were symptomatic and 89 were asymptomatic at diagnosis. While the proportion was significantly lower than that in the symptomatic group (28.8 %), 15.7 % of asymptomatic group patients had cavitary lesions (P = 0.042). In the asymptomatic group, treatments were initiated in 38 (42.7 %) patients, and cavitary lesions, a positive acid-fast bacilli smear, and younger age were independent risk factors for treatment initiation. Among 22 (57.9 %) patients who experienced disease progression necessitating treatment during follow-up, 13 (34.2 %) displayed radiological progression without any worsening of symptoms. Agents used for treatment were consistent across the groups, with no significant differences in culture conversion, microbiological recurrence rates, or spontaneous culture conversion rates. ConclusionRoutine health checkups and radiological examinations can detect clinically important MAC-PIs even in the absence of symptoms. Considering that the clinical course of asymptomatic MAC-PI patients is largely similar to that of symptomatic patients, timely and appropriate management and intervention are essential for all MAC-PI patients.

Osteoarticular TB specimen yield rates. Large joint analysis at a single centre.

Tuberculosis (TB) remains endemic in South Africa. The spine, hip, and knee joints are common extra-pulmonary TB sites. Sound history taking, clinical examination, and basic laboratory and pathological tests remain key important steps in osteoarticular TB diagnosis. In our resources-stricken context cost is everything, if we can make a diagnosis cheaply that would go a long way. The diagnostic yield of standard laboratory tests compared to a real-time polymerase chain reaction (PCR) for osteoarticular TB diagnosis in a single orthopaedic unit has not been analysed. We conducted a retrospective record review of extra-spinal osteoarticular TB infection at our hospital from 01 June 2016 to 31 December 2021. Patient demographics, clinical history, and laboratory test results were analysed. A total of 34 cases were identified, with 32 of the cases being articular and two osseous involvement. The knee was the most common joint affected followed hip joint. Acid Fast Bacilli were detected in 32% of cases with microscopy, while TB culture was positive in 29% of samples. Histopathological examination and real-time PCR diagnosed TB in 66% and 63% of the cases, respectively. Our findings suggest that in the right context of a suggestive history and examination, histological analysis is as good as PCR for diagnosing osteoarticular TB.

Comparison of Individual Regimen Containing Bedaquiline with Delamanid and Bedaquiline without Delamanid on Efficacy and Safety in Multidrug-resistant Tuberculosis Patients: Implementation in Dr. Soetomo General Academic Hospital, Indonesia.

Bedaquiline is one of the core drugs used to treat multidrug-resistant TB (MDR-TB). Delamanid is one of the companion drugs in group C which is used to complete the treatment regimen when drugs in groups A and B can not be used. This study was conducted to analyze the efficacy and safety between individual regimens containing bedaquiline with delamanid and bedaquiline without delamanid. This was an observational analytic study with a retrospective design in MDR-TB patients treated with individual regimens containing bedaquiline with delamanid (bedaquiline-delamanid group) and bedaquiline without delamanid (bedaquiline group). Efficacy was measured according to the time to Acid Fast Bacilli (AFB) conversion and Mycobacterium tuberculosis culture conversion, while safety was measured specifically on QTc interval prolongation. The median (range) time to AFB conversion in bedaquiline-delamanid group was faster than bedaquiline group, although there was no significant difference (1.5 (1-4) months vs. 1 (1-6) months, P=0.429), the median time to culture conversion in bedaquiline-delamanid group also faster than bedaquiline group, although there was no significant difference (1 (1-6) months vs. 2 (1-6) months, P=0.089). The incidence of QTc interval prolongation in bedaquiline-delamanid group was less than bedaquiline group, although there was no significant difference (26.9% vs. 40.3%, P=0.223). Individual regimens containing bedaquiline with delamanid was proven to provide similar efficacy and safety profiles with individual regimens containing bedaquiline without delamanid. Delamanid should be preferred when selecting drugs to complete the treatment regimen when drugs in groups A and B can not be used.

Epididymo-orchitis with epididymal abscess in a patient with disseminated tuberculosis

Abstract Tuberculosis remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations like genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old male with left scrotal swelling, backache, and fever, highlighting the importance of considering tuberculosis in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and contrast-enhanced magnetic resonance imaging Dorso-lumbar spine, confirmed disseminated tuberculosis. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital tuberculosis, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of tuberculous epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications like hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.

Comparison of the real-time polymerase chain reaction and xpert Mycobacterium tuberculosis/rifampicin assay for the detection of Mycobacterium tuberculosis

Abstract Background A serious issue with world health is tuberculosis (TB). Annual estimates from the World Health Organization (WHO) put the number of incident cases at 9.6 million. The aim of this work was to compare between real-time polymerase chain reaction (PCR) and GeneXpert in recognition of Mycobacterium tuberculosis (MTB) with special reference to quantification of MTB and to speed of detection of the organism. Materials and Methods Thirty individuals participated in this prospective clinical quasi-interventional trial with clinical data and chest radiography suggestive of pulmonary tuberculosis. Participants were split into three groups equally: group I (control group) was zielneilsen stain (ZN) stain positive and culture positive, group II were ZN stain negative and culture positive and group III were ZN stain negative and culture negative. Each participant was exposed to a plain chest radiography and a complete blood picture. Results Real-time PCR result was significantly correlated with loss of appetite and weight in group III. There were negative correlations between PCR and mediastinal lymphadenopathy in group I. In group I GeneXpert was significantly correlated with night sweat and fever, breathlessness and cavitary lesion. In group III GeneXpert was significant correlated with site of lesion and night sweat and fever. Conclusions For TB patients, the PCR test is crucial in order to provide prompt diagnosis and therapy. When comparing AdvanSure tuberculous /non tuberculous mycobacterium (TB/NTM) real-time PCR with Xpert MTB/rifampicin (RIF) assay, the latter is more advantageous due to its test-method simplicity and quicker than real-time PCR ability to simultaneously identify rifampin resistance. However, its sensitivity for specimens with an acid-fast bacilli (AFB) smear negative but a positive culture is less than AdvanSure TB/NTM real-time PCR. With special reference to the quantification of MTB, TB/NTM real-time PCR is a quantitative test but Xpert MTB/RIF is semiquanitative.

Adjuvant surgical resection for nontuberculous mycobacterial pulmonary disease: Effectiveness and complications.

Standard antibiotic treatment for nontuberculous mycobacteria pulmonary disease (NTMPD) has unsatisfactory success rates. Pulmonary resection is considered adjunctive therapy for patients with refractory disease or severe complications, but surgical indications and extent of resection remain unclear. We present surgical treatment outcomes for NTMPD and analyzes risk factors for unfavorable outcomes. We conducted a retrospective investigation of medical records for patients diagnosed with NTMPD who underwent surgical treatment at Asan Medical Center between 2007 and 2021. We analyzed clinical data including microbiological and surgical outcomes. A total of 71 NTMPD patients underwent thoracic surgery. Negative conversion of acid-fast bacillus (AFB) culture following pulmonary resection was observed in 51 (73.9%) patients. In terms of long-term outcomes, negative conversion was sustained in 38 cases (55.1%). Mortality occurred in 7 patients who underwent pulmonary resections for NTMPD. Statistically significant associations with factors for recurrence or non-negative conversion of AFB culture were found in older age (odds ratio [OR] =1.093, 95% confidence interval [CI]: 1.029-1.161, P = 0.004), male sex (OR = 0.251, 95% CI: 0.071-0.892, P = 0.033), and extensive NTMPD lesions involving three lobes or more (OR = 5.362, 95% CI: 1.315-21.857, P = 0.019). Interstitial lung disease (OR = 13.111, 95% CI: 1.554-110.585, P = 0.018) and pneumonectomy (OR = 19.667, 95% CI: 2.017-191.797, P = 0.018) were statistically significant risk factors for postoperative mortality. Pulmonary resection can be an effective adjuvant treatment option for NTMPD patients, with post-operative antibiotic treatment as the primary treatment. Careful patient selection is crucial, considering the associated risk factors and resectability due to complications and recurrence.

Tuberculosis of the thyroid gland: A rare case report

Abstract Tuberculosis (TB) of the thyroid gland is exceedingly rare, even in regions like India, where tuberculosis is prevalent, with an estimated incidence of 0.1–0.4%. While tuberculosis can affect various organs, its involvement in the thyroid, pancreas, striated, and cardiac muscle is uncommon. Diagnosis poses a challenge due to the lack of distinctive clinical features—microscopic examination revealing epithelioid granulomas, sometimes with caseous necrosis and Langhans-type giant cells, aids in diagnosis. Confirmation typically involves detecting acid-fast bacilli through staining techniques like Ziehl Neelsen (ZN), molecular diagnostic methods such as TB Gene Expert or polymerase chain reaction for Mycobacterium tuberculosis (TB PCR), and histopathological examination of excised specimens. Recently, we encountered a case involving a 21-year-old male presenting with a 2-month history of diffuse neck swelling. Clinical examination suggested thyroid swelling, confirmed by ultrasound, showing a cystic lesion with necrotic areas, suggestive of thyroiditis, accompanied by bilateral cervical lymphadenopathy. Fine Needle Aspiration Cytology revealed necrotizing granulomatous thyroiditis, prompting further investigation for tuberculosis. TB Gene Expert and ZN staining performed on fine needle aspiration cytology (FNAC) material confirmed tuberculosis, leading to anti-tuberculous treatment, which resulted in a positive response. In presenting this case, we aim to highlight the rarity of tuberculosis affecting the thyroid gland and emphasize the importance of considering minimally invasive diagnostic methods, such as FNAC and molecular techniques, before resorting to surgical interventions. This case underscores the significance of clinicians’ awareness regarding unusual tuberculosis presentations and the availability of advanced diagnostic tools to ensure timely and appropriate management.

Mycobacterium welchii Vaccine Granuloma – A Cautionary Tale

Background: Mycobacterium welchii (Mycobacterium w) vaccine was one of the many strategies used to both treat and prevent coronavirus disease 2019 (COVID-19) infection. We report the results of a retrospective analysis of 15 cases with vaccine-site granulomas after administration of prophylactic Mycobacterium w vaccine as part of a trial for COVID-19 and our experience in managing those cases. Methods: This was a retrospective analysis of 15 patients with vaccine-site granulomas who were given the vaccine as a prophylactic measure as part of a trial with informed consent. Results: The mean average age of cases was 37 and the male-to-female ratio was 1:0.87. All of the patients developed erythematous tender nodules over the injection sites within a month of receiving the inoculations. Mycobacterial cultures and cartridge-based nucleic acid amplification tests yielded negative results. Skin biopsy revealed granulomatous dermatitis with acid-fast bacilli positivity. A diagnosis of noninfective granulomatous dermatitis was made. Treatment started with analgesics and anti-inflammatory agents. Systemic antibiotics were required in 9/15 patients. Patients are being followed up with no reported recurrence till date. Conclusion: The possibility of injection-site granuloma should be taken into the risk–benefit analysis for the administration of Mycobacterium w vaccine and the patients should be counseled as such. Patients with persistent ulceration respond to combinations of doxycycline, ofloxacin, and clarithromycin.

Osteomyelitis Tuberculosis in long bone mimicking bone malignancy: A case report

Osteomyelitis tuberculosis in developing countries is still a severe problem. Early diagnosis and treatment of osteomyelitis tuberculosis are very important because a delay in diagnosis can resemble malignancies. Osteomyelitis tuberculosis is often difficult to distinguish from a malignancy both clinically and radiologically. We present a rare case of a 10 years old boy with chief complaint was a lump around his left knee. He was treated earlier at a peripheral hospital as a malignancy process of bone, and referred to Dr. Soetomo Hospital, as a tertiary hospital, and decided to do an open biopsy in the operating room. On clinical examination was found lump and deformity with surrounding soft tissue swelling and limited ROM. On X-ray examination obtained pathological fractures and bone destruction in the distal femur with a lytic lesion on along the femur metadiaphysis without joint involvement and periosteal reaction proximally, from the examination it cannot be distinguished between osteomyelitis tuberculosis and malignancy. During the surgery, a voluminous amount of odourless pus with multiple septa surrounding the diaphysis. Pus culture and some of the tissue was taken to be examined by pathology that shows connective tissues infiltrated by inflammatory cells. Zeihl-Nielsen staining was done and obtained an image of acid-fast bacilli. Clinical and Radiological Features of osteomyelitis tuberculosis can mimic malignancy. The definitive diagnosis of tuberculosis osteomyelitis is usually made by CT-guided needle aspiration cytology and histologic examination using open biopsy. The latter has better sensitivity, especially if the acid-fast bacilli is obtained.

Faces of tuberculosis: a riveting exploration into demographics and health profiles of patients in rural Jharkhand

Background: Tuberculosis is a pressing health concern in Jharkhand, India, claiming 13,000 lives annually. This retrospective study, conducted by Tata steel foundation, delves into the health and sociodemographic profiles of TB patients in the tribal-dominated East Singhbhum district. Noteworthy findings include risk factors such as Anaemia, Diabetes compounded by challenges like limited access to health facilities. TSF's initiatives, including Nikshay Mitra and support for NTEP, are crucial components in addressing TB in the region. Methods: A retrospective study (September to November 2023) analyzed records from TSF's DOTS centre in East Singhbhum. Data from 2019-2023 were extracted and analyzed using descriptive statistics. Results: The average age of 293 patients was 37.36±14.97 years, with 83.6% belonging to Scheduled Tribes. Sputum analysis revealed a 61.4% positive rate for Acid Fast Bacillus. Notably, 85.3% completed treatment, and abnormal chest radiographs were observed in 99.3% of cases. Conclusions: The proposed way forward outlines actionable strategies to further strengthen TB awareness, focus on challenging districts, engage communities, and collaborate with government health centers. Regular research and monitoring, coupled with periodic impact assessments, will be crucial for adapting and refining interventions in alignment with the dynamic landscape of TB prevalence.