Antitubercular Treatment Research Articles

Isolated first metatarsal tubercular osteomyelitis of the foot in a boy: A case report with review of literature

Isolated tubercular lesions of the metatarsal bones are rare, with an incidence of less than 0.5%. Because of ambiguous signs and symptoms, and reasonably normal laboratory investigations, these lesions pose a diagnostic challenge and there are chances of misinterpretation of radiographic images. We present a case of tubercular osteomyelitis of the first metatarsal of right foot in a 9-year-old boy. The diagnosis was initially made using plain X-ray, which was supported by magnetic resonance imaging and confirmed by the histopathological examination of the resected samples and microbiological culture combined with polymerase chain reaction. The patient was managed with open biopsy and curettage followed by a prolonged course of anti-tubercular treatment. The patient showed complete resolution of symptoms with no sign of recurrence.

Tuberculous Pericarditis in Childhood: A Case Report and a Systematic Literature Review.

Tuberculous pericarditis (TBP) is an important cause of pericarditis worldwide while being infrequent in childhood, especially in low-TB-incidence countries. We report a case of TBP and provide a systematic review of the literature, conducted by searching PubMed, Scopus, and Cochrane to find cases of TBP in pediatric age published in the English language between the year 1990 and the time of the search. Of the 587 search results obtained, after screening and a backward citation search, 45 studies were selected to be included in this review, accounting for a total of 125 patients. The main signs and symptoms were fever, cough, weight loss, hepatomegaly, dyspnea, and increased jugular venous pressure or jugular vein turgor. A definitive diagnosis of TBP was made in 36 patients, either thanks to microbiological investigations, histological analysis, or both. First-line antitubercular treatment (ATT) was administered in nearly all cases, and 69 children underwent surgical procedures. Only six patients died, and only two died of TBP. TBP in childhood is relatively uncommon, even in high-TB-prevalence countries. Clinical manifestations, often suggestive of right-sided cardiac failure, are subtle, and diagnosis is challenging. TBP has an excellent prognosis in childhood; however, in a significant proportion of cases, invasive surgical procedures are necessary.

Tuberculous otomastoiditis: analysis of otological tuberculosis with intact tympanic membrane

In recent years extra pulmonary tuberculosis has more frequently been associated with mastoiditis in patients with immunodeficiency state. Although tuberculosis of the mastoid or otomastoiditis is a very rare complication of tuberculosis today, when occurs it may cause significant morbidity. Complications such as facial paralysis and permanent hearing loss may develop. Our purpose was to evaluate the differential findings of tuberculous otomastoiditis and evaluation of outcomes in patients undergoing surgery along with anti-tubercular therapy rather than patients receiving only anti-tubercular therapy. We reviewed 12 cases of TOM, all of which had been confirmed on sputum and pathological examination following middle ear mucosal biopsy. Neuroradiologists analyzed the typical findings of HRCT temporal bone. Tympanomastoid ear surgery was planned according to the extent of the disease involved. The soft tissue attenuation in the entire middle ear cavity and extension to the external auditory canal (EAC) or mucosal thickening of the bony EAC, erosion of the ossicles and scutum was clinically significant. Patients who underwent tympanomastoid surgery showed better prognosis than the patients receiving anti tubercular drugs alone. Patients with extra-pulmonary tuberculosis, especially otomastoiditis should get operated to remove the disease along with anti-tubercular treatment to prevent complications.

Single Sequence Whole-Spine Screening Magnetic Resonance Imaging: Diagnostic and Therapeutic Role in Multiple-Level Spinal Tuberculosis.

Spinal tuberculosis (TB) is the most common form of skeletal tuberculosis. Paradiscal continuous vertebral involvement at a single level is the most prevalent pattern among all forms of spinal TB. There is a wide range of reported incidences of multiple-level non-contiguous spinal TB in the literature. We would like to discuss on the utility of single whole spine screening T2-weighted (T2W) mid-sagittal magnetic resonance imaging (MRI) film in diagnosing multiple-level spinal TB and therapeutic benefits it can provide. We have done a retrospective review of the collected data of patients in Vardhman Mahavir Medical College and Safdarjung Hospital from August 2017 to October 2021 to find the incidence of multiple-level spinal TB and possible factors attributed to this specific disease pattern. All the patients who had been diagnosed of spinal TB either microbiologically or histopathologically or by a good clinical response to anti-tubercular treatment (ATT) and had a whole spine screening MRI film, were included. Patients of spinal TB who did not have a whole spine screening MRI were excluded from the study. Multiple-level spinal TB was diagnosed when lesions were identified in vertebral levels other than a typical paradiscal lesion, and additional lesions were separated from the primary disease by at least one normal spinal segment. Among the patients, 242 met the inclusion criteria, and 76 showed multiple-level non-contiguous spinal TB on MRI, incidence being 31.4%. The rest of the 166 patients showed typical single-segment contiguous lesions. By doing multivariate analysis to determine the independent risk factors for multiple-level spinal TB, extremes of age (<20 years and >50 years) have been found to be a significant factor with p value of 0.0001. Though drug resistance was not found to be a significant risk factor (p value 0.051), the proportion of patients having multiple-level TB was far more in the drug-resistant group (13/76). Single sequence whole spine screening MRI film is an effective, economical, and time-saving tool to detect multiple-level spinal TB. Along with its diagnostic accuracy, it also provides therapeutic benefits like access to a more approachable site for biopsy.

A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis

Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value&lt;0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.

A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis

Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value&lt;0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.

VITAMIN C AS AN ADD ON SUPPLEMENTATION TO STANDARD ANTITUBERCULAR TREATMENT IMPROVES SPUTUM SMEAR CONVERSION IN NEWLY DIAGNOSED DRUG SENSITIVE PULMONARY TUBERCULOSIS PATIENTS

Objective: This study was aimed to evaluate the effect of oral supplementation of Vitamin C along with standard anti-tubercular (anti-TB) drugs on the sputum smear conversion in newly diagnosed pulmonary tuberculosis (TB) patients. Methods: This was a prospective, observational study in which 49 newly diagnosed pulmonary TB patients were given oral vitamin C supplementation along with standard anti-TB treatment during the intensive phase (2 months) of the treatment. An examination of the sputum smear at the end of the intensive phase of anti-tubercular treatment was done. At the end of the intensive phase, a comparison was done between the results of the sputum smear examination of the study population and the TB patients of the general population from the same locality who were receiving only standard anti-TB treatment and not add on Vitamin C supplementation. Results: The comparison between the results of the study population (sputum conversion–100%) with those of the general population (sputum conversion–92.47%) shows a significant difference between both populations with p&lt;0.05 (p=0.041). Conclusion: This study showed that Vitamin C supplementation as an add-on therapy to the existing standard anti-TB treatment improves sputum smear conversion and decreases disease activity to a greater extent than routine standard anti-TB treatment alone.

QuantiFERON Gold-In-Tube for the diagnosis of mycobacterial tuberculosis infection in children under 5 years of age: A systematic review and meta-analysis.

Previous meta-analysis regarding the performance of QuantiFERON Gold-In-Tube in children have yielded contrasting results. Emerging data in children younger than 5 years of age necessitates a new analysis. Systematic searches were conducted of MedLINE, EMBASE and Cochrane databases between 1998-2023. Pooled estimates of sensitivities and specificities of QFT-GIT compared to tuberculin skin test (TST) were calculated. The Kappa (k) coefficient was calculated for each study to determine the degree of congruence between TST and QFT-GIT results. Studies including patients co-infected with HIV or other immune compromising conditions or those treated with anti-tubercular treatment were excluded. Seventeen studies (4335 patients) were included in quantitative analysis. All studies were conducted in middle to high income countries. They were conducted across 14 countries and 4 studies in countries with high TB incidence. The pooled sensitivity, specificity and DOR were 0.45 (0.42-0.48), 0.96 (0.96-0.97) and 18.84 (7.33-48.41) respectively. The ability of QFT-GIT to discriminate with disease and no disease was "good" as demonstrated by a summary receiver operating characteristic curve with area under curve of 0.7812. The average Kappa (k) co-efficient was 0.501 with a wide variety of values between studies (0.167 to 0.800). The findings of this meta-analysis support the judicious use of QFT-GIT in children 5 years and under, with caution as a sole test to exclude Tuberculosis in this age group. The heterogeneity and methodological quality of diagnostic studies limits the generalisability of results.

Effect of Intensive Phase Anti-tubercular Treatment on Hematological Parameters in Pulmonary Tuberculosis in Children

Aim and objectives: To study the effect of intensive phase ATI on various hematological parameters in pulmonary TB in children. Material and methods: Study design: Prospective observational study. Children were chosen at random from children who were identified and diagnosed at the Dr. Ram Manohar Lohia Hospital in New Delhi's Atal Bihari Vajpayee Institute of Medical Sciences using a straightforward sampling technique. Every patient is diagnosed with pulmonary tuberculosis based on RNTCP standards. The research was conducted from November 2019 to March 2021 (one year four months). Results: Hemoglobin count (t-value -2.914), Red Blood Cells (t-value -4.338), Platelet Count (t-value -4.762), Lymphocytes (t-value -4.472), Monocyte (t-value 5.991),ESR count (t-value 5.118), Packed Cell Volume (t-value -4.228), Mean Corpuscular Volume (t-value -3.418), Platelet Large Cell Ratio (t-value -4.254), C-reactive count (t-value 3.131), Ferritin (t-value 4.747), X-ray (t-value 5.213) significant at &lt;0.05 level respectively. Conclusion: The various parameters used in the study as the inflammatory process have an extremely important part in the TB pathogenesis. These parameters can be used as markers can be used for prognosis, response to treatment, and follow-up purposes. It can increase the predicting accuracy of treatment outcomes as ones can monitor the TB cases objectively in addition to subjective parameters (improvement in clinical symptoms and examination findings, weight gain, Increase in appetite). Anti-tuberculosis Drug Treatment (ATT) is highly successful in enhancing hematological parameters, which suggests that responders' immune responses have improved in an indirect manner.

A Case Series of Bile Cast Nephropathy-induced Rapidly Progressive Renal Failure

Abstract A 45-year-old male presented to the hospital with symptoms of left inguinal swelling, which showed granulomatous adenitis on fine-needle aspiration cytology. He was diagnosed with tuberculous adenitis, for which he was started on antitubercular treatment. After 15 days of antitubercular treatment, the patient developed deranged renal parameters, with serum creatinine of 8.8 mg/dL while serum bilirubin rose to 7.4 mg/dL. The patient was oliguric and underwent four sessions of hemodialysis. Following this, a renal biopsy was done, which showed normal glomeruli with tubular casts that were pigmented, consistent with acute tubular injury secondary to bile cast nephropathy. The patient’s condition improved with one more session of hemodialysis and conservative management. Serum creatinine declined to 1.2 mg/dL, at the time of discharge, with normal urine output. This case illustrates features of bile cast nephropathy presenting as rapidly progressive renal failure secondary to antitubercular treatment.

Assessment of antitubercular treatment induced adverse drug reactions data at a tertiary care hospital

Background: Standard anti-tuberculosis (TB) treatment is highly effective, but managing adverse drug responses is a major challenge that can negatively affect treatment compliance and outcomes of an anti-tubercular treatment (ATT) regimen. Hence, monitoring of these adverse drug reactions (ADRs) is very essential wherein the drug-causing ADR can be detected and an appropriate therapeutic regimen can be given to the patient. Aims and Objectives: To assess the ATT-induced ADRs in Individual Case Safety Reports (ICSRs), to find the incidence and prevalence of ADRs due to ATT, and to analyze the causality assessment of the ADRs due to ATT. Materials and Methods: A retrospective observational study was carried out using spontaneous ICSRs data from the ADR monitoring centre at Madras Medical College, Chennai. A suspected adverse drug reaction reporting form (sADR reporting form) provided by the Pharmacovigilance Programme of India was used to collect the data of an ICSR. Results: A total of 93 ICSRs were assessed during the study period. The majority of the ADRs occurred in males (n = 55), and the maximum number of ADRs were found in the age group of 18–44 years (n = 46). The majority of the ICSRs were categorized as “serious” (n = 60), of which the maximum number of ADRs belonged to the “hospitalization/prolonged hospital stay” category (n = 45). Most of the suspected ATT drugs involved in implicating ADRs were found to be fixed-dose combination pills of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (n = 71). Most of the ADRs were “skin and subcutaneous disorders” (n = 51) of the system organ class. The outcome of the ADRs was assessed and found that the majority of them were in the “recovering” (n = 54) category, and the majority of the ICSRs were found to be “probable” (n = 67). Conclusion: An effective implementation of a Pharmacovigilance system with early detection and management of ADRs is needed to overcome the nonadherence to TB therapy.

Role of anti-tubercular treatment in vitro fertilization (IVF)

ObjectiveTo evaluate the role of anti-tubercular treatment (ATT) in vitro fertilization (IVF). DesignRetrospective analysis. MethodsA retrospective study was performed in 45 women suffering from infertility with a diagnosis of thin endometrium, history of repeated IVF failure, recurrent miscarriages or hysteroscopic or laparoscopic adhesiolysis in 4 years duration. Based on composite reference standard (CRS), in all females, Akt 4 Kit (combination of four medicines – Isoniazid 300 mg, rifampicin 450 mg, ethambutol 800 mg and pyrazinamide 750 mg) was started for 2 months with supportive medicines followed by AKT 2 (combination of two medicines – Isoniazid 300 mg and rifampicin 450 mg) for 4 months. Fertility treatment was started after 2 months of Akt 4 medication. In all cases, frozen embryo transfer was planned with tab estradiol valerate 6–8 mg in divided doses followed by endometrial thickness scanning. In all cases, embryo transfer was planned when endometrial thickness >8 mm in transvaginal scanning. The efficacy of ATT in above cases was evaluated by assessing the endometrium thickness before embryo transfer, pregnancy rates and clinical pregnancy rates. ResultsThere was no significant difference regarding demographic variables, egg reserve, sperm parameters, number of embryos transferred and embryo quality in all cases. Out of 45 cases, the pregnancy was positive in 31 cases (Pregnancy rate – 68.8 %). The clinical pregnancy rate was 64.4 % (29/45). ConclusionThere is a significant role of anti-tubercular treatment (ATT) in infertility in case of thin endometrium not responsive to medications, repeated IVF failure, recurrent miscarriages or hysteroscopic or laparoscopic adhesiolysis. It improved the endometrial thickness, pregnancy rate and the clinical pregnancy rate in IVF. But further studies are needed with large sample size to collaborate our findings.

Extrapulmonary Tuberculosis in Otorhinolar¬yngology: A Case Series Describing the Challenges in their Management

Background: In Otorhinolaryngology, tuberculosis (TB) though uncommon is not a rare clinical problem. HIV-TB co-infection, multidrug resistant tuberculosis (MDR TB), and Extrapulmonary tuberculosis (EPTB) continue to be major public health threats. The success of the WHO, “END TB” strategy requires their effective management. In this article we look into the challenges while dealing with cases of EPTB in otorhinolaryngology. Case Series: The clinical presentations &amp; epidemiology of patients with extra pulmonary tuberculosis in otorhinolaryngology highlight the challenges in their management. Patients with laryngeal TB and TB of oral cavity and oropharynx are cases where the diagnosis can be easily delayed owing to lack of awareness and the need to exclude the other commoner lesions. The early diagnosis can be challenging with symptoms that mimic malignancy with subsequent hurdle being obtaining the histopathology report and confirmation of diagnosis. As elimination of this disease is the target which needs to be met there is need to ascertain features that will help accomplish the goal. Discussion: Laryngeal tuberculosis is an area that demands high index of suspicion with technical expertise in obtaining positive yield on histopathology which can at times be challenging. Dysphagia is a symptom where the diagnosis of tuberculosis in our patient came as a surprise rather than the norm which required the histopathological report to retrospectively think on the likely pathology. Conclusion: Extrapulmonary tuberculosis in otorhinolaryngology can have varied and atypical presentations responsible for delay in diagnosis. Awareness of this entity especially when the clinical signs are out of proportion to the symptoms among patients presenting to ENT OPD and emergency is necessary for prompt treatment. The features of carcinoma co-existing and confusing the diagnosis; along with paucibacillary nature of the specimens resulting in negative cultures makes histopathological examination mandatory, which is one among the challenges to be addressed for early diagnosis of EPTB cases in ENT. The timely initiation of anti tubercular treatment (ATT) can help avoid unnecessary surgery and morbidity

Mutational analysis in drug resistant Mycobacterium tuberculosis in Western Uttar Pradesh

BackgroundMulti-drug resistant tuberculosis (MDR-TB) results in treatment failure and poor clinical outcomes. This study was carried out with the aim to determine the pattern of drug resistance against Mycobacterium tuberculosis towards first line ATT (anti-tubercular treatment) in sputum smear–positive patients using Line Probe Assay (LPA). MethodsA cross sectional prospective study was carried out in a tertiary care Hospital of Meerut. A total of 898 sputum samples (on spot and early morning) collected from 449 suspected pulmonary tuberculosis patients as per RNTCP guidelines were screened by microscopy. Decontamination was done by N-acetyl-l-cysteine and sodium hydroxide. Then smear positive samples were subjected to 1st line drug susceptibility testing (DST) using LPA GenoType® MTBDRplus (HAIN Life Science) assay, a molecular method which allows rapid detection of Rifampicin (Rif) and Isoniazid (INH) resistance. ResultsThe overall burden of MDR TB in this geographical area was 7.9 %. Mono-resistance with Rif alone was around 2.8 %. However, the mono-resistance with INH (inhA gene) and INH (katG gene) was 2.8 % and 1.1 % respectively. Drug resistance of Rif was due to mutations in rpoB gene while resistances to INH were more commonly due to mutation in inhA gene followed by katG gene. TB was more commonly seen in the age group of 30–59 years (43.8 %) and predominantly in males. ConclusionTuberculosis positivity rate is high in Western Uttar Pradesh. Burden of MDR TB in Western Uttar Pradesh was similar to National data. Line probe assay can be used as a primary method to diagnose multi drug resistant TB as done in present study which can help in earlier initiation of correct therapy.

Foreign Body Causing Diagnostic Dilemma in Koch’s Abdomen Patient Presenting with Acute Intestinal Obstruction: A Case Report

The ileocaecal region is the most commonly affected region in Koch’s abdomen; however, it can involve any part of the Gastrointestinal Tract (GIT). Patients usually present late with either features of acute or subacute intestinal obstruction or with features of perforation peritonitis. Early diagnosis of abdominal Tuberculosis (TB) is still challenging due to the vague and non specific symptomatology of the disease. Hereby, the authors present a case report of 11-year-old boy who was on Antitubercular Treatment (ATT) for suspected abdominal TB, presented with features of subacute intestinal obstruction which subsequently had to be operated for acute obstruction. However, the cause of obstruction was not due to the complications of abdominal TB but due to the mechanical obstruction caused by the seeds of bayberry, which got obstructed in the relatively narrowed part of the ileocaecal region due to thickening of the bowel wall. No similar case reports have been found in the literature earlier. Hence, the present case is being reported.

Bilateral choroidal neovascular membrane in multifocal serpiginoid choroiditis in young children - Case report of two patients with swept-source optical coherence tomography angiography correlation

We present two cases of bilateral multifocal serpiginoid choroiditis (MSC) in young children with latent tuberculosis infection. Vitritis was seen in both cases. Multiple recurrences were noticed over regular follow-up visits. Anti-tubercular treatment was advised along with oral corticosteroids and immunomodulatory drugs for better remission. Swept-source optical coherence tomography angiography (SS-OCTA), used for monitoring disease activity, showed the development of bilateral choroidal neovascular membrane in both cases due to long-standing choroidal inflammation. Intravitreal anti-VEGF was administered for the regression of the neovascular membrane. MSC in the younger age group is a rare occurrence. This case highlights the importance of SS-OCTA and regular follow-up.

Gastric Tuberculosis Accompanied by Cutaneous Fistula: A Case Report

Gastric Tuberculosis (TB) is a rare presentation. Posterior gastric perforation with tuberculosis complications is extremely unusual. The authors herewith present a case of a 32-year-old male, with complaints of fever for two months and discharge from the left-side of the back for 15 days, through which ingested food particles were drained. The patient was a known case of Type 2 Diabetes Mellitus (T2DM) and was recently diagnosed with pulmonary TB. He was evaluated with an upper Gastrointestinal (GI) endoscopic biopsy, Contrast-enhanced Computed Tomography (CECT), and Gastrografin (GGF) studies to confirm the diagnosis. He presumably developed gastric ulceration with posterior perforation, tracking through the retroperitoneum and presenting as a subcostal abscess that was inadvertently incised and converted into a fistula. He was treated both medically and surgically. He recovered completely and discharged with full course of Antitubercular Treatment (ATT) drugs and didactic medications. The presence of a cutaneous fistula in association with gastric TB underscores the diverse clinical presentations of this infectious disease, emphasising the importance of early detection and tailored management approaches.

Recurrent Pneumonia in a Child: Identifying an Underlying Pulmonary Sequestration

Abstract Background: Pulmonary sequestration is a rare foregut abnormality, accounting for a small percentage of lung malformations, with intralobar type being more common than extralobar. Clinical Description: A 10-year-old girl presented with recurring symptoms of breathlessness, cough, chest pain, and intermittent fever since 6 months of age. Earlier, she had been hospitalized four times in the past, and even received antitubercular treatment, but without any relief. Evaluation at our hospital revealed a cystic mass in the left lower lung with anomalous feeding vessels, leading to a diagnosis of pulmonary sequestration. Management and Outcomes: Surgical correction in the form of lobar resection and ligation of the feeding vessels was done. The patient’s symptoms significantly improved postoperatively, and there were no complications or recurrence during follow-up. Conclusion: Pulmonary sequestration is a rare abnormality. Misdiagnosis as a common respiratory infection can delay appropriate management. Surgical treatment through lobar resection can dramatically alleviate symptoms.

Assessment of Factors Associated With Anti-Tubercular Treatment Compliance in Children: A Cross-Sectional Study.

Objective. This study aims to investigate compliance and the influencing factors related to pediatric tuberculosis patients who are undergoing treatment with anti-tuberculosis drugs in the Sichuan Province of China. Methods. A questionnaire survey was conducted between March 2019 and March 2021. The survey was distributed to caregivers of children aged 0 to 14 who had been diagnosed with pulmonary tuberculosis. These children had been receiving oral anti-tuberculosis drug treatment for more than 1 month. The survey was administered at the pediatric infection departments of West China Second University Hospital, Sichuan University, and The First People's Hospital of Ganzi Prefecture. Results. The study revealed a notable lack of medication adherence among the pediatric patients. Through multiple linear regression analysis, it was determined that several factors played a role in influencing medication adherence among children with tuberculosis. These factors include the educational level of the parents, the frequency of daily anti-tuberculosis drug prescriptions, and the parents' comprehension of the disease. All of these factors showed statistically significant influence on medication adherence among pediatric tuberculosis patients (all P < .05). Conclusion. In order to enhance adherence among pediatric patients undergoing anti-tuberculosis treatment, it is imperative to focus on reinforcing health education, particularly for parents with lower educational attainment and limited understanding of the disease.

Antitubercular treatment-induced chronic progressive sensory-motor polyneuropathy with optic neuropathy

Polyneuropathy is a major complication in tuberculosis (TB) patients associated with various causes, including comorbid conditions and antitubercular medications, particularly involving drugs such as isoniazid (INH) and ethambutol. INH interferes with pyridoxine synthesis, leading to sensory peripheral neuropathy, and presents with symptoms such as tingling, burning, numbness, and difficulty in walking. Ethambutol, on the other hand, is associated with optic neuropathy, presenting as bilateral and symmetrical visual field abnormalities. We report a case of a 39-year-old male with TB undergoing antitubercular treatment for 4 months, experiencing weakness in all four limbs and blurred vision. The patient developed chronic progressive sensory-motor polyneuropathy with optic neuropathy. Prevention strategies, routine screening, and prompt management are crucial in mitigating the impact of this condition. The article emphasizes the importance of early identification, withdrawal of offending agents, and management strategies, such as vitamin supplementation and physical therapy, to prevent permanent disability.