Evidence Of Pulmonary Tuberculosis Research Articles

Intracranial tuberculomas: review of MRI findings and clinical features

To present a comprehensive analysis of the clinical features and magnetic resonance imaging (MRI) findings of intracranial tuberculomas in Indonesia. This was a retrospective analysis of brain MRI from 58 patients (29 women), mean age±SD=39±2 years, diagnosed with intracranial tuberculomas. Clinical data, including symptoms, cerebrospinal fluid examination results, and MRI were also analysed. The diagnosis of intracranial tuberculoma was confirmed based on observed MRI changes following anti-tuberculosis therapy. A total of 603 tuberculomas were fully detected via MRI in all patients. Among these lesions, 507 (84%) were located in the cerebrum, 61 (10%) in the cerebellum, 19 (3%) in the basal ganglia, 12 (2%) in the brain stem, and four (1%) in the thalamus. The MRI signals were classified into two groups: tuberculomas with caseating granulomas and tuberculomas with non-caseating granulomas. Among the patients, 29 had concomitant meningitis, seven had hydrocephalus, and four had cerebral infarction. Evidence of pulmonary tuberculosis was found in 16 patients, with one patient having coexisting thoracic vertebral tuberculosis. The present study confirmed the significance of MRI as a valuable tool in the diagnosis of intracranial tuberculomas and the detection of associated abnormalities. The combination of MRI findings with clinical features can enhance the overall diagnostic accuracy for intracranial tuberculomas.

Gastric outlet obstruction secondary to peptic ulcer disease in a case of abdominal Koch’s

Gastroduodenal tuberculosis (TB) presenting as gastric outlet obstruction is rare and often misdiagnosed, it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. Gastro-duodenal involvement is rarer disease (1%) in abdominal TB. We report a case of a 43-year-old male with no evidence of pulmonary tuberculosis and retroviral infection with complaints of abdominal pain since 4 months and features of gastric outlet obstruction, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP) were suggestive of pneumobilia, and on endoscopy bilioenteric fistula was confirmed also features of pan gastritis and duodenitis with concentric wall thickening noted at D1 and D2, although histological examination of biopsies showed no evidence of malignancy or tuberculosis. The diagnosis was established after surgery, when a specimen of an enlarged lymph node was sent for histopathological examination (HPE) and GeneXpert showed the presence of giant cells and caseating granuloma. The surgery performed was Roux-en-Y gastrojejunostomy. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement. To the best of our knowledge this has been the first case reported as gastric outlet obstruction with bilioenteric fistula due to gastroduodenal tuberculosis.

A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

PREVALENCE OF INTESTINAL TUBERCULOSIS IN CASES OF ACUTE ABDOMEN AT VMMC & SAFDARJUNG HOSPITAL, NEW DELHI

Objective: To determine the prevalence of Intestinal Tuberculosis in cases of Acute abdomen. Design & Duration: A randomized prospective study from August 2019 to July 2020. Setting: Department of Surgery, VMMC & Safdarjung Hospital, New Delhi. Patients: A total number of 200 patients with Acute Abdomen, who presented as intestinal obstruction or peritonitis. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed proforma, compiled and analyzed. Results: Among the 200 patients with acute abdomen, 32 (16%) had Intestinal Tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 15 to 65 years; majority (75%) were in the age group of 20 to 40 years. Male to female ratio was 1:0.45. Twelve (37.5%) patients had evidence of Pulmonary Tuberculosis as well on X-ray chest. The commonest operative findings were hyperplastic ileocaecal tuberculosis (34.3%), followed by strictures (25%), and perforations (25%). The overall mortality in cases of acute abdomen was 6% and among tubercular patients 9.3%. Conclusion: Intestinal Tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications.

Late prosthetic valve endocarditis with Mycobacterium tuberculosis after the Bentall procedure

BackgroundProsthetic valve endocarditis (PVE) is a rare but severe complication of valve replacement surgery, with an incidence rate of 0.3–1.2% per patient-year. At present, staphylococci are the predominant causative microorganism of PVE. Herein, we report a confirmed case of late PVE in a mechanical aortic valve caused by Mycobacterium tuberculosis.Case presentationA 32-year-old immunocompetent man with recurrent fever and 5-kg weight loss had a history of having undergone the Bentall procedure due to congenital heart disease. Nine years after the operation, he developed a paravalvular abscess in the mechanical aortic valve, presented with evidence of pulmonary tuberculosis on CT scan and was diagnosed with tuberculous endocarditis. This case report highlights a rare and non-negligible example of tuberculous endocarditis involving a mechanical valve.ConclusionsTuberculous PVE should be considered in patients with a history of valve replacement, recurrent fever, unexplained weight loss, pulmonary tuberculosis and meaningful valvular findings on echocardiogram.

Primary Laryngeal Tuberculosis: A Series of 15 Cases.

Tuberculosis usually involves the lungs, but can also involve various other organs. Extra pulmonary tuberculosis is very rarely confined to the larynx in the absence of an associated pulmonary lesion. In this retrospective study, clinicopathological characteristics of patients with final diagnosis of laryngeal tuberculosis (LTB) were reviewed. The diagnosis of LTB was based on: (1) the existence of chronic granulomatous inflammation with caseous necrosis in the histopathology of laryngeal lesions or (2) the presence of laryngeal lesions with atypical histopathology (chronic granulomatous inflammation) which had a complete response to anti-tuberculosis therapy. Fifteen cases with a diagnosis of LTB were collected. The patients' age ranged between 24 and 75years with a mean of 49years. On laryngoscopy, 66.6% of cases (10/15) had an ulceroproliferative lesion while the remaining 33.3% of cases (5/15) had an exophytic growth. The pathology of laryngeal lesions revealed chronic granulomatous inflammation with caseous necrosis in nine cases and chronic granulomatous inflammation without necrosis in six cases. Nine out of 15 cases (60%) showed presence of acid-fast bacilli on Ziehl-Neelsen stain. Any evidence of pulmonary tuberculosis was ruled out by chest X-ray findings. The response to anti-tuberculosis therapy was desirable in all patients. Since the introduction of anti-tuberculous therapy, the incidence of LTB has declined. However, with the incidence of TB increasing, the overall incidence of laryngeal involvement may be on the rise. This study highlights the importance to consider the rare possibility of LTB in the presence of non-specific clinical and laryngoscopic signs and to confirm this by histological examination.

Primary nasal tuberculosis with lacrimal drainage involvement

Abstract Primary tuberculosis of the nasolacrimal system is a rare entity. We report two cases of nasal tuberculosis from an endemic area who presented with epiphora as the only symptom. Both cases had no nasal symptoms, no cervical lymph nodes involvement and no evidence of pulmonary tuberculosis. Histopathology of biopsy from nasal mucosa in both cases was consistent with tuberculosis. Tuberculin test and Quantiferon TB-Gold test were positive. The patients were treated with anti tubercular therapy along with endoscopic dacryocystorhinostomy. At three months post-operative follow up epiphora resolved and patients were asymptomatic.

Normalization of mediastinal widening after successful treatment of mediastinal tuberculosis

Clinical image of an asymmetrical mediastinal widening due to tuberculosis of mediastinal lymph nodes, without evidence of pulmonary tuberculosis. Image at first presentation and after successful treatment, showing normalization of the mediastinum.

A CASE OF DISSEMINATED TUBERCULOSIS WITH OCULAR INVOLVEMENT

AbstractDisseminated Tuberculosis (DTB) refers to tubercular involvement of two or more non-contiguous sites and is commonly associated with immunocompromised state. It is an unusual presentation of Tuberculosis (TB), especially in the absence of immunodeficiency. 1.4% of patients with Pulmonary Tuberculosis (PTB) develop ocular manifestations but many patients with ocular TB have no evidence of PTB. Tuberculosis can cause a wide variety of ophthalmic findings, ranging from the ocular surface through the optic nerve and to the central nervous system. In this article, we report a case of Disseminated Tuberculosis with ocular involvement in a 5years old female. Our case is unique for the presence of bilateral squint, unilateral nebular type of corneal opacity, bilateral iritis with posterior synechiae and cataract at the same time. It lays emphasis on the fact that a patient with tuberculosis should be screened for multiple foci.

Primary Tuberculosis of Tonsil in a Diabetic Patient—A Case Report

Though Tuberculosis is one of the most common causes of ill health and death worldwide, people with diabetes have 2 - 3 times higher risk of tuberculosis when compared with people without diabetes. Though tuberculosis can affect any part of the body, oral and oropharyngeal tuberculosis is rare, but reported. And it’s association with diabetes mellitus because of the decreased host mechanism, is still rare, but reported. A 50-year-old female diabetic who was on insulin therapy came to OPD of MGM hospital, Kakatiya Medical College, Warangal with complaints of severe pain in throat for the last 6 months. On examination, right tonsil was enlarged with granular surface. Left tonsil and rest of the oropharynx were normal. Examination of chest was normal and there was no evidence of pulmonary tuberculosis. Punch biopsy revealed tuberculosis of tonsil. Isolated cases of primary tuberculosis of tonsil without evidence of pulmonary tuberculosis are rare. Presence of diabetes mellitus makes patients 2 - 3 times more vulnerable for tubercular infection.

Intraperitoneal tuberculous abscess: Computed tomography features.

To evaluate the computed tomography (CT) features of intraperitoneal tuberculous abscess (IPTA). Eight patients with IPTA confirmed by pathology were analyzed retrospectively. The clinical symptoms, medical images, and surgical findings were evaluated. Involvement of the intestine, peritoneum, viscera, and lymph nodes was also assessed. All 8 patients had a history of abdominal discomfort for 1 to 6 mo. Physical examination revealed a palpable abdominal mass in 6 patients. Three patients had no evidence of pulmonary tuberculosis (TB). All IPTAs (11 abscesses) were seen as a multiseptated, peripherally enhanced, hypodense mass with enlarged, rim-enhanced lymph nodes. The largest abscess diameter ranged from 4.5 cm to 12.2 cm. CT showed 2 types of IPTA: Lymph node fusion and encapsulation. Of the 8 patients, one had liver tuberculosis and one had splenic and ovarian tuberculosis. Two cases showed involvement of the terminal ileum and ileocecal junction. Ascites were found in 4 cases. Three patients had peritonitis and mesenteritis. Three patients showed involvement of the omentum. Three patients had histological evidence of caseating granuloma, and 5 had histological evidence of acid-fast bacilli. CT is crucial in the detection and characterization of IPTA. Certain CT findings are necessary for correct diagnosis.

Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

Primary intestinal tuberculosis is unusual in North American, European and Caribbean countries. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. There is no reported case of ileal tubercular ulcer perforation from the Caribbean. We present a 59 year old HIV negative patient presented with peritonitis with solitary perforation of terminal ileum. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation and culture grew acid fast bacilli. A subsequent Manteaux test was strongly positive. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and it is now over one year, the symptoms have not recurs back again.

Primary hepatic tuberculosis in an immuno-competent lady masquerading as hepatic neoplasm

We report a 38 year old non-diabetic, immune-competent lady who presented with fever, anorexia, weight loss and right upper quadrant abdominal pain and was found to have multiple hepatic space-occupying lesions on Contrast enhanced Computed Tomography scan of abdomen in absence of any intra-abdominal lymphadenopathy or ascites. Demonstration of epithelioid cell granulomas and culture of the aspirate confirmed its tuberculous etiology thus ruling out any neoplastic pathology. There was no evidence of pulmonary tuberculosis. Patient responded excellently to antitubercular drugs with radiological resolution of the lesions. Despite the rarity of this condition, primary hepatic tuberculosis should be considered among the differential diagnoses of space-occupying lesions of the liver.

Tuberculous parotid Lymphadenitis in a HIV positive patient: A case report

Tuberculosis is a chronic, granulomatous disease. Primary lesion usually occurs in the lung. Extra pulmonary infection commonly involves head, neck and the abdomen. In an attempt to highlight an uncommon presentation, we document a case of extra pulmonary tuberculosis in the parotid gland (tuberculous parotitis), without evidence of pulmonary tuberculosis. A 15 year old HIV positive female patient was reported with chief complaint of repeated history of loose stools, vomiting, and swelling in the left parotid region and difficulty in opening of the mouth. She was diagnosed to be having tuberculosis of parotid gland after Ultrasonography (USG), fine needle aspiration cytology (FNAC), histopathological examination and was treated medically.

Gastric Tuberculosis with Outlet Obstruction: A Case Report Presenting with a Mass Lesion

Tuberculosis is a major health problem worldwide. In India, it is highly endemic. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocecal region being the commonest site. Gastric tuberculosis is rare and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report a case of gastric tuberculosis presenting as gastric outlet obstruction in an immunocompetent patient without evidence of pulmonary tuberculosis. Biopsy and PCR confirmed the diagnosis, and the patient responded well to standard antitubercular treatment. Though, gastric tuberculosis is rare, it should be considered as a possibility when patients present with gastric outlet obstruction, particularly in endemic areas with tuberculosis.

Immune responses in the lungs of patients with tuberculous pleural effusion without pulmonary tuberculosis

BackgroundTuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. Because most studies of TPE focused on the pleural space, little information regarding lung parenchyma is available. We therefore aimed to investigate immune responses in the lung parenchyma of TPE patients without pulmonary tuberculosis.MethodsPatients with any evidence of pulmonary tuberculosis, either from radiologic or bacteriologic evaluation, were excluded. Bronchoalveolar lavage fluid (BALF) was collected from 10 newly diagnosed, untreated, HIV-negative TPE patients and 10 healthy controls. We analyzed T-lymphocyte subpopulations and measured 10 cytokines in BALF. Cytokine levels in BALF were standardised using urea.ResultsThe concentrations of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and the CD4+/CD8+ ratio of T-lymphocytes were significantly higher in TPE patients without pulmonary tuberculosis than in the controls. Of the cytokines measured in BALF, VEGF showed the highest concentration. No difference was observed in T-helper type 2 cytokines between the 2 groups.ConclusionThere were significant immune responses and increases in IFN-γ, TNF-α, and VEGF in the lung parenchyma of TPE patients without pulmonary tuberculosis. This result suggests that TPE may induce a significant immune response in lung parenchyma.

Tuberculosis of the Foot and Ankle in Children

To report manifestations and management of tuberculosis of the foot and ankle in 21 children. Records of 12 girls and 9 boys aged 3 to 14 (mean, 7) years with tuberculosis of the foot and ankle were reviewed. The mean delay in presentation was 4.7 (range, 0.5-14) months. All the patients had local swelling, tenderness, and antalgic gait; 16 were limping; 5 had an antecedent trauma; 11 had an abscess; and 6 had a discharging sinus. The diagnosis was based on a smear positive for acid-fast bacilli (n=2), histopathology (n=15), or clinicoradiological findings (n=4). Nine patients had osteoarticular tuberculosis in other parts of the body. None had evidence of pulmonary tuberculosis. Lesions were classified into synovial (articular) and osseous. All 3 synovial lesions occurred in the ankle, 2 of which were at an advanced stage. Osseous lesions occurred in the calcaneus (n=5), metatarsal (n=5), talus (n=3), cuboid (n=3), medial cuneiform (n=1), and phalanx (n=1), and were sub-classified into stages 1 (n=3), 2 (n=5), and 3 (n=10) according to disease progression. All the patients were treated conservatively with splintage and chemotherapy. The mean follow-up period was 21 (range, 7-51) months. All the 3 patients with stage 1 osseous lesions showed healing within 6 weeks and had complete recovery of function. Four of the 5 patients with stage 2 lesions also showed complete recovery of function and reformation of bony trabeculations; radiological incorporation of sequestrum was obvious by 6 months in most patients. In patients with stage 3 lesions, healing was delayed and there was residual alteration in bony architecture and joint changes. Sclerotic changes and joint involvement also increased the likelihood of poor outcomes. However, none of our patients had any residual tenderness or foot deformity at the final follow-up. Outcome after non-operative treatment is good, provided the lesions are treated early.

Abdominal lymphadenopathy in children with tuberculosis presenting with respiratory symptoms

Diagnosis of pulmonary tuberculosis (PTB) in children is challenging and radiographs are often normal or non-specific. Access to the chest using ultrasound is difficult, but access to the abdomen is simple and carries no radiation burden. Diagnosis of PTB using abdominal lymphadenopathy as a surrogate for mediastinal lymphadenopathy may present a simple and accurate additional diagnostic technique that is of value in developing countries. We determined the prevalence of abdominal lymphadenopathy in paediatric patients with confirmed TB presenting with respiratory symptoms. Chest radiographs and abdominal ultrasounds of 47 children with confirmed TB and respiratory symptoms were reviewed. The prevalence of abdominal TB was determined and comparisons made between thoracic and abdominal lymphadenopathy to determine the relative value of ultrasound. On ultrasound, the prevalence of abdominal lymphadenopathy was 19% and solid organ involvement was found in 23% of patients. Some 70% of children had thoracic lymphadenopathy on chest radiography, with 89% of patients having evidence of PTB. If chest radiography were to be considered the radiological reference standard, abdominal ultrasonography had a sensitivity of 18% (95% CI 7.0–35.5%) with a specificity of 79% (95% CI 49.2–95.1%) for thoracic lymphadenopathy. Ultrasound and chest radiography in combination detected a total of 36 patients with lymphadenopathy, with a 6% improvement in the rate of lymphadenopathy detection; however, this was not statistically significant. The prevalence of abdominal TB of 23% is noteworthy. We suggest that abdominal ultrasound has a definitive adjunctive role in investigating children with suspected TB.

Esophageal Foreign Body Masquerading as Myocardial Infarction with Atrioventricular Block

To the Editor: Symptoms after esophageal foreign body impaction vary from dysphagia to retrosternal discomfort. We describe an unusual, hitherto unreported presentation of an esophageal impaction. A 25-yr-old man was scheduled for urgent esophagoscopy after esophageal impaction from a meat bolus. Complaints included dysphagia, odynophagia, vomiting, and a foreign body sensation along with retrosternal discomfort 2 days after ingestion of meat. The discomfort in the retrosternal region was dull and aching in nature, nonradiating, increased on swallowing, had not increased in severity since its onset, and was not associated with any palpitations, syncope, breathlessness, or dysphoria. The findings from physical examination and laboratory investigations were unremarkable except for partial collapse of the left lung, along with evidence of pulmonary tuberculosis on the chest radiograph. A 12-lead electrocardiogram (ECG) showed evidence of myocardial infarction in the lateral wall (ST elevation in lead I/aVL with reciprocal changes in inferior leads), T-wave inversion in leads V1–V4, and a recent onset 2:1 atrioventricular (AV) block (Fig. 1). The acquired nature of the AV block and its recent onset were obvious from its presence in precordial leads and concomitant absence in limb leads. Because the limb leads are recorded first during a 12-lead ECG, followed by the precordial leads, this ECG captured the very moment of the onset of AV block (Fig. 1). Considering the possibility of the meat bolus leading to cardiac compression and thus inducing ECG changes, an urgent computed tomography scan was advised. Simultaneously, troponin levels were measured. The computed tomography scan showed the meat bolus to be impacted intraluminally at the midesophageal level (T5-7), with a maximum transverse diameter of 1.9 cm, and was compressing the left atrium and AV sulcus posteriorly (Fig. 2). Meanwhile, the troponin concentration was normal (0.05 μg/L). Esophagoscopy was conducted uneventfully under general anesthesia, with resolution of all ECG changes in the immediate postoperative period. Normal cardiac troponin levels and resolution of ECG changes after removal of the meat bolus suggested mass effect on the heart by the meat bolus as the likely etiology of the cardiac alterations.Figure 1.: Perioperative 12-lead electrocardiogram showing ST elevation in lead I/aVL with reciprocal changes in inferior leads, T-wave inversion in leads V1–V4, 2:1 atrioventricular block in precordial leads, and right axis deviation.Figure 2.: Computed tomography scan showing left atrial and atrioventricular sulcus compression.Previous reports of reversible ECG changes resembling those of myocardial ischemia or infarction from cardiac compression by extracardiac causes include a gastric tube located retrosternally after esophageal reconstruction, causing marked reversible ST-T changes due to cardiac compression.1–4 An anterior mediastinal tumor has also been reported to cause reversible ST-T changes, which disappeared after tumor removal.5 In a slight variation of these case reports, the cardiac compression in our patient was caused by a pressure effect from the posterior rather than the anterior mediastinum. A previous case report of left atrial and ventricular compression from the posterior mediastinum followed pyloroplasty, wherein a dilated stomach conduit resulted in sensation of chest compression along with ST elevation in leads II, III, and avF.6 The symptoms and ST changes subsided after nasogastric suction and decrease in stomach conduit size. This case suggests that a large esophageal foreign body may alter the ECG simulating myocardial ischemia or infarction, whereas in reality reflecting a mass effect on the cardiac chambers. Asha Tyagi, MD, DNB, MNAMS Nitin Behl, DA Debyani Dey, MD Shuchi Bhatt, MD Ashok K. Sethi, DA, MD UCMS and GTB Hospital Delhi, India [email protected]

Surgical treatment of gastric outlet obstruction due to gastroduodenal tuberculosis

Gastroduodenal tuberculosis is a very rare location of abdominal tuberculosis; it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. We report a case of a 45-year-old woman with no HIV infection and no evidence of pulmonary tuberculosis, with a history of duodenal ulcer treated for several months, who presented at the emergency department with severe gastric outlet obstruction of recent onset caused by ulcerohypertrophic antroduodenal tuberculosis. The lesion was misdiagnosed at endoscopy as a malignancy, although histological examination of biopsies showed only chronic inflammation. The diagnosis was established at surgery, when a frozen section of an enlarged lymph node showed the presence of giant cells and caseating granuloma. The treatment was gastric resection with Roux-en-Y gastrojejunal anastomosis. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement.