Extrapulmonary Tuberculosis Group Research Articles

Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment.

Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.

Diagnosis of extrapulmonary tuberculosis by ultrasound-guided biopsy: A retrospective comparison study.

To compare the diagnostic performance of laboratory assays on the ultrasound-guided core needle biopsy samples for diagnosis of extra-pulmonary tuberculosis (EPTB) in HIV-positive and HIV-negative patients. A total of 217 patients suspected to have EPTB underwent lesion biopsy from 2017 to 2020. Results of laboratory tests on the biopsy and non-biopsy samples were collected with clinical data for retrospective analysis of test utility. The calculated diagnostic accuracy of the tests was stratified according to the specimen types and HIV status. The cohort contained 118 patients with a final positive diagnosis of extrapulmonary tuberculosis (EPTB group, 54.4%) and 99 finally diagnosed as without TB (non-EPTB group, 45.6%). The risk factor for EPTB was HIV co-infection (OR 2.22, 95% CI 1.17-4.28, p = 0.014). In biopsy samples, GeneXpert (Xpert) showed higher sensitivity (96.6% [91.6-98.7], p < 0.0001) than culture (56.1% [47.0-64.9]). Regardless of HIV status, Xpert had the highest sensitivity (>95%) and specificity (nearly 100%) of any methods. In non-biopsy samples, only T-SPOT.TB (T-SPOT) showed higher sensitivity than culture (90.9% [62.3-99.5] vs 35.3% [17.3-58.7], p = 0.0037). Furthermore, the sensitivities of Xpert were lower in non-biopsy samples (60.0% [23.1-92.9], p = 0.022) than in biopsy samples (100% [86.7-100]). Even in smear-negative biopsy samples, Xpert still had higher sensitivity than culture and retained high specificity (100% [95.7-100]). Superior performance of Xpert in diagnosing EPTB was observed regardless of HIV status and specimen types. Nevertheless, the biopsy samples still substantially facilitated the accurate diagnosis of extrapulmonary tuberculosis.

Demographic and microbiological characteristics of tuberculous lymphadenitis and other extrapulmonary tuberculosis cases

Objective: Tuberculosis (TB) is a significant public health problem that remains important worldwide. This study aimed to examine the demographic characteristics and clinical features of patients with extrapulmonary tuberculosis (EPTB) and also identify the comorbidities of EPTB. Our secondary aim was to compare tuberculous lymphadenitis (TBL) with other forms of EPTB. Patients and Methods: This single-center, retrospective, observational study was conducted on patients diagnosed with EPTB in a training hospital in Turkey between January 1, 2011 and December 31, 2020. The demographic characteristics and clinical features of the patients were examined. TBL cases were compared with other forms of EPTB cases. Results: The most common clinical form was TBL. Fever, night sweats, and accelerated erythrocyte sedimentation rate were significantly more common in the other forms of the EPTB group compared to TBL. The rate of tuberculin skin test positivity was significantly higher in patients with TBL. The complication rate was 3%, and mortality rate was 4% among all patients. Conclusions: Extrapulmonary tuberculosis should be considered in the differential diagnosis by evaluating the medical history of patients who present with organ-specific symptoms, especially in TB endemic countries. The clinic may differ according to the organ involvement. TBL may be seen with milder symptoms compared to other clinical forms.

Clinical usefulness of cancer antigen 125 biomarker for tuberculosis diagnosis: experience in Cali, Colombia

Introduction: Diagnosing extra-pulmonary tuberculosis (EPTB) is a challenge for physicians. It has been suggested that cancer antigen 125 (CA-125), which is produced by mesothelial cells, may be an EPTB diagnostic biomarker. Objective: To describe serum CA-125 levels behavior in patients with TB treated in a referral university hospital located in Cali, Colombia. Materials and methods: A cross-sectional study was conducted in 99 TB patients with CA-125 measurements (U/mL) made before TB treatment was started, and treated at Fundación Valle del Lili between 2007 and 2016. Cases were classified as pulmonary TB (PTB) (n=33) or EPTB (n=66). A bivariate analysis was performed to compare the variables of interest (sociodemographic, clinical, and laboratory findings data) between EPTB and PTB groups, and to determine differences between patients with CA-125 positive results and those with negative results in relation to mortality. Results: Elevated CA-125 levels were reported in 55 patients (55.56%). Positive CA-125 results (&gt;35 U/mL) were more frequent in the EPTB group (59.09% vs. 48.48%). In the EPTB group, positive results were found in tuberculous serositis cases (100% pericardial TB, 68.42% peritoneal TB and 66.66% pleural TB), and in 66.66% of miliary TB and TB of the spine cases, respectively. Also, 15 TB infection-related deaths were reported in the follow-up period (n=66), of which 13 had a CA-125 positive result, finding a significant difference with those with negative results (p=0.021), however 47.05% of the surviving patients also had a positive result. Conclusions: Most of tuberculous serositis, miliary and TB of the spine cases showed elevated CA-125 levels before starting TB treatment. CA-125 may prove to be useful for prognostic purposes in these patients.

Clinical usefulness of Mycobacterium tuberculosis/NTM real-time polymerase chain reaction in diagnosis of tuberculosis

Background Tuberculosis (TB) management and prevention of further spread is crucially based on early and prompt diagnosis. Even though conventional methods are the gold standard for detection of Mycobacterium tuberculosis (MTB), they are time consuming and do not detect nontuberculous mycobacteria in most cases. The present study evaluated Anyplex MTB/NTM real-time (RT)-PCR assay (Seegene) for TB diagnosis in pulmonary and extrapulmonary TB cases in comparison with culture on Lowenstein–Jensen as a gold standard for diagnosis of MTB. Patients and methods The study included 100 patients with suspected TB: pulmonary TB represented 68 patients and extrapulmonary TB represented 32 patients. All pathological samples were stained by Ziehl–Neelsen staining (ZNS), cultured on Lowenstein–Jensen media and processed for PCR by the Anyplex MTB/NTM RT-PCR. Results Anyplex MTB/NTM RT-PCR showed a sensitivity and specificity of 100 and 65.5%, respectively, when compared with the sensitivity and specificity of ZNS, which were 87.2 and 79.3%, respectively, in the clinically suspected pulmonary TB group. However, in the clinically suspected extrapulmonary TB group, Anyplex MTB/NTM RT-PCR had sensitivity and specificity of 100 and 79.2%, respectively, when compared with those of ZNS, which were 75 and 100%, respectively. Conclusion The use of Seegene Anyplex MTB/NTM assay for detection and differentiation of pulmonary and extrapulmonary TB in our area is more convenient and accurate compared with ZNS.

Diagnostic Value of T-Cell Enzyme Linked Immunospot Assay for Tuberculosis Infection in Pulmonary Tuberculosis and Extrapulmonary Tuberculosis

This study aims to observe and analyze the diagnostic value of T-cell enzyme linked immunospot assay for tuberculosis infection during the diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis. The study objects were 200 cases of tuberculosis patients in the outpatient department or inpatient department of our hospital, including 100 patients with active pulmonary tuberculosis, 100 patients with extrapulmonary tuberculosis. Meanwhile, we selected 90 non pulmonary tuberculosis patients with pulmonary disease, 90 cases of extrapulmonary nontuberculous disease and 90 cases with health examination. T-cell enzyme linked immunospot test for tuberculosis infection was used to detect tuberculosis antigen specificity and the frequency of T cells secreting Interferon gamma and the results were analyzed in detail. The positive rate of T-cell enzyme-linked immunospot assay for tuberculosis infection in pulmonary tuberculosis group was higher than that in non-pulmonary tuberculosis group and healthy control group (p<0.05). The positive rate of pulmonary tuberculosis group was significantly higher than that of non-pulmonary tuberculosis group and healthy control group (p<0.05). The diagnostic sensitivity of T-cell enzyme linked immunospot assay for tuberculosis infection was 88.56 % to bacteriological positive tuberculosis, 80.25 % to bacteriological negative tuberculosis and 93.36 % to extrapulmonary tuberculosis. The diagnosis specificity was respectively 85.67 %, 84.36 %, 89.73 %, the positive predictive values were respectively 93.95 %, 88.79 % and 96.56 %, while the negative predictive values were 74.00 %, 74.00 % and 80.00 %, respectively. By comparing the bacteriological positive tuberculosis and bacteriological negative tuberculosis, there is no significant difference in diagnostic efficiency of T-cell enzyme linked immunospot assay for tuberculosis infection (p>0.05). In comparison of extrapulmonary tuberculosis group, bacteriological negative pulmonary tuberculosis and bacteriological positive pulmonary tuberculosis group, result showed that T-cell enzyme linked immunospot assay for tuberculosis infection diagnostic efficacy was not statistically significant (p>0.05). T-cell enzyme linked immunosorbent assay has ideal sensibility, specificity in diagnosis of tuberculosis infection, which can be widely used in diagnosis of extrapulmonary tuberculosis and bacteriological negative pulmonary tuberculosis.

Clinical features of tuberculosis and Bacillus Calmette-Guérin (BCG) -associated adverse effects in children: A 12-year study

To investigate the clinical feature of tuberculosis and BCG adverse effects in children and to examine whether delayed BCG vaccination changes the incidence of BCG osteomyelitis. We analyzed patients younger than 18 years with tuberculosis or BCG-associated adverse effects from 2008 to 2019. We compared their clinical features, laboratory tests and outcomes. Totally 137 patients were collected, with 27% of pulmonary tuberculosis (PTB), 31% of extrapulmonary tuberculosis (EPTB) and 42% of BCG-associated adverse effects. The median age was older in PTB than EPTB group (17.1 vs 15.4 years; p=0.015). More patients in EPTB group had fever than PTB group (55% vs 25%; p=0.008). Compared with exclusively EPTB, more patients in EPTB plus PTB group had fever (78% vs 38%; p=0.009), and had more systemic symptoms (67% vs 25%; p=0.007), lower absolute lymphocyte count (1230 vs 1850/μL; p=0.033), higher CRP level (5.62 vs 2.21mg/dL; p=0.024) and longer hospital stay (20 vs 11 days; p=0.031). In BCG osteomyelitis group, the median time interval from vaccination to diagnosis was 16.4 months (IQR 15.0-20.2). Age at vaccination, either at birth or 5-8 month-old, did not affect the proportion of BCG osteomyelitis among children with BCG-associated adverse effects. Children with EPTB plus PTB had more fever, lower lymphocyte count and higher CRP. The median time interval from vaccination to diagnosis of BCG osteomyelitis was 16.4 months and the proportion of BCG osteomyelitis among children with BCG-associated adverse effects was not affected by delayed vaccination in this study.

Burden of diabetes among patients with tuberculosis: 10-year experience from a tertiary care referral teaching hospital in South India.

Context:Tuberculosis (TB) and diabetes mellitus (DM) are converging epidemics, each worsening the morbidity of the other. A study of the prevalence of DM in TB patients assumes great importance.Aims:The study aims to evaluate the association between DM and TB over a 10-year period in a tertiary care hospital.Settings and Design:A retrospective observational study in a southern Indian tertiary care teaching hospital was conducted.Materials and Methods:All patients with TB diagnosed and treated during the 10-year study period were identified from the hospital database. All relevant clinical, microbiological, and laboratory results pertaining to diagnosis of DM were collected. The diagnosis of TB and DM was made as per the standard criteria.Statistical Analysis:Categorical variables were analyzed using Chi-square test while continuous variables using independent sample t-test.Results:From 2001 to 2012, we studied 1979 TB patients among whom data on DM were available. The prevalence of DM was 29%, 21%, and 14%, in smear positive, smear negative and extrapulmonary TB respectively (overall 24%). Diabetics were more likely to be men (77.3% vs. 61%; P = 0.001); >40 years of age (81.7% vs. 38.9%; P < 0.001); heavier (59.96 vs. 50.37; P = 0.004); tobacco smokers (16.1% vs. 8.1%; P < 0.001); and alcohol consumers (6.8% vs. 4%; P = 0.02). They were less likely to be HIV coinfected (1.8% vs. 6.1%; P < 0.001). HIV coinfection was seen in 5% of patients and was substantially higher in extrapulmonary TB group (19.4%). Multidrug-resistant TB was lower in DM (11.7%) compared to non-DM (15.9%) (P = 0.02). Overall, 48% of the DM patients were diagnosed at the time of TB diagnosis. Over 10 years, no obvious changes in the trend were evident.Conclusions:Over a 10-year study period, 24% of the TB patients were diabetic, nearly half were detected at the time of TB diagnosis. There may be a good case for screening all TB patients for DM.

Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens.

INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

The Diagnostic Value of TSPOT.TB in Children with Tuberculosis

To evaluate the diagnostic value of T-cells enzyme linked immunospot (TSPOT.TB) in the children with tuberculosis. The clinical data was retrieved from 2 348 children who underwent TSPOT.TB test in the Children's Hospital of Chongqing Medical University from January 2017 to December 2017. The diagnostic value of TSPOT.TB in the children with tuberculosis was analyzed. In the diagnosis of children tuberculosis, the sensitivity of TSPOT.TB was 84.0%, the specificity was 99.1%, the positive predictive value was 93.1%, and the negative predictive value was 97.8%. To the area under receiver operating characteristic (ROC) curve of TSPOT.TB, the area under the curve ( AUC) value of A antigen and B antigen were 0.893 and 0.883, respectively ( P<0.05). When the number of A or B antigens was less than 50， the sensitivity was increased with the increase of puncture number, but there was no clear linear relationship. TSPOT.TB had a highly sensitivity to childhood tuberculosis when the number of A or B antigens was greater than 50. In the true positive groups of TSPOT.TB, the sensitivity of pulmonary tuberculosis group was significantly higher than that of extrapulmonary tuberculosis group ( P<0.05). In addition, the sensitivity to TSPOT.TB increased with age. TSPOT.TB has high diagnostic value in the children with tuberculosis, which can rapidly assist to diagnose pediatric tuberculosis.

Incremental cost-effectiveness of the second Xpert MTB/RIF assay for detection of Mycobacterium tuberculosis

Objective: To study the incremental cost-effectiveness of the second Xpert assay in detection of Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) resistance. Methods: We continuously collected 2 896 specimens from suspected tuberculosis patients who had undergone 2 Xpert tests in a week from March 2015 to March 2018, including 2 402 suspected tuberculosis patients with 1 523 males and 879 females, with an average age of 50 years. Among them, 2 144 specimens of sputum and 258 cases of bronchoalveolar lavage fluid were collected. We also enrolled 494 patients with suspected extrapulmonary tuberculosis, 318 males and 176 females, with an average age of 42 years. Among them, 157 pleural effusion specimens, 106 cerebrospinal fluid specimens, 34 urine specimens and 197 pus specimens were collected. All specimens were subjected to two Xpert tests, smear microscopy, liquid rapid culture (BACTEC MGIT 960), and positively cultured bacteria were tested for drug susceptibility. Results: Among the 2 896 specimens from suspected tuberculosis patients, either one of the two Xpert test results was positive (including both tests were positive, the same below) in 1 639 patients, and 1 502 (91.6%) were positive in the first Xpert tests. The additional 137 (8.4%) test results were positive in the second tests. According to the smear test results, all specimens were divided into the smear negative group and the smear positive group. The second Xpert test was significantly higher than the smear-positive group (14.86%, 3.2%, P<0.001), and the extrapulmonary tuberculosis group was higher than the tuberculosis group (11.2%, 8.0%, P=0.12).Of the susceptibility test results, a total of 371 were rifampicin-resistant specimens. The first Xpert detected 91.4% (339/371), and the second Xpert detected the additional 8.1% (30/371).The cost increase of the second test was very significant. Tests were calculated at 650 yuan per time, the tuberculosis group was 1 184 yuan and 13 696 yuan(P<0.001); the extrapulmonary tuberculosis group was 1 755 yuan and 13 961 yuan(P<0.001). In the test of specimens of tuberculosis and extrapulmonary tuberculosis, the smear-negative specimen cost increase of the second Xpert test was lower than that of the smear-positive specimen. Conclusion: The second xpert test showed significant value-added cost-effectiveness in the diagnosis of tuberculosis.

Drug resistance in extra-pulmonary tuberculosis in South Korea: comparison with pulmonary tuberculosis.

To compare the prevalence of and trends in drug resistance in extra-pulmonary tuberculosis (EPTB) and pulmonary tuberculosis (PTB). We retrospectively analysed the results of phenotypic drug susceptibility testing (DST) in culture-confirmed TB patients from January 2010 to December 2014 at seven university hospitals in South Korea. Of 5599 patients included, 320 (5.7%) were classified in the EPTB group and 5279 (94.3%) in the PTB group. The proportion of EPTB among all TB cases had gradually increased from 2010 to 2014 (P = 0.004). Among both new and previously treated patients, there were no significant differences in rates of resistance to any kind of anti-tuberculosis drug between the EPTB and PTB groups. The trends in drug resistance rates among new patients were similar in both the EPTB and PTB groups. The rates of multidrug-resistant TB among new patients gradually decreased in both groups (P = 0.031 and P = 0.001, respectively). The prevalence of and trends in drug resistance among new patients are not significantly different between patients with EPTB and those with PTB.

Comparison of the Socioeconomic Factors and Diagnostic Test between Pulmonary Tuberculosis (PTB) and Extrapulmonary Tuberculosis (ETB) in Boyacá (Colombia), in 2015

Introduction: Tuberculosis (TB) is an infectious disease caused by Micobacterium tuberculosis. It usually affects the lungs, but can also affect other systems. The objective of this study was to make a comparison of the socioeconomic factors and diagnostic test between pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (ETB) in Boyacá (Colombia) in 2015. Methods: A retrospective analytical observational study was conducted on the data provided by the Boyacá Department of Health about the TB possible cases reported in the SIVIGILA system. 103 TB possible cases were selected, then these cases were divided in accordance with the TB type in two groups, PTB and ETB. Duplicated data were excluded. Results: The highest number of isolates was of PTB. With regard to the ETB group, they required more medical attention, and the most frequent isolates were meningeal, pleural and osteoarticular. In addition, undernourishment was related with PTB. Conclusion: The creation of new social, cultural and economic approaches against the TB dissemination becomes a primary point for the control of this disease.

The risk of tuberculosis in SLE patients from an Asian tertiary hospital.

Systemic lupus erythematosus (SLE) has been associated with increased risk of tuberculosis (TB). However, little is known about the extent and risk factors for TB among Asian patient with SLE. We aimed to assess the rate of TB in patients with SLE, and investigate the risk of SLE on TB development using hospital administrative database. This is an historical cohort study of hospital discharge database from 2004 to 2011 to identify cases with SLE and TB using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. Of 301568 hospitalized patients, 841 (0.3%) patients had SLE, 1843 (0.6%) patients had TB, including 17 SLE patients (2.0%). SLE patients had a significantly higher rate of TB (2.0 vs. 0.6%, p < 0.001) compared to that of patients without SLE. The differences in the higher rate after breaking down was in the pulmonary TB group (1.7 vs. 0.5%, p < 0.00) but not in extrapulmonary TB group (0.4 vs. 0.1%, p = 0.060). Logistic regression analyses showed that SLE was a significant and independent predictor of TB (odds ratio 4.6, 95% CI 2.8-7.5, p < 0.001) after adjustment for factors such as age group, gender, ethnicity, admission class, nutritional deficiency, organ transplantation, and Charlson comorbidity index. SLE patients were found to experience higher rates of tuberculosis in this group of Asian patient population. Patients with SLE should be considered as a high-risk group for TB, active screening for latent patients and treatment for positive TB patients is needed.

Epidemiology of extrapulmonary and disseminated tuberculosis in a tertiary care center in Oman.

The incidence of extrapulmonary and disseminated tuberculosis (TB) cases is increasing worldwide, and this growth significantly impacts TB-related morbidity and mortality. Little is known about the host risk factors for extrapulmonary and disseminated TB. In this study, we examined those risk factors. We conducted a retrospective review of all TB cases admitted to Sultan Qaboos University Hospital from 2006 to 2015. We compared extrapulmonary TB (EPTB) cases with pulmonary and disseminated TB cases. We evaluated the risk factors associated with the development of extrapulmonary and disseminated TB using logistic regression analysis. We reviewed 260 TB cases, of which EPTB comprised 37%, PTB comprised 53%, and disseminated TB comprised 10%. The most common sites of infection in the EPTB group were the lymph nodes and the abdomen. Disseminated TB and TB meningitis were more common in expatriates than in Omanis. Patients with EPTB were less likely to smoke compared to a patient with PTB. Patients with disseminated TB had a higher mortality when compared to patients with EPTB (adjusted odds ratio [OR], 0.004; 95% confidence intervals [CI]: 0.001-0.054;P = 0.001) and PTB (adjusted OR, 0.022; 95% CI: 0.004-0.115;P = 0.001). Human immunodeficiency virus (HIV) was the main risk factor for patients with disseminated TB when compared to patients with extrapulmonary and PTB. The rates of extrapulmonary and disseminated TB in Oman are higher than what has been recognized. Expatriates, patients with HIV, and smokers are at high risk for disseminated TB. In these patients, suspected extrapulmonary sites should be evaluated and sampled to exclude disseminated TB.

Evaluation of lipoarabinomannan in the diagnosis of tuberculosis

The detection of lipoarabinomannan (LAM) antigens in body fluids has several potential advantages compared with the diagnostic methods used currently. The aim of this study was to evaluate the possible role of the detection of LAM in the serum and the urine as a diagnostic aid in the diagnosis of different forms of tuberculosis (TB). This study included 62 newly confirmed tuberculosis cases classified into two groups: group A included patients with pulmonary TB (n=36), and was further divided into two groups: group A1 [the smear-positive pulmonary TB group (n=24)] and group A2 [the smearnegative pulmonary TB group (n=12)]; group B included the extrapulmonary TB group (n=26); and 10 apparently healthy individuals served as the control group. The LAM level was measured in the serum and the urine by an enzyme-linked immunosorbant assay. The mean level of quantitative serum LAM was higher in group A1 (0.55±0.20?ng/ml) compared with group A2 (0.44±0.30?ng/ml) or group B (0.41±0.27?ng/ml). The mean level of quantitative urine LAM was higher in group A1 (0.81±0.24?ng/ml) compared with group B (0.72±0.35?ng/ml) and group A2 (0.65±0.37?ng/ml; P<0.001). The quantitative urine LAM test correlated positively with the degree of bacillary burden (P<0.05). Quantitative serum LAM had a sensitivity of 88.7%, specificity 90%, accuracy 88.9%, positive predictive value 98.2%, and negative predictive value 56.3%. Quantitative urine LAM had a sensitivity of 85.5%, specificity 90%, accuracy 86.1%, positive predictive value 98.1%, and negative predictive value 50%. A combination of serum and urine LAM tests identified that 98.4% of the cases with a positive TB culture correlated with higher serum LAM levels. Advanced chest radiography involvement and TB culture correlated with higher urine LAM levels (P<0.05). The LAM test is a valuable addition in the diagnosis of TB and its different forms. A combination of quantitative serum and urine LAM increased the sensitivity of the test. The quantitative urine LAM test offers additional clinical insight into the degree of TB disease severity and has more applicability.

Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases.

BackgroundTuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults.MethodsMedical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases.ResultsOf these 411 cases, 208 (50.6 %) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4 %). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6 %), while EPTB was more commonly detected in women (52.2 %) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7 %), clinical-radiological data (21.7 %) and biopsy (6.1 %); while biopsy (71.5 %), sputum/fluid analysis (18.8 %) and clinical-radiological data (4.9 %) were used for confirming EPTB (p < 0.0019). The most common sites of EPTB involvement were lymph nodes (39.4 %), followed by pleura (23.6 %), peritoneum (9.9 %) and bone (7.4 %).ConclusıonsExtrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.

Differences between pediatric extra-pulmonary and pulmonary tuberculosis: a warning sign for the future.

BackgroundTuberculosis (TB) remains a major global health problem. The childhood tuberculosis has some unique features different which makes the diagnosis more complicated. Here we described the epidemiologic, clinical and microbiologic features of children with extra pulmonary and pulmonary TB.MethodsThe data of the patients <14 years with active TB were collected and compared in pulmonary (PTB) and extrapulmonary TB (EXPTB) patients.ResultsA total of 128 cases was included. Forty-two cases occurred in children were < 5 years of age; 41 cases between 6–10 years and 45 cases > 10 years. PTB was present in 75,0% of the cases, and EXPTB was present in 25% of cases. There was no significant difference between the EXPTB and PTB by means of distribution of age groups (p=0,201). The rate of patients free of constitutional symptoms were significantly higher in EXPTB compared to PTB(p=0,000). There was no significant difference between EXPTB and PTB by means of sources detection(p=0,069).ConclusionTB is still a major public health problem. EXPTB has an insidious and silent onset without any constitutional symptoms, and both microbiological confirmation and the source by an adult are not frequently found. Moreover, detection of the adult source is mandatory for controlling the TB disease in children

Clinical Research On Hematological Malignancies Complicated With Active Tuberculosis:A Single Center Experience In China

ObjectivesLarge sample clinical retrospective studies about infection caused by Mycobacterium tuberculosis (TB) among the patients with hematological malignancies(HM) have rarely been investigated. The aim of this study was to analyze the clinical features and treatment of the HM patients complicated with active TB. MethodsHM patients complicated with active TB in our single center between January 2006 and December 2012 were retrospectively studied. ResultsUp to 4712 HM patients have been diagnosed and treated, sixty-six patients of which were confirmed with active TB, as a result, the prevalence of active TB in HM patients was 1.40%（pulmonary TB 1.10%, extra-pulmonary TB 0.30%）. The prevalence of various subgroups of HM patients were as following: AML 2.02%、ALL 1.22%、CML and CLL 1.38%、MDS 1.85%、Lymphoma 0.58%、MM 1.15%、SAA 1.66%. In addition, the patients with AML had a significantly higher incidence of TB disease than other subtypes of HM (2.02% vs 1.13%, P=0.017).Most of the patients were male patients, with a male：female ratio of 2.67：1, median age 41 years old (range 14 to 78). Among them, the median age of extra-pulmonary TB group was younger than the pulmonary TB group (38 vs 44.5 years), so did the neutropenia group when compared with the non-neutropenic group (38 vs 48years). Fifty-two cases（80.3%）were pulmonary TB, 14 cases were（21.2%）extra-pulmonary TB and other 8 cases（12.1%）presented as both pulmonary and extra-pulmonary TB. In addition, atypical clinical manifestations, such as high fever, cough, malnutrition, pleural effusion were the main clinical manifestations in our patients.Twenty-nine patients(43.9%) were diagnosed with definitely etiological evidence while other 37 patients（56.1%）were diagnosed clinically. The extra-pulmonary TB group had a higher PPD test positive rate than that of the pulmonary TB group（85.7% vs 46.2%，P=0.014）; The main characteristics of chest CT were as follows：mediastinal or hilar lymphadenopathy, nodules, fibrous cord shadow, pleural effusion. The specificity and sensitivity of T-SPOT.TB test were 100% and 83.3% when 14 patients were checked by this test, which was a helpful tool for diagnosis. In addition, finding more ways to put the lesions under pathological examination was beneficial to the diagnosis of extra-pulmonary TB.The efficacy of first-line anti-tuberculosis chemotherapy was 87.3%, but the extra-pulmonary TB group presented a lower response rate than the pulmonary one (64.3% vs 90.4%, P=0.01).Patients with fever needed a median 8–day（3～26 days）anti-tuberculosis chemotherapy before their temperature dropped to normal range ,meanwhile the patients who had suffered from lymphnode TB needed 12 days（7～28 days）to get their enlarged lymphnode shrink. The total course in order to cure TB was around 12 months. Six cases were dead due to TB with a 9.1% attributable mortality, moreover, the rate was especially higher in the extra-pulmonary TB group（28.6% vs 3.8%，P=0.016）.Our study demonstrated that the potential risk factors of HM patients complicated with active TB were as follows: age less than 50 years old, male patients, three months within the diagnosis of HM, intravenous use of immunosuppressive drugs. In addition, age less than 50 years old was the only risk factor of extra-pulmonary TB. ConclusionsThe prevalence of HM patients complicated with active tuberculosis is higher than the general population. Definitely etiological evidence was not easy to collect, which made it difficult for the diagnosis and differential diagnosis of TB. A few characteristics such as age less than 50 years old, male patients, three months within the diagnosis of HM, intravenous use of immunosuppressive drugs were the potential risk factors of HM patients with TB. It was clearly showed that these patients demonstrated good overall responses to the first-line anti-tuberculosis chemotherapy, with relatively lower attributable mortality and good outcome. Disclosures:No relevant conflicts of interest to declare.

Clinical analysis of 44 cases of leukemia complicated with active tuberculosis-a single-center report

To analyze the prevalence, clinical features, diagnosis, potential risk factors, anti-tuberculosis treatment efficacy and prognosis of the patients with leukemia complicated with active tuberculosis (TB). A retrospective study was performed to analyze the clinical characteristics, relevant examination data, diagnosis methods and follow-up data about 44 leukemia cases complicated with active TB from January 2006 to December 2011 in our single center. The prevalence of leukemia complicated with active TB was 1.70% (pulmonary TB 1.35%, extra-pulmonary TB 0.35%) and no statistically significant difference was found between each subgroup of acute and chronic leukemia groups (P>0.05). Most of the patients were men, with a male to female ratio of 2.14:1, the median age of 40 years old (range 16 to 78), presenting as atypical clinical manifestations, such as high fever, cough, and so on. Eighteen patients (40.9%) were diagnosed with definitely etiological evidence while the other 26 patients (59.1%) were diagnosed clinically. The extra-pulmonary TB group had a higher purified protein derivative (PPD) test positive rate than that of the pulmonary TB group (88.9% vs 42.9%, P=0.020). The chest CT and T-cell spot of tuberculosis test (T-SPOT.TB) were helpful tools for diagnosis. The potential risk factors included age, sex, nutritional status, neutropenia, decreased cellular immunity, type and course of leukemia, etc. The significant differences in age, gender, administration route of immunosuppressive drugs were found between neutropenic and non-neutropenic groups (P<0.05). The efficacy of first-line anti-tuberculosis therapy was 83.7% and the total course to cure TB was around 12 months. Four patients were dead due to pulmonary TB with a 9.1% attributable mortality. The prevalence of leukemia complicated with active TB is higher than the general population in our single center. The main characteristics including various potential risk factors, atypical clinical features, diagnoses mainly made by clinical features were found in our patients with leukemia complicated with active TB. However, it showed that these patients demonstrated good responses to the first-line anti-tuberculosis therapy and relative lower attributable mortality.