Extrapulmonary Forms Of Disease Research Articles

Prevalence of nontuberculous Mycobacterial infection in Non-HIV subjects of clinically presumed tuberculosis at a tertiary care center, Hyderabad

Introduction: Tuberculosis continues to be the leading cause of morbidity and mortality in developing nations. Off late infections due to mycobacterial species other than tubercle bacilli are being reported frequently. Nontuberculous mycobacteria are being increasingly recognized and isolated as pathogens from immunocompetent host too. They are found in both pulmonary and extrapulmonary form of disease. The prevalence of infections due to NTM is known to vary with place, host and climatic factors. Aim: the present study is a retrospective cross-sectional observational study for a period of two years from Jan.2013- Dec.2014, at Princess Era Hospital,a teaching hospital of Deccan college of medical sciences at Hyderabad. Data from microbiology lab records was retrieved and analysed. Materials and Methods: about 232 specimens from 229 patients with clinical symptoms of tuberculosis were analysed for laboratory diagnosis of nontuberculosis mycobacterial infection in mycobacteriology section of microbiology laboratory. Seventy nine samples were obtained from 78 patients with pulmonary form of disease and 153 samples were from 151 patients with extrapulmonary form of disease. Study was approved by ethical committee of the college and patient consent was obtained prior to sample collection. All the specimens received in the laboratory were processed by direct microscopy for acid fast bacilli using Ziehl Neelsen stain. Culture was performed on conventional LJ media and Middle Brook 7H12 media in MGIT 320 automated system. Identification of culture positive isolates was achieved by standard biochemical test and rapid immunochromatography test for detection of mycobacterial tuberculosis protein 64 antigen [MPT64]. Results: Direct microscopy was positive in 20.52%. and 4.25% of which were later identified as NTM. Culture yielded positive result in 22.27% of the subjects. NTM were isolated in 3.49% of the total subjects studied. Mycobacterium tuberculosis was the most common

Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014.

BackgroundWe explored host-related factors associated with the site of tuberculosis (TB) disease using variables routinely collected by the 31 EU/EEA countries for national surveillance.MethodsLogistic regression models were fitted to case-based surveillance data reported to the European Centre for Disease Prevention and Control for TB cases notified from 2003 to 2014. Missing data on HIV infection and on susceptibility to isoniazid and rifampicin for many patients precluded the inclusion of these variables in the analysis. Records from Finland, Lithuania, Spain and the United Kingdom were excluded for lack of exact details of disease localisation; other records without one or more variable (e.g. previous treatment history, geographical origin) or who had mixed pulmonary and extrapulmonary disease or more than one form of extrapulmonary disease were also removed (total exclusion = 38% of 913,637 notifications).Results564,916 TB cases reported by 27 EU/EEA countries had exclusive pulmonary (PTB; 83%) or extrapulmonary (EPTB; 17%) disease. EPTB was associated with age <15 years (aOR: 5.50), female sex (aOR: 1.60), no previous TB treatment (aOR: 3.10), and geographic origin (aOR range: 0.52–3.74). Origin from the Indian subcontinent or Africa was most strongly associated with lymphatic, osteo-articular and peritoneal/digestive localization (aOR>3.7), and age <15 years with lymphatic (aOR: 17.96) and central nervous system disease (aOR: 11.41).ConclusionsAwareness of host-related determinants of site of TB is useful for diagnosis. The predilection for EPTB among patients originating from countries outside Europe may reflect strain preferences for disease localization, geographic/ethnic differences in disease manifestation and other factors, like HIV.

Pleural tuberculosis: is radiological evidence of pulmonary-associated disease related to the exacerbation of the inflammatory response?

OBJECTIVE:Pleural tuberculosis is the most frequently occurring form of extra pulmonary disease in adults. In up to 40% of cases, the lung parenchyma is concomitantly involved, which can have an epidemiological impact. This study aims to evaluate the pleural and systemic inflammatory response of patients with pleural or pleuropulmonary tuberculosis.METHODS:A prospective study of 39 patients with confirmed pleural tuberculosis. After thoracentesis, a high resolution chest tomography was performed to evaluate the pulmonary involvement. Of the 39 patients, 20 exhibited only pleural effusion, and high resolution chest tomography revealed active associated-pulmonary disease in 19 patients. The total protein, lactic dehydrogenase, adenosine deaminase, vascular endothelial growth factor, interleukin-8, tumor necrosis factor-α, and transforming growth factor-β1 levels were quantified in the patient serum and pleural fluid.RESULTS:All of the effusions were exudates with high levels of adenosine deaminase. The levels of vascular endothelial growth factor and transforming growth factor-β1 were increased in the blood and pleural fluid of all of the patients with pleural tuberculosis, with no differences between the two forms of tuberculosis. The tumor necrosis factor-α levels were significantly higher in the pleural fluid of the patients with the pleuropulmonary form of tuberculosis. The interleukin-8 levels were high in the pleural fluid of all of the patients, without any differences between the forms of tuberculosis.CONCLUSION:Tumor necrosis factor-α was the single cytokine that significantly increased in the pleural fluid of the patients with pulmonary involvement. However, an overlap in the results does not permit us to suggest that cytokine is a biological marker of concomitant parenchymal involvement. Although high resolution chest tomography can be useful in identifying these patients, the investigation of fast acid bacilli and cultures for M. tuberculosis in the sputum is recommended for all patients who are diagnosed with pleural tuberculosis.

Extra pulmonary tuberculosis: a diagnostic dilemma.

Tuberculosis remains a major public health problem globally, with India being one of the high burden countries. The common causative agent is Mycobacterium tuberculosis but in developing countries M. bovis is reported as a potential human pathogen. Almost 20% of all reported cases of tuberculosis are of extra pulmonary form of disease. Diagnosis of extra pulmonary tuberculosis (EPTB) is not always possible with conventional methods, due to the long time required and the paucibacillary nature of samples; hence the need of rapid molecular methods. A prospective study was conducted on 300 patients of EPTB over a period of 5years. These patients were suspected cases of tubercular meningitis, tubercular ascites and tubercular lymphadenitis. Samples analyzed were cerebrospinal fluid, ascitic fluid and lymph node fine needle aspirate. A two step PCR targeting hup B gene was used. Clinical response to anti tubercular therapy (ATT) was taken as positive (gold standard). PCR for hup B gene was positive in 147 samples out of 155 ATT responders. Of these 85.71% were infected with M. tuberculosis, 9.52% with M. bovis alone and 4.76% showed co infection with both M.tb and M. bovis. The sensitivity and specificity of PCR was 90.32 and 94.48% respectively.