Form Of Extrapulmonary Tuberculosis Research Articles

Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis

Tuberculosis (TB) remains a major cause of morbidity and mortality globally. Although TB most commonly affects the lungs, any organ or tissue can be involved. Extra-pulmonary forms of TB are commonly unrecognized or late diagnosed. Chylous effusion, i.e. chylothorax and chylous ascites, which is characterized by the presence of chyle in the pleural and peritoneal cavities, is an uncommon manifestation of extra-pulmonary TB. A 22-year-old male, referred to Dr. Soetomo Hospital with complaints of dyspnea, fever, and abdominal distension. Chest X-ray showed pleural effusion. Analysis of fluid obtained from thoracentesis and paracentesis showed chylothorax and chylous ascites. M. tuberculosis had been found in sputum smear examination. ADA (adenosine deaminase) test was performed on ascites fluid and a positive result was obtained. Chylous effusion in this patient were concluded to be related to TB. Patient was then treated with anti-TB drugs and somatostatin. Chylothorax and chylous ascites improved after treatment with somatostatin for 1 week. Administration of anti-TB drugs was planned to be continued for 9 months. The most common causes of non-traumatic chylous effusion in developing countries are infection of TB and filariasis. Chylous effusion is caused by obstruction or disruption of the lymphatic system. ADA test is a new biomedical method that begins to expand its use in body fluids to diagnose extra-pulmonary TB. Fasting, together with total parenteral nutrition, can decrease the lymph flow and balance metabolic impairment. Somatostatin has been used in the treatment of chylous effusion as it diminishes peristalsis and intestinal absorption of fats as well as decreases portal pressure.

Clinical, laboratory and evolutionary features of abdominal tuberculosis in comparison with other forms of extrapulmonary tuberculosis

Background/objectivesTuberculosis is a multisystem disease that might affect any organ. Abdominal tuberculosis (ABT) represents 5–17% from all extrapulmonary tuberculosis (EPT) sites. We aimed to study the clinical, laboratory and evolutionary features of ABT cases and to identify predictive factors associated with ABT. MethodsWe conducted a retrospective study including all patients hospitalized in the infectious diseases department for EPT between 1991 and 2019. We studied the characteristics of ABT cases, and we compared them with other EPT cases. ResultsWe identified 519 patients with EPT, among whom 86 (16.6%) patients had ABT. There were 58 females (67.4%). Peritoneal tuberculosis was the most common clinical form of ABT (68.6%), followed by intestinal tuberculosis (18.6%). Patients aged 60 years and above were significantly less affected with ABT (odds ratio (OR) = 0.2; p = 0.001). The revealing systemic symptoms including fever (OR = 2.04; p = 0.006), weight loss (OR = 2.5; p < 0.001) and anorexia (OR = 1.7; p = 0.021) were significantly more frequent among ABT patients. Inflammatory markers including C-reactive protein levels (37 [10–89] mg/l vs 10 [4–57] mg/l; p < 0.001) and erythrocyte sedimentation rates (43 [15–95] mm/h vs 27 [15–60] mm/h; p = 0.044) were significantly higher among ABT cases. Multivariate logistic regression analysis showed that anorexia (adjusted OR (AOR) = 1.9; p = 0.015) and pulmonary involvement (AOR = 3.3; p = 0.002) were independent predictors of higher rate of ABT. Concomitant involvement of neuro-meningeal (AOR = 0.18; p = 0.001) and osteo-articular (AOR = 0.2; p = 0.01) sites, 40–59 (AOR = 0.2; p < 0.001) and ≥60 (AOR = 0.2; p < 0.001) age groups as well as hemoglobin rate (AOR = 0.7; p < 0.001) were independently associated with lower rate of ABT. ConclusionsAnorexia and pulmonary involvement were independent predictors of higher rate of ABT. Concomitant involvement of neuro-meningeal and osteo-articular sites, 40–59 and ≥60 age groups and hemoglobin rate were independently associated with lower rate of ABT.

A CASE OF SPINAL TUBERCULOSIS MISEVALUATED AS INTESTINAL OBSTRUCTION

Tuberculosis of spine (Pott's disease) is a frequently encountered extra pulmonary form of tuberculosis and is the most dangerous form . We report a case of spinal tuberculosis which present with clinical features of intestinal obstruction. A 45 1 year old male patient came to general surgery out patient department with chief complaints of pain abdomen since two weeks, constipation since two weeks and distension of abdomen since 10 days. History of fever present since 2 months low grade on and off. Case was evaluated with X ray erect abdomen, colonoscopy, CT abdomen which showing features of tuberculosis of spine. Patients of tuberculosis of spine can be asymptomatic and sometimes diagnosis is made incidentally during the course of evaluation for other symptoms

Disseminated tuberculosis with pulmonary and renal infections: A confirmed case in a severely immunocompromised HIV patient

Tuberculosis continues to be a major public health issue. The advent of human immunodeficiency virus (HIV) infections led to a dramatic increase in extrapulmonary forms of tuberculosis, with a non-negligible number of cases with multifocal lesions. This study reports a disseminated tuberculosis case with pulmonary and renal localization in a severely immunocompromised HIV patient diagnosed by microscopic examination and the GeneXpert MTB/RIF on sputum and urine in the absence of a urine test, in particular, the urine lipoarabinomannan assay (TB-LAM). Key words: Tuberculosis, disseminated, immunosuppression, HIV, Bangui.

Helminth Coinfection Is Associated With Enhanced Plasma Levels of Matrix Metalloproteinases and Tissue Inhibitor of Metalloproteinases in Tuberculous Lymphadenitis.

Matrix metalloproteinases (MMPs) are crucial for tissue remodeling and repair and are expressed in diverse infections, whereas tissue inhibitors of metalloproteinases (TIMPs) are endogenous inhibitors of MMPs. However, the interaction of MMPs and TIMPs in tuberculous lymphadenitis (TBL), an extra-pulmonary form of tuberculosis (EPTB) and helminth (Hel+) coinfection is not known. Therefore, this present study investigates the levels of circulating MMPs (1, 2, 3, 7, 8, 9, 12, 13) and TIMPs (1, 2, 3, 4) in TBL individuals with helminth (Strongyloides stercoralis [Ss], hereafter Hel+) coinfection and without helminth coinfection (hereafter, Hel-). In addition, we have also carried out the regression analysis and calculated the MMP/TIMP ratios between the two study groups. We describe that the circulating levels of MMPs (except MMP-8 and MMP-12) were elevated in TBL-Hel+ coinfected individuals compared to TBL-Hel- individuals. Similarly, the systemic levels of TIMPs (1, 2, 3, 4) were increased in TBL-Hel+ compared to TBL-Hel- groups indicating that it is a feature of helminth coinfection per se. Finally, our multivariate analysis data also revealed that the changes in MMPs and TIMPs were independent of age, sex, and culture status between TBL-Hel+ and TBL-Hel- individuals. We show that the MMP-2 ratio with all TIMPs were significantly associated with TBL-helminth coinfection. Thus, our results describe how helminth infection has a profound effect on the pathogenesis of TBL and that both MMPs and TIMPs could dampen the immunity against the TBL-Hel+ coinfected individuals.

Immunocytochemical Study of Rabbit-Polyclonal to Mycobacterium Tuberculosis, AB905: Improving Diagnostic of Tuberculous Lymphadenitis

Tuberculous lymphadenitis (TBLN) is the most common form of extrapulmonary tuberculosis. However, the optimal diagnosis using Fine-Needle Aspiration Cytology (FNAC) or excisional biopsy is uncertain. This research aims to improve the diagnostic of TBLN with FNAC and immunocytochemistry (ICC) compared to the response to antituberculosis therapy. The cross-sectional study involved 43 patients with the criteria for TBLN diagnosis based on the appropriate clinical history of tuberculosis and indicative cytological results. Immunocytochemical examination employed rabbit-polyclonal to Mycobacterium tuberculosis (MTB) antibody (AB905). The MTB expression was found in 35 out of 43 cases (81%) that appropriate cytological features of the tuberculosis process. Meanwhile, eight out of 43 cases (19%) did not express MTB. Diagnostic tests for lesions with a positive cytologic appearance of TBLN and ICC were compared to the response to anti-tuberculosis therapy, revealing the sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 75%, 95.2%, and 17%, respectively. Besides, Fisher's exact tests utilized to identify the relationship between two variables; p 0.05 was considered significant. This research found immunocytochemical study was a sensitive and specific tool for improving the diagnostic of TBLN.

ОСОБЕННОСТИ ВЫЯВЛЕНИЯ И ДИАГНОСТИКИ ТУБЕРКУЛЁЗА У ДЕТЕЙ И ПОДРОСТКОВ

Objectives. To assess the peculiarities of diagnosis and clinical course of tuberculosis in children and adolescents. Material and methods. Retrospective analysis of outpatient records of children and adolescents with tuberculosis in Vitebsk region during the period from 2016 to 2020 was made. Results. In the tuberculous disease structure in children and adolescents, pulmonary tuberculosis (infiltrative pulmonary tuberculosis) prevails. In the majority of cases, tuberculosis was diagnosed during adolescence. Almost all of the sick had close family contact with tuberculosis patients. The medical risk group included 25% of patients. In patients with infiltrative pulmonary tuberculosis, symptoms and changes in the total blood count were observed only in the phase of disintegration and seeding. Bacteriological excreters made up 75% of cases. More than half of children and adolescents with tuberculosis had multidrug resistance of mycobacterium tuberculosis. Immunodiagnosing plays an important role in the detection of tuberculosis in children and adolescents. Among the sick children, only extrapulmonary forms of tuberculosis were recorded. Conclusions. Most often, tuberculosis in children and adolescents affects the respiratory organs and is asymptomatic or oligosymptomatic. 75% of patients were bacteria discharging persons, more than half of them having multidrug resistance. Family contact is of great importance in tuberculosis in children and adolescents. Doctors of all specialties need to have phthisiatric alertness in relation to patients with diseases of various localization resistant to nonspecific therapy, especially to persons with chronic diseases and to those who contact with patients suffering from tuberculosis. In case of ineffective antibiotic therapy, it is necessary to take the material for the study and verification of tuberculous infection and to carry out immunodiagnosing of tuberculosis.

Extrapulmonary Tuberculosis and Its Association with HIV in Patients Hospitalized in a Tertiary Care Center

Context: Extrapulmonary tuberculosis (EPTB) presentation can be unusual, and the diagnosis may often be challenging when associated with HIV. Aims: This study was conducted to find out the pattern of newly diagnosed EPTB in hospitalized patients, the diagnostic modalities used to arrive at the diagnosis, frequency of HIV positivity among them, and its association with CD4 counts. Settings and Design: All patients newly diagnosed to have EPTB admitted in a tertiary care medical college hospital in various departments over 1 year were included. Methods and Materials: Clinical presentation, comorbidities, and investigations done to arrive at diagnosis of EPTB were recorded. They were classified based on the affected site. HIV was tested for all patients, and CD4 counts in positive patients. Results: A total of 230 patients were newly diagnosed to have EPTB. The median age was 35 years (IQR 29–45), and the proportion of males was 127 (55%). Imaging was used alone in 47 (20%) patients and in combination with cytology or biopsy in 133 (57.8%) patients to establish the diagnosis. Pleural effusion, 50 (21.7%) patients, peripheral lymph node TB (LNTB), 44 (19.1%) patients, and CNS TB, 37 (16.1%) patients, were the most common forms. HIV was associated in 61 (26.5%) patients and diabetes in 27 (11.5%) patients. Both diseases influenced the presentation of EPTB. There was an association between HIV positivity and type of EPTB with peripheral LNTB being the most common in HIV patients. High CD4 counts were associated with pleural effusion and low counts with disseminated forms. Statistical Analysis Used: chi-square, ANOVA, and Student t test. Conclusion: The pattern of EPTB changes with HIV and vigilance is required to detect severe and disseminated forms of EPTB with lower CD4 counts.

LARYNGEAL TUBERCULOSIS – A NEGLECTED DISEASE THAT CAN MIMIC LARYNGEAL CARCINOMA

Laryngeal tuberculosis is a form of extra-pulmonary tuberculosis that occurs in only 1% of all tuberculosis cases, with the mortality rate of less than 2%. It can be a complication of pulmonary or some other form of extra-pulmonary tuberculosis (via bronchogenic, haematogenic or lymphagenic spread of bacilli), or the larynx can be the only organ affected after the direct invasion of Mycobacterium tuberculosis. Clinical, laryngoscopic and radiological findings of laryngeal tuberculosis tend to mimic laryngeal cancer, delaying the appropriate treatment. In this paper, we present a case of the laryngeal and pulmonary tuberculosis which was primarily diagnosed and almost treated as laryngeal carcinoma. An 84 years old Caucasian male presented with a 3-months history of hoarseness, odynophagia, dysphagia, cough with expectoration and weight loss. After the laryngoscopy and biopsy of the laryngeal ulceration, a squamous cell carcinoma was suspected. However, chest X-ray and CT scan detected pulmonary infiltrates, while the positive sputum smear for acid-fast bacilli was obtained and the sputum cultures grew Mycobacterium tuberculosis. Detailed histopathological analysis of the biopsies was in accordance with tuberculosis, and no signs of timorous tissue were found. After the end of the proposed antituberculous treatment, the patient reported no symptoms of the diseases, laryngoscopic findings showed no signs of neoplastic tissue, and CT findings showed partial radiological regression. Distinguishing laryngeal carcinoma and tuberculosis can be very challenging, even after obtaining histopathological material. Nevertheless, biopsies should be taken from all suspicious lesions and at multiple sites and Ziehl-Neelson staining of sputum and bioptic tissue is necessary. Otorhinolaryngologists should always consider tuberculosis in differential diagnosis of laryngeal lesions, especially nowadays when the incidence of laryngeal tuberculosis is increasing in developing countries.

Comparative analysis between tuberculous meningitis and other forms of extrapulmonary tuberculosis.

Tuberculosis is a multisystem disease that may affect any organ or tissue. Tuberculous meningitis (TBM) is the most severe form of tuberculosis and commonly affects the brain. We aimed to study the epidemiological, clinical, therapeutic and evolutionary features of TBM among adults and to compare them with other forms of extrapulmonary tuberculosis. We conducted a retrospective study including all patients hospitalized for extrapulmonary tuberculosis in the infectious disease department in Sfax, Tunisia between 1993 and 2018. We specified the particularities of TBM cases, and we compared them with other extrapulmonary tuberculosis cases. We encountered 78 patients diagnosed with TBM, among 519 patients with extrapulmonary tuberculosis (15%). The median age was 36 years (23-50) years. There were 44 females (56.4%). In comparison with other forms of extrapulmonary tuberculosis, fever [odds ratio (OR)=4.4; p<0.001], asthenia (OR=3.4; p<0.001) and anorexia (OR=2.3; p=0.001) were significantly more frequent in TBM patients. Adverse effects of antitubercular therapy were more frequent among TBM patients (OR=3.1; p<0.001). The mean duration of antitubercular therapy was 15 (12-20) months. Recovery occurred in 66 cases (84.6%), complications in 44 cases (56.4%) and death in 7 cases (9%). Comparison of the disease evolution showed that complications (OR=7.4; p<0.001) and mortality rates (OR=10.7; p<0.001) were significantly more frequent in TBM patients, while recovery was significantly more frequent in other sites of extrapulmonary tuberculosis patients (OR=0.5; p=0.02). In our country, TBM remains a disabling disease. Despite antitubercular therapy, the prognosis was more severe with the occurrence of not only complications but also a high mortality rate in comparison with other forms of extrapulmonary tuberculosis. When clinical and laboratory features suggest the diagnosis of TBM, clinicians should look for tuberculosis elsewhere in the body.

Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.

Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.

Factors Associated with Tuberclosis-HIV Co-Infection in Diagnosis in the Nzanza Health Zone

Aim: To determine the factors associated with the increase in the proportion of HIV-infected TB patients of Kiamvu and Baobab Tuberculosis Screening and Treatment Health Center (TSTHC) in the Nzanza HZ, Matadi, between January 2012 and December 2017. Methods: This was a control case study of 187 HIV-positive TB patients and 187 HIV-negative TB patients followed at the Nzanza HZ Tuberculosis Screening and Treatment Health Center (TSTHC) from January 1, 2012 to December 31, 2017. We used Pearson’s Khi square test and homogeneity as well as logistic regression. This identified the factors associated with TB/HIV co-infection. Results: HIV-positive TB patients had a high daily household income [OR: 2.90; p: 0.000]) than HIV-negative people. The majority of HIV-positive TB patients had unprotected sex with a casual partner prior to diagnosis [OR: 1.82; p: 0.000]) than HIV-negative. After adjustment, alcohol intake [OR: 12.2; p: 0.004]) and extra pulmonary forms of tuberculosis [OR: 31.5; 0.002] were associated with increased TB/HIV co-infection. Conclusion: Alcohol intake and extra-pulmonary forms of tuberculosis were factors associated with increased TB/HIV co-infection. Awareness of TB patients may help reduce the risk of HIV infection.

Extrapulmonary forms of tuberculosis

Extrapulmonary tuberculosis is understood as the localization of the pathological process outside the chest cavity; most frequently, this form has a hematogenous transmission route. There is not a single organ in the human body that could not be affected by tuberculosis, however, some are involved in the pathological process more often than others. In the Russian Federation, tuberculosis of the lymph nodes ranks first in terms of the prevalence of extrapulmonary forms of tuberculosis, while tuberculosis of the genitourinary system and osteoarticular tuberculosis rank second and third, accordingly. In different countries, the proportion of patients with extrapulmonary forms of tuberculosis varies from 4 to 16 %. Due to the difficulty of diagnosis, about a third of cases of extrapulmonary tuberculosis remain undetected. An interesting fact is that pulmonary tuberculosis occurs mainly in men, while extrapulmonary tuberculosis affects women more often (in 59–63 % of cases). This trend is especially clearly traced in tuberculous lesions of the genitourinary system — women account for 75 % of its cases. Osteoarticular tuberculosis has not sexual, but age-specific prevalence: most frequently, it is diagnosed in children aged 0 to 4 years. According to the clinical classification used at the present stage, extrapulmonary forms represent the section «tuberculosis of other organs and systems».

A study on incidence of cervical lymphadenopathy: An observational study

Aim and Objective: To study incidence of cervical lymphadenopathy between age, sex and disease. Methodology: A review of 100 cases of cervical lymphadenopathy from Shadan Institute of Medical Sciences, Hyderabad were used for analysis and discussion. Results: Tuberculous cervical lymphadenitis is the commonest disease affecting the cervical lymphnodes 50% followed by secondaries from various primaries 39%, non-specific 5%, Hodgkins lymphoma 4% and non Hodgekins lymphoma 2% were diseases commonly found to be effecting cervical lymphonodes in the study conducted above, we had no cases of cat scratch disease or toxoplasma gondi or other in the group. Heigher incidence of tuberculous cervical lymphadenitis in the age group between 11-40 years. The youngest in the series was 11 years, oldest its 66 years. Average age is 35 years. The male: female ratio is 1:1 in present series. Tuberculosis is a disease of the poor still holds good. In the present study 71% of patients belong to socioeconomically low income groups. Hindus were more commonly affected than Muslim which usually vice versa is explained due to the fact that Hindu population is more than Muslim population in the area when this study was conducted. Distribution of disease is more in rural area 67%. According to the present series, this could be due to increase the awareness of the disease and improvement in living condition of the population living in the urban area. Conclusion: There is very high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like India. Cervical lymph node adenopathy constitutes the most common presentation of extra pulmonary form of tuberculosis. However, it mimics other pathological conditions like metastasis from other primary sites, reactive lymphadenitis, chronic non-specific lymphadenitis, lymphoma etc. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region which can aid in early diagnosis with the help of simple investigations and subsequently patients can be managed promptly without delay.

The history of the formation of phthisiology as a science

Humanity has been familiar with tuberculosis for a long time: the confirmation of this was found during archaeological excavations and the discovery of traces of damage to the remains of people who lived more than 5 thousand years ago. Scientists associate this fact with the high prevalence of mycobacteria among animals, as well as the extreme duration of the disease and the high degree of chronicity of the process. The first descriptions of tuberculous lesions were found in the writings of Hippocrates. The most characteristic symptom of the disease, as in the present days, was considered hemoptysis, and the extreme degree of exhaustion and pulmonary bleeding was quite typical for this category of patients. This disease was initially called consumption, or phthisi. Subsequently, it gave the name to the science that studies various clinical manifestations in the tuberculosis process, their diagnosis and treatment. Today, phthisiology is a clinical discipline that studies the etiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis of pulmonary and extrapulmonary forms of tuberculosis, as well as the main approaches to etiotropic and pathogenetic treatment.

Chronic foot ulcers – Rule out cutaneous tuberculosis!

Cutaneous tuberculosis is a form of extrapulmonary tuberculosis and is seen in a small but significant subset of patients seeking dermatology outpatient services. Children constitute a significant proportion of overall cases of cutaneous tuberculosis. We report the case of an 8-year-old boy who presented with multiple discharging ulcers over bilateral feet. High suspicion of cutaneous tuberculosis led to early diagnosis and initiation of therapy. Cutaneous tuberculosis can have a varied clinical presentation. We wish to draw attention to mycetoma-like presentation of cutaneous tuberculosis characterized by chronic discharging foot ulcers.

Retrospective Analysis of Patients Taking Anti-Koch’s Treatment (AKT) in Incidence of Tuberculosis in the Urban Population of South Gujarat

Background: Tuberculosis (TB) continues to be a serious worldwide health issue, necessitating immediate effort to manage and eventu-ally eradicate the disease. The current burden of TB in India is as high as that of more than 25% of all patients present globally are found in India, which means that it is double the amount of patients that are present in any other country. This makes India the most important focal point for any TB control Strategy and Gujarat is the state that has the most number of patients thus it is the representative of the TB both in terms of incidences as well as prevalence.Aims and Objectives: To Study the incidence of tuberculosis in the urban area of South Gujarat and also identify the reasons for discon-tinuation of anti-Koch’s treatment (AKT).Material and Methods: A retrospective and observational study was carried out in a South Gujarat tertiary care hospital. 500 patients suffering from pulmonary and extrapulmonary tuberculosis were recorded. The data were collected from the medical record department from 1st August 2018 to 31st July 2019 at a tertiary care health centre in South Gujarat. The ethics committee’s approval was taken before the start of the study. The data collected was analyzed in Microsoft Excel and the frequency of incidence and their percentages were calculated.Results: In this study, it was observed that the majority of the affected patients, around 74%, lie within the age group of 21-30 years. Various forms of extrapulmonary tuberculosis have been included of which pleural effusion, tuberculosis lymphadenitis, abdominal tuberculosis were more prevalent. The reasons for the default of the patients as observed in this study were migration for work, AKT-induced side effects, feeling better, other medical conditions, and no improvement.Conclusion: Most susceptible age group for developing tuberculosis is from 21-30 and males are seen to be more affected than females, so the default rate was also more in males as compared to females. Migration for work was the main reason among the defaulters. The incidence of pulmonary tuberculosis incidence was highest compared to the other types of tuberculosis. The second highest incidence of TB was of tubercular lymphadenitis with males and females having an almost equal percentage of Drug Resistant TB cases (MDR TB) was also recorded in some patients.

Внелегочный туберкулез во время пандемии COVID-19: особенности выявления и течения

Background. COVID-19 pandemic caused by novel coronavirus has destabilized the world's health systems, revealing flaws in the organization of work in extreme conditions. Currently, there is limited empirical data on the impact of COVID-19 on tuberculosis outcomes. Materials and methods. Non-interventional comparative retrospective cohort study of the structure of the incidence of extrapulmonary tuberculosis (EPTB) in the Siberian and Far Eastern Federal Districts for the period 1999–2020 was carried out. Data of 13 852 patients were analyzed. Results. Of all 13 852 EPTB patients who were first diagnosed during the study period, the majority of cases (973) were registered in 1999, and the smallest number (550) – in 2017. Then, for 2 years, an increase in EPTB incidence was observed again (582 cases in 2018, and 563 cases in 2019) with a natural reduction by 18.5% in 2020 (459 cases). Over the first year of the COVID-19 epidemic, the incidence of central nervous system tuberculosis decreased by almost half (by 45.9%), the incidence of peripheral lymph nodes tuberculosis remained virtually unchanged, and the number of cases of "other" localizations, mainly abdominal tuberculosis, increased by 55.3%. Overall, in the Siberian and Far Eastern Federal Districts, the detection of isolated forms of EPTB over the first year of the pandemic reduced by 18.5% (from 563 to 459 patients). A large variability of data was found across regions. Thus, in the Novosibirsk, Tomsk and Omsk regions there was a significant decrease in the number of patients diagnosed with isolated EPTB (by 30.2; 47.1 and 64.5%, respectively) while in the Kemerovo and Irkutsk regions, the number of patients with isolated EPTB increased (by 80.9 and 32.3%, respectively). Conclusion. COVID-19 has had a significant negative impact on all services of national and global healthcare, the ultimate losses we have yet to calculate. Diagnostics of any diseases, and particularly EPTB, in the first year of the pandemic was difficult due to the restriction of patient visits to medical and preventive institutions, the closure or re-profiling of some of them, as well as a decrease in the number of specialists due to their selfisolation, re-profiling and COVID-19 disease. Nevertheless, the role of EPTB is still important.

Primary tuberculosis cutis orificialis; a different face of the same coin.

Primary tuberculosis cutis orificialis (TCO) is a rare form of extrapulmonary TB. The Lack of respiratory symptoms and similarity of the presentations to other oral lesions can pose a diagnostic dilemma. Hence, delaying treatment and potentially devastating consequences

Awareness of Long-Term Prednisolone Use Among Patients Attending a Respiratory Clinic in Sri Lanka: A Clinical Audit

Background: Prednisolone is recognized as one of the most commonly used, highly effective anti-inflammatory agent. It plays a pivotal role in the management of various disease conditions in pulmonology, such as interstitial lung diseases, sarcoidosis, bronchial asthma, chronic obstructive airway disease, allergic bronchopulmonary aspergillosis and even in some forms of extrapulmonary tuberculosis. However, this medication with great therapeutic importance is not free of risks. Long-term use and use in higher doses are known to cause various systemic adverse effects. Therefore, complying with recommended precautionary strategies is of paramount importance. Objectives: To assess awareness of correct use of prednisolone particularly among long-term, outpatient users. Methodology: A structured interviewer-based questionnaire was used to assess awareness of prednisolone usage in patients attending Central chest clinic, Colombo. Forty-one consecutive patients on long term prednisolone were selected from the clinic. The questionnaire was prepared based on recommendations and guidelines related to proper use of corticosteroids. Data were collected by the principal investigator. Results: This clinical audit highlighted the inadequacy of awareness about side effects and safety practices among patients on prolonged courses of prednisolone. Conclusion: Patients need to be educated more on adverse effects, safety measures and correct use to improve risk/ benefit ratio. Designing a steroid treatment card was identified as a potential method to optimize patient education, monitoring and adverse outcome prevention in long-term steroid therapy. Intended quality improvement will be evaluated by re-auditing the implemented protocol.