Extrapulmonary Tuberculosis Research Articles

Intestinal tuberculosis revealed by stercoral peritonitis in a patient at D3 postpartum: A case report

Digestive tuberculosis is uncommon compared to pulmonary tuberculosis. Gastrointestinal tuberculosis accounts for 2.5% of cases of extra-pulmonary tuberculosis. Early diagnosis is not easy because of the non-specific clinical picture. We report a case of intestinal tuberculosis revealed by stercoral peritonitis in a 29- year-old patient whose CT scan showed a large pneumoperitoneum. The procedure consisted of a bowel resection, removing both perforations and performing a Bouilly volkman ileostomy. Anatomopathological examination of the operative specimen revealed ulcerated and perforated ileitis with epithelio-giganto-cellular and necrotizing granulomatous lesions suggestive of tuberculosis.

Resistance Rates of Mycobacterium tuberculosis Complex Isolates to Primary Anti-tuberculosis Drugs: A 5-Year Retrospective Study

Background/Aim: Tuberculosis remains a major global health problem with a high morbidity and mortality rate, approximately a quarter of the population is infected with tuberculosis. Drug susceptibility testing is an essential tool for identifying and managing drug-resistant tuberculosis. This study was conducted to evaluate the drug susceptibility pattern of Mycobacterium tuberculosis complex strains isolated from a university hospital. Methods: A total of 10900 samples sent to the microbiology laboratory with the suspicion of tuberculosis clinically between January 2018 and January 2022 were analyzed retrospectively. The automated BACTEC MGIT 960 (Becton Dickinson, USA) was used for sample culture and susceptibility testing. The obtained data were statistically analyzed with the Statistical Package for Social Sciences (SPSS version 20). Results: Out of the 154 isolated positive samples, males and females constituted equal parts of the study population (50%). The majority of tuberculosis cases were in the age group 56–75 years (42.2%), Pulmonary TB was detected in (90.3%) of the patients, while extrapulmonary TB cases were observed in (9.7%). As a result of susceptibility studies on positive samples, isoniazid resistance was 5.2%; streptomycin resistance 1.3%; ethambutol resistance was detected at a rate of 0.6%, while no rifampicin resistant sample was found. Both streptomycin and isoniazid resistance were seen together in 1.3% of the samples. Conclusion: A similar resistance pattern of the first-line antituberculosis drugs was observed in other studies conducted in different provinces of Turkey. The absence of multi-drug resistant and extensively drug-resistant tuberculosis in our study indicates that the tuberculosis surveillance program implemented in our region was successful.

Case Report: Milliary TB in Adolescence Diagnosed in Tapin, South Kalimantan, A Call for TB Awereness

This case report presents the clinical scenario of a 15-year-old adolescent admitted to the emergency room with complaints of shortness of breath and a persistent productive cough for the past 3 weeks, despite over-the-counter medication. The cough did not improve with over-the-counter medication. He also sometimes noticed blood stains in his phlegm. During the physical examination, a BCG scar was found on the right upper arm. The results showed that positive HIV status and the absence of BCG scars were significantly associated with miliary TB and extrapulmonary TB. However, in this case, both factors were not detected. The treatment regimen for miliary TB requires therapy for a minimum of 12 months, but teenagers experience difficulties in undergoing therapy due to the consumption of illegal drugs every day for a long period of time. Apart from that, social isolation and disrupted daily activities are also challenges for teenagers. The death rate from miliary TB in children reaches 15-20%, highlighting the importance of awareness of this disease. Therefore, handling and treating TB in adolescents requires special attention and further efforts to reduce the risk of treatment failure. Awareness of TB, especially in adolescents with chronic respiratory symptoms, must be increased to overcome this challenge in the future.

Myeloid-derived suppressor cells in pleural effusion as a diagnostic marker for early discrimination of pulmonary tuberculosis from pneumonia.

Tuberculous pleural effusion (TPE) stands as one of the primary forms of extrapulmonary tuberculosis (TB) and frequently manifests in regions with a high prevalence of TB, consequently being a notable cause of pleural effusion in such areas. However, the differentiation between TPE and parapneumonic pleural effusion (PPE) presents diagnostic complexities. This study aimed to evaluate the potential of myeloid-derived suppressor cells (MDSCs) in the pleural fluid as a potential diagnostic marker for distinguishing between TPE and PPE. Adult patients, aged 18 years or older, who presented to the emergency room of a tertiary referral hospital and received a first-time diagnosis of pleural effusion, were prospectively enrolled in the study. Various immune cell populations, including T cells, B cells, natural killer (NK) cells, and MDSCs, were analyzed in both pleural fluid and peripheral blood samples. In pleural fluid, the frequency of lymphocytes, including T, B, and NK cells, was notably higher in TPE compared to PPE. Conversely, the frequency of polymorphonuclear (PMN)-MDSCs was significantly higher in PPE. Notably, compared to traditional markers such as the neutrophil-to-lymphocyte ratio and adenosine deaminase level, the frequency of PMN-MDSCs emerged as a more effective discriminator between PPE and TPE. PMN-MDSCs demonstrated superior positive and negative predictive values and exhibited a higher area under the curve in the receiver operating characteristic curve analysis. PMN-MDSCs in pleural effusion increased the levels of reactive oxygen species and suppressed the production of interferon-gamma from T cells following nonspecific stimulation. These findings suggest that MDSC-mediated immune suppression may contribute to the pathology of both TPE and PPE. The frequency of PMN-MDSCs in pleural fluid is a clinically useful indicator for distinguishing between TPE and PPE.

An 11-month-old boy with tuberculous meningitis presenting as progressive limb weakness, fever, developmental retardation, and loss of consciousness: a case report

BackgroundTuberculous meningitis (TBM) accounts for about 1% of all tuberculosis cases and about 5% of extrapulmonary tuberculosis cases. However, it poses major importance because approximately half of those affected die or become severely disabled. Herein, the successful treatment of an 11-month-old boy with progressive limb weakness, fever, developmental retardation, and loss of consciousness due to tuberculosis, was reported.Case presentationAn 11-month-old (Iranian Turk) boy was referred to Loghman Hakim hospital for progressive limb weakness and loss of previously attained developmental milestones for the past 2 months. He also had persistent fever and loss of consciousness for about 14 to 21 days. Before being referred to our center, the patient had been diagnosed with hydrocephalus at another center due to possible acute bacterial meningitis based on a CT scan and MRI imaging. On physical examination, anterior fontanel bulging and neck stiffness were observed on the admission. His body temperature and heart rate were 38.1 C and 86 beats per minute (bpm), respectively. He had left 6 cranial nerve palsy and spastic quadriparesis with a power of grade 3/5. Other systemic examinations were normal. Endoscopic third ventriculostomy (ETV) (and leptomeningeal biopsy) revealed diffuse thickening of the floor and lateral walls of the 3rd ventricle and also a cobblestone appearance in the form of multiple white patchy lesions was detected on the floor of the 3rd ventricle. CSF analysis and polymerase chain reaction confirmed the TB meningitis. During hospitalization, a temporary EVD (external ventricular drain) was initially inserted. Eventually, defervescence was denoted 5–6 days after initiation of anti-TB medications, and a permanent ventriculoperitoneal shunt was inserted due to hydrocephalus. Gradually his truncal and limb tone and motor function improved, as did his emotional responses to his parents and ability to eat. The patient can walk without help in the 15th month following the operation and resolved hydrocephalus demonstrated on follow-up imaging.ConclusionOver half of treated TB meningitis patients die or suffer severe neurological sequelae, mainly due to late diagnosis. Hence, early diagnosis and prompt initiation of TB treatment offer the best chance of a good neurological outcome.

Unusual Presentation of Extra Pulmonary Tuberculosis in Middle aged Female: A Unique Case Report

Pulmonary tuberculosis (TB) is a leading cause of morbidity and mortality among all infectious diseases especially in Pakistan where TB is endemic while extra pulmonary TB often encountered. However, primary salivary gland specifically unilateral parotid gland involvement is exceedingly uncommon. We present a case of 38-year old woman with six months duration of right parotid lump. The lump was firm and non-tender with bilateral cervical lymphadenopathy. No other constitutional symptoms of TB in our patient except weight loss. We presumed it a parotid neoplasm but after workup it reveals parotid TB which responds to first line anti-tuberculous therapy (ATT). So, careful exclusion of parotid neoplasm prevented unwanted surgery in our patient and patient recovered without any residual disease. We proposed that the differential diagnosis of a parotid gland swelling should include the infrequent possibility of parotid gland tuberculosis.

Prevalence of Tuberculosis in Children

Background: Pulmonary TB is a relatively common disease in developing countries including Iraq . A relatively small proportion (5–10%) of the approximately 2 billion people infected with M. tuberculosis worldwide will develop TB. Objective: To show the prevalence of T.B. among children in Abu-Ghraib city Patients and Methods: A descriptive retrospective center-based study in the Abu-Ghraib health sector (chest and respiratory disease unit) was conducted to show the distribution of TB in children ≤ 18 years from the 1st January 2001 till the 31st December 2020. Results: A total sample of 248 patients which represents 15.1% of all patients with TB in Abu-Ghraib (1642) from1st January 2001 till 31st December 2020. Female (152; 61.2%) and male (96; 38.8%). Most common age group affected was 13-18 years which represents 71.7% of patient. The prevalence of TB in Abu-Ghraib during the study period for children was (3.4/100,000). Conclusion: The prevalence of all forms of TB in Abu-Ghraib during the study period was (3.4/100000). Females were affected more than males with a mean of 6.7+/-1.5 Extra-pulmonary TB was found to be more common than pulmonary TB. Keywords: TB, Children, Epidemiology, Iraq

Prevalence of Tuberculosis in Children

Background: Pulmonary TB is a relatively common disease in developing countries including Iraq . A relatively small proportion (5–10%) of the approximately 2 billion people infected with M. tuberculosis worldwide will develop TB. Objective: To show the prevalence of T.B. among children in Abu-Ghraib city Patients and Methods: A descriptive retrospective center-based study in the Abu-Ghraib health sector (chest and respiratory disease unit) was conducted to show the distribution of TB in children ≤ 18 years from the 1st January 2001 till the 31st December 2020. Results: A total sample of 248 patients which represents 15.1% of all patients with TB in Abu-Ghraib (1642) from1st January 2001 till 31st December 2020. Female (152; 61.2%) and male (96; 38.8%). Most common age group affected was 13-18 years which represents 71.7% of patient. The prevalence of TB in Abu-Ghraib during the study period for children was (3.4/100,000). Conclusion: The prevalence of all forms of TB in Abu-Ghraib during the study period was (3.4/100000). Females were affected more than males with a mean of 6.7+/-1.5 Extra-pulmonary TB was found to be more common than pulmonary TB.

Extra-pulmonary tuberculosis frequency and the risk factors influence (case of the PHE-Batna regional unit) (2017-2022)

Context: Tuberculosis is an infectious disease that is endemic in developing countries. The causal agent is Mycobacterium tuberculosis. Extra-pulmonary tuberculosis (EPTB) is receiving renewed attention due to an unexplained increase in its relative frequency. The aim of this study was to carry out a retrospective descriptive survey to assess the frequency of extra-pulmonary tuberculosis in an eastern Algeria population range. Methods: this study took place at the regional tuberculosis Batna’s Public hospitalian establishment unit; over a period of 64 months (2017-2022). 2405 files were studied through the collection of information recorded at laboratory level. Results: Out of 2405 samples, 102 were positive (4.24%). There was a clear predominance of females (64.70%) and males (35.29%), giving a sex ratio of 1.8. The age group most affected was 11 to 49. Pus was the most common specimen with a percentage of 44.12%, followed by urine (28.43%), CSF (14.70%). The incidence of extra pulmonary tuberculosis in patients in Batna’s Department and neighbouring Departments is 4.24%, with adult women being the most affected. Conclusion: Extrapulmonary tuberculosis is common and should not be neglected; it is no longer a pathology of the past but still remains relevant today.

Dynamics of Matricellular Protein Levels in Blood Predict Recovery in Patients with Human Immunodeficiency Virus-Tuberculosis Coinfection.

Chronic immune activation in tuberculosis (TB) associated with human immunodeficiency virus (HIV) infection (HIV/TB) modifies their clinical course. We prospectively measured osteopontin (OPN), full-length galectin-9 (FL-Gal9), and total-Gal9 (T-Gal9) levels in 32 patients with HIV/TB coinfection treated with anti-tuberculosis and antiretroviral therapies over 6-18 months to determine the amelioration of inflammatory conditions in response to the therapies. We observed a significant time-dependent decrease in FL-Gal9 in both pulmonary TB (PTB, n = 20) and extrapulmonary TB (EPTB, n = 12) patients. The levels of T-Gal9, OPN, and CRP decreased significantly after treatment in only PTB patients. We calculated the inflammatory score (INS) indicating immunologic recovery based on the decline in OPN, FL-Gal9, T-Gal9, and CRP levels. Baseline levels of T-Gal9 and OPN positively correlated with INS in all TB and only PTB patients, respectively, indicating that their levels predict better recovery. In contrast, FL-Gal9 levels at the second visit negatively correlated with INS in EPTB patients. The decrease rate in OPN levels at the second visit also correlated positively with INS in PTB patients. Women showed a higher INS and lower levels of FL-Gal9 than men. The patients with moderate grade severity on chest X-ray had higher CD4 cell numbers than those with limited grade severity. Monitoring these markers will help to predict and assess the response to therapy as well as to devise strategies to reduce the complications caused by chronic immune activation in patients with HIV/TB coinfection.

Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India.

Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, thehematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.

Diagnostic Challenge: A case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

Introduction: Breast tuberculosis is a rare form of extra pulmonary tuberculosis with its primary form considered even rarer. Case presentation: A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary breast tuberculosis, necessitating anti-tubercular therapy. Clinical discussion: Breast tuberculosis, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, Persistent symptoms despite treatment should prompt consideration of breast tuberculosis in TB endemic regions. Conclusion: Primary Breast Tuberculosis might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.

Comparative Study of Vitamin D Levels in Newly Diagnosed Tuberculosis and a Normal Population.

Background and Objectives: Tuberculosis (TB) is an ancient disease caused by Mycobacterium tuberculosis, a member of the Mycobacterium tuberculosis complex. It contributes to significant morbidity and mortality. Treatment of TB poses a considerable challenge because of emerging drug resistance and the longer duration of therapy. Various past studies, both in vitro and in vivo, have established the role of vitamin D in the pathogenesis and treatment of TB. Results of in vivo studies are inconsistent, and this study aims to determine vitamin D levels and their association with newly diagnosed TB (pulmonary and extrapulmonary) cases and normal populations. Material and Methods: A Prospective Case-Control study with 116 subjects (58 cases and 58 controls) was conducted over two years. 29 cases of pulmonary TB and 29 cases of extrapulmonary TB constituted 58 cases of TB. Vitamin D levels were measured and compared in both the cases and controls. Data analysis was carried out using SPSS software 22.0. Results: The prevalence of vitamin D deficiency was 68.96% in the cases, while it was 51.72% in the controls. The reported median and quartile of serum vitamin D levels were 14.35 ng/mL (8.65, 25.48) in the TB group and 19.08 ng/mL (13.92, 26.17) in the control group. There was a significant statistical difference between the TB and non-TB populations with a p-value of 0.029 on the Mann-Whitney test. Conclusion: Vitamin D deficiency was more prevalent in individuals with TB than those without TB.

Utility of CBNAAT (GeneXpert MTB/RIF assay) in rapid diagnosis of extrapulmonary tuberculosis in a hepatobiliary tertiary center

Objectives Newer diagnostic techniques like cartridge-based nucleic acid amplification techniques (CB NAAT) need to be evaluated for extrapulmonary tuberculosis (EPTB), as being a paucibacillary condition, it is often underdiagnosed with conventional methods. We conducted this study to assess the utility of CB NAAT (GeneXpert MTB/RIF assay) in rapid diagnosis of extrapulmonary tuberculosis. Material and Methods Liver disease patients admitted from June 2019 to June 2020 were investigated for EPTB based on clinical and radiological suspicion. EPTB was diagnosed based on one of the following: (i) histological evidence of caseating granulomas; (ii) smear positivity for acid-fast bacilli; (iii) CB NAAT (GeneXpert MTB/RIF assay, Cepheid, USA). Results A total of 290 EPTB specimens received in the laboratory were included. The extrapulmonary samples that were received included body fluids (n = 143) which included pleural fluid, ascitic fluid, drain fluids, and pus aspirates, followed by biopsies (n = 82), lymph nodes (n = 43), urine (n = 19), and CSF (n = 3). GeneXpert MTB/RIF assay was positive in 10.3% (n = 30) samples, whereas negative in 89.7% (n = 260) samples. The overall sensitivity of GeneXpert MTB/RIF assay was 61.36% (95% CI 46.62%–74.28%), specificity 89.29% (95% CI 72.8%–96.29%), positive predictive value (PPV) 90% (95% CI 74.38%–96.54%), and negative predictive value (NPV) 59.52% (95% CI 44.49%–72.96%). Conclusion The GeneXpert MTB/RIF assay is a valuable tool for extrapulmonary tuberculosis. In addition to other tests like smear, culture GeneXpert MTB/RIF assay helps in the confirmation of diagnosis. Rapid diagnosis of tuberculosis with overall good sensitivity and specificity makes it a beneficial test.

Pott’s disease and scrofuloderma as presentation of clinically extrapulmonary tuberculosis in 15 years old girl: a case report

Backgrounds: Extrapulmonary tuberculosis (TB) accounts for 15–20% of all tuberculosis cases, with the lymph node being the most commonly affected organ. Spinal tuberculosis and scrofuloderma are rare manifestations of extrapulmonary TB and constitute less than 5% of the cases. Establishing the diagnosis is a challenge. Eradication and prevention of sequelae complicate further management of the disease. This study aims to describe the clinical manifestation and the management of spondylitis tuberculosis and scrofuloderma in a child. Case presentation: A 15-year-old girl came with a chief complaint of lower extremities weakness for a week following monthly chronic low back pain. She also reported a painless lesion on her back with no sign of acute inflammation. She also complained of intermittent fever with night sweats and lost 3 kilos of body weight in the last two months. From physical examination, we found a kyphotic posture and severe malnutrition. Skin examination revealed an open wound on her right lower back, size 4x3 cm, with no sign of inflammation. The tuberculin skin test was positive with 15 mm induration. The spinal magnetic resonance imaging revealed destruction of the vertebral corpus thoracal segment, hyperintense sacrum, and right ileum bone with a cold abscess, suggesting spondylitis TB. A wound biopsy with hematoxylin-eosin stain concluded chronic granulomatous inflammation and showed multinucleated giant cell Langhans-type, suggestive of cutaneous tuberculosis. Microbiology examination (PCR GeneXpert) from wound biopsy and ziehl neelsen stain failed to detect Mycobacterium tuberculosis. The patient was diagnosed with Pott’s disease and scrofuloderma. Anti-tuberculous therapy commenced, and the patient responded well after several months of treatment. Conclusions: The diagnosis of extrapulmonary TB manifests as spinal tuberculosis, and scrofuloderma could be made from clinical manifestation and imaging.

A Rare Presentation - Case Report on Tubercular Cold Abscess

Tuberculosis is a chronic granulomatous infection that is quite common and a threat to many developing countries. However, extrapulmonary cases involving tubercular skin and soft tissue abscess formation are rare, accounting for 1 or 2% of cases of Mycobacterium TB infections with skin and soft tissue involvement. The typical extrapulmonary tuberculosis symptoms and indications are nonspecific, making diagnosis difficult and time-consuming. We present a case of right arm tubercular cold abscess in a child related to mycobacterium tuberculosis, which was diagnosed by Ziehl- Neelson stain FNAC (Fine needle Aspiration cytology) and Mantoux test (18mm) induration. Due to its rare manifestation, it often gets misdiagnosed or overlooked. A proper diagnosis will ensure a proper treatment plan. Our case further depicts the collaborative effort of healthcare professionals. The patient came back complaining about the increased swelling in his right arm.
 Keywords: Tubercular Cold Abscess, Ziehl- Neelson, Fine needle Aspiration cytology, Mantoux test, Mycobacterium Tuberculosis

Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013-2022.

To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0-4 years old, 5-9 years old, 10-14 years old) and different periods (2013-2017 and 2018-2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035-2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442-11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401-38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355-0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children.

Magnetic Resonance Imaging (MRI) Images in Tuberculosis Spondylitis Patients at the Central General Hospital Prof. Dr. I.G.N.G. Ngoerah Year 2021-2023

Background: Tuberculous spondylitis is extrapulmonary tuberculosis that attacks the spine. The incidence of tuberculosis has decreased. However, the prevalence of deaths due to tuberculosis is still high, so it requires appropriate management. Method: This study used a cross-sectional descriptive method, the research population was tuberculous spondylitis patients diagnosed at RSUP Prof. Dr. I.G.N.G Ngoerah 2021-2023. The research data source is PACS MRI data, with a sample size of 25. This research uses a consecutive sampling technique. Data analysis uses univariate analysis. Result: The research results showed that 25 samples met the inclusion criteria. Patients in the largest age group were 19 – 39 (36%) years and 40 – 59 years (36%) and the largest sex was female (56%). The most common location of vertebral MR Imaging was found in the thoracic (36%), intervertebral disc involvement was (52%) with normal discs and (48%) with disc destruction, there was endplate defect and paravertebral abscess in all samples (100%), the presence of gibbus deformity As many as (88%) of the sample, spinal cord compression was (96%), the most destruction of the corpus vertebral was on the anterior side (64%), and the most change in intensity of the interverbal disc was without contrast enhancement (60%). Conclusion: There are more women than men. The largest age groups are 19 - 39 years and 40 - 59 years with the most MR Imaging, namely in the thoracic location, normal intervertebral discs, endplatedefect, and paravertebral abscesses in all samples, gibbus deformity, spinal cord compression, anterior corpus vertebral destruction, and changes in intensity, intervertebral disc without contrast enhancement. Keywords: Tuberculous spondylitis, MRI, Bali

Tuberculosis in Poland in 2021.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2021 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2021, data from Statistics Poland on deaths from tuberculosis in 2020, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2021 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." In 2021, 3704 TB cases were reported in Poland. The incidence rate was 9.7 cases per 100,000 with large variability between voivodeships from 5.4 to 12.6 per 100,000. A decrease in the incidence with respect to 2020 was found in 8 voivodeships, the most significant in lubuskie voivodship (42.6%). The number of all pulmonary tuberculosis cases was 3,553 i.e. 9.3 per 100,000. Pulmonary cases represented 95.9% of all TB cases. In 2021, 151 extrapulmonary TB cases were notified (4.1% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,970 cases (83.6% of all pulmonary TB cases, the incidence rate 7.8 per 100,000). The number of smear-positive pulmonary TB cases was 2,085 i.e. 5.5 per 100,000 (58.7% of all pulmonary TB cases). In 2021, there were 54 cases (25 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.9% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 0.6 per 100,000 among children (0-14 years) to 15.8 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 11.7 per 100,000. There were 37 cases in children up to 14 years of age (1.0% of the total) and 51 cases in adolescents between 15 and 19 years of age - rates 0.6 and 2.8 per 100,000 respectively. In 2021, there were 2,690 cases of tuberculosis in men and 1,014 in women. The TB incidence in men - 14.6 per 100,000 was almost 3.0 times higher than among women - 5.1. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55-59 years, 30.5 vs. 6.6 and in age group 60 to 64 years, 26.0 vs. 5.7. In 2021, there were 132 patients of foreign origin among all cases of tuberculosis in Poland (3.6%). In 2020, TB was the cause of death for 474 people (mortality rate - 1.2 per 100,000). The incidence of tuberculosis in Poland in 2021 was 10.2% higher than in 2020. The percentage of tuberculosis cases with bacteriological confirmation was 82.6%, higher than the average in EU/EEA countries (72.0%). The percentage of MDR-TB cases was lower than the average in EU/EEA countries (1.9% vs. 3.8%). The highest incidence rates are found in Poland in the older age groups (in EU/EEA countries in people aged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.0%, the average in the EU/EEA countries was 3.5%. The incidence of tuberculosis in men was nearly three times higher than in women in Poland. The impact of migration on the epidemiological situation of tuberculosis in Poland in 2021 was smaller than in the EU/EEA countries (in Poland, the percentage of foreigners among all TB patients was 3.6 vs. 33.8% in the EU/EEA).

Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China.

Tuberculosis (TB) is recognized as a significant global public health concern. Still, there remains a dearth of comprehensive evaluation regarding the specific indicators and their influencing factors of delay for adolescents and young adults. All notified pulmonary TB (PTB) patients in Jiaxing City were collected between 2005 and 2022 from China's TB Information Management System. Logistic regression models were conducted to ascertain the factors that influenced patient and health system delays for PTB cases, respectively. Furthermore, the impact of the COVID-19 pandemic on local delays has been explored. From January 1, 2005 to December 31, 2022, a total of 5,282 PTB cases were notified in Jiaxing City, including 1,678 adolescents and 3,604 young adults. For patient delay, female (AOR: 1.18, 95%CI: 1.05-1.32), PTB complicated with extra-pulmonary TB (AOR: 1.70, 95% CI: 1.28-2.26), passive case finding (AOR: 1.46, 95% CI: 1.07-1.98) and retreatment (AOR: 1.52, 95% CI: 1.11-2.09) showed a higher risk of delay. For health system delay, minorities (AOR: 0.69, 95% CI: 0.53-0.90) and non-students (AOR: 0.83, 95% CI: 0.71-0.98) experienced a lower delay. Referral (AOR: 1.46, 95% CI: 1.29-1.65) had a higher health system delay compared with clinical consultation. Furthermore, county hospitals (AOR: 1.47, 95% CI: 1.32-1.65) and etiological positive results (AOR: 1.46, 95% CI: 1.30-1.63) were associated with comparatively high odds of patient delay. Contrarily, county hospitals (AOR: 0.88, 95% CI: 0.78-1.00) and etiological positive results (AOR: 0.67, 95% CI: 0.59-0.74) experienced a lower health system delay. Besides, the median of patient delay, health system delay, and total delay during the COVID-19 pandemic were significantly lower than that before. In general, there has been a noteworthy decline in the notification rate of PTB among adolescents and young adults in Jiaxing City while the declining trend was not obvious in patient delay, health system delay, and total delay, respectively. It also found factors such as gender, case-finding method, and the hospital level might influence the times of seeking health care and diagnosis in health agencies. These findings will provide valuable insights for refining preventive and treatment strategies for TB among adolescents and young adults.