Features Of Active Tuberculosis Research Articles

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis. DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB). SettingIt was a prospective cross-sectional study in a tertiary referral centre. PatientsA total of 348 patients with infertility with FGTB on various tests. InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings. Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m2 and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation. ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.

Diagnostic delay and mortality of active tuberculosis in patients after kidney transplantation in a tertiary care hospital in China.

TB infection in patients after kidney transplantation remains a concern in a successful long-term outcome. This retrospective, descriptive study was performed on tuberculosis infection after kidney transplantation in the Department of Infectious Disease of the First Affiliated Hospital of Zhejiang University, a tertiary care hospital in China, from January 2011 to April 2017, with the aim to explain the clinical features of active tuberculosis after kidney transplantation and explore the correlated factors for diagnostic delay and mortality. It included 48 cases. All these cases were followed up for at least 12 months after anti-tuberculosis therapy, except the ones who died during this period. The median time of transplantation to active tuberculosis of these 48 patients was about 5.4 years. The time from a first hospital visit to the diagnosis (diagnostic delay) of 12 (25%) cases was more than 30 days. The correlated factors for the diagnostic delay more than 30 days were a fever for more than 2 weeks and antibiotic use for more than 2 weeks. Nine (18.8%) cases died during the anti-tuberculosis therapy or following-up period due to TB relapse. The risk factors for mortality were severe complications, such as encephaledema, severe pneumonia, intestinal perforation, liver function failure, and the following multiple-organ failure. In conclusion, the possibility of tuberculosis infection should be carefully assessed and sometimes diagnostic anti-tuberculosis therapy may be required for patients who had a fever for more than 2 weeks or used antibiotics for more than 2 weeks after kidney transplantation. Severe complications and the following multiple-organ failure might increase the mortality among these patients.

Disseminated Tuberculosis Causing Addison’s Disease in an Adult Diabetic Patient

Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyroid with adrenal gland being the commonest. We describe a patient presented with recurrent spontaneous hypoglycemia, hypotension, fever, weight loss and cough. Along with this clinical picture, high ACTH in the face of low cortisol was compatible with diagnosis of Addison’s disease. Rapid ACTH stimulation test affirmed the diagnosis. Disseminated TB affecting adrenal glands was supported by CXR, USG, CT Abdomen and FNAC. Adrenal Crisis was led by add-on bacterial pneumonia. Patient made good recovery with treatment for adrenal crisis and subsequently with standard antitubercular regimen and steroid replacement therapy. Tuberculosis, although uncommon but potentially devastating cause of adrenal failure, merits consideration when fever, weight loss, gastrointestinal symptoms, hyponatremia, hyperkalemia are observed in patients with features of active tuberculosis or past history of tuberculosisJ Bangladesh Coll Phys Surg 2015; 33(1): 44-47

P422. Risks and clinical features of active tuberculosis developed in patients with inflammatory bowel disease receiving anti-tumour necrosis factor therapy

P422. Risks and clinical features of active tuberculosis developed in patients with inflammatory bowel disease receiving anti-tumour necrosis factor therapy

Primary tuberculosis in a nomadic Fulani population and their cattle herds in Kano, Nigeria: a one health approach

Background: Nigeria has a large population of Fulani pastoralists. Zoonotic infections like bovine tuberculosis (TB) are common among nomadic Fulani and their livestock. Close interaction between the nomads and their animals provide a critical human–animal interface with potential for transmission of zoonoses. We conducted a survey to determine the prevalence of primary TB infection among nomads and their cattle in Kano, north-western Nigeria. Materials and Methods: We performed tuberculin skin test (TST) to all inhabitants of the nomadic setting and a randomly selected population of their cattle. We obtained sociodemographic information and symptoms of pulmonary TB in both respondents and their cattle. We explore knowledge of respondents regarding risk of disease transmission between them and their livestock. We compare rates of TST among the respondents and the cattle. Participants with features of active TB were referred for further evaluation and treatment. Results: Out of 244 individuals evaluated, 103 (42.2%) were females with a median age (range) of 35 years (1–80 years). Among 167 participants who consented for and returned for TST reading, 45 (26.9%) were positive; 33 (73.3%) of which were between 20 and 50 years of age. A total of 29 (11.9%) respondents reported having cough for at least 3 weeks at the time of the study. Of the 244 participants interviewed, 51 (20.9%) reported having animals with chronic cough. A total of 26 (12.7%) of the 204 cattle tested had positive TST. Majority of the respondent (71%) were aware of potential risk of transmission of infectious diseases between them and their herds. Conclusion: High TST positivity among the nomads of economically viable age and their herds suggests that TB is prevalent in their communities with potential for animal–human transmission. TB and other infectious diseases control programs should capture nomads in their planning and implementation.

Sa1119 Clinical Features of Active Tuberculosis Developed During Anti-Tumor Necrosis Factor-α Therapy in Patients With Inflammatory Bowel Diseases

Introduction: Long-term treatment of Crohn's disease (CD) with thiopurines modifies the risk of various cancers, depending on gender and age for lymphomas, and presence of extensive colitis (EC) for colorectal cancer. We evaluated risks and benefits of withdrawing or continuing thiopurines in patients with CD in sustained clinical remission. Methods: We developed a Markov model assessing risks and benefits of withdrawing or continuing thiopurines in a lifetime horizon. We simulated a cohort of CD patients in stable clinical remission for 5 years under thiopurines. The model was stratified by age, gender and presence of EC. Parameter estimates were taken from French hospital Diagnosis Related Groups (DRGs) databases, the French cancer and death national registries (FRANCIM), the CESAME cohort, the Saint-Antoine hospital database (MICISTA)), and from the literature. The primary outcome was life expectancy. Secondary outcomes included the probability of CD relapse, cancers, and causes-of-deaths. We conducted threshold analyses on age to assess potential age-related changes in best life expectancy according to the two strategies. Results: The continuing strategy was globally associated with decreased lifetime risk of flares and increased risk of lymphoma. However, life-expectancy and risks associated with the two strategies differed markedly according to age at decision, gender and presence or absence of EC, as illustrated in Table 1. In terms of life expectancy, in patients without EC, withdrawal strategy was associated with increased life expextancy after the age of 41.7 years for men, and 47.0 years for women. In patients with EC, continuing thiopurines was associated with increased life expectancy, regardless of age. Conclusion: Factors determining life expectancy associated with withdrawal or continuation of thiopurines in patients with CD and 5-year sustained clinical remission vary substantially according to gender, age and presence of EC. Individual decisions to continue or withdraw thiopurines in patients with CD in sustained remission should take into account age, gender, and presence of EC. Table 1 : Life expectancy, relapse, cancers and causes of death associated with continuing (C) or withdrawing (W) maintenance treatment with thiopurines

P27 Does a direct Radiology referral system to a rapid access Tuberculosis clinic improve TB diagnosis?

IntroductionDelayed diagnosis of active pulmonary tuberculosis (TB) is common and significantly contributes to transmission especially in smear-positive pulmonary TB. Persons with symptoms suggestive of pulmonary TB often have chest radiographs...

Nocardiosis - an emerging complication in the clinical management of HIV infected patients

Out of the 8 patients diagnosed with nocardiosis in this study, 7 (7.4%) were not receiving antiretroviral therapy (ART) while 1(0.7%) with a CD4 count of 109 cells/ul had already commenced ART. We also observed that all 8 patients diagnosed with nocardiosis all had a negative AFB result after producing three sputum samples for TB analysis. Conclusions In Nigeria where HIV-related tuberculosis occurs frequently, some patients diagnosed as having sputum smear-negative pulmonary tuberculosis actually have nocardiosis. It is pertinent that TB laboratories include gram staining during routine investigations of sputum samples especially for patients who present with typical features of active tuberculosis but whose smears are repeatedly negative for AFB.

Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study

BackgroundHIV and tuberculosis (TB) are commonly associated. Identifying latent and asymptomatic tuberculosis infection in HIV-positive patients is important in preventing death and morbidity associated with active TB.MethodsCross-sectional study of one time use of an interferon-gamma release assay (T-SPOT.TB - immunospot) to detect tuberculosis infection in patients in a UK inner city HIV clinic with a large sub-Saharan population.Results542 patient samples from 520 patients who disclosed their symptoms of TB were tested. Median follow-up was 35 months (range 27-69). More than half (55%) originated from countries with medium or high tuberculosis burden and 57% were women. Antiretroviral therapy was used by 67%; median CD4 count at test was 458 cells/μl. A negative test was found in 452 samples and an indeterminate results in 40 (7.4%) but neither were associated with a low CD4 count. A positive test was found in 10% (50/502) individuals. All patients with positive tests were referred to the TB specialist, 47 (94%) had a chest radiograph and 46 (92%) attended the TB clinic. Two had culture-positive TB and a third individual with features of active TB was treated. 40 started and 38 completed preventive treatment. One patient who completed preventive treatment with isoniazid monotherapy subsequently developed isoniazid-resistant pulmonary tuberculosis. No patient with a negative test has developed TB.ConclusionsWe found an overall prevalence of latent TB infection of 10% through screening for TB in those with HIV infection and without symptoms, and a further 1% with active disease, a yield greater than typically found in contact tracing. Acceptability of preventive treatment was high with 85% of those with latent TB infection eventually completing their TB chemotherapy regimens. IGRA-based TB screening among HIV-infected individuals was feasible in the clinical setting and assisted with appropriate management (including preventive treatment and therapy for active disease). Follow-up of TB incidence in this group is needed to assess the long-term effects of preventive treatment.

Nocardiosis - an emerging complication in the clinical management of HIV/AIDS patients in Africa

Purpose of study: In Nigeria, as well as other parts of Africa, little is known regarding the prevalence of nocardiosis among HIV-positive patients. Most tuberculosis (TB) /HIV treatment programs do not consider nocardiosis in the differential diagnosis for TB since it is not regarded as an AIDS-defining illness according to the World Health Organization's guideline. The aim of this study is to determine the prevalence of nocardiosis in HIV-positive patients suspected of having tuberculosis. Methods: In this prospective study, sputum samples of 234 HIV-positive patients with suspected cases of pulmonary tuberculosis were analyzed for Mycobacterium TB and Nocardia species. Each sample was processed by conventional Ziehl Neelsen stain and examined for the presence of acid-fast bacilli (AFB). AFB-negative samples were streaked on slopes of Sabouraud's dextrose agar and paraffin-coated glass rods which acted as bait for Nocardia was introduced into each of these inoculated media and incubated at 37 °C. Cultures were examined after two weeks for the presence of cream/orange tufts around the rods suggestive of Nocardia . The isolates were scraped and further identified using biochemical tests. The CD4 cell count of each patient was estimated using Becton Dickinson FACS count system. Results: Of the 234 patient samples examined, 8 had positive culture for Nocardia . The prevalence of TB was 10.3% while that of Nocardia spp was 3.4%. All cases of nocardiosis detected was found in patients with CD4 count of <200 cells/μl with 75% of these cases having CD4 count below 100 cells/μl. Out of the 8 patients diagnosed with nocardiosis in this study, 7 (7.4%) were not receiving antiretroviral therapy (ART) while 1 (0.7%) with a CD4 count of 109 cells/μl had already commenced ART. We also observed that all 8 patients diagnosed with nocardiosis all had a negative AFB result after producing three sputum samples for TB analysis. Conclusions: In Nigeria, where HIV-related tuberculosis occurs frequently, some patients diagnosed as having sputum smear-negative pulmonary tuberculosis actually have nocardiosis. It is pertinent that TB laboratories include gram staining during routine investigations of sputum samples, especially for patients who present with typical features of active tuberculosis but whose smears are repeatedly negative for AFB.

Management of multiple drug-resistant tuberculosis

There has been a worldwide increase in multiple drug-resistant tuberculosis (MDR-TB) which has in the past been associated with a poor prognosis. In the U.K., about half of the cases live in the London area and we have set out to obtain further information on their treatment and outcome. We examined the risk factors, drug resistance, drug treatment, sputum conversion, and outcome in patients with MDR-TB at three hospitals in South London and diagnosed during the period June 1995–January 1999. Human Immunodeficiency Virus (HIV)-positive patients were excluded. There were 760 patients resident in Lambeth, Southwark and Lewisham Health Authority (LSLHA) who were notified as tuberculosis (TB) during the time period and who were of negative or unknown HIV status. (The population of LSLHA is approx. 750 000.) There was a total of 13 patients with MDR-TB, known or presumed to be HIV negative. Their median age was 28 years (range 15–53); nine (69%) were born outside the U.K. and 11 had pulmonary disease; they had organisms resistant to a median of two first-line drugs (range 2–4) and to a median of four of all drugs tested (range 2–10). They received treatment with a median of six drugs (range 3–9). Eight were followed up for at least 3 years (range 3–6) after the completion of treatment; at their last assessment none had features of active TB and all were sputum negative (smear and culture). Two returned to their countries of origin during treatment; they were sputum negative at that time. Two patients are well and continue on treatment in the U.K. One patient (known HIV negative) died following treatment failure. In conclusion, we obtained disease-free survival in eight cases of MDR-TB, known or presumed to be HIV negative and followed up for 3 years or more. The prognosis for patients treated at specialised centres is good (and better than is generally believed). We describe a new protocol for the detection and management of MDR-TB.

Active tuberculosis in HIV-infected injecting drug users from a low-rate tuberculosis area.

This article describes the features of active tuberculosis in HIV-infected injecting drug users (IDUs) from a low-rate tuberculosis area. The cohort was followed in a hospital-based HIV/AIDS registry, and data were extracted from the registry, patient charts, and the Tuberculosis Control Program of the Connecticut Health Department. The setting was an acute care inner-city hospital-based health care system, with a high incidence of AIDS, serving a small-to-medium urban area in Connecticut. The patients were 905 HIV-infected IDUs whose time of HIV diagnosis (TOHD) was between 1984 and 1992. The outcome measures were demographics, clinical characteristics, and morbidity rates of active tuberculosis. Of the 27 IDUs who developed active tuberculosis, none were white, all but one were male, and only one was known to have had a positive purified protein derivative (PPD) reaction prior to TOHD: 59% of cases developed in patients known to be HIV infected, 11% occurred in established AIDS patients, and 67% qualified as extrapulmonary tuberculosis (that is, AIDS defining by pre-1993 definitions). In 22% of cases, both Mycobacterium tuberculosis and M. avium-intracellulare were isolated. Mycobacterium tuberculosis was most commonly isolated from a respiratory specimen (67%). The annual incidence rate has been < or = 1.0% since 1988. The cumulative incidence rate was highest for patients with a positive PPD reaction or a history of tuberculosis (1.4 cases/100 patient years; 52 patients; mean follow-up 4.0 years). The demographics and clinical characteristics of active tuberculosis in our HIV-infected IDUs are similar to those described elsewhere in the United States; the morbidity rates are low and stable. The implications of our findings on tuberculosis control in HIV-infected IDUs may be applicable to health care systems with low tuberculosis rates.