Form Of Extrapulmonary Tuberculosis Research Articles

Orbital tuberculosis presenting as vision loss and headache: early management is paramount

Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches.

Decoding the hidden realm: Molecular pioneering unravelling osteoarticular tuberculosis diagnosis

Osteoarticular tuberculosis (TB), a form of extrapulmonary tuberculosis, refers to the involvement of Mycobacterium tuberculosis (M.tb) in the bones and joints. While pulmonary tuberculosis is the most common form, osteoarticular TB represents a relatively rare but significant manifestation, accounting for approximately 1–3% of all TB cases. Accurate and timely diagnosis plays a pivotal role in the management of osteoarticular TB. Conventional diagnostic methods for osteoarticular TB, such as acid-fast bacilli smear microscopy and culture, have limitations in terms of sensitivity, specificity, and turnaround time. The purpose of this review is to comprehensively evaluate and synthesize the existing literature on molecular pioneering in osteoarticular TB diagnosis. Molecular techniques, such as nucleic acid amplification tests and gene-based assays, have emerged as promising tools for diagnosing TB. These techniques target specific genetic sequences of M.tb, enabling rapid and sensitive detection of the pathogen. However, the diagnostic accuracy, advantages, and limitations of these molecular techniques in the context of osteoarticular TB diagnosis require further investigation and consolidation of evidence. Furthermore, this review aims to identify areas for future research and development in the field of molecular diagnostics for osteoarticular TB.

The diagnostic potential of urine in paediatric patients undergoing initial treatment for tuberculous meningitis

Tuberculous meningitis (TBM)—the extrapulmonary form of tuberculosis, is the most severe complication associated with tuberculosis, particularly in infants and children. The gold standard for the diagnosis of TBM requires cerebrospinal fluid (CSF) through lumbar puncture—an invasive sample collection method, and currently available CSF assays are often not sufficient for a definitive TBM diagnosis. Urine is metabolite-rich and relatively unexplored in terms of its potential to diagnose neuroinfectious diseases. We used an untargeted proton magnetic resonance (1H-NMR) metabolomics approach to compare the urine from 32 patients with TBM (stratified into stages 1, 2 and 3) against that from 39 controls in a South African paediatric cohort. Significant spectral bins had to satisfy three of our four strict cut-off quantitative statistical criteria. Five significant biological metabolites were identified—1-methylnicotinamide, 3-hydroxyisovaleric acid, 5-aminolevulinic acid, N-acetylglutamine and methanol—which had no correlation with medication metabolites. ROC analysis revealed that methanol lacked diagnostic sensitivity, but the other four metabolites showed good diagnostic potential. Furthermore, we compared mild (stage 1) TBM and severe (stages 2 and 3) TBM, and our multivariate metabolic model could successfully classify severe but not mild TBM. Our results show that urine can potentially be used to diagnose severe TBM.

Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China.

This study aimed to investigate the epidemiological and drug resistance (DR) characteristics of extrapulmonary tuberculosis (EPTB) in South-Central China. EPTB inpatients who were culture-positive for Mycobacterium tuberculosis were retrospectively included in a study at a provincial TB hospital in Hunan, a province in South-Central China, from January 2013 to December 2021. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment records. Descriptive statistical methods and a Chi-squared test were used to analyze the epidemiological and DR characteristics of EPTB patients. A logistic regression model was used to explore the risk factors of rifampicin-resistant/multidrug-resistant (RR/MDR)-EPTB. A total of 1,324 cases were included. The majority of EPTB patients were in the age range of 20-29 years, were predominantly men (male-to-female ratio: 2.03), and were farmers (65.63%). Most EPTB cases were found in 2013 and 2017 from 2013 to 2021. The most prevalent subtypes of EPTB were lymphatic TB (29.83%, 395/1,324), multiple EPTB (20.85%, 276/1,324), and musculoskeletal TB (14.65%, 194/1,324). Musculoskeletal TB and genitourinary TB predominantly presented as exclusive EPTB forms, while lymphatic TB and pharyngeal/laryngeal TB often co-occurred with pulmonary TB (PTB). Drug susceptibility testing results showed that total DR rates (resistance to any of RFP, isoniazid [INH], streptomycin [STR], and/or ethambutol [EMB]) and RR/MDR rates in EPTB were 25.23% and 12.39%, respectively. Musculoskeletal TB exhibited the highest rates of total DR (31.40%), INH resistance (28.90%), STR resistance (20.10%), EMB resistance (6.20%), MDR (13.90%), and poly-DR (6.70%). The multivariable logistic regression model showed that patients aged from 20 to 59 years (compared to those aged 10 years), workers (compared to retirees), and EPTB patients from the south and west of Hunan (compared to those from the east of Hunan) were at an increased risk of developing RR/MDR EPTB (all OR values > 1). Our study provided a detailed account of the epidemiological and DR characteristics of EPTB in Hunan province, China. The significant DR rates, particularly in musculoskeletal TB cases, highlight the need for timely diagnosis, effective drug susceptibility testing, and the development of more effective treatment regimens for EPTB, especially targeting musculoskeletal TB treatments.

A Case Report on Peritoneal Tuberculosis in an Immunocompromised Patient

Background: Peritoneal tuberculosis (PTB) is one of the most challenging forms of extra pulmonary tuberculosis. Abdominal TB cases make up above 3% of all extra pulmonary TB as per the Index TB Guidelines. PTB is commonly due to reactivation of latent tuberculosis in the peritoneum. Numerous cases were still misdiagnosed due to nonspecific presentation. The golden standard for diagnosis is laparoscopic biopsy. Presenting signs and symptoms of PTB are unspecific such as ascites, abdominal pain and distension, fever, weight loss, diarrhea/constipation. Peritoneal tuberculosis is a significant cause of ascites in developing countries. The causative agent of peritoneal tuberculosis is Mycobacterium tuberculosis. Case Presentation: In this case study, a 52 year old male had complaints of progressive abdominal distension and fever for 2 weeks. Patient underwent diagnostic paracentesis, upper and lower GI endoscopy, biopsy and gene xpert to confirm peritoneal tuberculosis. Patient with peritoneal TB have gradually progressive abdominal swelling due to ascites and abdominal pain. Conclusion: Peritoneal tuberculosis should be considered in differential diagnosis. Differential diagnosis, especially in the developing countries or under developed countries. This case highlights the easy diagnosis of the condition other than the other case reports.

Uncommon presentation of gastrointestinal tuberculosis-A case series

Tuberculosis (TB) is a common disease in underdeveloped countries. Of all tuberculosis cases worldwide, 28% were reported from India. The most prevalent site of infection is the lungs (pulmonary TB), whereas extrapulmonary tuberculosis (EPTB) is less common. The most common form of EPTB in India is Lymph Node TB, which accounts for around 35% of total EPTB cases. Splenic tuberculosis incidence is 8 % whereas tuberculosis of pancreas and gall bladder is extremely rare. Pancreatic and gallbladder tuberculosis (GT) is extremely rare and presents with non-specific features. The clinical manifestations of EPTB are variable, imitate other diseases, and are usually confused with other diseases. Thus, it is crucial to be cautious and highly suspicious of EPTB infection in endemic areas. Probability of developing EPTB in immunocompromised patients is higher than in immunocompetent patients. The burden of EPTB in HIV patients ranges from 15 to 20% of all TB cases in HIV-negative patients, while in HIV-positive people, it accounts for around 40–50% of new TB cases. Histopathological examination (HPE) and positive Acid-Fast Bacilli (AFB) smears are used to make the diagnosis. ATT is given to such patients for 6 months. Due to such a diverse presentation of TB, here, we report a case series of extrapulmonary TB occurring in the abdomen in, pancreas, gallbladder, and spleen.

Multi-level tuberculosis of the spine identified by 18F-FDG-PET/CT and concomitant urogenital tuberculosis: a case report from the spinal TB X cohort.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb) and typically infects the lungs. However, extrapulmonary forms of TB can be found in approximately 20% of cases. It is suggested, that up to 10% of extrapulmonary TB affects the musculoskeletal system, in which spinal elements (spinal tuberculosis, STB) are involved in approximately 50% of the cases. STB is a debilitating disease with nonspecific symptoms and diagnosis is often delayed for months to years. In our Spinal TB X Cohort, we aim to describe the clinical phenotype of STB using whole-body 18F-fluorodeoxyglucose positron emission tomography computed tomography (PET/CT) and to identify a specific gene expression profile for the different stages of dissemination on PET/CT. Here we report on the first patient recruited into our cohort who underwent PET/CT before treatment initiation, at 6-months and at 12-months - time of TB treatment completion. A 27-year-old immunocompetent male presented with severe thoracolumbar back pain for 9 months with severe antalgic gait and night sweats. Magnetic resonance imaging (MRI) of the whole spine revealed multilevel spinal disease (T5/6, T11/12, L3/4) in keeping with STB. After informed consent and recruitment into the Spinal TB X Cohort, the patient underwent PET/CT as per protocol, which revealed isolated multilevel STB (T4-7, T11/12, L3/4) with no concomitant lung or urogenital lesion. However, sputum and urine were Xpert MTB/RIF Ultra positive and Mtb was cultured from the urine sample. CT-guided biopsy of the T11/12 lesion confirmed drug-sensitive Mtb on Xpert MTB/RIF Ultra and the patient was started on TB treatment according to local guidelines for 12 months. The 6-month follow-up PET/CT revealed new and existing spinal lesions with increased FDG-uptake despite significant improvement of clinical features and laboratory markers. After 9 months of treatment, the patient developed an acute urethral stricture, most likely due to urogenital TB, and a suprapubic catheter was inserted. The 12-month PET/CT showed significantly decreased PET/CT values of all lesions, however, significant persistent spinal inflammation was present at the end of TB treatment. Clinically, the patient was considered cured by the TB control program and currently awaits urethroplasty. In our case, PET/CT emerged as a valuable imaging modality for the initial assessment, surpassing MRI by revealing more comprehensive extensive disease. Subsequent PET/CT scans at 6-month uncovered new lesions and increased inflammation in existing ones, while by the end of TB treatment, all lesions exhibited improvement. However, the interpretation of FDG avidity remains ambiguous, whether it correlates with active infection and viable Mtb. or fibro- and osteoblast activity indicative of the healing process. Additionally, the absence of extraspinal TB lesions on PET/CT despite positive microbiology from sputum and urine maybe explained by paucibacillary, subclinical infection of extraspinal organs. The Spinal TB X Cohort endeavours to shed light on whole-body imaging patterns at diagnosis, their evolution midway through TB treatment, and upon treatment completion. Ultimately, this study aims to advance our understanding of the biology of this complex disease.

Extrapulmonary forms of tuberculosis. Clinical case report of a child with tuberculous osteoarthritis

Introduction: Tuberculous osteoarthritis, caused by Mycobacterium tuberculosis, is a very rare extrapulmonary manifestation of tuberculosis, especially in children. Aim: This article presents a clinical case of a 21-month-old male patient with tuberculous osteoarthritis affecting the ankle joint. The rarity of this pathology underscores the critical importance of swift diagnosis and a multidisciplinary approach involving specialists from diverse medical fields. Results: Early initiation of specific antituberculous treatment, coupled with timely surgical intervention, ameliorated the patient’s immediate suffering. Furthermore, this combined therapeutic strategy holds promise for a favorable long-term prognosis regarding joint function. Conclusion: Tuberculosis in children exhibits markedly diminished incidence, and its extrapulmonary variants are exceedingly rare. However, clinicians should maintain a high index of suspicion, particularly when confronted with recalcitrant diseases that defy conventional therapeutic approaches. A comprehensive understanding of tuberculous osteoarthritis, despite its rarity, is pivotal for effective management.

Outcome of Abdominal Tuberculosis Complicated by Portal Hypertension, Pulmonary Tuberculosis, and Severe Acute Malnutrition

Background: Abdominal tuberculosis (TB) is a form of extrapulmonary TB that can present with or without involvement of the lungs. The diagnosis is difficult to establish, which may lead to diagnostic delays. Effective management of adolescent TB requires a holistic approach from various medical disciplines and interventions. This case presented a rare case 13-year-old girl diagnosed with abdominal TB Case: A 13-year-old girl presented with seven-months history of subfebrile fever, lymph node enlargement, abdominal distention, pallor, and severe weight loss. She was diagnosed with abdominal TB. The diagnosis was further complicated by portal hypertension, pulmonary TB, and severe acute malnutrition. To address these challenges, a multidisciplinary treatment plan was implemented and closely monitored for a period of 12 months Discussion: Multiple factors are significantly contributing to the successful outcome of the treatment for abdominal tuberculosis, including good adherence to the prescribed anti-tuberculous medications, absence of side effects from the drugs, the patient's positive knowledge, attitude and health behaviours, and housing and environmental health. Conclusion: This case highlights the importance of factors influencing disease outcomes of abdominal TB. Proper management of the factors would lead to significant clinical and nutritional status improvement, reduce TB transmission, and improved the overall quality of life.

“Lumbar swelling: And up into the lungs…” A radiology case report of spinal tuberculosis

Spinal tuberculosis is one form of extra-pulmonary tuberculosis which usually has delayed presentation with spinal deformities in most cases. The para-spinal soft-tissue involvement can lead to a cold abscess which can present as swellings, mainly in the neck and lumbar regions. Here, a case of a young man is being presented, who had lumbar swelling which on computed tomography evaluation showed para-spinal collection, vertebral lytic foci, and lung parenchymal lesions suggestive of infection.

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.

Concomitant bedaquiline and delamanid therapy in patients with drug-resistant extra-pulmonary tuberculosis in Mumbai, India

BackgroundWorld Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant extrapulmonary tuberculosis (EPTB) is extremely limited. This study documents the treatment outcomes and adverse events associated with concurrent BDQ-DLM-based regimens in patients with drug-resistant EPTB at a Médecins Sans Frontières clinic in Mumbai, India. MethodsRetrospective cohort study based on routinely collected programmatic data. Individualised regimens were based on drug-susceptibility testing and previous drug exposure. Drug-resistant EPTB patients initiated on regimens containing concurrent BDQ and DLM from April 2016 to October 2019 were included.Patients who completed treatment were followed up at 12 months. ResultsOf 17 patients, median age was 23 years (IQR = 21–30 years) and 12/17 (71 %) were female. Pre-extensively drug-resistant tuberculosis and extensively drug-resistant TB was reported in 13/17 (76.4 %) and 2/17 (11.7 %) patients respectively. Microbiological reports were unavailable for two patients with central nervous system TB. Lymph node TB was the commonest form of EPTB in 9/17 (53 %) of patients. Median duration of treatment was 18.9 months. At least one grade three or four severe adverse event (SAE) was reported by 13/17 (76.4 %) patients. Thirteen (76.4 %) patients had favourable outcomes. None of the patients relapsed or died in the one-year period of post-treatment follow-up. ConclusionConcurrent BDQ-DLM-based regimens in drug-resistant EPTB were effective and associated with manageable adverse events.

Clinical characteristic, common sites, and geographical distribution of pediatric tuberculosis patients in Southwest China.

The data report of a large sample, dynamic epidemiology, and characteristic analysis of pediatric tuberculosis (TB) in Southwest China is not clear. Herein, we conducted descriptive dynamic epidemiology, characteristic analysis and geographical distribution study of pediatric TB inpatients in Southwest China for more than 20 years. Patients with pediatric TB were recruited from October 2002 to September 2022 in Southwest of China based on etiology or clinical confirmation. Extract hospitalization medical record information for each patient. The geographical distribution chart of cases is used to display the trend of case flow segmented every 5 years. Among 3,024 pediatric TB patients with an average age of 9.11 ± 4.39, 17.49% (529) had pulmonary tuberculosis (PTB), 9.06% (274) had extrapulmonary tuberculosis (EPTB), and 73.45% (2,221) had combined TB. The most common form of EPTB is disseminated TB (28.98%), followed by TB lymphadenitis (20.56%), pleural TB (19.72%), and TB meningitis (19.68%). Children aged 0-4 years had a high risk of TB meningitis and a severe symptoms, while children in the elderly age group had a high risk of pleural TB. In the past 20 years, hospitalized TB pediatric cases mainly came from Sichuan, Tibet, Qinghai, Yunnan and other places. The number of patients from ethnic minorities, especially Tibetans, showed an upward trend on a yearly basis (χ2 = 401.43, P < 0.001). Public health investment and effective management in pediatric TB should be further strengthened.

A case of tuberculous peritonitis accompanied by tuberculous pleuritis

Tuberculous peritonitis is a form of extrapulmonary tuberculosis, a peritoneal or visceral inflammation caused by Mycobacterium tuberculosis. The disease is rarely independent, but is usually a continuation of the tuberculosis process elsewhere, especially pulmonary tuberculosis. We report a case of TB peritonitis accompanied by TB pleurisy, a 29-year-old female patient with complaints of an enlarged abdomen, heartburn, fever, diarrhea, and decreased appetite. Treatment history was Acitral, Zinc, and Metronidazole. On physical examination, it was found that the general condition was weak and the axilla temperature was 39.5ºC. Thorax examination; decreased vesicular sound on the left chest. Abdominal examination; found distension, epigastric tenderness, undulation, shifting dullness, checkerboard phenomenon, and increased bowel noise. Laboratory examination of complete blood; within normal limits. Complete stool; yellow color, mucus (+), leukocytes 4-6/LPB, bacteria (+). The thorax photo showed left pleural effusion, BOF 3 position: ascites. Abdominal ultrasound results: thickening of the peritoneum, ascites, suspected TB peritonitis. Results of ascites and pleural fluid analysis: rivalta (+) and Adenosine Deaminase (ADA) increased. So that from anamnesis, physical examination, supporting examination can be established diagnosis of TB Peritonitis and TB Pleuritis, followed by OAT therapy; FDC for 12 months. From this case it can be concluded that clinical and supporting examinations (radiology) are needed to make a correct diagnosis and body fluid analysis examinations can help confirm the diagnosis.

Studi Kasus Pasien Dengan Meningitis Tuberkulosis Dalam Pengobatan Tuberkulosis Paru

TB meningitis is the most severe manifestation of tuberculosis infection and causes death and disability in 50% of sufferers. Tuberculosis primarily affects adults at their most productive ages. However, all age groups remain at risk. Tuberculous meningitis is a form of extra-pulmonary tuberculosis with neurological abnormalities that accounts for 70-80% of all neurological tuberculosis cases, 5.2% of all extrapulmonary tuberculosis and 0.7% of all tuberculosis cases. Tuberculous meningitis (TB) is preceded by prodromal symptoms such as headache, anorexia, nausea/vomiting, subfebrile fever, accompanied by behavioural changes, and decreased consciousness. The patient, a 42-year-old male Mr SM, presented with decreased consciousness, a history of seizures and was taking tuberculosis drugs. Meningeal stimulation was found to be rigid, laseque test and kernique test were positive. Motor system impression of lateralisation to the right. Laboratory examination showed leukocytes 13,500/uL, platelets 728,000/uL, sodium 123 mmol, Kgd 135, thoracic X-ray with the impression of pulmonary tuberculosis with pneumonia, cranial CT-scan obtained with the impression of appropriate Tb meningitis, Non Communicating hydrocephalus. Specific treatments given were IVFD NaCL 0.9 % 20 drops / m, Omeprazole vial 2x40 mg, paracetamol infusion 3x1000 mg, Ceftriaxone 1 gram Vial, dexamethason ampoule loading 2 ampoules then 3x5 mg, Phenytoin 3x100 mg, Levofloxacin 750 mg, rifampicin 1x450 mg, isoniazid 1x300 mg, pyrazinamide 1x1000 mg, ethambutol 1x1000 mg, mg, B6 and B12 2x1 tablets.

Tuberculosis among labor migrants in the Republic of Tajikistan

In the structure of patients with tuberculosis, labor migrants in 2021 in the Republic of Tajikistan amounted to 16.9%. Among labor migrants with tuberculosis there were men - 85.0%, most of whom were young people aged 19-29 years. Of the total number of TB patients, identified in 2021who was in migration, 68.6% suffered from pulmonary forms of tuberculosis, 73.9% of which were bacterial excretory. Among labor migrants, 79.0% of patients suffered from an infiltrative form, 10.1% - focal, 4.6% - disseminated, tuberculoma - 4.2%, extrapulmonary forms of tuberculosis were detected in 10.6% of cases.

A Rare Case of Parotid Tuberculosis in a Pediatric Patient: A Case Report

Even in countries like India where the general dictum is to consider Tuberculosis as one of the differential diagnosis to any condition that is still under evaluation. Parotid Tuberculosis is a very rare entity. There are fewer than 200 cases reported in literature worldwide of Parotid gland Tuberculosis, a form of extrapulmonary Tuberculosis. We present an interesting case of Parotid Tuberculosis which presented as unilateral swelling in the parotid region of a four-year-old male child with an underlying abscess.

1897. Therapeutic Drug Monitoring in CSF and Plasma in Tuberculous Meningitis:Correlation with Disease Outcome

Abstract Background Tuberculous meningitis (TBM) is a serious form of extra-pulmonary tuberculosis with significant morbidity and mortality. TBM patients are treated with pulmonary tuberculosis regimen, often requiring extension for 1 year or longer. Current study was designed to find any association of CSF and blood levels of anti-tubercular drugs with treatment response in patients with tuberculous meningitis using therapeutic drug monitoring. Pharmacokinetic Parameters of Rifampicin and Isoniazid in CSF and Plasma Methods A prospective observational study was conducted in a tertiary care institute in North India among clinic-radiologically and/or microbiologically diagnosed TBM patients. Plasma and CSF levels of anti TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) were determined using Liquid Chromatography Mass Spectrometry technology at 1 week and 1 month (follow up) after initiating treatment. The primary outcome assessed was association of drug levels with treatment response. The secondary outcomes assessed were association of drug levels with treatment duration/alteration, patient demographic profile, comorbidities and adverse effects. Patients were followed-up till treatment completion. Results A total of 40 patients with TBM were recruited. All received daily weight-based doses of anti TB drugs. Low Cmax of INH and rifampicin in plasma were observed in 60.5% &amp; 42.1% of observations respectively. In CSF, low Cmax of INH and rifampicin were observed in 77.6% &amp; 82.9% of observations respectively. The concentrations of INH (4 hours after drug intake) during follow up were significantly lower among patients with poor response, at 1 month (p=0.008) &amp; 6 months (p=0.009). Similarly, low Cmax &amp; CSF levels of INH at follow up sampling were significantly associated with poor response at 6 months of therapy (p= 0.022 &amp; 0.042 respectively). Conclusion Low plasma and CSF concentrations of isoniazid were associated with a poor response to treatment in patients with TBM. Therapeutic drug monitoring can guide dose modification of ATT to achieve target concentrations in patients with TBM and facilitate optimal treatment outcomes. Higher dose INH can be considered in TBM treatment regimen for better outcome. Disclosures All Authors: No reported disclosures

Evaluation of Fine Needle Aspiration for diagnosis of Tuberculous Lymphadenitis in Children using the Xpert MTB/RIF Ultra at the University Teaching Hospitals Children’s Hospital, Lusaka, Zambia

Background: Tuberculous Lymphadenitis (TBL) is the commonest form of Extra Pulmonary TB and poses diagnostic challenges in setting with no access to Histopathology. Our goal was to evaluate the diagnostic yield of Xpert MTB Ultra performed on lymph node aspirate obtained using Fine Needle Aspiration (FNA) in children with suspected TBL. Methods: This was a cross-sectional study conducted at a tertiary and main referral hospital in Zambia. Children aged 6 months to 15 years with lymphadenopathy and presumed TBL were enrolled. FNA was performed and lymph node aspirate samples were analysed using XPERT MTB/RIF ULTRA. Data was collected and analysed as frequencies and percentages. Logistic regression was used to measure the odds of testing positive for MTB. Results: Sixty one children were enrolled in the study, 34(55.7%) were males and a median age of 6 years (IQR: 3-11 years). Sixteen (26%) were diagnosed with TB, 7 on clinical basis while, one was positive on gastric lavage, five (31%) were positive for TB on lymph node FNA using Xpert MTB/RIF Ultra. Then, 3 were positive Histopathology, with one also positive on XPERT MTB/RIF Ultra. Alternative diagnosis included malignancies like lymphomas and acute Leukemias. While non malignant lymphadenopathy included, benign reactive lymphadenopathy and HIV associated lymphadenopathy. The prevalence of HIV among the children diagnosed with TB was 37.5% (6/16). Thirty one percent (5/16) of children with TB had a close contact with TB, OR=9.0 (95% CI: 1.3-77, p-value (&lt;0.05). Conclusion: TBL is not uncommon in children presenting with Lymphadenopathy. FNA is a less invasive, inexpensive technique and coupled with use of Xpert MTB/RIF Ultra has potential for early diagnosis of TBL, in a low resource setting with limited Histopathology services.

Cutaneous tuberculosis-management

Since antiquity, people have been plagued by tuberculosis (TB), and its effects are likely older than recorded history. For many centuries, TB was the most significant human infection due to its devastating mortality and morbidity rates and global prevalence. In developed nations, there is less evidence of Mycobacterium tuberculosis infections as a result of improved socioeconomic status. In developing nations like India, it is still regarded as a significant cause of morbidity and mortality. Cutaneous TB occurs worldwide and it comprises only a small proportion of all cases of TB, but considering the high prevalence of TB in many developing countries like India these numbers become significant. Cutaneous TB is a form of extra pulmonary TB and is characterized by a spectrum of multiple distinct clinical and histopathological presentations. It is imperative that the treating dermatologist is aware of the varied manifestations of cutaneous TB which would significantly prevent the morbidity and complications. This review aims to discuss the epidemiology, clinical, histopathological features, diagnosis, differential diagnosis and treatment options, especially in the Indian context.