Hematogenous Dissemination Of Mycobacterium Tuberculosis Research Articles

Pneumothorax revealing miliary tuberculosis: A case report

Pulmonary tuberculosis can take several clinical and radiological forms; spontaneous pneumothorax is a serious complication of tuberculosis, and tuberculous miliary is a severe form of secondary tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis. We report a case of tuberculous miliary revealed by pneumothorax. The patient was 57 years old and a farmer. He was been presented to the emergency department of Mohamed VI University Hospital in Marrakech with acute dyspnea associated with chest pain. Clinical examination and imaging revealed a spontaneous pneumothorax that complicated tuberculous miliary. Treatment consisted of a combination of anti-tuberculosis chemotherapy, chest drainage, and kinesrespiratory therapy. The outcome was favorable, with improvement in clinical and radiological signs. Pneumothorax complicating TM requires careful diagnosis and prompt management to improve prognosis.

Mycobacterium tuberculosis sepsis with multiple intermuscular abscesses and respiratory failure as the main manifestations: a case report

BackgroundTuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment.Case presentationThis report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period.ConclusionIt is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.

A CASE OF DISSEMINATED TUBERCULOSIS IN A IMMUNOCOMPETENT PATIENT: TB MENINGITIS, PLEURAL TB, INTESTINAL/PERITONEAL TB

Disseminatedtuberculosis (TB)isdenedas thepresenceoftwo or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread or rarely through iatrogenic origin. Nowadays, the term miliary TB also refers to progressive and widely spread forms of pulmonary TB. It entails a hematogenous spreadofthediseasetoseveral organ.

POS-065 DISSEMINATED TUBERCULOSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS: A RARE PRESENTATION AS A PULMONARY-RENAL SYNDROME

Disseminated tuberculosis (TB) is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis. Higher rates of TB infection (both pulmonary and extra pulmonary) are observed in individuals with SLE compared with the general population. This has been attributed to the immunodysregulatory effects of SLE as well as to the immunosuppressive agents used in its treatment. We describe a case of SLE who succumbed to an unfortunate interplay between active lupus and disseminated tuberculosis.

Retrospective assessment of the patients with disseminated tuberculosis

Background: Disseminated tuberculosis (TB) is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread, or rarely through iatrogenic origin. Hence; the present study was undertaken for assessing the patients with disseminated tuberculosis. Materials & methods: A total of 50 patients who reported to the department and were confirmed with diagnosis of disseminated tuberculosis in the past one year. Complete demographic and clinical data of all the subjects was enrolled. Clinical profile of all the patients was recorded. Assessment of all the results was done using SPSS software. Results: Fever, malaise, weight loss and poor appetite were seen in 66 percent, 30 percent, 24 percent and 20 percent of the patients respectively. Cough, dyspnea, myalgia and joint pain was seen in 20 percent, 12 percent, 14 percent and 18 percent of the patients respectively. On chest imaging, consolidation, fibrotic change, miliary lesion and nodular change was seen in 16 percent, 10 percent, 50 percent and 8 percent of the patients respectively. Conclusion: Majority of the patients demonstrate clinical findings suggestive of disseminated TB.

A woman with disseminated tuberculosis experienced preterm delivery, fallopian tube pregnancy, and delivered successfully following in vitro fertilization: a case report

BackgroundDisseminated tuberculosis (TB) is a fatal disease resulting from hematogenous dissemination of Mycobacterium tuberculosis. Spontaneous pregnancy rate of women with TB is low; furthermore, live birth, spontaneous abortion or ectopic pregnancy may be the outcomes even if pregnancy occurs.Case presentationWe report a case of a woman with disseminated TB who had a series of complications including preterm delivery with congenital TB and infant death of pulmonary TB, fallopian tube pregnancy. She was treated by in vitro fertilization-embryo transfer (IVF-ET), and gave birth to a healthy baby.ConclusionDisseminated TB has a significant impact on female fertility. We should take more active efforts to diagnose and treat this disease in a timely fashion. Moreover, IVF treatment is a feasible approach for an infertile woman after TB.

Miliary tuberculosis and acute respiratory distress syndrome

BackgroundMiliary tuberculosis is a serious and uncommon form of tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis. ObjectiveThis study aimed to describe the epidemiological and clinical features of miliary tuberculosis. Patients and MethodsData were collected from clinical files between August 2016 and July 2018. ResultsIn 2 years, 24 cases were recorded, representing a proportional morbidity of 13%. Among them, 71% were smokers and 38% had diabetes. The presence of a BCG vaccination scar was observed in 2 patients (8%). Human immunodeficiency virus (HIV) serology was positive in 4 cases (17%). The symptomatology was dominated by: fever (100%), cough (83%), and chest pain (79%). Radiological images with micronodular opacities were the most common (54%), followed by macronodular densities (33%), and reticulonodular densities (13%). The evolution was favorable in 77%, with no patient lost to follow-up, but 7/24 (29%) died, either before the initiation of therapy (n = 2) or during therapy (n = 5). ConclusionMiliary tuberculosis is an acute and severe form of life-threatening tuberculosis. It requires a prompt and accurate diagnosis and treatment. An improved accessibility to early diagnosis and treatment and prevention of TB infection should reduce its prevalence.

A rare case of miliary tuberculosis accompanying perihepatitis.

Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.

An Update on Tubercular Uveitis

Tuberculosis (TB) is an important cause of infectious uveitis causing significant morbidity and mortality especially in endemic countries. Mycobacterium tuberculosis (MTb) may infect any tissue or organ in the body, lungs being the most commonly affected. Ocular TB occurs due to hematogenous dissemination of MTb or due to a hypersensitivity reaction to the bacteria. It may lead to a very severe inflammation and destruction of ocular tissues leading to an irreversible loss of vision. Infection of the eye by MTb most commonly involves the uveal tissue causing anterior, intermediate, and posterior or panuveitis. Awareness of the varied clinical manifestations is important to suspect the ocular TB which may often be difficult to confirm by diagnostic tests available. A timely diagnosis and management may help in preventing severe loss of vision and the eye.

Renal tuberculosis

Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if necessary, or to resolve the consequent urinary obstruction using different reconstructive techniques.

Transcriptional profiling of Mycobacterium tuberculosis replicating ex vivo in blood from HIV- and HIV+ subjects.

Hematogenous dissemination of Mycobacterium tuberculosis (M. tb) occurs during both primary and reactivated tuberculosis (TB). Although hematogenous dissemination occurs in non-HIV TB patients, in ∼80% of these patients, TB manifests exclusively as pulmonary disease. In contrast, extrapulmonary, disseminated, and/or miliary TB is seen in 60–70% of HIV-infected TB patients, suggesting that hematogenous dissemination is likely more common in HIV+ patients. To understand M. tb adaptation to the blood environment during bacteremia, we have studied the transcriptome of M. tb replicating in human whole blood. To investigate if M. tb discriminates between the hematogenous environments of immunocompetent and immunodeficient individuals, we compared the M. tb transcriptional profiles during replication in blood from HIV- and HIV+ donors. Our results demonstrate that M. tb survives and replicates in blood from both HIV- and HIV+ donors and enhances its virulence/pathogenic potential in the hematogenous environment. The M. tb blood-specific transcriptome reflects suppression of dormancy, induction of cell-wall remodeling, alteration in mode of iron acquisition, potential evasion of immune surveillance, and enhanced expression of important virulence factors that drive active M. tb infection and dissemination. These changes are accentuated during bacterial replication in blood from HIV+ patients. Furthermore, the expression of ESAT-6, which participates in dissemination of M. tb from the lungs, is upregulated in M. tb growing in blood, especially during growth in blood from HIV+ patients. Preliminary experiments also demonstrate that ESAT-6 promotes HIV replication in U1 cells. These studies provide evidence, for the first time, that during bacteremia, M. tb can adapt to the blood environment by modifying its transcriptome in a manner indicative of an enhanced-virulence phenotype that favors active infection. Additionally, transcriptional modifications in HIV+ blood may further accentuate M. tb virulence and drive both M. tb and HIV infection.

Pott’s paraplegia secondary to Scrofuloderma is a rare association

Spinal tuberculosis as all other osteoarticular tuberculosis occurs as a result of hematogenous dissemination of Mycobacterium tuberculosis from a primarily infected visceral focus mainly lungs, but Pott's paraplegia occurring secondarily to Scrofuloderma has not been reported till date. To document such an association of Pott's paraplegia and Scrofuloderma. A 29-year-old female presented to us with low backache and paraplegia of 1 month duration. Clinical examination showed multiple healed Scrofuloderma lesions over sterum and neck (Figure 1). Magnetic resonance imaging (Figure 4), computed tomography (Figure 3) and X-ray (Figure 2) showed Pott's spine involving dorsal vertebrae (D8-10) with pre and paravetebral abscess with intraspinal extension. She was treated by minimally invasive surgery to drain pus and granulation tissue by resecting transverse process of D9 vertebra. Drained material was sent for histopathological examination, Zielh-neelsen (ZN) staining, culture and sensitivity for M. tuberculosis. Patient completely recovered neurologically after 1 month of surgery. Patient completely recovered neurologically after surgery and is presently on multidrug chemotherapy and spinal brace. Pott's paraplegia can occur secondary to Scrofuloderma and it can be managed by multidrug antitubercular therapy and minimally invasive surgical procedure.

Acute respiratory distress syndrome with miliary tuberculosis: a fatal combination.

Miliary tuberculosis (TB) results from hematogenous dissemination of mycobacterium tuberculosis (1). The term miliary was first described in 1700 by John Jacobus Manget, who linked the appearance of the involved lung, with its surface covered with firm small white nodules, to millet seeds.

Diagnosis and treatment of tuberculosis of the central nervous system in children

Abstract Central nervous system infections in children result from the hematogenous dissemination of Mycobacterium tuberculosis from primary pulmonary infection and the formation of small subpial and subependymal foci in the brain and spinal cord, causing meningitis or tuberculoma. The general principles of diagnostic and therapeutic approach to these tubercular infections are discussed in this article.

Hematogenous Dissemination of Mycobacterium tuberculosis in Patients with AIDS

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.