History Of Tuberculosis Infection Research Articles

Burden and predictors of anxiety disorder among HIV patients on ART in Nairobi Kenya

Anxiety disorders are prevalent among people living with Human Immunodeficiency Virus (HIV) globally, but data on the prevalence and factors associated with this mental illness are limited among HIV patients on antiretroviral therapy (ART) in Kenya. This study determined the prevalence and correlates of anxiety disorder among HIV patients receiving care and treatment at the Comprehensive Care Clinic (CCC) in Mbagathi Hospital in Nairobi, Kenya. This was a cross-sectional study where 205 eligible and consenting participants were systematically enrolled. The Beck Anxiety Inventory (BAI) Questionnaire was used to assess anxiety levels, with a score of 8 or more indicating moderate to severe anxiety. Structured questionnaires were used to collect information on factors associated with anxiety disorder. Descriptive statistics and logistic regression models were used to analyze data. Of the enrolled 205 patients, 122 (59.5%) were female. The median age and household size were 49 years (Interquartile range IQR 39–54) and 3 people (IQR 2–3) respectively. A large proportion of the participants, 169 (82.4%) were on the first-line ART regimen and the median duration on ART was 13 years (IQR 7–18). Nearly a third of the participants 60 (29.3%) had anxiety disorder. Male participants (adjusted odds ratio—aOR 0.33; 95% confidence interval—CI 0.13–0.78) were less likely to have anxiety disorder. Self-employment (aOR 5.57; 95% CI 2.17–20.06), larger households (aOR 1.48; 95%CI 1.11–2.03) and no history of tuberculosis infection (aOR 2.9; 95% CI; 1.29–6.96) were factors associated with having anxiety disorder. Among PLHIV receiving ART in Nairobi County, Kenya, there is a considerable burden of anxiety disorder which was associated with gender, occupation, household population size and history of tuberculosis infection.

MRI imaging pattern of metastasis and tuberculous spondylitis in the spine: serial case report

Background: Tuberculous spondylitis and spinal metastasis manifestations have a similar clinical manifestation. Spinal metastasis prevalence is high in malignant process while tuberculosis is frequent in endemic areas. Back pain, paresthesia, and paralysis are commonly caused by vertebral fractures, soft tissue mass, and spinal canal involvement. The magnetic resonance imaging (MRI) is a useful modality in the pattern differentiation of these diseases. This case series aimed to provide a differentiation between those two diseases using MRI. Case report: In the first case, we presented a 24-year-old female complained of hip pain without history of tuberculosis infection or malignancy. Whole spine MRI showed kyphotic deformity, compression of T9 vertebral body, erosion of anterior aspect T8 and T10 vertebral body, and subligamentous abscess at T7-T12 vertebrae level. Tuberculous infection was proven. The second case was a 39-year-old female complained of leg weakness without complaint of cough or breathing difficulty. Whole spine MRI showed kyphotic thoracic vertebrae, compression T10 vertebral body, destruction of inferior endplate T9 vertebrae, bone marrow changes on thoracic vertebral body, and paravertebral soft tissue mass on anterior T6 to T11 vertebral body. Tuberculosis etiology was proven. The third case was a 51-year-old female that came to the hospital due to waist pain with no history of tuberculosis infection or malignancy. Whole spine MRI revealed T8 and T9 vertebral body compression and bone marrow replacement on cervical, thoracic, and lumbar vertebrae, spinous process of thoracic and lumbar, bilateral posterior rib T4-T5, and soft tissue mass at the posterior T9 vertebrae. In the last case, we presented a 58-year-old male that complianed pain in the back and both legs. Lumbosacral MRI showed compression fracture with signal intensity change on L3 vertebral body, bone marrow replacement on thoracic, lumbar, and sacral vertebrae, expanding to epidural and cause spinal canal stenosis. CT-scan thorax showed lung malignancy proven to be non-small cell lung carcinoma. A spinal biopsy revealed malignant infiltration. Conclusion: Tuberculous spondylitis and metastasis differentiation can be a challenge. Early complaints mostly are back pain, paresthesia, and paralysis. Spine MRI can differentiate the pattern of both diseases and identify the possible etiology.

Previous tuberculosis infection associated with increased frequency of asthma and respiratory symptoms in a Nordic-Baltic multicentre population study.

Tuberculosis (TB) infection induces profound local and systemic, immunological and inflammatory changes that could influence the development of other respiratory diseases; however, the association between TB and asthma is only partly understood. Our objective was to study the association of TB with asthma and respiratory symptoms in a Nordic-Baltic population-based study. We included data from the Respiratory Health in Northern Europe (RHINE) study, in which information on general characteristics, TB infection, asthma and asthma-like symptoms were collected using standardised postal questionnaires. Asthma was defined based on asthma medication usage and/or asthma attacks 12 months prior to the study, and/or by a report of ≥three out of five respiratory symptoms in the last 12 months. Allergic/nonallergic asthma were defined as asthma with/without nasal allergy. The associations of TB with asthma outcomes were analysed using logistic regressions with adjustments for age, sex, smoking, body mass index and parental education. We included 8379 study participants aged 50-75 years, 61 of whom reported having had TB. In adjusted analyses, participants with a history of TB had higher odds of asthma (OR 1.99, 95% CI 1.13-3.47). The associations were consistent for nonallergic asthma (OR 2.17, 95% CI 1.16-4.07), but not for allergic asthma (OR 1.20, 95% CI 0.53-2.71). We found that in a large Northern European population-based cohort, persons with a history of TB infection more frequently had asthma and asthma symptoms. We speculate that this may reflect long-term effects of TB, including direct damage to the airways and lungs, as well as inflammatory responses.

PLEURISY IN CHILDREN : EXPERIENCE OF THE DEPARTMENT OF PEDIATRICS

Purpose: Our study aims to investigate the epidemiological, clinical, biological, therapeutic and evolutionary profile of pleurisy in children. Materials and methods: A retrospective study was conducted on 245 cases of pleurisy who were seen from 2008 to 2023 in the pediatric department of the university hospital center of Marrakesh. Results: Pleurisy represent 1.4% of hospitalized cases. Boys were the most affected. The average age was 7.8 years. 75.5% of the patients we treated were vaccinated, and the history of tuberculosis infection was present in 18.36% of patients. Functional signs were represented by fever in 88.5% (217 cases), dry cough in 50.2% (123 cases) and productive cough in 22.8% (56 cases), dyspnea in 66.5% (163 cases) and chest pain in 66.12% (162 cases). A chest X-ray was performed in all patients showing pleurisy of high abundance in 30.6% (78 cases), medium abundance in 46.1% (113 cases) and low abundance in 22% (54 cases). Pleurisy was associated with a pulmonary focus in 37 cases (15.1%). A chest ultrasound was performed in 193 cases (78.77%) with the aim of identifying and eliminating a hydatid cyst before puncturing. Pleural puncture was performed in 177 patients. The etiologies were dominated by purulent pleurisy representing 66.5%, tuberculous causes 29.8% and 3.7% were of malignant origin. The treatment has two components: an etiological component and a symptomatic component. The evolution of pleurisy is generally good. Conclusion : Pleurisy is a pathology that is common in our environment of poor functional prognosis, necessitating early treatment.

Dorso-Lumbar Wall Abscess Associated with Sacroiliitis: Exceptional Localizations of Tuberculosis

Introduction: Tuberculosis of the abdominal wall is a rare localization, the diagnosis of which on imaging remains difficult due to the absence of specific radiological signs, despite advances in imaging. Objective: The aim of this work is to reveal the interest of imaging in the diagnosis of this pathology. Case Report: We report the case of a 42- year-old man, with no history of tuberculosis infection, who presented for 4 months with a painless right dorsolumbar tumefaction, without fever, progressively increasing in volume, with the appearance of low back pain and uncounted weight loss 2 months later. Ultrasound examination of the swelling revealed two parietal collections, measuring respectively 1.2x3.5 cm and 4.8x3cm in long axis, with thickened walls communicating with each other through a pertus; they had a heterogeneous hypoechoic echostructure, containing fine non-vascularized echoes on color Doppler. A complementary CT scan) showed heterogeneously dense collections opposite L4 and L5, merging in depth, associated with a right sacroiliitis consisting of a significant widening of the joint space, erosions and subchondral geodes of the sacral joint side, with bone sequestration.The lesion assessment revealed another cerebral localization in the form of a left parietal tuberculoma. Percutaneous puncture of the parietal collection with culture on Löwenstein-Jensen medium revealed tubercle bacilli. Conclusion: Isolated parietal localization is a rare and unrecognized form of tuberculosis. Imaging can distinguish a tuberculous cold abscess from a wall tumor. Only histological and/or bacteriological examination of biopsies of the mass can confirm the diagnosis.

Tuberculosis in the Head and Neck: Changing Trends and Age-Related Patterns.

To evaluate changing trends in patient collectives, age-related patterns of manifestation, and diagnostic pathways of patients with extrapulmonary head and neck tuberculosis (TB), and to provide strategies to fasten diagnosis in these patients. Case control study. A 10-year retrospective analysis of 35 patients diagnosed with extrapulmonary TB in the head and neck at a tertiary university institution from 2009 to 2019, with special focus on the influence of the patient's age on consideration of TB and clinical patterns. The vast majority of patients younger than 40 years had their origin in countries with high TB burden (P= .0003), and TB was considered very early as a differential diagnosis (P= .0068), while most patients older than 40 years were domestic citizens initially suspected for a malignancy, who more often had an underlying immunosuppressive condition (0.0472). Most frequent manifestations in both groups were the lymph nodes, larynx, and oropharynx. Surprisingly, no differences in the rates of open TB or history of TB infection in the family anamnesis were found. The two groups of patients found most often are younger patients migrating from regions with high TB burden and elderly domestic patients suffering from immunosuppressive conditions, with the latter often being misdiagnosed as malignancies. TB remains an important but difficult differential diagnosis, due to the initially unspecific symptoms and the great variety in the presentation of manifestations in the head and neck. 4 Laryngoscope, 131:2701-2705, 2021.

Tuberculosis Exposure With Risk of Behçet Disease Among Patients With Uveitis

Although experimental studies support the hypothesis that exposure of infectious agents may trigger an aberrant immune response and contribute to noninfectious uveitis, the association of a definite pathogen with human noninfectious uveitis conditions appears not to have been well established in a population. To evaluate associations of tuberculosis infection with risk of several noninfectious uveitis conditions. These mendelian randomization and observational analyses were conducted with the genetic data of a Chinese cohort enrolled between April 2008 and January 2018 and a Japanese cohort enrolled between January 2002 and June 2009. We recruited participants for T-SPOT.TB (Oxford Immunotec) assays between July and November 2019. The Chinese cohort included patients with uveitis associated with Behçet disease or other uveitis conditions and control participants. The Japanese cohort and the group given T-SPOT.TB assays included individuals with Behçet disease and control participants. Data analyses for this study were completed from July 2019 to January 2020. Genetic variants associated with tuberculosis as natural proxies for tuberculosis exposure. The primary outcome was the odds ratio (OR) for Behçet disease, estimated by an inverse variance weighted mean of associations with genetically determined tuberculosis susceptibility. The T-SPOT.TB positivity rate was examined in individuals with Behçet disease and compared with that of control participants. The Chinese cohort included 999 patients with uveitis associated with Behçet disease, 1585 with other uveitis conditions, and 4417 control participants. The Japanese cohort included 611 individuals with Behçet disease and 737 control participants. The group given T-SPOT.TB assays included 116 individuals with Behçet disease and 121 control participants. Of the Chinese individuals with Behçet disease and control participants, 2257 (41.7%) were female and the mean (SD) age was 35.4 (12.5) years. In the Japanese cohort, 564 (41.8%) were female and the mean (SD) age was 39.1 (12.7) years. Genetically determined tuberculosis susceptibility was associated with an increased risk for Behçet disease. The OR for Behçet disease per 2-fold increase in tuberculosis incidence was 1.26 (95% CI, 1.12-1.43; P = 1.47 × 10-4). Replication using the Japanese cohort yielded similar results (OR, 1.16 [95% CI, 1.08-1.26]). In T-SPOT.TB assays, having a positive result, indicating a history of tuberculosis infection, was found to be an independent risk factor for Behçet disease (OR, 2.26 [95% CI, 1.11-4.60]). These human genetic and biomarker data demonstrated that tuberculosis exposure was a risk factor for Behçet disease. This study provides novel evidence linking an infectious agent to the risk of a noninfectious uveitis condition.

Nontuberculous mycobacterial infection in rheumatoid arthritis patients: a single-center experience in South Korea.

Nontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area.We performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry.Among 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection.In South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.

Tuberculosis Infection Could Mimic Malignant Lymphoma In F-18 FDG PET: A Case Report

Introduction: Lymphoma and tuberculosis in several cases share similar clinical features that are difficult to differentiate. Lymphadenopathy, fever, malaise, weight loss, and respiratory symptoms are clinical features that could be found in both lymphoma and tuberculosis. Positron Emission Tomography/Computed Tomography Fluorodeoxyglucose (F-18 FDG PET) is a pivotal modality for imaging patients with cancer. Several non-malignant diseases like tuberculosis infection show high FDG uptake and lead to low specificity of F-18 FDG PET.Case Presentation: This case report describes a 55-year-old male patient with a history of Diffuse Large B-cell Lymphoma (DLBCL) who was suspected of having a recurrent disease. The patient has had a 6-month remission period after 6 cycles of R-CHOP regimen chemotherapy. He denied any known history of tuberculosis infection and HIV. F-18 FDG PET was performed to assess the extent of suspected lymphoma recurrent disease. F-18 FDG PET demonstrated multiple hypermetabolic bilateral neck region, mediastinum, and bilateral axilla lymphadenopathies. There were also multiple high FDG uptakes in the liver, mesocolon, and bones. The patient was suspected of having a lymphoma recurrent disease based on these findings. He underwent an excisional biopsy in the neck and was found to have lymphadenitis granulomatous disease from tuberculosis. Based on the histopathology finding, the patient received anti-tuberculosis drugs for 12 months and showed relief of signs and symptoms. F-18 FDG PET for anti-tuberculosis treatment evaluation revealed a complete metabolic response.Conclusion: Tuberculosis should be one of the differential diagnoses when a lymphoma recurrent disease is suspected. Clinical features, laboratory results, and imaging findings sometimes show similarities between lymphoma and tuberculosis. Histopathology evaluation is mandatory to confirm the diagnosis.

Nontuberculous mycobacterial endophthalmitis: case series and review of literature

BackgroundTo report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.MethodsClinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.ResultsWe reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.ConclusionsNTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

Tuberculosis Contact Investigations Conducted in New York City Adult Day Care and Senior Centers, 2011-2018.

Multiple tuberculosis (TB) exposures have been reported in New York City (NYC) adult day care and senior centers. Strategies to identify TB transmission at such locations are needed. Review of the NYC TB Registry identified 12 contact investigations (CIs) at adult day care or senior centers (2011-2018). Median age of the 12 index patients was 81 years. Of 148 contacts identified who had no history of TB infection or disease, 141 (95%) were tested for TB, primarily with interferon gamma release assays; 46 (33%) tested positive. Transmission was probable (n = 3) or possible (n = 1) at 4 (33%) centers; at all of these, the index patient had an acid-fast bacilli-positive sputum smear. Transmission was not found from index patients with negative sputum smears. We found evidence of transmission of smear-positive respiratory TB disease to contacts in adult day care or senior centers, underscoring the importance of CI.

Can we treat bladder cancer with intravesical Bacillus Calmette-Guerin in patients with prior tuberculosis infection? A population-based cohort study

BackgroundIntravesical bacillus Calmette-Guerin (BCG) therapy is the treatment of choice for patients with T1 or high-grade superficial bladder cancer or those with carcinoma in situ after transurethral resection. A personal history of tuberculosis infection has been viewed as a relative contraindication for BCG therapy, because it may increase the risk of complications or decrease the treatment effectiveness. We determined the safety and efficacy of intravesical BCG treatment for patients with prior tuberculosis infection by analyzing the data obtained from the National Health Insurance Research Database in Taiwan.MethodsWe included patients who were newly diagnosed with bladder cancer from 2000 to 2009 and who received adjuvant intravesical BCG therapy within 3 months after the surgery. We excluded those who developed upper urinary tract cancer during the study period. Disease recurrence, disease progression, and major adverse effects were compared between patients with and without a prior diagnosis of tuberculosis infection until December 31, 2011.ResultsAmong the 3915 patients included, 187 (4.8%) had been previously diagnosed with tuberculosis infection. The proportion of men (84.0% versus 76.9%) and older patients was higher in the group with a prior tuberculosis infection than in those without a prior tuberculosis infection. Significant differences in disease recurrence (20.3% versus 22.8%; hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.63–1.21, p = 0.404) or disease progression (10.2% versus 12.8%, HR, 0.74; 95% CI, 0.46–1.17, p = 0.191) were not observed between the two groups. None of the patients with a prior tuberculosis infection had severe urinary tract infections, whereas four (0.1%) patients without such an infection developed severe urinary tract infections.ConclusionA prior tuberculosis infection did not affect the treatment efficacy or safety of intravesical BCG treatment. The efficacy and safety of intravesical BCG therapy are comparable between bladder cancer patients with and without prior tuberculosis infections.

Brucellosis spondylitis

A 68-year-old woman presented with asthenia and low back pain. She had no history of tuberculosis infection or known exposure. Laboratory tests showed that her leukocyte count was 3800/mm3 (reference range 3500–9500), erythrocyte sedimentation rate was 66 mm/h (reference range 0–20), and tumor markers were negative. Single photon emission computed tomography (SPECT) bone imaging showed increased tracer uptake (T12, L3–L4) (Figure 1A ). Magnetic resonance imaging (MRI) showed a large and obvious enhancement shadow (T12, L3–L4) (Figure 1B). Brucella antibodies were positive on her serum agglutination test. Her son had a fever 3 days prior and blood culture grew Brucella melitensis; the lady raised goats with her son. She received treatment with doxycycline and rifampicin for 3 months. Her back pain disappeared and she remained symptom-free at follow-up 1 year later. On behalf of all authors, the corresponding author states that there is no conflict of interest.

Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn's disease in patients with positive results.

Aim:The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment.Methods:A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients.Results:Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml (p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis (p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference (p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss (p < 0.05).Conclusion:Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

The prevalence of latent tuberculosis infection in patients with inflammatory arthritis and the diagnostic efficacy of different screening methods

Objective: To investigate the prevalence of latent tuberculosis infection (LTBI) in patients with inflammatory arthritis, and to compare the efficacy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) in screening for LTBI in these patients. Method: Medical records of 149 patients with inflammatory arthritis admitted to inpatient of Peking University International Hospital from December 2015 to December 2017 (diagnosis with rheumatoid arthritis, ankylosing spondylitis, sero-negative spondyloarthropathy, psoriatic arthritis, or reactive arthritis) who accepted TST or QFT were collected. The information included gender, age, history of tuberculosis infection, calcifications presence in chest X-ray or chest CT, TST result, QFT result, medication history before test, and biological treatment and all the patients were made a follow-up. Results: The positive rate of TST was 18.2%(14/77) and that of QFT was 27.1%(26/96), and the overall consistency between the two tests was fair. The rate of LTBI diagnosed by QFT was 22.9%(22/96). The positive rate of TST in patients older than 50 years was significantly higher than those younger than 50 years, but there was no significant difference between the two groups screened by QFT. The M-N values in QFT were decreased in both the patients above the age of 50 and in the patients using immunosuppressive agents. A total of 64 patients accepted biological agent therapy, and in those with a positive result of TST or QFT, only 2 cases received anti-LTBI treatment, but the other 14 cases without anti-LTBI treatment. None of them developed active tuberculosis in the following 3-24 months. Conclusion: The prevalence of LTBI in patients with inflammatory arthritis is consistent with that reported in rheumatoid patients, which is higher than in general people. In patients with inflammatory arthritis older than 50 years, especially those accepted immunosuppressive agents therapy, the immunity may be impaired and QFT is more sensitive than TST for screening LTBI.

Results of a population screening intervention for tuberculosis in a Nunavik village, Quebec, 2015-2016.

A small village in Nunavik, Quebec experienced a tuberculosis (TB) outbreak in 2012-2013 and then a resurgence in 2015-2016. Cases were still occurring, despite the fact that contact tracing had already been conducted on one quarter of the population. A decision was taken to conduct large-scale screening of the population for TB. To describe the results of a population-based TB screening intervention designed to identify individuals with latent TB infection (LTBI) or active TB requiring treatment. The history of TB infection (either active TB or LTBI, defined as a positive tuberculin skin test result of at least five mm induration) and treatment (considered adequate if at least 80% of prescribed doses were taken) were determined. Those who were two years of age and older and had not been included in contact tracing after June 1, 2015 were included for TB screening (n=1,026 eligible individuals). Screening included a nurse assessment, tuberculin skin test (TST) for those with previous negative TST or of unknown status and chest X-ray for the others. Of the eligible individuals in the affected village, 1,004 (98%) participated in the screening. Of these, 30% had a history of previous TB infection. A TST screening was administered to 71% of the participants, 10% of whom had positive results. Assessments were performed on 425 participants and 385 underwent a chest X-ray. Fifty-two cases of previously diagnosed active TB and three cases of new active TB were documented. In addition, there were 247 individuals with LTBI who had been previously identified (191 were found to have had adequate LTBI treatment, 56 were found to have had inadequate LTBI treatment) and 69 were identified with de novo LTBI. In addition, 633 participants were found to have no TB infection. There were 125 participants who were referred for LTBI treatment. Follow-up information was available for 120 and 85 (71%) of these completed the treatment. Within this northern village, which had persistent TB transmission despite classic control measures, population-based screening had a high degree of coverage and was an effective way to detect additional cases of individuals with active TB and those with LTBI.

Rice body formation without rheumatic disease or tuberculosis infection in a sausage ring finger – a case report

Subcutaneous masses in the finger gather numerous lesions, among which tumors, inflammation-induced lesions, and post-traumatic lesions. Rice bodies are very unfrequent lesions, encountered in rheumatoid or tuberculous chronic synovitis. We present the case of a young patient with no history of tuberculosis infection or rheumatoid pathology who required surgical treatment for a rice body formation localized on the palmar side of the fourth left finger. A 31-year old, right dominant hand man presented with a 15 years history of progressively growing “sausage-like swelling” of the finger. There was an inamovible, painless mass with restriction of the DIP and PIP joints range of motion, without skin lesion, redness or stiffness. Imaging showed a large non-agressive mass within the tendon sheath. We realized a complete excision of the mass. Histopathological examination showed synovial villus with body rice shape and central necrosis evoking tuberculous synovitis or reumatoid arthritis. However, there was no argument for mycobacterial infection nor rheumatoid pathology. Rice bodies mostly evoke chronic synovitis or arthritis in northern countries, but may also be found in infectious diseases such as mycobacterial infections, related to chronic bursitis. No physiopathological mechanism has been formally identified (microinfarctions after intra-articular synovial inflammation and ischemia + de novo formation and progressive enlargement by fibrin + alteration in fluid viscosity and fibrinogen content of the synovial fluid). Different locations of rice bodies have been documented such as shoulder, knee, extensor tendon in the hand, wrist and carpal tunnel and flexor tendon sheath, but at the knowledge of the authors, this is the first reported case of digit flexor sheath rice body formation not related to inflammatory disease such as mycobacteria infection or rheumatoid arthritis. Differential diagnosis include synovial chondromatosis, pigmented villonodular synovitis, gout, sarcoidosis, systemic lupus erythematosus, chronic fungal infection and atypical mycobacterial infection, but the absence of suggestive complications, negative bacterial and fungal cultures, and laboratory test results, allowed us to assume the absence of classic etiology. In a case like ours, even less described than tuberculosis or arthritis, there is no established treatment standard. Despite the absence of associated systemic therapy, radical excision of the mass should provide definitive treatment. Therefore, prolonged observation will be necessary to confirm absence of recurrence with radical excision. Rice body formation should be better known as a muskulosqueletal form of mycobacterial infection or rheumatoid affection either by radiologists, surgeons and pathologists to provide optimal care for patients.

Incidence and Clinical profiles of Pulmonary and Extra-Pulmonary Tuberculosis patients in North Indian population: A hospital based Retrospective study

Introduction: Tuberculosis (TB) is one of the most important global health problems. The prevalence of TB is high among the developing world. This retrospective study was carried out to find the incidence and clinical profiles of pulmonary and extrapulmonary tuberculosis patients in North Indian population. Material and methods: A retrospective analysis of 552 patients having EPTB and PTB was undertaken from the Dept. of Respiratory Medicine, King George’s Medical University, U.P., Lucknow, out of which 300 were of pulmonary tuberculosis and 252 of EPTB. Demographic characteristics, clinical features and apparent risk factors of disease were obtained from medical case records of all patients visiting the hospital from. The Study included only the confirmed cases of EPTB and PTB with or without other co-infections. Results: Results were tabulated and statistically studied. The prevalence of EPTB was higher among females than males as compared to PTB and this was statistically significant (p=0.001). No significant (p>0.05) association was found between EPTB and PTB according to the place of residence. However, the tobacco habit, smoking habit, alcohol use and family history were found to be significantly (p<0.01) associated with the type of TB. Pleural (62.3%) site of EPTB was a most common site in EPTB patients. The study shows a significant (p=0.04) association between age distribution and disease condition (both EPTB and PTB) among males. A similar observation was found among female patients. The prevalence of EPTB was 1.80 times significantly higher among smokers. The prevalence of EPTB was also higher among those who had a family history of tuberculosis infection in comparison with new cases. Diabetes was present in 16.7% of the EPTB patients and MDR-TB was present in 12.7%. HIV was present in 8%. Most of the patients of EPTB were new cases (88.1) in comparison with the retreatment cases (11.9). Conclusion: Among evaluated tuberculosis patients, maximum had EPTB. Pleural tuberculosis was the most common presentation of EPTB. Both pulmonary, as well as extrapulmonary forms of tuberculosis, affected the younger population, between 20-40 years of age, more commonly. The study shows female preponderance among EPTB cases as compared to PTB cases. In female population, EPTB affected younger age group as compared to male patients where PTB was found to be more common. A Higher proportion of EPTB cases were found to be HIV positive and suffering from diabetes as compared to PTB.

Nontuberculous mycobacterial infection in rheumatoid arthritis patients: a single-center experience in South Korea.

Background/AimsNontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area.MethodsWe performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry.ResultsAmong 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection.ConclusionsIn South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.

Evaluation of interferon-gamma release assay (T-SPOT.TB(™) ) for diagnosis of tuberculosis infection in rheumatic disease patients.

Patients with rheumatic diseases are at higher risk of developing tuberculosis (TB). The objective of this prospective study was to evaluate the T-SPOT.TB assay (T cell enzyme-linked immuno-spot assay), for the diagnosis of tuberculosis infection in rheumatic disease patients in China. Prospectively enrolled patients came from the Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine between July 2008 and Aug 2012 for TB screening. Subjects' histories of TB infection, previous TB contact or bacille Calmette-Guérin vaccination and concurrent immunosuppressive therapy, were reviewed carefully and recorded in detail. TST (tuberculin skin test) and TSPOT.TB assay were performed on the subjects. A prospective evaluation by Chi-square test was used for sensitivity and specificity of both TST and T-SPOT assay. A total of 311 subjects included 114 (36.66%) male and 197 (63.34%) female subjects, with a median age of 37.7 ± 12.6 years (range 17-72). Thirty-two patients (10.29%) had a history of TB infection or previous TB contact; 256 patients (82.32%) were using glucocorticoids or immunosuppressants; 28 patients (9.0%) were clinically diagnosed as having TB infection. The sensitivity and specificity of TST for TB screening in rheumatic disease patients was 81.82% (9/11) and 67% (67/100), respectively. However, the sensitivity and specificity of T-SPOT assay was statistically higher at 92.86% (26/28) and 93.64% (265/283), respectively (P < 0.05). As a new immunoassay for TB diagnosis, the sensitivity and specificity of T-SPOT is higher than TST. It is of great importance in the diagnosis of active or latent TB infection in rheumatic disease patients.