Positive PPD Test Research Articles

(PM-02) GENITOURINARY TUBERCULOSIS IN MALE PATIENTS: A CASE SERIES FROM A FEDERAL UNIVERSITY HOSPITAL

Abstract Introduction Tuberculosis is a significant global public health threat, causing 1.2 million deaths in 2019. In Brazil, the incidence of the disease in the same year was 46 new cases per 100,000 inhabitants. Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis, resulting from the spread of mycobacteria through hematogenous dissemination from a latent chronic pulmonary infection or by local spread. Objective This study aims to present a case series of genitourinary tuberculosis in male patients from a tertiary university hospital. Method The study conducted a descriptive analysis of a case series using data from the Unit of Pathological Anatomy Laboratory and the Center for Infectious Diseases between 1999 and 2020. Results Four male patients, with a mean age of 32 years (ranging from 23 to 46), were evaluated. Key symptoms reported during medical consultations at the Urology outpatient service included scrotal nodules, increased testicular volume, and orchialgia, with an average symptom duration of six months. Physical examinations revealed a hard nodular mass in the epididymis or upper testicular pole, mostly on the right side (in half of the cases) or the left side (in the other half). Histological examination of biopsies indicated chronic granulomatous inflammation consistent with tuberculoid in all cases, with negative tumor markers. Notably, none of the patients reported contact with tuberculosis or leprosy patients, and only one patient had a positive PPD test (>24mm). Conclusion Genitourinary tuberculosis is a treatable and preventable disease. Understanding its clinical aspects, forms of presentation, dissemination, diagnosis, and treatment is crucial. Drug therapy, including rifampicin, isoniazid, pyrazinamide, and ethambutol, was effective in resolving symptoms in all patients. Surgical intervention in the form of orchidectomy was required for some cases, resulting in positive outcomes. Financing No conflict.

Investigation of the Frequency of Positive PPD Test in Candidate Patients Receiving Immunosuppressive Drugs Hospitalized in Shahid Sadoughi Hospital in Years 2019-2020

Introduction: Tuberculosis is one of the most common infections that lead to death,; incidence of tuberculosis is higher in individuals with immune system deficiency. Candidates for receiving immunosuppressive drugs should be examined for the presence of latent tuberculosis, so that if this test is positive, appropriate treatment and prophylaxis measures for tuberculosis can be carried out for them. The purpose of this study was to screen patients who are candidates for receiving immunosuppressive drugs in terms of tuberculosis.
 Methods: This cross-sectional study was conducted on the patients who were candidates for injectable immunosuppressive drugs hospitalized in Shahid Sadoughi Hospital between 2019 to 2020. Tuberculin skin test (TST) was taken from all eligible patients by the infection control unit of the hospital. Statistical analysis was done by SPSS V16. The P value less than 0.05 was considered statistically significant.
 Results: Participants were divided into three groups: healthy (TST=0-4), suspected (TST=5-9) and infected with tuberculosis (TST≥10); the frequency in the three groups was 83 (23.9%), 164 respectively. (47.3%) and 100 (28.8%). There was a significant relationship between the reason for referral to receive immunosuppressive drugs and the results of the TST test (P=0.003).
 Conclusion: If the patients with rheumatology, dermatology disorders and kidney transplant candidates receive immunosuppressive drugs, they are at high risk of primary tuberculosis infection and activation of latent tuberculosis, and it is necessary for health workers to pay more attention to this issue

"Frequency of Positive PPD Test After Inoculation of BCG Vaccine in 4-Month-Old Infants to 5-Year-Old Children"

"Frequency of Positive PPD Test After Inoculation of BCG Vaccine in 4-Month-Old Infants to 5-Year-Old Children"

Pulmonary Cavitary Tuberculosis in a Patient with SARS-CoV-2 Pneumonia

<strong>Background:</strong> COVID-19 disease caused by SARS-CoV-2 can lead to severe disease with pneumonia, respiratory failure, and death. Pathologic mechanisms include systemic inflammation with elevated IL-6 level. Glucocorticosteroids and Tocilizumab (TCZ), a monoclonal antibody that inhibits IL-6 receptors, are used to dampen systemic inflammation. We report a case of progressive cavitary tuberculosis during hospitalization for severe COVID-19 disease. <strong>Methods:</strong> Case report and data extraction of baseline demographic disease characteristics and longitudinal data extraction of clinical course, treatment and outcomes. <em><strong>Figure 1</strong></em> can be referred to for a timeline of important clinical events. <strong>Results:</strong> A 44-year-old male with severe COVID-19 disease was placed on invasive mechanical ventilation. He has a history of diabetes and serum glucose was 222 mg/dL at presentation. Interventions included a single dose of TCZ and high dose steroids, with a cumulative dose equivalent to 717 mg of prednisone. The Quantiferon TB (QT TB) test performed on day 2 of steroid administration and prior to TCZ use was negative. His respiratory status improved and he was subsequently extubated. One week later, he developed fever with leukocytosis. Serial, blood, urine, and fungal cultures, as well as serum galactomannan were negative. Serial chest X-rays showed persistent multifocal infiltrates. On day 29, chest CT scan showed a 6.6 × 9.4 × 9.5 cm soft tissue density consolidation within the right lower lobe with multiple internal airspaces and right hilar adenopathy with calcified subcarinal lymph nodes (<em><strong>Figure 2</strong></em>). A sputum culture grew Klebsiella pneumoniae. Despite treatment with broad-spectrum antibacterial and antifungal agents, fever and leukocytosis persisted. On day 35, a second scan revealed increased size of the infiltrate and cavities together with multifocal bronchiectasis and bronchiolectasis. Diabetes control was suboptimal with 45% (79/174) of serum glucose values &gt;180 (range, 50 to 450 mg/dL). Three acid-fast bacillus smears of sputum were found to be positive 3+ and the isolate was subsequently identified as Rifampinsusceptible Mycobacterium tuberculosis. He promptly improved after initiation of a four drug anti-TB treatment with prompt resolution of fever and leukocytosis. Upon further questioning, the patient reported that he had had a positive PPD test in the past after traveling to and from Haiti multiple times and was treated for 3 months in the last 10 years. <strong>Conclusions:</strong> This case illustrates that clinical deterioration in severe COVID-19 disease may be associated with the presence of coexisting pulmonary infections, including TB. While we cannot exclude reactivation of latent TB infection in the setting of incomplete TB infection chemoprophylaxis, it is more likely that the patient presented with unrecognized TB. COVID infiltrates may obscure the radiological features of TB. Multiple factors likely contributed to progressive cavitary disease including delated TB diagnosis, suboptimal diabetes control, immunosuppression, and Klebsiella pneumoniae. Timely use of CT scan when clinical response is slow or atypical for isolated COVID-19 disease together with complete microbiologic evaluation could lead to prompt recognition of coexisting pulmonary infections and improved outcomes.

PULMONARY CAVITARY TB IN A PATIENT WITH SARS COV 2 PNEUMONIA

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: COVID-19 disease caused by SARS COV 2 can lead to severe disease with pneumonia, respiratory failure, and death. Pathologic mechanisms include a cytokine storm with an elevated IL-6 level. Tocilizumab (TCZ), a monoclonal antibody that inhibits IL-6 receptors, has been used as a potential therapeutic intervention. We report a case of rapidly progressive tuberculosis (TB) following TCZ and steroid use. CASE PRESENTATION: A 44-year-old male was placed on invasive mechanical ventilation for worsening hypoxia due to SARS COV 2 pneumonia. Other interventions included high dose steroids, with a cumulative dose of 675 mg over 8 days, and a single dose of 400 mg of TCZ. The Quantiferon TB (QT TB) test performed on day 2 of steroid administration and prior to TCZ use was negative. His respiratory status improved and he was subsequently extubated. One week later, he developed fever with leukocytosis. Respiratory, blood, urine, and fungal cultures, as well as serum galactomannan were negative. Repeat chest X-ray showed persistent multifocal infiltrates. Chest CT scan showed a 6.6 x 9.4 x 9.5 cm soft tissue density consolidation within the right lower lobe with multiple intralesional airspaces. Despite treatment with broad-spectrum antibacterial and antifungal agents, fever and leukocytosis persisted. A second scan revealed increased size of the cavity, from 6 cm to 8 cm, along with multifocal bronchiectasis and bronchiolectasis throughout the right upper lobe, and increased bronchiolectasis and bronchiectasis in right upper, middle and bilateral lower lobes. Three acid-fast bacillus smears of sputum were found to be positive 3+ and the isolate was subsequently identified as Rifampin-susceptible Mycobacterium tuberculosis (MTB). He improved after initiation of a four drug anti-TB treatment with prompt resolution of fever and leukocytosis. Upon further questioning, the patient reported that he had had a positive PPD test in the past after traveling to and from Haiti multiple times and was treated for 3 months in the last 10 years or so. DISCUSSION: This case illustrates the potential for reactivation of latent TB infection with rapid progression to cavitary disease following the use of corticosteroid and TCZ for severe COVID-19. It is possible that prior administration of corticosteroid could have led to a false negative QT TB test. Dual TCZ and corticosteroid likely contributed to impaired MTB host defenses and to the reactivation of incompletely treated latent MTB infection. CONCLUSIONS: Rapidly progressive cavitary TB can follow the concomitant use of TCZ and high dose steroids for COVID-19. Complete TB history, along with TB screening before use could increase the detection of latent TB infection and trigger appropriate interventions to reduce the risk of reactivation of latent TB infection. Reference #1: Russell B, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting?. Ecancermedicalscience 2020;14:1023. Reference #2: Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience [published online ahead of print, 2020 Apr 6]. J Med Virol 2020;10.1002. Reference #3: Sotgiu G, Saderi L, Petruccioli E, Aliberti S, Piana A, Petrone L, Goletti D. Quantiferon TB Gold for the diagnosis of tuberculosis: a systematic review and meta-analysis. J Infect 2019;79:444-453. DISCLOSURES: No relevant relationships by Amna Aijaz, source=Web Response No relevant relationships by Svetlana Chernyavsky, source=Web Response Scientific Medical Advisor relationship with Gilead Please note: $1001 - $5000 Added 06/02/2020 by Nadim Salomon, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with VIIV Please note: $1001 - $5000 Added 06/02/2020 by Nadim Salomon, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with Janssen Please note: $1001 - $5000 Added 06/02/2020 by Nadim Salomon, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with Theratechnologies Please note: $1-$1000 Added 06/02/2020 by Nadim Salomon, source=Web Response, value=Honoraria Stock Owner relationship with TXMD Please note: $5001 - $20000 Added 06/02/2020 by Nadim Salomon, source=Web Response, value=Ownership interest No relevant relationships by Arielle Sasson, source=Web Response

MON-LB064 A Zebra of Adrenal Insufficiency: What Was Once Common Is Now Rare

Background: TB was once a common cause of primary adrenal insufficiency, it is now most often autoimmune in the developed world, but there are rarely observed infectious causes, including TB, Fungal, and CMV. The extra-adrenal manifestations typically stem from pulmonary TB. When TB invades the adrenals, imaging of the adrenal glands initially shows hypertrophy, which progresses to fibrosis and calcification in almost half the cases. This adrenal hypertrophy is often a key marker for differentiating tuberculous adrenal insufficiency from autoimmune adrenalitis, in which case adrenals are usually atrophied. Case: A 62 year old woman with a history of CKD, hyperlipidemia, and possible heart failure presented to the hospital with a 3 week history of worsening right knee pain. She was initially hypotensive at 68/48. Her hospital course was complicated by renal failure, persistent hypotension, and hyponatremia. She received approximately 5 liters of fluid with no significant hemodynamic response. Initial labs showed sodium of 125 with normal range 135-145 and a creatinine of 3.63 with sodium levels hovering in the low 130’s throughout the next 8 days while systolic pressure remained less than 110. Endocrinology was consulted to evaluate the ongoing hypotension and hyponatremia 5 days into admission. Infectious disease was also consulted after it was later revealed that the patient had a history of TB with a positive ppd in 2014, treated with Isoniazid but she was unable to confidently state whether she completed treatment. Other lab work was remarkable for a positive ppd test, negative HIV, and random cortisol levels of 1.3 and 1.1. Cosyntropin stimulation test was very abnormal with cortisol results of 1.3 and 1.1 at 30 and 60 minute intervals (normal >18). ACTH on day 6 of admission was greater than 2000, consistent with primary adrenal insufficiency. Abdominal CT without contrast on day 11 showed adrenal fullness with nodal calcifications consistent with post-infectious TB. Blood pressure and sodium improved on hydrocortisone 50 mg three times daily. She was discharged on hydrocortisone 20mg in the AM and 10mg in the PM, fludrocortisone 0.1mg daily and the 4 drug combo for TB; Rifampin, Isoniazid, Pyrazinamide, and Ethambutol. Conclusion: This case of primary adrenal insufficiency highlights an atypical cause that is now rare in the developed world. TB causes adrenal destruction in a gradual manner, targeting the medulla and cortex secondarily as illustrated here by this HIV-negative latent TB patient. Tuberculous adrenal insufficiency typically presents in an insidious manner. This case demonstrates the importance of a thorough history and evaluation coupled with the realization that not all primary adrenal insufficiency is autoimmune. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Unusual presentation of tuberculous meningitis: Two case reports

Introduction Central nervous system tuberculosis is a serious health problem worldwide and accounts for more than 7% of all cases of tuberculosis especially in developing countries with high prevalence of tuberculosis and also should be considered in high risk patients or in patient emigrated from regions with a high prevalence of tuberculosis. Tuberculous radiculomylitis is a complication of tuberculous meningitis which has been infrequently reported in medical literature. Case description Case I: A 49-year-old previously healthy Filipino female with 5 days history of fever, back pain radiating to both legs followed by acute onset of lower limb weakness and urine retention one day prior to presentation. Physical examination revealed pyrexia, alert patient, no sign of meningeal irritation and lower limb power decrease (3/5) normal exam of upper limb. Investigation showed elevated WBC in Cerebral Spinal Fluid (60% lymphocyte). Positive PPD and positive quantiferon test. MRI showed extensive enhancement around nerve roots extending cranially to lower thoracic. Patient started on antituberculous treatment, steroid and physiotherapy. Six month post treatment did not show significant neurological improvement, but fever respond after start of treatment. Case II: A 27-year-old healthy Filipino female, presented with history of fever, headache, neck and back pain with vomiting, three weeks prior to presentation and was treated as case of otitis media with two different antibiotic given during two primary health care visits. Presented with one day lower abdominal pain with urinary retention and body weakness. Physical exam showed lethargic patient afebrile with spastic quadriparesis power of upper limb 4/5 and lower limb 3/5. Investigation showed cerebrospinal fluid, high WBC (90% lymphocyte), high CSF protein and low glucose. High serum ESR. MRI showed increase leptomeningeal enhancement of spinal cord extending to the pons. Patient also started on steroid and antituberclous drugs. Patient made good clinical recovery and discharged. Results and conclusions In patient with tuberculous meningitis, an early diagnosis and initiation of therapy plays a major role in preventing unnecessary morbidity and mortality. In several series, use of the steroid has been considered beneficial and should be given for secondary neurological complications, associated with tuberculous meningitis. Emergency clinician must be aware of unusual presentation of tuberculous meningitis and other different causes of lower limb weakness. Neuroimaging with MRI with and without contrast and lumber puncture is critical for diagnosis.

Evaluation of Tuberculin Skin Test (TST) in Medical Students in Mazandaran University of Medical Sciences, Sari, Iran

&lt;p&gt;&lt;strong&gt;BACKGROUND: &lt;/strong&gt;Working in health care units has been known as occupational risk factor in mycobacterium tuberculosis (TB) infection. The TB exposure rate in medical students is more than other people. In several studies significant correlation has been reported between hospital presence hours and positive PPD test prevalence. With regard to morbidity of several medical students and nursing staff due to primary tuberculosis in recent years, we decided to investigate positive tuberculin skin test (TST) prevalence in medical students and examine correlation between positive cases prevalence with presence hours in hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS: &lt;/strong&gt;This was a cross sectional study and 297 medical students of Mazandaran University of medical sciences were investigated. TST was done with Mantoux method. After 48 hours, injection site induration was measured. Subjects that had induration &amp;lt;10 millimeters were injected again (1-3 weeks later) with same method. (As a booster dose)&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS: &lt;/strong&gt;32 cases (10.7%) had positive test at the first phase. Second phase was done on rest 265 persons and 20 cases had positive test. In summation 52 positive cases (17.5%) were observed. 21 cases of 151 persons (13.9%) in group with &amp;lt;100 hours/annual hospital presence, had positive tests. 21 cases of 71 persons (16.9%) in group with 100-1000 h/a hospital presence (Extern) and 19 cases of 75 people (25.3%) those who had &amp;gt;1000 h/a hospital presence(Intern), had positive tests. There was a meaningful statically difference in positive tests, between groups &amp;lt; 1000 hours exposure and the other who had &amp;gt; 1000 hours contact (p=0.032).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSIONS: &lt;/strong&gt;Because of, Interns’ high responsibilities and their more involvement in patient’s diagnostic and therapeutic process, they have high chance to contact with undiagnosed and diagnosed tuberculosis patients. Due to these reasons, TB infection rate is increasing among Interns. As a result of these findings, performing PPD test should be considered at the beginning of entrance to hospital departments and then annually. Necessary tasks and following up are needed to new positive cases.&lt;/p&gt;

Primary lingual tuberculosis, a rare case report

Sir, Lingual tubercular lesions are rare occurrences even in endemic countries like India. The lesions can present in a variety of appearances. They may masquerade as vascular malformations or malignant neoplasm clinically. Cases of lingual tuberculosis have been described from 1888 [1]. There have been occasional reports of lingual tuberculosis since then [2,3]. The clinical diagnosis is often difficult if not impossible as it is rare to suspect especially if it presents as a diffuse swelling. Most often, the diagnosis is made either by fine needle aspiration cytology or histopathological examination of a biopsy from the lesion. In this case, we present a patient who initially complained of a lingual swelling since 3 years. It had been gradually increasing in size and had occasionally ulcerated with minimal bloody discharge. The swelling was over the dorsal aspect of tongue and measured around 2.5x2.5cms in size (Fig. 1). It was firm in consistency with some areas being harder. There were no palpable cervical lymph nodes. Clinically a diagnosis of lymphatic malformation was made and excision biopsy was done (Fig. 2). Histopathological examination revealed numerous caseating epithelioid and giant cells granulomata, containing scanty acid fast bacilli. A final histopathological diagnosis of tuberculous lesion was later made and was supported by a positive PPD test and Mycobacterial culture from a sputum specimen. The patient was started on antituberculous therapy and follow up showed good initial response. Many believe that the rarity of oral tuberculosis is due to the continuous cleansing of the oral mucosa by saliva, the presence of a variable normal flora in addition to the presence of submucosal antibodies which gives the buccal mucosa a normal resistance [4]. The case differs from previously reported cases because the patient presented with a nodular and tumor-like mass which was clinically mistaken for a lymphatic malformation. PRIMARY LINGUAL TUBERCULOSIS, A RARE CASE REPORT PIERWOTNA GRUŹLICA JĘZYKA, RZADKI OPIS PRZYPADKU

Human leukocyte antigen alleles polymorphism in Han nationality suffered from Eales disease or tuberculosis in Zunyi city

Objective To analyze the relationship of human leukocyte antigen alleles (HLA-A/B,HLA-DRB/DQB) polymorphism and Eales disease, tuberculosis infection in a Han population in Zunyi city of China. Methods The subjects were analyzed by case-control study, which consisted of three groups including Eales disease group (47 patients), pulmonary tuberculosis group (36 patients) and normal control group (100 healthy people). Thirty-nine patients in Eales disease group who had complete history were divided into 4 subgroups according to the history and tuberculin PPD test. Twelve patients with past or present pulmonary tuberculosis were in group A, 27 patients without pulmonary tuberculosis were in group B, 27 patients with positive PPD test were in group C, and 12 patients with negative PPD test were in group D. Fifty-nine alleles of HLA-A/B and HLA-DRB/DQB were analyzed by polymerase chain reaction with sequence-specific primers (PCR-SSP) in all subjects. Odds ratios between each group (OR) and 95%confidence interval (CI) were calculated; Frequency distribution of HLA-A * 02 gene were analyzed for the group A and the TB group. Results The frequency distribution of HLA-A* 02 (OR=9. 719, OR 95% CI:4. 377-21. 580, P=0. 000) and HLA-B* 07 (OR= 11. 605, OR 95% CI: 2. 397-56. 191, P=0. 001) alleles in Eales disease group were obviously higher than that in normal control group, but frequency distribution of HLA-A * 11 (OR = 0. 495, OR 95% CI: 0. 245-1. 000, P= 0. 048) in Eales disease group was obviously lower than that in normal control group. There was no significant difference in frequency distribution of HLA-A * 02, HLA-A * 11 and HLA-B* 07 alleles between groups A and B, and between groups C and D (P＞0. 05). The distribution frequency of HLA-A * 02, HLA-A * 24, HLA-B * 07 and HLA-DRB * 16alleles among Eales disease group, pulmonary tuberculosis group and control group was statistically different (P＜0. 05). The frequency distribution of HLA-A * 24 alleles in pulmonary tuberculosis group was lower than that in Eales disease group (x2 = 7. 289, P = 0. 007), but the frequency distribution of HLA-A * 02 alleles had no significant difference (OR=0. 515, P=0. 202) between two groups. Conclusions The alleles of HLA-A * 02 and HLA-B * 07 may be genetic predisposing genes of Eales disease, but HLA-A * 11 alleles may be protective gene in population of Han nationality from Zunyi city. The alleles of HLA-DRB * 16 and HLA-A * 02 may be genetic predisposing genes of pulmonay tuberculosis. The alleles of HLA-A * 02 may be a common susceptible gene for Eales disease and pulmonary tuberculosis. HLA-A * 11 and HLA-A * 24 alleles were protective genes of Eales disease and pulmonary tuberculosis respectively. Key words: Retinal vasculitis/etiology; Tuberculosis/etiology; HLA antigens/genetics

Comparison of Tuberculin Skin Test and Interferon Gamma Assay for the Diagnosis Latent Tuberculosis

Problem statement: After HIV infection, TB is the most common cause of mortality due to a single infectious agent. Until 1985, tuberculosis cases in the world were decreasing every year, but then with the prevalence of HIV infection, TB cases are increasing every year. Obviously, with this prevalence of tuberculosis, the best way to control it is to track the patient and identify the people with latent TB and treat them. One third of the world population is infected with latent tuberculosis micro bacterium and tuberculosis causes two million deaths a year. Identification of people with latent TB infection is the primary aim to eradicate TB in the community. The method to measure gamma interferon in the blood called QuantiFERON®-TB Test is a promising diagnostic test for diagnosing latent TB infection and is more beneficent than compared to PPD. The aim of this study is to compare IFN-δ test and PPD test in diagnosis of patients with latent TB. Approach: In a crosssectional descriptive-analytic study on 76 patients referred to the clinic or infectious diseases ward of Imam Reza or Sina hospitals or Tabriz University of Medical Sciences during 2007 and 2008, the patients whose CXR had fibrotic images or calcification compatible with latent TB infection were included in the study and the correlations between IFN-δ and PPD tests was evaluated. Results: Mean age of the patients in this study was 64.96±4.54 years with minimum 43 and maximum 81 of age. About 33.3% of people under study had a positive PPD test and 4% of the patients had a positive IFN-δ and the correlation coefficient between IFN-δ test and PPD test was estimated at 0.376 (p<01/0). Age and gender had no effect on positivity of the results of PPD test and IFN-δ tests. Conclusion: Capability of IFN-δ test in diagnosis of latent tuberculosis infection is comparable to that of PPD test; however, the correlation coefficient between the two tests was low and also, unlike other studies, gender and age had no effect on positivity or negativity of PPD and IFN-δ tests.

Isoniazide-Induced Pancreatitis

Purpose: Introduction: Isoniazid (INH) is the most commonly used agent for treatment and chemoprophylaxis of tuberculosis. Isoniazid adverse reactions include hepatitis and peripheral neuropathy. We are reporting a case of isoniazid-induced pancreatitis. Case report: We are reporting a 60 year African-American Male who presented with epigastric pain and anorexia for two weeks. Past medical history included diabetes and hypertention. He denied a history of drug or alcohol abuse. One week before his symptoms started, he had a positive PPD test during routine pre-employment physical exam. A chest x-ray was negative for active disease and the patient was started on 300 mg of INH daily. In addition, the patient was taking Lisinopril and Insulin. On Physical exam, the patient had severe epigastric tenderness on palpation. On laboratory testing: Amylase 354 u/L, lipase 386 u/L, alkaline phosphates 103 u/L, AST 58 u/L, ALT 46 u/L, calcium 9.6 mg/dl and serum triglyceride 439 mg/dl. A CT scan of the abdomen showed normal biliary system. An INH-induced pancreatitis was suspected based on diagnosis of exclusion of other causes of acute pancreatitis. The patient was admitted to the hospital and INH was held. Patient's symptoms improved within 12 hours and totally resolved at 48 hours. At the time of discharge, serum amylase and lipase were 217 and 156 respectively. Patient was discharged from the hospital within 2 days of admission and asked to avoid INH in the future. Discussion: Over the past 50 years, INH has been the 1st line of treatment and chemoprophylaxis of tuberculosis. Anti-tuberculos-therapy-induced pancreatitis has been reported in the past and attributed mostly to rifampicin. However, INH has been incriminated as a cause of pancreatitis in few case reports. Based on a review of the literature, patients with INH-induced pancreatitis usually present within a few hours to 3 weeks of introduction of Isoniziad. They respond well to withdrawal of the drug and patients may recover anytime between 2 to 14 days. INH as a cause for pancreatitis can be classified as class Ia i.e. at least 1 case reported with positive re-challenge, excluding all other causes. Re-challenge was not attempted with our patient for obvious safety reasons. Other causes of acute pancreatitis were also excluded, including medications other than INH. Thus, INH was a “probable” cause of this patient's pancreatitis. Pancreatitis should be listed as a potential adverse reaction to isoniazid treatment and treating physicians should always include this medicine in the differential diagnosis of pancreatitis patients receiving anti-tuberculosis therapy.

QuantiFERON-TB gold assay for tuberculosis infection

Abstract Latent Mycobacterium tuberculosis infections can be difficult to diagnose, and diagnosis has formerly relied primarily on the tuberculin skin test (TST), an vivo assay with inherent limitations. Recently, vitro gamma interferon (IFN-γ) release assays have been developed that measure IFN-γ after stimulation with tuberculosis (TB) antigens such as PPD, CFP-10, and ESAT-6. The QuantiFERON-TB GOLD test (QFT-G) was the first such assay to garner U.S. Food and Drug Administration clearance. Potential uses of the QFT-G include screening for latent TB, testing for active TB infection, and confirmation of a positive or intermediate PPD test. The advantages of QFT-G over the TST include potentially easier follow-up and more objective test administration and measurement; however, multiple clinical studies have shown that the QFT-G has its own limitations, such as indeterminate results immunocompromised patients (e.g., HIV and chemotherapy patients), sensitivity and specificity concerns, and the requisite infrastructure to collect and analyze specimens. Implementation of in tube QFT-G and T-SPOT TB assays may offer further promise over the QFT-G.

Purified Protein Derivative - PPD

A 55-year-old physician had a PPD made as part of a clinical evaluation. Laboratory tests were unremarkable and PPD, read in 48 hours, showed an area of induration of 18 mm and an erythema of 51 mm (Panel A). A 2 mm punch biopsy was done in the center of the induration 96 hours after the injection. Histopathology showed an intense perivascular cuffing with macrophages and lymphocytes and edema involving the dermis. The macrophages were predominant and most of them showed cellular swelling. There was some degree of vasculitis, as shown (Panel C). A positive PPD test is generally defined as greater than 10 mm of (Panel B) induration, not erythema, and can be measured by using a medium-point ballpoint pen to draw a line starting 1 to 2 cm away from the skin reaction (induration) and moving toward its center. The pen is lifted when resistance is felt. The procedure is repeated from the opposite direction and the distance between opposing lines is measured (Panel A). Virtually all people with PPD greater than 15 mm of induration are infected with Mycobacterium tuberculosis (Mtb), so the physician is infected with Mtb. PPD is also called Tuberculin and Mantoux test after the French physician Charles Mantoux (1877-1947). In 1934 Florence B. Seibert (1897-1991), an American Scientist, developed the method to obtain the Purified Protein Derivative-PPD, that became the basis for the standard Tuberculosis Test. Seibert, was a Professor of Biochemistry at the Henry Phipps Institute at the University of Pennsylvania.

Prevalencia de tuberculosis en una población procedente de Kosovo acogida en Cataluña

Prevalence of tubeculosis (TB) among refugees is high. The goal was to detect TB active cases in a group of refugees from Kosovo and to describe the prevalence of TB infection. 222 people sheltered in Catalonia, Spain, were tested for TB using the Mantoux method and a chest x-ray. The odds ratio (OR) was adjusted by the age of presenting a positive PPD test for different diameters of induration according to the previous BCG vaccination history. No cases of active TB were detected and 82% of the population was found to be vaccinated with BCG. The OR of presenting a positive PPD was higher, and statistically significant, in vaccinated subjects compared to non-vaccinated ones for indurations >= 5 mm and >= 10 mm (OR: 4.5 and 3.6 respectively). BCG-vaccinated subjects from this population can be considered to be infected by Mycobacterium tuberculosis as long as the induration is higher than 15 mm.

Patient's Self-interpretation of Tuberculin Skin Tests

In the outpatient use of tuberculin skin testing (purified protein derivative [PPD]), it is at times inconvenient to have a patient revisit for interpretation. Therefore, we assessed patients' ability to self-interpret these test results. In keeping with prior custom, patients were seen by an experienced nurse, who performed skin testing with PPD intermediate strength as well as mumps and Candida anergy control tests in some cases, and explained the procedure. The patients were asked to return 48 to 72 h later, at which time one of the researchers recorded their test interpretations before they were again evaluated by the nurse. Sixty-eight patients were studied, of whom 59 returned at appropriate interval. Eighteen patients had a positive PPD test reaction of 10 to 20 mm induration, which only one patient correctly identified as a positive test result. However, positive anergy control tests were correctly interpreted in 10 of 27 cases. The small number of positive PPD test result recognition by these patients may be partially attributed to their lack of education, as well as foreign birth and denial of illness. PPD results should be checked by an experienced professional.

Challenges associated with assessment of risk for tuberculosis in a dental school setting

Background: Reproted risk among health care workers, related to tuberculosis exposure, motivated us to accurately assess this occupational risk at our College of Dentistry. Methods: Our sample population included all dental students entering their junior (third) year (beginning of maximum patient exposure). Screening for tuberculosis infection, with the standardized Mantoux test (purified protein derivative [PDP]), was conducted by the authors; several variables, previously associated with inaccurate test results in the literature, were controlled for during the study. Results: Among the study population of 158 students, the PDD conversion rate, as determined by one-stop testing, after one academic year was 10.6%. To further investigate factors (other than possible workplace exposure) contributing to PPD conversion in the study population, the authors also examined PPD results from previous employee and student screenings and conducted a retrospective chart review of selected patients registered at the college for the same period. Conclusions: We found that being born outside of the United States and having previously received bacille Calmette-Guérin vaccine are associated with positive PPD test results. In addition, PPD conversion among the study group may not be associated with occupational exposure at the College but, in fact, may be related to other factors, including community- and hospital-based clinical exposure. Finally, we recommend further research that examines the possible systemic effects of periodic testing with PPD on test subjects.

Risk for Developing Tuberculosis among Anergic Patients Infected with HIV

To assess the risk for development of tuberculosis among anergic patients infected with the human immunodeficiency virus (HIV). Retrospective cohort study. Tertiary referral center. All HIV-infected patients who had a baseline positive protein purified derivative test (PPD) and delayed-type hypersensitivity skin tests. Development of active tuberculosis. Of 374 patients, 108 (29%) had positive results of PPD tests, 154 (41%) had negative results of PPD tests but no skin anergy, and 112 (30%) were anergic. Conversion of the PPD to positive was observed in 10 of 67 (15%) patients with previously negative results of PPD tests and no anergy and in 3 of 36 (8%) anergic patients who were retested during the follow-up period (mean, 26 months). The risk for active tuberculosis to develop in patients not receiving isoniazid chemoprophylaxis was similar in patients with a positive PPD test result (10.4 cases per 100 person-years) and in anergic patients (12.4 cases per 100 person-years) and higher in both groups than in nonanergic patients with a negative PPD test result (5.4 cases per 100 person-years). Tuberculosis was more frequent among intravenous drug abusers with no previous isoniazid treatment (63 of 290, 22%) than among homosexual men (0 of 29) or patients in other HIV transmission categories (0 of 31). Preventive therapy with isoniazid reduced tuberculosis development (4% as compared with 31%; P = 0.008). Among 15 anergic patients who had CD4 counts measured within 3 months of tuberculosis development, only 1 (7%) had more than 500 CD4 cells/mm3. Anergic HIV-infected patients are at high risk for development of tuberculosis. Anergic HIV-infected patients, in addition to HIV-infected patients with positive results of PPD tests, should be offered preventive therapy if they live in areas with a high prevalence of tuberculosis, at least when the CD4 count decreases to less than 500 CD4 cells/mm3.

Mycobacterial subcutaneous arteritis

The authors report three patients with subcutaneous erythematous nodules in different phases of development, unspecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an unspecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.