Positive Purified Protein Derivative Research Articles

Case Report: Reiterating the importance of tissue biopsy in the diagnosis of tuberculosis: lessons from a case of pediatric pulmonary tuberculosis complicated by Hodgkin's lymphoma

The clinical symptoms of tuberculosis infection in children are not typical and need to be distinguished from many diseases, and the tumor is one of them. We present a case of cervical lymphadenopathy in a child with positive purified protein derivative (PPD) and Interferon-Gamma Release Assay results, ultimately diagnosed with Hodgkin's lymphoma via cervical lymph node biopsy. We learned some lessons from the case: First, Pathological biopsy remains the “gold standard” for diagnosing tuberculosis. Second, there are limitations of sampling in lump fine needle aspiration biopsy, surgical methods for lymph node are preferred to obtain larger tissues and improve tuberculosis detection sensitivity.

Diagnostic approach of tuberculous lymphadenitis in a multicenter study.

Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon-gamma release test result (p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels (p < 0.05). Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy.

Frequency of abnormal findings on chest radiograph after positive PPD in children and adolescents in an urban setting in the United States

BackgroundChest radiographs (CXR) for tuberculosis (TB) screening in children are valuable in high-burden settings. However, less certain in low prevalence contexts. In the United States, positive PPD is sufficient to treat for “latent” TB, or TB infection in asymptomatic patients. ObjectiveWe sought to determine frequency of abnormal CXR findings after a positive purified protein derivative (PPD) test at a tertiary pediatric center in the United States. MethodA retrospective evaluation was conducted of patients (0–18 years) with a CXR after a positive PPD (e.g., known exposure, employment, migratory requirements or before immunosuppression) between 2011 and 2021. Clinical information, demographics, and reason for PPD were recorded from health record. CXRs were evaluated using initial report and by a pediatric radiologist with special interest in TB and 8 years of experience. ResultOf 485 patients, median [interquartile range (IQR)] age 8.5[3.3–14.4], abnormal CXRs were described in 5 (1%). Most common reasons for PPD included: close contact with someone with TB or with high risk for TB. Most patients 373 (76.9%) received treatment for latent TB, and 111 (22.9%) no treatment. One patient (0.2%) received treatment for active disease. Radiographic findings included isolated lymphadenopathy (n = 2), consolidation (n = 1), pleural fluid/thickening (n = 1) and a patient with lymphadenopathy and a calcified nodule (n = 1). ConclusionIn our experience, prevalence of chest radiographs findings for patients with positive PPD was very low. Moreover, no cases of severe disease were seen and those with abnormal findings would not merit treatment change under current WHO guidelines.

Comparative Evaluation of Specific Antibody against Mycobacterium tuberculosis ESAT-6 Recombinant Antigen in Healthy Subject with Positive and Negative Skin Test.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis). The laboratory diagnosis of the disease includes various bacteriologic and immunologic methods. Despite the effectiveness of many of these methods in diagnosing active TB, their high cost and time-consuming nature have led researchers to adopt more accurate and rapid screening methods based on specific antigens for M. tuberculosis. The present study aimed to measure specific antibody serum levels against the early secretory antigenic target 6 kDa (ESAT-6) recombinant protein in healthy people and compare it to TB patients. The target population included 27 TB patients and 87 healthy individuals with no clinical TB symptoms. The healthy population was divided into two groups, including positive purified protein derivative (PPD) and negative PPD (35 and 52 people, respectively), using the Tuberculin skin test. The specific antibody level against the ESAT-6 recombinant antigen and the PPD protein was measured using an indirect Enzyme-Linked Immunosorbent Assay (ELISA) test. The results of the study showed that the majority of the healthy population with no symptoms of clinical TB and having negative skin test results did not have antibodies against the recombinant ESAT-6 (98%) and PPD (96%) antigens. On the other hand, there was a high level of the specific antibody of the ESAT-6 recombinant and PPD antigens in TB patients (77%). It is notable that in people with positive skin test results, the level of the antibody against the ESAT-6 recombinant antigen and PPD antigen was 94%. The results demonstrated that the ELISA method based on the measurement of antibodies against the ESAT-6 recombinant antigen can be a proper diagnostic method for rapid and accurate screening of healthy from infected people.

Evaluation of Preschool Screening Program in the Kingdom of Bahrain: A Survey in Primary Healthcare Centers

Background: Preschool screening is one of the services provided by primary healthcare centers, in the Kingdom of Bahrain, for children aged 5 to 6 years. This service includes assessing growth and development parameters, which includes measuring hemoglobin levels, conducting vision examinations, and administering Purified Protein Derivative (PPD) tests. Objectives: To evaluate the prevalence of anemia, reduced visual acuity, and positive PPD tests, in children’s preschool screening. Methodology: This survey was conducted in 25 primary healthcare centers, between the period of January to March 2020, with a total sample size of 2,637 children. Electronic preschool screening visit sheets, of children who attended the health centers for screening, were reviewed and evaluated. Results: Out of the 2,637 records reviewed; anemia, reduced visual acuity, and positive PPD tests, were found in 19.9%, 4.7%, and 0.45% of children, respectively. Conclusion: The overall prevalence of reduced visual acuity and positive PPD tests was low. On the other hand, although the overall prevalence of anemia was also low, at about 20%, this can be reduced further by raising physicians’ adherence to anemia management guidelines, at earlier ages. Moreover, further studies are needed to assess the causes and risks of anemia in this age group. Keywords: Bahrain, Preschool, Screening, Primary Healthcare Centers, Prevalence

Tuberculosis Uveitis Associated With Ocular Surface Squamous Neoplasia in an Otherwise Healthy Patient

We describe a 34-year-old woman with isolated tuberculosis (TB) uveitis who had unsuccessful resolution of her ocular surface squamous neoplasia after multiple shave excisions with a positive purified protein derivative (PPD) test and interferon-gamma (IFN-γ) release assays (IGRAs) proven tuberculosis. She was managed with wide local excision of the lesion. Histopathology confirmed conjunctival intraepithelial neoplasia (CIN) grade II. Topical interferon alpha-2b (4 times daily) and anti-tuberculous therapy was planned for her, and there was no sign of recurrence of the lesion at six months follow-up.

DIFFUSE ALVEOLAR HEMORRHAGE DUE TO EOSINOPHILIC PNEUMONIA

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Eosinophilic Pneumonia commonly presents with fever, dry cough, and dyspnea.1 In this case, we present a patient with diffuse alveolar hemorrhage due to eosinophilic pneumonia. CASE PRESENTATION: A 65 y.o. female former healthcare worker with past medical history of obstructive sleep apnea on continuous positive airway pressure with 2 liters per minute of oxygen at night, gastroesophageal reflux disease, and previous exposure to tuberculosis 25 years ago at a health care facility with previously positive purified protein derivative (PPD) and no treatment, mild intermittent asthma, and regular marijuana use who presented with the chief complaint of hemoptysis and dyspnea. Patient states that she was having a dry cough for over a month. A week prior to presentation she developed drenching night sweats, fever, and hemoptysis. She did not have any family history as she was adopted. Social history was positive for alcohol use of 2-4 beers a month, no tobacco use, and smoking marijuana daily via pipe. She denied any recent travel, sick contacts, history of rheumatologic disorders, Raynaud’s phenomenon, joint pain, or hematuria. For her hobby, she would paint silk and was not using respirator protection. She also reported exposure to Jacquard dye set concentration where she accidentally put the dye set in her CPAP machine in place of distilled water. A computed tomography scan done on admission showed diffuse nodular opacities with ground glass opacities and mediastinal lymphadenopathy. Due to previously positive PPD, the patient had 3 acid fast smears done which were negative. Further infectious workup was also negative. Sedimentation rate and C-Reactive protein were elevated. Additional autoimmune workup was also negative. The patient underwent a bronchoscopy which showed diffuse alveolar hemorrhage while fungal, acid fast, and bronchial cultures were negative. She then underwent an open lung biopsy, and pathology confirmed eosinophilic pneumonia in a subacute setting. Patient was started on 60 mg prednisone for 3 weeks, and then 40 mg for a week, and then further tapered. She had complete resolution of her symptoms following initiation of prednisone. DISCUSSION: Eosinophilic Pneumonia is a rare lung disease that involves activation of alveolar macrophages which release cytokines that recruit eosinophils to the lung parenchyma.1 Patients commonly present with fever, dry cough, and dyspnea.1 It can present as acute, subacute, or chronic and is generally brought on by an offending agent such as smoking or an infection.1 Rarely, eosinophilic pneumonia can cause damage and inflammation to the alveoli themselves which may cause alveolar hemorrhage.2,3 This case has two potential causes in the patient’s daily marijuana smoking along with her silk painting and exposure of dyeset in her CPAP machine. CONCLUSIONS: This is an unusual documented case of eosinophilic pneumonia causing alveolar hemorrhage. Reference #1: De Giacomi, Federica; Vassallo, Robert; Yi, Eunhee S; Ryu, Jay H. Acute Eosinophilic Pneumonia: Causes, Diagnosis, and Management Reference #2: Rothenberg M, Hogan S. The eosinophil. Annu Rev Immunol 24: 147-174, 2006 Reference #3: Hogan SP, Rosenberg HF, Moqbel R, et al. Eosinophils: biological properties and role in health and disease. Clin Exp Allergy 38: 709-750, 2008. DISCLOSURES: No relevant relationships by Brian Dykstra, source=Web Response No relevant relationships by Adam Ladzinski, source=Web Response No relevant relationships by Aditya Mehta, source=Web Response

Tuberculosis prevalence among university freshmen in Zhengzhou, China, during 2004-2013.

Tuberculosis (TB) is a major public health concern worldwide, and spreads more easily in densely populated areas such as school campuses. The aim of this study was to determine the prevalence of positive TB skin tests among freshmen, i.e. newly-enrolled college students, in Zhengzhou City, China. We reviewed the data of purified protein derivative (PPD) skin tests in 656,212 freshmen in 2004-2013. A positive test showed a diameter of swelling ≥ 5 mm. The PPD positive rate was 40.69 %, with a prevalence of 146.29 per 100,000. During the 10-year study period, the rate of students with positive PPD test increased from 34.19 % in 2004 to 40.69 % in 2013. The positive PPD rate was significantly higher in males than in females (41.68 % vs 39.61 %, P<0.0001), and in rural compared with urban areas (42.04 % vs 38.03 %, P<0.0001). These findings indicated a high prevalence of PPD positivity among participants during the study period, with an increasing trend. Therefore, this population needs to be targeted by TB prevention and control programs.

1576. Risk of Clinical Tuberculosis (TB) Among Patients with Latent TB Infection (LTBI) Who Undergo Allogeneic Hematopoietic-Cell Transplantation (HCT)

Background Mycobacterium tuberculosis is a leading cause of morbidity and mortality worldwide. The risk of developing active TB in persons with hematological malignancies is higher than the general population. However, the magnitude and timing of this risk has not been determined in non-endemic settings after HCT. The purpose of this study was to evaluate treatment practices and active TB rates in a cohort of HCT recipients.MethodsA retrospective cohort study was performed of all adult patients who underwent HCT at Dana-Farber Cancer Institute between January 2010 and January 2015. Baseline characteristics and laboratory parameters were collected. LTBI diagnostic tests included purified protein derivative (PPD) and interferon-gamma release assays (IGRA). Baseline chest radiography, history of BCG vaccination, and previous LTBI therapy were documented. Institutional guidance recommends that LTBI treatment begins upon discharge or by Day +28 after HCT, whichever is first. Patients were followed until April 2018 for development of active TB.ResultsIn a cohort of 1,288 HCT recipients, 44 (3.4%) had evidence of LTBI, with 43 positive PPD tests and one positive IGRA. Median age was 55 years (range 19–72); 24/44 (54.5%) were male and 28/44 (63.6%) were non-US-born. Nine (20%) patients were treated for LTBI before HCT. Of the remaining 35 patients, 11 (25%) were treated within 3 months of HCT, three (6.8%) initiated treatment later than 3 months post HCT, and 21 (47.7%) did not receive treatment for reasons including death (n = 14, median survival 1.5 years from HCT) and treatment refusal (n = 4). Three patients were lost to follow-up. Among patients who initiated treatment, isoniazid (n = 10) and levofloxacin (n = 4) were used for a median of 145 days (range 7–326). There were no cases of active TB in the whole HCT cohort during the study period, which included a combined 139 person-years of follow-up in 44 patients with LTBI, of which 68 person-years were contributed by untreated individuals.ConclusionThese data suggest that TB reactivation does not usually occur very early after HCT. LTBI therapy could be deferred in the immediate post-transplant setting and initiated once patients are clinically stable with a lower risk of synergistic hepatotoxicity. Disclosures S. P. Hammond, Merck: Investigator, Research support

Review of children with Takayasu's arteritis at a Southern African tertiary care centre.

The objective of this study was to determine the clinical presentation, demographic profile, vascular involvement, origins, management, and outcome of children diagnosed with Takayasu's arteritis at a Southern African tertiary care centre between 1993 and 2015. This is a retrospective analysis of all children with Takayasu's arteritis captured on a computerised electronic database during the study period. A total of 55 children were identified. The female:male ratio was 3.2:1, and the mean age was 9.7±3.04 years. Most originated outside the provincial borders of the study centre. The majority presented with hypertension and heart failure. In all, 37 (67%) patients had a cardiomyopathy with a mean fractional shortening of 15±5%. A positive purified protein derivative test was documented in 73%. Abdominal aorta and renal artery stenosis were the predominant angiographic lesions. A total of 23 patients underwent 30 percutaneous interventions of the aorta, pulmonary, and renal arteries: eight stents, 22 balloon angioplasties, and seven had nephrectomies. All patients received empiric tuberculosis treatment, immunosuppressive therapy, and anti-hypertensive agents as required. Overall, there was a significant reduction in systolic blood pressure and improvement in fractional shortening (p<0.05) with all treatments. Takayasu's arteritis is more common in girls and frequently manifests with hypertension and heart failure. The abdominal aorta and renal arteries are mostly affected. Immunosuppressive, anti-hypertensive, and vascular intervention therapies improve blood pressure control and cardiac function.

Presumed tuberculous uveitis in a university-based tertiary referral center in Saudi Arabia.

To describe clinical characteristics and outcomes of treatment in patients with presumed tuberculous uveitis (PTU). All patients diagnosed with PTU between January 1996 and March 2013 were reviewed. The diagnosis was made when clinical findings were consistent with possible intraocular tuberculosis, strongly positive purified protein derivative (PPD) skin test result, and response to anti-tuberculous therapy with no other cause of uveitis as suggested by history, symptoms, or ancillary testing. Ninety patients (141 eyes) were identified. There were 43 males (47.3%) and 47 females (52.7%). Mean age was 48.2±14.4years. Mean duration of symptoms prior to presentation was 6.7±8.3months. Ten eyes (7.1%) had anterior uveitis, 18 eyes (12.8%) had intermediate uveitis, 34 eyes (24.1%) had posterior uveitis, and 79 eyes (56%) had panuveitis. Macular edema was present in 33.3% of the eyes at presentation. All patients received anti-tuberculous therapy and systemic corticosteroids. Mean follow-up after completion of therapy was 36±2.5months. Only 2 eyes developed recurrent inflammation after treatment completion. At last follow-up, all eyes showed resolution of inflammation, associated with significant improvement in visual acuity. There was a significant positive correlation between initial and final VA. Eyes that had macular edema at presentation showed a significant reduction in central macular thickness at final follow-up. There is delay in presentation of patients with PTU. The most common anatomic diagnosis was panuveitis. Treatment with anti-tuberculous therapy combined with systemic corticosteroids resulted in resolution of inflammation and macular edema with significant improvement in visual acuity.

Purified protein derivative skin test reactions are associated with clinical outcomes of patients with nonmuscle invasive bladder cancer treated with induction bacillus Calmette-Guérin therapy

ObjectivesTo investigate the relationship between purified protein derivative (PPD) skin test reactions before bacillus Calmette-Guérin (BCG) therapy and the clinical outcomes of BCG-naïve nonmuscle invasive bladder cancer patients treated with adjuvant BCG therapy. Materials and methodsA total of 288 nonmuscle invasive bladder cancer patients subjected to the PPD skin test before BCG therapy were included. PPD skin test reactions were categorized into 3 groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, erythema of 10mm or more and less than 10mm corresponded to slightly positive and negative, respectively. ResultsA total of 66 (22.9%), 149 (51.7%), and 73 (25.3%) patients exhibited a positive, slightly positive, and negative to PPD skin test, respectively. The 5-year recurrence-free survival rate of patients with positive PPD skin test reactions was 89.4 ± 4.1%, which was significantly higher than those of patients with slightly positive (65.5 ± 4.2%, P = 0.001) and negative reactions (56.4 ± 6.6%, P<0.001). A multivariate Cox regression analysis revealed that a positive PPD skin test reaction was independently associated with tumor recurrence (hazard ratio of 0.233, P<0.001), but not with stage progression. The incidence of fever persisting for more than 2 days or fever of ≥38°C was significantly higher in patients with a positive PPD skin test reaction (18.2%) than in patients with slightly positive (8.7%) and negative PPD skin test reactions (4.1%). ConclusionsThe PPD skin test reactions before BCG therapy may predict clinical outcomes following BCG therapy and help clinicians counsel patients exhibiting strong therapeutic effects with BCG therapy and potentially major BCG-related side effects.

S.16.02 - Glucocorticoid receptor-dependent signalling in astrocytes as target of opioid action

To investigate the relationship between purified protein derivative (PPD) skin test reactions before bacillus Calmette-Guérin (BCG) therapy and the clinical outcomes of BCG-naïve nonmuscle invasive bladder cancer patients treated with adjuvant BCG therapy.A total of 288 nonmuscle invasive bladder cancer patients subjected to the PPD skin test before BCG therapy were included. PPD skin test reactions were categorized into 3 groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, erythema of 10 mm or more and less than 10 mm corresponded to slightly positive and negative, respectively.A total of 66 (22.9%), 149 (51.7%), and 73 (25.3%) patients exhibited a positive, slightly positive, and negative to PPD skin test, respectively. The 5-year recurrence-free survival rate of patients with positive PPD skin test reactions was 89.4 ± 4.1%, which was significantly higher than those of patients with slightly positive (65.5 ± 4.2%, P = 0.001) and negative reactions (56.4 ± 6.6%, P<0.001). A multivariate Cox regression analysis revealed that a positive PPD skin test reaction was independently associated with tumor recurrence (hazard ratio of 0.233, P<0.001), but not with stage progression. The incidence of fever persisting for more than 2 days or fever of ≥38°C was significantly higher in patients with a positive PPD skin test reaction (18.2%) than in patients with slightly positive (8.7%) and negative PPD skin test reactions (4.1%).The PPD skin test reactions before BCG therapy may predict clinical outcomes following BCG therapy and help clinicians counsel patients exhibiting strong therapeutic effects with BCG therapy and potentially major BCG-related side effects.

The clinical role of purified protein derivative skin test reaction in patients with non-muscle invasive bladder cancer treated with bacillus-Calmette Guerin.

4545 Background: We investigated the association between purified protein derivative (PPD) skin test reaction prior to BCG therapy and clinical outcomes, both oncological outcomes and occurrence of side effects, in BCG-naïve non-muscle invasive bladder cancer (NMIBC) patients. Methods: A total of 288 NMIBC patients who received PPD skin test prior to BCG therapy were included. The PPD skin test reaction was categorized into three groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, an erythema 10 mm or more and less than 10 mm corresponds to slightly positive and negative, respectively. Results: Sixty-six (22.9%), 149 (51.7%), and 73 (25.3%) patients had positive, slightly positive, and negative PPD skin test results, respectively. The 5-year recurrence-free survival rate of patients with a positive PPD skin test was 89.4±4.1%, which was significantly higher than that of patients with slightly positive (65.5±4.2%, p = 0.001) and negative (56.4±6.6%, p &lt; 0.001) results. Multivariate Cox regression analysis demonstrated that a positive PPD skin test was independently associated with tumor recurrence (Hazard ratio of 0.213, p &lt; 0.001) but not with stage progression. The occurrence rate of major side effects in patients with a positive BCG skin test (33.3%) was significantly higher than that in patients with slightly positive (26.8%) and negative PPD skin tests (13.7%). The incidence rate of fever persisting beyond 2 days or fever of ≥38°C in patients with a positive PPD skin test (18.2%) was significantly higher than that in patients with slightly positive (8.7%) and negative PPD skin tests (4.1%). Conclusions: NMIBC patients with a positive PPD skin test and who were treated with BCG therapy had a significantly lower tumor recurrence rate and higher incidence of major side effects such as fever persisting beyond 2 days or fever of ≥38°C. Our findings suggest that PPD skin test prior to BCG therapy can predict clinical outcomes following BCG therapy and provide useful information regarding who would experience a strong therapeutic effect for BCG therapy and BCG-related major side effects.

Low Yield of Chest Radiography in General Inpatients and Outpatients with “Positive PPD” Results in a Country with Low Prevalence of TB

The purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB). The reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010-2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms. Of the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease. Universal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB.

Tuberculosis and Leprosy Co-Infection: A Perspective on Diagnosis and Treatment

BackgroundThe Marshall Islands are known to be endemic for both leprosy and tuberculosis (TB). Active TB needs to be ruled out in all cases of leprosy, as treatment will lead to rifampin monotherapy of undiagnosed TB co-infection. The use of protein based interferon gamma release assays (IGRAS) to test for latent TB in leprosy endemic areas is confounded by the crossreactivity of T-cell response to the antigenic homologs of these proteins in Mycobacterium leparae.MethodsThe Purified Protein Derivative (PPD) skin test may have some utility in the diagnosis of latent TB in the setting of paucibacillary leprosy, however “giant reactions” to PPD testing have been documented in monoinfection with multibacillary leprosy.ResultsA 32-year-old Marshallese woman presented to the surgical department with symptoms concerning for osteomyelitis of the third distal phalanx, multiple burn wounds on both hands, and hypoaesthetic- hypopigmented skin lesions. She was referred to the National Hansen’s institute where a limited disarticulation of the distal phalanx and a slit skin biopsy was performed. Fite stain was negative, but PCR was positive for Mycobacterium leprae. The patient also had a strongly positive IGRA test for TB, and a positive PPD skin test. A chest x-ray showed a subtle infiltrate in the right middle lobe, three induced sputa were AFB negative by smear - however 1/3 was culture positive for drug-susceptible TB. The patient then underwent standard drug therapy for TB with the addition of dapsone for the treatment of Hanson’s. Repeat sputum cultures were negative at one month, and the patient had improvement in her skin hypopigmentation within four months of therapy.ConclusionThe immunological milieu of the host appears to paradoxically influence susceptibility to mycobacterial coinfection, with no consensus regarding whether prior exposure to one offers protection or predisposition to the other. The clinical implications of failure to identify active TB in a case of leprosy can not be understated, and positive IGRA or PPD testing in leprosy should not be considered falsely positive without further investigation. If treatment for paucibacillary leprosy is to be considered before ruling out active TB then minocycline may temporarily replace Rifampin.Disclosures All authors: No reported disclosures.

Clinical manifestations and outcome of tuberculous sclerokeratitis

AimTo study the clinical manifestations and outcome of patients with tuberculous sclerokeratitis treated with antituberculous therapy without concomitant use of systemic steroids.MethodsWe reviewed retrospectively the medical records of eight consecutive...

Preventive therapy for iatrogenic active tuberculosis in systemic lupus erythematosus patients

To explore the efficacy and safety of preventive therapy for iatrogenic active tuberculosis (TB) induced by glucocorticoid. During 2007-2011, a total of 203 systemic lupus erythematosus (SLE) patients with high-risk active TB, such as a history of TB infection, TB family member and strong positive purified protein derivative (PPD) skin test or hypoalbuminemia and hyperglycemia were enrolled. They were randomly divided into three groups based on whether or not anti-TB treatment was offered at the beginning of glucocorticoid treatment for SLE: simple glucocorticoid group (n = 70); glucocorticoid plus rimifon group (n = 67); glucocorticoid plus rimifon plus ethambutol group (n = 66). Anti-TB treatment was offered at least 12 months for the preventive anti-TB group. And follow-ups were conducted every 2-3 months for 2 year to observe the efficacy and side effects of anti-TB drugs. During this period, anyone with fever and/or cough consulted a physician immediately. No active TB occurred in anti-TB treatment group. And 8 patients (11.43%) had active TB in simple glucocorticoid group, including hematogenous disseminated TB (n = 1), pulmonary TB (n = 3), bone TB (n = 1), tuberculous meningitis (n = 1) and undefined focus TB infection (n = 2). And 6/8 cases had active TB within 6 months after using glucocorticoids. According to the study protocol, any case of active TB shall receive 3-4 combined anti-TB drugs for 1 year. The TB conditions of 7/8 patients were better controlled by anti-TB treatment.One patient died of tuberculous meningitis after lost follow-up. Two patients had mild temporary numbness in finger tap of both hands. And 3 patients on double anti-TB drugs showed a mild elevation of liver enzymes. For high-risk population of active TB, glucocorticoid therapy plus 1 or 2 preventive anti-TB treatment drugs may prevent its occurrence. And there is no serious adverse reaction during preventive anti-TB treatment.

Incidence of tuberculosis at a university from 2007 to 2010

The statistics of purified protein derivative (PPD) test and chest radiograph of freshmen at a university from 2007 to 2010 were collected and examined. The result showed 25 tuberculosis cases (a prevalence rate of 0.18%) and 1 790 cases (13.40%) with strong positive PPD. After giving informed consents, the students with strong positive result and no abnormality on chest radiograph were divided into two groups. The treatment group (n=814) received precautionary anti-tuberculosis treatment while the non-treatment group (n=976) had no treatment. And 34 tuberculosis cases were found during four years in school (0.25%). Except for freshmen in 2008, the prevalence rate of the strong positive PPD groups much higher than that of the positive and negative groups and the difference had statistic significance between the groups (χ2=23.20, 10.58, 18.80, P<0.05). Therefore PPD test and chest radiograph are two main methods for an early diagnosis of tuberculosis among freshmen. Adopting precautionary anti-tuberculosis treatment for students with strong positive PPD and regular physical examinations are effective measures for tuberculosis control at universities. Key words: Tuberculosis; Tuberculosis precaution

The utility of routine tuberculosis screening in county hospital patients with uveitis

Background/aimTo evaluate the utility of tuberculosis (TB) screening in diagnosing ocular TB in uveitis patients in a government-funded hospital.MethodsThe charts of 142 consecutive patients seen during August 2011–July 2012 at...