Presentation Of Tuberculosis Research Articles

Determinants of tuberculosis site among 1035 cases in Frankfurt, 2008-2023: does lineage matter?

Abstract Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a diagnostic challenge. Currently, there are no clear predictors for EPTB. We aimed to identify these factors for better diagnosis and disease control. We included tuberculosis cases reported in Frankfurt from 2008-2023, with available clinical and whole genome sequencing data. According to WHO criteria, cases with pulmonary or combined pulmonary and extrapulmonary symptoms were categorised as pulmonary tuberculosis, while exclusively extrapulmonary symptoms were categorised as extrapulmonary tuberculosis. We assessed the association between EPTB and M. tuberculosis lineage, comorbidities and demographic characteristics using logistic regression, calculating crude and adjusted odds ratios (aOR). Of the 1035 reported tuberculosis cases, 272 had exclusively extrapulmonary disease and 136 had both pulmonary and extrapulmonary disease. In the univariable analysis, lineages 1 and 3 were significantly associated with extrapulmonary disease compared to lineage 4. However, this association was not observed in the multivariable analysis. In the final regression model, females were more likely to develop EPTB than men (aOR: 1.65, CI: 1.19-2.27). The odds of developing extrapulmonary disease were higher among patients born in the South-East Asian (aOR: 6.48, CI: 3.72-11.43) and Eastern Mediterranean (aOR: 5.54, CI: 3.41-9.11) than in other regions. Among the comorbidities, diabetes was found to be negatively associated with extrapulmonary disease (aOR: 0.50, CI: 0.26-0.91). Our results indicate that host factors such as geographic origin and sex are stronger predictors for extrapulmonary presentation of tuberculosis than a specific lineage. We recommend increasing physicians’ awareness of the nonspecific presentation of EPTB and adapting screening programmes, particularly for patients from South-East Asian and Eastern Mediterranean regions to foster more effective tuberculosis control measures. Key messages • Our study highlights the importance of considering host factors in predicting extrapulmonary tuberculosis, indicating their stronger influence compared to specific M. tuberculosis lineages. • Increased physicians’ awareness of the nonspecific symptoms of EPTB and targeted screening programs for high-risk populations are crucial for enhancing tuberculosis control measures.

Red herrings and zebras and TB, oh my! Unexpected bone marrow presentation of Mycobacterium tuberculosis

Abstract Introduction/Objective Epithelioid granulomas are uncommon and non-specific findings in bone marrow samples, and should prompt additional testing for appropriate diagnosis and treatment, especially in the immunocompromised patient. The differential diagnosis for bone marrow granulomas includes infections, neoplasia, autoimmune disease, sarcoidosis, and drug/therapy reaction. Although bone marrow workup to delineate the cause of granulomas should include staining to rule out both infection and lymphoma, morphologic review is often inconclusive. Final diagnosis requires clinical consultation and additional testing. Methods/Case Report A 76-year-old male was admitted to the hospital from the emergency department for a level 2 trauma after being found on the ground ~3 hours after a fall. The patient reported a recent increasing frequency of falls with associated weakness, as well as an almost 30 lb weight loss over the last 3.5 months and low grade fevers over several weeks. His past medical history was significant for treatment for urothelial carcinoma with transurethral resection and BCG therapy, hypertension, coronary artery disease, and peripheral vascular disease. Imaging showed hepatosplenomgaly, suspicious for early cirrhosis, and mild peripancreatic lymphadenopathy. Initial laboratory abnormalities demonstrated mild anemia, low albumin, and mild increase in ALT, AST, and alkaline phosphotase. Initial Infectious Diseases workup was negative for causative etiology (blood cultures, tick-borne parasites, and respiratory pathogens). Patient symptoms did not improve and cytopenias worsened. A bone marrow biopsy showed multiple non-necrotizing epithelioid granulomas. Despite low clinical concern for infectious etiology, mycobacteria blood culture isolated Mycobacterium tuberculosis complex. Final results were available 112 days after specimen collection. Results (if a Case Study enter NA) NA Conclusion Although tuberculosis is commonly associated with granulomatous pathology, infection is very uncommon in North American patients who have not traveled and alternative diagnoses might initially be favored. A high suspicion for mycobacterial infections is essential for diagnosis even in low-incidence populations with no known exposure or risk factor(s).

Unusual Presentation of Tuberculosis in the Lungs and Lymph Nodes

Abstract Introduction/Objective Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis mainly affecting the lungs. Despite treatment advancements, TB remains a major cause of morbidity. This report presents a patient with active pulmonary and lymph node TB. Methods/Case Report The patient is a 41-year-old male from Bangladesh admitted for worsening cough and shortness of breath. Earlier, he had a cough and right cervical lymphadenopathy with lymph node biopsy demonstrating noncaseating granuloma and a positive Quantiferon-Gold. Outpatient workup included negative sputum TB PCR with negative cultures. The patient was febrile, tachycardic, and oxygenating normally. D-dimer was 1484. CT angiography was negative for emboli and showed mediastinal and right hilar lymphadenopathy. Imaging was otherwise non-indicative of active TB. We started rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy with bronchoalveolar lavage for additional sputum sampling and excisional lymph node biopsy to rule out malignancy. Workup for autoimmune disease and sarcoidosis was negative. An acid-fast bacilli stain of the biopsy was positive, indicating active TB. The patient was discharged on RIPE with outpatient follow-up. Results (if a Case Study enter NA) NA Conclusion Histological findings of TB demonstrate caseating granulomatous lesions. Sarcoidosis can be considered in patients with hilar or mediastinal lymphadenopathy with noncaseating granulomatous lesions. However, both active and inactive TB should be considered in the differential diagnosis with biopsy results indicating noncaseating granuloma, as infected tissues can lack the central necrosis to produce caseation. Common chest radiographic findings in TB include pulmonary consolidation, hilar and mediastinal lymphadenopathy, disseminated miliary disease, and a normal chest radiograph. Our patient had just hilar and mediastinal lymphadenopathy. While a common finding in tuberculosis, this is also present in other inflammatory pathologies, emphasizing the importance of keeping a broad differential even in settings where initial biopsy and imaging results may indicate latent infection or other diagnoses. We utilized the expertise of pathologists to identify lymph nodes with active TB infection in a patient who previously had inconsistent pathological and radiological findings. Without the help of the pathologists in this case, diagnosing and treating this patient would not have been possible, showing the necessity of histopathological correlation with clinical and radiologic findings.

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

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

Cutaneous tuberculosis of the pinna: A rare entity

IntroductionCutaneous tuberculosis (CTB) is a rare form of extrapulmonary tuberculosis (TB), accounting for only 1% to 2% of all extrapulmonary cases. It typically affects the face, and to a lesser extent, the neck or chest, with a higher incidence among young women. In Malaysia, TB is endemic; however, CTB involving the pinna is exceptionally rare. Consequently, there is often a delay in diagnosis and treatment due to frequent.AimThis case report aims to emphasize the presentation, diagnosis, and subsequent management of cutaneous pinna tuberculosis, supplemented by a review of the existing literature on this disease.Case studyWe present an 83-year-old patient with painful left auricular swelling and deformity and pus discharge for 4 months. His condition did not improve despite prolonged antibiotics treatment and multiple incision and drainage done.Results and discussionExamination under anaesthesia, wound exploration extended incision and drainage was performed, revealing auricular cartilage necrosis, tissue biopsy confirmed the presence of <i>Mycobacterium tuberculosis</i>.Conclusions(1) A non-healing auricular wound despite adequate antibiotics treatment should raise suspicion of TB. (2) Bactec is the most rapid and sensitive culture for tuberculosis. (3) Complications of pinna TB include pain, non-healing wound and permanent ear deformity.

The spleen as a starting point to the final diagnosis – an atypical presentation of tuberculosis during anti-tumor necrosis factor therapy

The spleen as a starting point to the final diagnosis – an atypical presentation of tuberculosis during anti-tumor necrosis factor therapy

Tubercular Mediastinal Lymphadenopathy Presenting as Hoarseness of Voice Confirmed by Endoscopic Ultrasound

Hoarseness of voice due to unilateral vocal cord palsy as the first clinical presentation of tuberculosis (TB) has been rarely reported. A 15-year-old female presented with a sole history of hoarseness of voice for the past 4 months. Axial computed tomography (CT) at the level of vocal cords revealed dilation of the left laryngeal ventricle with ipsilateral deviation of arytenoid cartilage (sail sign), suggestive of left vocal cord palsy. Thoracic CT revealed multiple necrotic mediastinal lymphadenopathy, which on endoscopic ultrasound-guided biopsy confirmed TB. She was started on regular antitubercular therapy, and her voice significantly improved after 1 month.

Bilateral tuberculous dactylitis of both hand and feet in a female toddler: a case report on a rare presentation of skeletal tuberculosis in children

BackgroundEven though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet.Case PresentationA one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery.ConclusionTubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

Peritoneal Tuberculosis Presenting as Chronic Ascites with Scrofula: A Case Report

Bacteria are one of the factors that cause skin infections. Staphylococcus aureus was the most prevalent type, and because of the frequent use of antibacterial, many of them have become resistant. From this principle, this study was conducted at the Faculty of Medical Technology, Islamic University, from January 2023 to May 2023, and the aim of the study is to investigate and detect bacteria that cause skin infections and test the antifungal synergy of with the antibacterials. the results show (Staphylococcus aureus 45%, Escherichia coli,35%, pseudomonas aeruginosa 8%, Staphylococcus epidermidis 5%, klebsiella pneumoniae %4 and proteus mirabilis 1%) and it is necessary to test new antibiotic. The combination of the antifungal itraconazole with the antibacterial amoxicillin, norfloxacin and trimethoprim was tested, and some results gave a higher effect compared to the antibacterial. It is possible to use these synergies for skin infections, and we conclude that the anti-fungal has an effect on the bacteria when it is mixed with other antibiotics.

Targeted nanopore sequencing using clinical specimens for the rapid diagnosis of extrapulmonary tuberculosis

BackgroundThe clinical presentation of extrapulmonary tuberculosis (EPTB) is atypical and it is easily confused with other diseases such as common infections, making prompt diagnosis a great challenge. This study aimed to evaluate the accuracy of targeted nanopore sequencing (TNS) in the diagnosis of EPTB. The diagnostic accuracy of TNS using different types of extrapulmonary specimens was also evaluated.MethodsWe reviewed the clinical data of patients with suspected EPTB for whom TNS was conducted and who were hospitalized at our center. The true positive, false positive, false negative, and true negative values were determined. Indices of diagnostic accuracy were computed, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for TNS and acid-fast bacilli (AFB) culture, and compared with those from clinical diagnosis.Results149 patients were included in the analysis. The overall sensitivity, specificity, PPV, NPV, and AUC of TNS for the diagnosis of EPTB were 86.4%, 87.5%, 97.3%, 55.3%, and 0.87, respectively. For diagnosis by AFB culture, these values were 25.6%, 100.0%, 100.0%, 20.5%, and 0.63, respectively. The most common specimens used were lymph node tissue, cerebrospinal fluid, pleural effusion, and pleural tissue. The diagnostic accuracy of TNS using all types of extrapulmonary specimens was good.ConclusionsTNS demonstrates good diagnostic accuracy in the rapid diagnosis of EPTB and this was true across different types of extrapulmonary specimens.

Thyroid tuberculosis mimicking multinodular goiter: a case report

BackgroundMycobacterium tuberculosis is the second most common infectious cause of death in adults worldwide. The ability of this organism to efficiently establish latent infection has enabled it to spread to nearly one-third of individuals worldwide. Approximately 8 million new cases of active tuberculosis disease occur each year, leading to about 1.7 million deaths. The disease incidence is magnified by the concurrent epidemic of human immunodeficiency virus infection. A total of 1.3 million people died from tuberculosis in 2022. In 2022, an estimated 10.6 million people fell ill with tuberculosis worldwide, including 5.8 million men, 3.5 million women, and 1.3 million children. We report a case of thyroid tuberculosis presenting as multinodular goiter. Neck ultrasound was done and revealed abscess collection on the background of multinodular colloid goiter. The diagnosis of thyroid tuberculosis was confirmed by a positive GeneXpert of the pus sample and the presence of extensive caseous necrosis on cytopathology examination. Furthermore, anterior neck swelling may provide a diagnostic challenge by clinically mimicking multinodular goiter or thyroid neoplasms. Owing to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report it.Case presentationA 60-year-old retired female Ethiopian high-school teacher presented to University of Gondar Hospital, Gondar, Ethiopia with firm, nontender multinodular anterior neck swelling measuring at largest 2 × 3 cm that moves with swallowing. GeneXpert of the pus sample and cytopathology examination confirmed the diagnosis of thyroid tuberculosis, and the patient was started on 2 rifampicin−ethambutol−isoniazid−pyrazinamide/4 rifampicin−isoniazid 3 tablets by mouth/day, which is defined as the preferred first-line anti-tuberculosis regimen in Ethiopia, and pyridoxine 50 mg by mouth per day for 6 months. Since then, she has been followed with regular liver function tests. The patient has shown a smooth course with no significant adverse effects encountered. Currently, the patient has completed her anti-tuberculosis treatment and is doing well.ConclusionIn the clinical evaluation of a patient with anterior neck swelling, tuberculosis must be considered as a differential diagnosis in subjects from endemic areas for early diagnostic workup and management.

Granulomatosis with polyangiitis masquerading as disseminated tuberculosis in presence of bilateral lung cavities and hemorrhagic infarct

Lung cavitations with constitutional symptoms are usually associated with pulmonary tuberculosis due to its high prevalence and are the most common infectious cause in India. Granulomatosis with polyangiitis (GPA) with the systemic pulmonary disease will have different radiological presentations such as nodule, mass, and consolidation with or without cavitation. In this case report, we have reported a 40-year-old female presented with cough, fever, and weight loss of 6 months duration with chest imaging suggestive of bilateral cavitary lung disease. She was labeled as a case of disseminated tuberculosis due to involvement of the central nervous system and empirically treated with anti-tuberculosis treatment (ATT) without microbiological evidence of tuberculosis in smear and cartridge-based nucleic acid amplification tests. The absence of clinical response and radiological worsening to empirical ATT gives a clue for an alternate diagnosis. Bronchoscopy workup documented Aspergillus colonization and vasculitis workup in the presence of cavitary lung disease documented abnormally raised proteinase 3 anti-neutrophil cytoplasmic antibodies titers. She was treated with a combination of systemic methylprednisolone and azathioprine with voriconazole. Her clinical response was observed in 4 weeks and radiological response with complete radiological clearance of pulmonary cavitations was documented after 6 months of treatment. We recommend prompt workup and ruling out GPA in all cases with pulmonary cavitations with negative microbiological workup and no empirical ATT should be given in the era of rapid microbiological tests with good sensitivity and specificity.

Spinal Adhesive Arachnoiditis Following Surgical Treatment for an Intramedullary Tuberculoma of the Conus Medullaris: A Case Report from Western Mexico

Objectives: Describe a rare case of intramedullary tuberculoma (IMT) complicated by chronic adhesive arachnoiditis (CAA). Presentation of Case: A 19-year-old woman presented with complaints of weight loss, progressive weakness of both lower limbs, and urinary retention. Neurological examination corroborated the motor dysfunction of the lower limbs, associated with sensory disturbances. Magnetic resonance imaging (MRI) detected a ring-enhancing intramedullary mass that expanded the conus medullaris. A provisional diagnosis of neoplastic origin lesion was made and the patient received complete resection of the mass. Histopathology was consistent with tuberculoma. 8 months after beginning postoperative antituberculous therapy, neurological symptoms worsened and follow-up MRI showed a distorted spinal cord with arachnoid cysts and septations, findings that corresponded to CAA. Despite a new surgical intervention, the patient remained with lasting disability. Discussion: IMT is an uncommon presentation of spine tuberculosis. The clinical manifestations mimic those of any space-occupying lesion (SOL), and are dependent on the location in the spine, thus a differential diagnosis with neoplastic, inflammatory, and other granulomatous lesions is required. Being IMT an encapsulated lesion, it is unexpected that the inflammatory response extends to pia-arachnoid layers conducting to complications, such as CAA. The association between IMT and CAA must be recognized, since it undermines the outcomes of therapeutical interventions. Conclusion: The diagnosis of IMT complicated by CAA is challenging due to its low frequency. Therefore, this report emphasizes the importance of recognizing the clinical and radiological features of this association to allow an early diagnosis, and facilitate the selection of therapeutic interventions.

An Interesting Case of Pulmonary Tuberculosis with Hypoxemic Respiratory Failure Mimicking Interstitial Lung Disease

Hypoxemic respiratory failure is a rare presentation of active pulmonary tuberculosis (TB). Though tuberculous acuterespiratory distress syndrome (ARDS) is well documented in medical literature, non-ARDS respiratory failure is seldomreported in active pulmonary TB. We herein report a case, which posed a diagnostic dilemma as it clinically mimickedinterstitial lung disease. Imaging showed unilateral localized smooth interlobular septal thickening along with consolidationwithout significant mediastinal lymphadenopathy. To the best of our knowledge, this rare radiological finding has not beenreported in medical literature as being associated with hypoxemic respiratory failure in pulmonary TB patients.

Tuberculosis presenting as a gastric subepithelial tumor: truly a great masquerade

Tuberculosis presenting as a gastric subepithelial tumor: truly a great masquerade

Area Postrema Syndrome as the Initial Presentation of CNS Tuberculosis.

Area Postrema Syndrome as the Initial Presentation of CNS Tuberculosis.

Unusual Case of Pulmonary Tuberculosis Presenting as Imaging Counterfeit of Lung Cancer - A Case Report

Introduction: Tuberculosis (TB) is a global health problem with alarming rate of morbidity and mortality. With its multitude presentation, it is considered a diagnostic chameleon as it may resemble several clinical conditions including malignancy, given similarities between the two conditions in terms of clinical and imaging features. Case Report: Here we present an illustrating case of an 83-year-old nonsmoker male who presented with intractable cough of two months duration. The blood parameters and sputum reports were not contributory to a specific diagnosis. His computed tomography (CT) imaging findings suggested a heterogeneously enhancing mass in right lower lobe and favored a diagnosis of lung cancer. So, for confirmation he underwent a transcutaneous CT guided lung biopsy for the mass but interestingly on histopathological evaluation, it turned out to be tuberculosis. Discussion: Tuberculosis is a communicable and preventable disease. Pulmonary TB (PTB) can mask or imitate lung cancer imaging features. A battery of tests is available to differentiate between the two, however, microbiological and histopathological results are the gold standard. An accurate diagnosis is must to initiate appropriate treatment and to avoid toxic chemotherapy and unnecessary surgery. Conclusion: Pulmonary tuberculosis (PTB) can have an atypical radiological presentation where it counterfeits lung cancer imaging. The case highlights that a diagnosis of PTB should always be considered in a TB endemic country like India. Keywords: Pulmonary tuberculosis, Lung cancer, Contrast enhanced computed tomography

TUBERCULOSIS OF THE WRIST

INTRODUCTIONTuberculosis (TB) is a public health challenge. However, musculoskeletal involvement represents 10–15% of all extrapulmonary cases. Upper extremity involvement is extremely rare. The slow progressive course of clinical symptoms and lack of radiological signs lead to difficulties in establishing early diagnosis. Hence, the patients who have tuberculosis of the wrist are usually misdiagnosed. We report 5 cases of tuberculosis of the wrist seen in our unit from the year 2012 to 2021.METHODSCases were retrospectively evaluated on demographics, nature of history, clinical presentation, culture finding, and histopathological findings from 2012 to 2021 at our unit.RESULTSA total of 5 cases were evaluated retrospectively. Three patients were more than 60 years old and two were less than 30 years old. Four of the patients presented with wrist swelling 2 of them had wrist pain and only 1 patient had discharge from the wound. The duration of the symptoms ranges from 2 months to 3 years. Only one of the patients had a history of pulmonary TB contact whereas the others didn't. All patients underwent surgery. All of the patients had positive cultures for Mycobacterium tuberculosis complex and histopathological examination showed necrotizing granulomatous inflammation from specimens taken intraoperatively, which confirmed the diagnosis of tuberculosis of the wrist.DISCUSSIONSOur cases show that the common presentation of tuberculosis of the wrist was comparable to other literature. Most of the patients presented with chronic wrist swelling with or without wrist pain. The diagnosis of the disease was delayed an average of 10 - 12 months from symptoms onset to diagnosis. S. Bayram et al reported a case where the diagnosis was made 45 months later. Due to its rarity, it often is misdiagnosed, resulting in delays in the proper treatment.CONCLUSIONThe diagnosis of the TB wrist remains difficult because of insidious and non-specific. presentation. However, early diagnosis is essential to avoid delays in treatment and complications. Hence, chronic wrist pain, and swelling with or without unexplained bone erosion around the wrist area must be highly suspected of being osteoarticular tuberculosis.

Conservative management of complicated retropharyngeal abscess with Antitubercular Therapy

Retropharyngeal abscess, the infection of deep neck spaces, extends from the base of the skull to the posterior mediastinum. It develops as a sequela of dental infection, upper respiratory tract infection, or any interventional procedure like laryngoscopy, endotracheal intubation, etc. Retropharyngeal abscess is a rare presentation of Tuberculosis (TB), with an annual incidence rate of 2.64 per 100,000 population, and gender-based incidence rates of 3.34 for males, and 1.94 for females per 100,000 population.1 It, as a part of head and neck TB, has a prevalence of 0.1-1% among all forms of TB. If not managed timely, it may lead to the spread of its infection to the mediastinum, which can be life-threatening at times, owing to airway compromission and other catastrophic complications like mediastinitis, mediastinal abscess, pericarditis, pyopneumothorax pleuritis and empyema. We hereby present a case of a middle-aged woman diagnosed with a complicated retropharyngeal abscess but managed conservatively with Antitubercular Therapy (ATT).

An Unusual Presentation of Pediatric Tuberculosis

An Unusual Presentation of Pediatric Tuberculosis