Primary Tuberculosis Infection Research Articles

Factors of postembryonic ontogeny: relationship with the effectiveness of tuberculosis chemoprophylaxis in children

Background. A child’s body as a functional system is formed starting from the fetal period. Therefore, analysis of even distant in time situations allows to identify factors that affect the functioning of the child’s body in the present time and, possibly, the effectiveness of chemoprophylaxis in children. Materials and methods. To study the presence of a correlation between factors of postembryonic ontogeny and the effectiveness of chemoprophylaxis of tuberculosis in children, an analysis was carried out of 300 patients aged 0 to 17 years in the early period of primary tuberculosis infection, who underwent a 3-month course of chemoprophylaxis with isoniazid. The dynamics of shin sensitivity according to the Mantoux test with 2 tuberculin units was used as a criterion for the effectiveness of chemoprophylaxis. Depending on the latter, the exa­minees were divided into two groups: a group with effective chemoprophylaxis (n = 200), in which the size of a wheal after the end of the course decreased by 4 mm or more, and a group with ineffective chemoprophylaxis, in which skin sensitivity to tuberculin increased or remained at the previous level or decreased in the size of a wheal by 3 mm or less. Results. The analysis showed that in the group with ineffective chemoprophylaxis compared to the alternative group, the following occurred significantly more often: short-term (up to 4 months) breast feeding, a history of acute bronchitis (p < 0.001) in a child, acute obstructive bronchitis. In addition, the following were characteristic of this group: the presence of tuberculosis contact (p < 0.001), tuberculosis contact with a patient with confirmed bacterial excretion (p < 0.001), age of child under 6 years (p < 0.001), the number (two and more) of concomitant pathologies (p < 0.001), a single BCG vaccination (p < 0.001), as well as the winter seasona­lity of chemoprophylaxis (p < 0.05). Conclusions. Significant correlations have been found between many factors of postembryonic ontogeny and the effectiveness of tuberculosis chemoprophylaxis in children, which allows them to be used for prognostic purposes. The closest connections with the effectiveness of chemoprophylaxis of tuberculosis in children was revealed for the presence of tuberculosis contact (ϕ = 1.08; p < 0.001), especially with a patient with confirmed bacterial excretion (ϕ = 1.72; p < 0.001), as well as the number of concomitant pathologies in a child (ϕ = 0.70; p < 0.001) and manifestations of allergy (ϕ = 0.67; p < 0.001).

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

Liver tuberculosis in children

Objective. The primary tuberculosis infection in childhood is manifested as a common disease. The diagnostics of liver tuberculosis is still a little-studied problem due to the absence of clinical manifestations.Purpose. To study clinical course, diagnostics and management of liver tuberculosis in children.Material and methods. 5 children, aged from 5 days to 16 years, with liver tuberculosis were under the observation. To put diagnosis, the researchers used the following parameters: anamnesis, examination, laboratory and specific tests, ultrasound, radiological methods including CT, biopsy of the surgical material.Results and discussion. Out of 5 children with liver tuberculosis, 3 had disseminated miliary pulmonary tuberculosis with liver damage; one had liver tuberculosis of the tuberculoma type and one had tumor-like liver tuberculosis. These three observations are described the article. In the diagnostics, basic indexes are CT of the abdominal organs, histological examination of the surgical material and positive Diaskin test.Conclusion. An isolated tuberculous liver damage is a rare case. More often, several anatomical regions are simultaneously involved in the specific process.

Adnexal torsion caused by tuberculous pyosalpinx: An uncommon case report of urogenital tuberculosis.

BackgroundAccording to the World Health Organization, TB is a global public health problem and it remains in 2020 the deadliest infectious disease in the world, ahead of Covid19 (Global Tuberculosis Report 2020, 2020). Morocco is an endemic area with more than 30,000 new cases of all forms of tuberculosis each year (Plan stratégique national 2018-2021 de lutte antituberculeuse, 2018). UGTB is the second most frequent localization after lymph node involvement and is responsible for 30 to 40% of all extrapulmonary cases.Case presentationWe hereby present the uncommon case of a 27-year-old virgin woman with unremarkable medical and surgical histories, who presented at the emergency department for left-sided pelvic pain of acute installation. An exploratory laparotomy using a Pfannenstiel incision, demonstrated a peritoneal effusion of low abundance with a twisted left ovary and a huge pyosalpinx. Detorsion was then carefully performed, with improvement in color of the ovary and decrease in edema within 10 min. Histopathological study of the Fallopian tube biopsy revealed granulomatous abscessificated salpingitis with genital tuberculosis. Thus, the patient received her anti-tuberculosis treatment with a course of 6 months of 2HRZE/4HR.ConclusionsIn view of the resurgence of cases of tuberculosis of all forms, the importance of prevention and screening should not be underestimated, especially in endemic areas. In fact, only BCG at birth and the correct treatment of any primary tuberculosis infection, whatever its location, will make it possible to reduce the consequences of this affection and avoid the tragedy of the home without children.

Tuberculosis: Poor Awareness Leads to Poor Control

Tuberculosis: Poor Awareness Leads to Poor Control

Microbiote et tuberculose

AbstractThe description of microbial communities in the healthy respiratory tract has recently paved the way for the study of the microbiota in tuberculosis, one of the top ten causes of death worldwide. The various microbial communities present in our body produce metabolites that modulate host immune responses. The microbiota has important functions on human health that are not confined to the intestinal sphere. The discovery of the gut-lung axis also offers new perspectives for the study of tuberculosis infection. Initial data show that susceptibility to primary tuberculosis infection and progression to tuberculosis active disease are related to lung and gut microbiota. Conversely, lung infection with Mycobacterium tuberculosis modifies the two microbiota, as does tuberculosis antibiotic treatment, which induces intestinal and pulmonary dysbiosis. Anaerobes could be interesting biomarkers predicting the progression of the infection as they produce metabolites that modulate pulmonary immunity. Finally, these data offer new perspectives in terms of therapeutic intervention with beneficial bacteria that stimulate the immune response to infection.

Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors.

Extra-pulmonary tuberculosis (EPTB) is recognized mainly as a secondary manifestation of a primary tuberculosis (TB) infection in the lungs contributing to a high incidence of morbidity and mortality. The TB bacilli upon reactivation maneuver from the primary site disseminating to other organs. Diagnosis and treatment of EPTB remains challenging due to the abstruse positioning of the infected organs and the associated invasiveness of sample acquisition as well as misdiagnosis, associated comorbidities, and the inadequacy of biomarkers. Female genital tuberculosis (FGTB) represents the most perilous form of EPTB leading to poor uterine receptivity (UR), recurrent implantation failure and infertility in females. Although the number of TB cases is reducing, FGTB cases are not getting enough attention because of a lack of clinical awareness, nonspecific symptoms, and inappropriate diagnostic measures. This review provides an overview for EPTB, particularly FGTB diagnostics and treatment challenges. We emphasize the need for new therapeutics and highlight the need for the exaction of biomarkers as a point of care diagnostic. Nuclear receptors have reported role in maintaining UR, immune modulation, and TB modulation; therefore, we postulate their role as a therapeutic drug target and biomarker that should be explored in FGTB.

In Vivo Biodistribution of Respirable Solid Lipid Nanoparticles Surface-Decorated with a Mannose-Based Surfactant: A Promising Tool for Pulmonary Tuberculosis Treatment?

The active targeting to alveolar macrophages (AM) is an attractive strategy to improve the therapeutic efficacy of ‘old’ drugs currently used in clinical practice for the treatment of pulmonary tuberculosis. Previous studies highlighted the ability of respirable solid lipid nanoparticle assemblies (SLNas), loaded with rifampicin (RIF) and functionalized with a novel synthesized mannose-based surfactant (MS), both alone and in a blend with sodium taurocholate, to efficiently target the AM via mannose receptor-mediated mechanism. Here, we present the in vivo biodistribution of these mannosylated SLNas, in comparison with the behavior of both non-functionalized SLNas and bare RIF. SLNas biodistribution was assessed, after intratracheal instillation in mice, by whole-body real-time fluorescence imaging in living animals and RIF quantification in excised organs and plasma. Additionally, SLNas cell uptake was determined by using fluorescence microscopy on AM from bronchoalveolar lavage fluid and alveolar epithelium from lung dissections. Finally, histopathological evaluation was performed on lungs 24 h after administration. SLNas functionalized with MS alone generated the highest retention in lungs associated with a poor spreading in extra-pulmonary regions. This effect could be probably due to a greater AM phagocytosis with respect to SLNas devoid of mannose on their surface. The results obtained pointed out the unique ability of the nanoparticle surface decoration to provide a potential more efficient treatment restricted to the lungs where the primary tuberculosis infection is located.

Analysis of the development of tuberculosis as an epidemic process in the student environment of the Оrenburg region

The analysis of epidemic situation on tuberculosis, features of detection of disease, and also clinical and epidemiological characteristics for the first time revealed specific process in separate social group of students of the special and higher educational organizations of the Orenburg region for 2000–2018 was carried out. ­Me­thods. The indicators of incidence of tuberculosis of respiratory organs and extra-thoracic localization, indicators of morbidity with established bacterial excretion, indicators of morbidity in the presence of pulmonary tissue decay, indicators of the ratio of patients from secondary or higher educational institutions were calculated. The number of students in the region has undergone signi­ficant changes in recent decades. Since 2000, there has been a tendency for its growth with a maximum value in 2009. Subsequently, there was an annual decrease in the number of students, mainly at the expense of higher education institutions. Were identified different periods in endemic tuberculosis region's population, and the dynamics of tuberculosis morbidity students were subject to fluctuations, but generally consistent with such, the total population of the region. It was revealed that focal and infiltrative pulmonary tuberculosis remained the dominant clinical forms for nineteen years. The absence in the clinical structure of respiratory tuberculosis in students of classical forms of primary tuberculosis (tuberculosis of the intrathoracic lymph nodes, primary tuberculosis complex) confirms the completed early period of primary tuberculosis infection, that is, the previous infection of students with Mycobacterium tuberculosis. The obtained results indicate the endogenous reactivation of tuberculosis infection as a priority pathogenesis of the disease in this population group. Among the students of the region in recent years, there has been a tendency to reduce the incidence of tuberculosis. The structure of morbidity is dominated by small uncomplicated forms of tuberculosis of the respiratory system, identified during preventive examinations. Conclusion. In General, over the past de­cades in the Orenburg region there is a tense epidemic situation in the incidence of tuberculosis of students with a characteristic tendency to improve it.

IFN-\u03b3-independent immune markers of Mycobacterium tuberculosis exposure

Exposure to Mycobacterium tuberculosis (Mtb) results in heterogeneous clinical outcomes including primary progressive tuberculosis and latent Mtb infection (LTBI). Mtb infection is identified using the tuberculin skin test and interferon-γ (IFN-γ) release assay IGRA, and a positive result may prompt chemoprophylaxis to prevent progression to tuberculosis. In the present study, we report on a cohort of Ugandan individuals who were household contacts of patients with TB. These individuals were highly exposed to Mtb but tested negative by IFN-γ release assay and tuberculin skin test, ‘resisting’ development of classic LTBI. We show that ‘resisters’ possess IgM, class-switched IgG antibody responses and non-IFN-γ T cell responses to the Mtb-specific proteins ESAT6 and CFP10, immunologic evidence of exposure to Mtb. Compared to subjects with classic LTBI, ‘resisters’ display enhanced antibody avidity and distinct Mtb-specific IgG Fc profiles. These data reveal a distinctive adaptive immune profile among Mtb-exposed subjects, supporting an expanded definition of the host response to Mtb exposure, with implications for public health and the design of clinical trials.

Centre-based Evaluation of Some Biochemical Effects of the Initial Phase of Anti-tuberculosis Therapy in Bayelsa State

Aim of the Study: This study aimed at evaluating the adverse drug effects on some biochemical parameters of anti-tuberculosis drugs among patients with primary tuberculosis infection.
 Study Design: Non-probability (purposive) sampling technique was employed in this study. 
 Place and Duration of Study: This study was carried out at the Chest Clinic unit of the Tuberculosis and Leprosy referral Hospital, Yenagoa, Bayelsa State, Nigeria. This study was conducted from July, 2017 to April, 2018.
 Methodology: Tuberculosis patients were selected using standard methods for clinical diagnosis and confirmed by laboratory analysis for Mycobacterium tuberculosis using acid fast bacilli as preliminary and Gene-Xpert® as confirmatory test. A total of 44 tuberculosis patients met the study inclusion and exclusion criteria and completed the study at the Tuberculosis and Leprosy Referral Hospital Yenegoa, Bayelsa State. Eligible patients were administered with appropriate daily dose of (rifampicin-150 mg, isoniazid-75 mg, pyrazinamide-400mg and ethambutol-275 mg) single drug combination for two months based on bodyweight. Blood was collected and evaluated for liver enzymes, Alkaline phosphatase (ALP), Alanine transaminase (ALT), Aspartate aminotransferase (AST); Total proteins, Bilirubin and Cholesterol at baseline, week 4 and week 8. Data were descriptively analyzed using statistical package for social sciences (SPSS 21).
 Results: Treatment in the intensive therapy phase resulted in significant increase of alanine aminotransferase and alkaline phosphatase levels (P=0.5). There was also significant decrease in total cholesterol and albumin (P=0.5). There were no significant changes in aspartate aminotransferase, total protein and total bilirubin.
 Conclusion: The study results showed changes in some biochemical parameters but were not severe enough to warrant discontinuation of therapy.

797. Tuberculosis Treatment: Combined Forms vs. Dissociated Forms

BackgroundTuberculosis treatment is based on the regular and concomitant intake of several antibiotics. The goal of this multidrug therapy is to prevent the selection of mutants resistant. This combination drug comes in two regimens with dissociated forms (DF) and combined forms (CF). Our study aimed to compare both forms of anti-tubercular treatment.MethodsWe retrospectively collected data from the regional registry of tuberculosis in the government of Sfax as a part of the National Tuberculosis Program. We included all new cases of tuberculosis from January 1995 to December 2016.ResultsWe counted 2,771 cases of tuberculosis. There were 59.5% cases with extra-pulmonary (n = 1,650) forms and 40.5% with pulmonary forms (n = 1,121). The median age was 38 years (IQR = [25–55 years]) with a male predominance (n = 1,508; 54.4%). We noted that 72.9% of patients (n = 1,985) received the DF, 26.2% (n = 714) received the CF and 0.8% (n = 23) received both forms of treatment. DF was significantly more prescribed in patients with extra-pulmonary tuberculosis (75.4% vs. 72%; OR = 0.837; P = 0.043) whereas CF was significantly prescribed in patients with pulmonary tuberculosis (28% vs. 24.6%; OR = 0.837; P = 0.043). DF was more used in patients with primary tuberculosis infection (30.3% vs. 21.6%; OR = 0.632; P < 0.001). The duration of treatment was significantly higher in patients who received DF (9 months vs. 8 months; P < 0.001). We did not find a difference in the evolution between patients treated with DF and those treated with CF.ConclusionCF are of a great importance to ensure better compliance and synergistic effects of different antibiotics with a reduced duration.Disclosures All authors: No reported disclosures.

Heterologous Boost Following Mycobacterium bovis BCG Reduces the Late Persistent, Rather Than the Early Stage of Intranasal Tuberculosis Challenge Infection

Adults are the leading population affected by tuberculosis (TB) epidemic and death. Developing an effective vaccine against adult TB is urgently needed. Mycobacterium bovis Bacillus Calmette-Guerin (BCG) prime-heterologous boost strategy has been explored extensively to protect adults against primary TB infection, but the majority of experimental regimens have not improved the protection primed by the BCG vaccine. The reason attributed to the failure remains unknown. In this study, CTT3H-based vaccines, namely DMT adjuvanted CTT3H subunit or DNA vaccine (pCTT3H-DMT), and recombinant adenovirus rAdCTT3H were constructed. Protective efficacy and immunogenicity of BCG prime-CTT3H based boosters were compared in C57BL/c mice models of primary or late persistent TB infection. Similar protective efficacy against early intranasal infection was provided by different CTT3H-based vaccines alone in vaccinated mice, and their protection was inferior to that of the BCG vaccine. In addition, CTT3H-based heterologous boosters did not enhance the protection conferred by the BCG vaccine against primary infection. However, all of these three boosters provided stronger protection against late persistent TB infection than BCG alone, regardless of vaccine types. Although BCG prime-boosters elicited Th1-biased responses to the antigen CTT3H, the number of CTT3H-sepcific IFN-γ-expressing TEM (CD62LloCD44hi) and IL-2-expressing TCM (CD62LhiCD44hi) cells in the spleen was not improved before exposure to Mycobacterium tuberculosis infection. In contrast, IFN-γ+ TEM and IL-2+ TCM cells in spleens, especially in lungs were significantly increased in BCG prime-boosters after exposure vaccination. Our results indicate that BCG prime-boost strategy might be a promising measure for the prevention against late persistent TB infection by induction of IFN-γ+ TEM and IL-2+ TCM cells in the lung, which can be used as alternative biomarkers for guiding the clinical practice and future development of TB vaccine for adults.

A RARE CASE OF ANTERIOR SEGMENT TB IN AN ELDERLY PATIENT WITH ENDOBRONCHIAL TB

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Anterior Segment Tuberculosis (ASTB) is an uncommon manifestation of pulmonary tuberculosis (TB). The incidence of localized anterior segment involvement is approximately 2.8%, occurring mostly in children, often associated with primary pulmonary TB. The incidence of ASTB in reactivation TB is low. We describe a case of an elderly patient with reactivation pulmonary TB infection, presenting with endobronchial tuberculosis (EBTB) with right anterior segment involvement. CASE PRESENTATION: A 95-year-old Caucasian female was evaluated for 1-2 weeks of non-productive cough and new intermittent wheezing. Her symptoms improved with bronchodilators. Past medical history is unremarkable. She lived all her life in Omaha, Nebraska prior to moving to New York State 5 years prior to admission. She is a never smoker, previously worked as a secretary, and her only international travel was to Mexico in the 1960s. Review of systems was negative for hemoptysis, weight loss, fever, chills or chest pain. Physical exam revealed a nourished woman who was not ill appearing with focal crackles in the right anterior parasternal chest. Laboratory exam showed hemoglobin 11.0 g/dL and serum sodium 139 mEq/L. Chest X-ray revealed a right upper lobe opacity, mostly perihilar [Figure 1]. CT chest showed a mass encasing the right upper lobe bronchus leading to anteromedial right upper lobe atelectasis, with multiple right subpleural nodules and right hilar lymphadenopathy [Figure 2]. Bronchoscopy was performed, with bronchial alveolar lavage (BAL) PCR positive for Mycobacterium tuberculosis and Mycobacterium avium complex. Patient was diagnosed with EBTB causing ASTB. She was started on Isoniazid, Pyrazinamide, Ethambutol and Rifampin. Prednisone was used as adjunctive therapy for endobronchial involvement; and after two weeks of therapy her chest x-ray had normalized and she had no local rales or wheezing. DISCUSSION: Both ASTB and EBTB are rare in adults. Cases of ASTB occur more often with primary TB infection in children. Infrequently, reactivation of TB may present as anterior segment disease. Uniquely, our 95-year-old patient also had endobronchial involvement. The prevalence of EBTB is 10-40% in patients with active pulmonary tuberculosis, and 90% of these patients will develop some degree of bronchial stenosis. The pathogenesis of EBTB is unclear, and diagnosis is frequently delayed until bronchial stenosis, atelectasis, and bronchiectasis are present. The most common bronchoscopic finding in EBTB is inflamed mucosa. The use of steroids to minimize bronchial stenosis remains controversial. CONCLUSIONS: Anterior Segment Tuberculosis and Endobronchial Tuberculosis are uncommon presentations of a common disease. Diagnosis is challenging due to rarity in the elderly population, nonspecific clinical presentation, and atypical radiographic findings. Reference #1: Kashyap, Surender et. Al. Endobronchial Tuberculosis. Indian J Chest Dis Allied Sci 2003; 45: 247-256. Reference #2: Rikimaru, Toru. Therapeutic Management of Endobronchial Tuberculosis. Expert Opinion on Pharmacotherapy. Vol. 5, ISS. 7, 2004. Reference #3: Spencer, David et. al. Anterior Segment Upper Lobe Tuberculosis in the Adult: Occurrence in Primary and Reactivation Disease. Chest. Vol 97, ISS.2, 1990. DISCLOSURES: No relevant relationships by richard blinkhorn, source=Web Response No relevant relationships by Hau Chieng, source=Web Response No relevant relationships by Shannon Murawski, source=Web Response No relevant relationships by Biplab Kumar Saha, source=Web Response

Heterologous Boost Vaccination Improves BCG Priming Protection Against Latent Tuberculosis Infection Rather than Primary Infection

Adults are the leading population affected by tuberculosis (TB) epidemic and death. Developing an effective vaccine against adult TB is urgently needed. BCG prime-heterologous boost strategy has been explored extensively to protect adults against primary TB infection, but the majority of experimental regimens have not improved the protection primed by the BCG vaccine with unknown reason. In this study, CTT3H-based vaccines, namely recombinant adenovirus rAdCTT3H, DMT adjuvanted subunit or DNA vaccine were constructed. Protective efficacy and immunogenicity of BCG prime-CTT3H based boosters were compared in C57BL/c mice models of primary TB and latent TB infection. Heterologous boosters did not enhance the protection primed by the BCG vaccine against primary infection, but they conferred stronger protection against latent TB infection than BCG alone, regardless of vaccine types. BCG prime-boosters elicited Th1-biased responses and increased the number of CTT3H-sepcific IFN-γ T cells and IFN-γ TEM cells in the spleen before exposure to M. tuberculosis infection, while IFN-γ and IL-2 T cells and memory T cells, including IL-2-expressing TCM cells and IFN-γ-expressing TEM cells, in the spleen and lung were significantly increased post-exposure vaccination. Therefore, BCG prime-boost strategy might be a promising measure to protect adult against latent TB infection. Funding Statement: This work was supported by grants of the National Megaproject of Science Research for both the 13th Five-year Plan of China (No. 2018ZX10302302002-001) and the 12th Five-year Plan of China (No. 2012ZX10003008-005), and the National Natural Science Foundation of China (No.81772147). The funders had no role in study design, data collection, data analysis,interpretation, and writing of the report. Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: The study protocol involving animal experiments were performed in accordance with the guidelines of the Chinese Council on Animal Care. The Committee on the Ethics of Animal Experiments and the School Committee on Biosaftey of Tongji Medical College (Wuhan, China) approved the research protocols.

Estimating the prevalence of Positive Tuberculin Skin Test Reactions in General Population and High-risk Groups: A Meta-analysis.

Results of tuberculin skin test (TST) surveys among different populations have been reported in many studies as a method for detecting primary Mycobacterium tuberculosis infection. Combining these results provides reliable estimates of primary latent tuberculosis (TB) infection for health policymakers. This study aims to estimate the prevalence of latent TB infection in general and high-risk populations in Iran. National and international databanks were searched using specific keywords. After restricting the search strategy, duplicates exclusion, reviewing titles, abstracts and full texts, and quality assessment, eligible papers were selected. The heterogeneity between the results was assessed according to Cochrane and I-squared indices. The prevalence of positive TST reactions was estimated using fixed and random effect models. Totally, 33 papers were entered into the meta-analysis reporting the TST results in 12693 people aged over 18. The prevalence (95% confidence intervals) of positive TST reactions in all groups, general population, health staff, medical students, household close contacts, patients with TB, immunocompromised patients, HIV/AIDS patients, and those with risky behaviors was 26.2% (19.6–32.8), 25.4% (4.8–46.1), 38.9% (27.4–50.9), 13.4% (9.9–16.7), 35.9% (16.4–55.5), 13.7% (8.4–18.9), 29.4% (21.2–37.7), and 14.6% (3.9–25.3), respectively. Our study showed great varieties of positive TST results among different Iranian subpopulations. Furthermore, the prevalence of latent TB infection among health professionals and family members of TB patients was considerably different from that of the other subgroup. Since TB control programs such as active case finding are routinely conducted among household close contacts and HIV/AIDS cases, other high-risk groups including health-care workers and immunocompromised patients should be taken into consideration in these preventive programs.

A rare complication of tuberculosis: Acute paraplegia

Tuberculous radiculomyelitis(TBRM) is one of the complications of neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of tuberculous meningitis (TBM). Here, we report a case of TBRM which presented with acute paraplegia. Neurological examination on admission revealed flaccid paralysis, bilateral extensor plantar responses, and exaggerated deep tendon reflexes. Cerebrospinal fluid analysis showed xanthochromic fluid that contained 600 cells/mm3, 98% lymphocytes, protein 318 mg/dl and glucose 51 mg/dl (blood glucose 118 mg/dl). On thorax CT, calcified lymph nodes that were sequelae of primary tuberculosis infection was detected. Antituberculosis and intravenous corticosteroids treatment was started. Seven weeks from the onset, on-control spinal MRI myelomalacia was determined, and there was no leptomeningeal enhancement. After six weeks of rehabilitation, lower limb total motor score was increased from 0/50 to 15/50. Tuberculous radiculomyelitis is a complication of TBM. It is rarely seen.

A Model for Tuberculosis with Endogenous Reactivation and Exogenous ReinfectionA Model for Tuberculosis with Endogenous Reactivation and Exogenous Reinfection

Endogenous infection and exogenous reinfection are two mechanisms responsible for the reactivation or regeneration of active tuberculosis (TB) in individuals who have experienced prior active TB infections. Following primary TB infection, only approximately 10% of individuals develop active TB. Most people are assumed to mount an effective immune response to the initial infection that limits proliferation of the bacilli and leads to long lasting partial immunity both to further infection and to reactivation of latent bacilli remaining from the original infection. Infected individuals may develop active TB as a consequence of exogenous reinfection, i. e., acquiring a new infection from another infectious individual.In this paper, we propose a new model of tuberculosis with endogenousreactivation and exogenous reinfection. The analysis reveals that the modelundergoes a backward bifurcation, where a stable disease-free equilibrium(DFE) co-exists with a stable endemic equilibrium when the associated reproduction threshold R is less than unity. This phenomenon resulted due to the exogenous reinfection property of TB disease. It is shown that, in the absence of such reinfection, the model has a globally-asymptotically stable DFE when R is less than unity. Numerical results are provided toillustrate theoretical results.

Primary tuberculosis in a nomadic Fulani population and their cattle herds in Kano, Nigeria: a one health approach

Background: Nigeria has a large population of Fulani pastoralists. Zoonotic infections like bovine tuberculosis (TB) are common among nomadic Fulani and their livestock. Close interaction between the nomads and their animals provide a critical human–animal interface with potential for transmission of zoonoses. We conducted a survey to determine the prevalence of primary TB infection among nomads and their cattle in Kano, north-western Nigeria. Materials and Methods: We performed tuberculin skin test (TST) to all inhabitants of the nomadic setting and a randomly selected population of their cattle. We obtained sociodemographic information and symptoms of pulmonary TB in both respondents and their cattle. We explore knowledge of respondents regarding risk of disease transmission between them and their livestock. We compare rates of TST among the respondents and the cattle. Participants with features of active TB were referred for further evaluation and treatment. Results: Out of 244 individuals evaluated, 103 (42.2%) were females with a median age (range) of 35 years (1–80 years). Among 167 participants who consented for and returned for TST reading, 45 (26.9%) were positive; 33 (73.3%) of which were between 20 and 50 years of age. A total of 29 (11.9%) respondents reported having cough for at least 3 weeks at the time of the study. Of the 244 participants interviewed, 51 (20.9%) reported having animals with chronic cough. A total of 26 (12.7%) of the 204 cattle tested had positive TST. Majority of the respondent (71%) were aware of potential risk of transmission of infectious diseases between them and their herds. Conclusion: High TST positivity among the nomads of economically viable age and their herds suggests that TB is prevalent in their communities with potential for animal–human transmission. TB and other infectious diseases control programs should capture nomads in their planning and implementation.

THE COURSE OF PYELONEPHRITIS IN CHILDREN AND ADOLESCENTS INFECTED IN THE PAST AND UNINFECTED WITH MYCOBACTERIUM TUBERCULOSIS

Objective: to evaluate the course of pyelonephritis in children and adolescents infected since the past years and uninfected with Mycobacterium tuberculosis. The study included 50 patients aged 3 to 17 years with acute and chronic pyelonephritis. Clinical, laboratory, instrumental, and functional examinations were used, by obligatorily verifying the uropathogenic etiological factor. The investigators identified contacts with tuberculosis patients and analyzed the results of BCG vaccination, Mantoux test, and, if indicated, chest X-ray, and urine test for Mycobacterium tuberculosis by flotation and culture methods. Among the 50 children with pyelonephritis, 24 patients were diagnosed with Mycobacterium tuberculosis infection since the previous years (more than 1 year); one had the early stage of primary tuberculosis infection. Among the 25 infected children, one patient was detected to have intrathoracic lymph node tuberculosis in the calcification phase (no evidence of activity). Conclusion. One-half of the children with pyelonephritis were found to have Mycobacterium tuberculosis infection; of them, one-half of the cases were identified to have contacted a patient with tuberculosis and the signs of its activity, as shown by a tuberculin test and Diaskintest®. The findings give grounds to consider children with pyelonephritis to be at risk for renal tuberculosis.