Form Of Pulmonary Tuberculosis Research Articles

The Association Between Lung Carcinoma and Tuberculosis.

Introduction:The association between lung tuberculosis and lung carcinoma is still controversial.Objective:to describe the characteristics of patients with associated lung tuberculosis (TB) and lung carcinoma (LC) in patients treated in Clinic for pulmonary diseases and TB “Podhrastovi”.Material and Methods:This is the retrospective study of patients with LC associated with TB treated in Clinic for pulmonary diseases and TB “Podhrastovi” in five-year period -from 2012 to 2016. We analyzed sex and age of patients, whether TB preceded LC or LC preceded TB, a time period between the developments of these two diseases, activity of TB, the histopathological type of LC, localization of LC in lungs (bronchial, peripheral, cavern) according to histopathological type.Results:In this period there were 2608 patients treated for LC. Among them there were 34 patients with diagnosed TB or 1.3%. All of them were smokers. No one had active TB. TB was the first diagnosis in all these patients. Each patient was previously treated for TB in hospital and had regular anti TB treatment. TB preceded LC in median time of 5 years (interquartile range 2 to 25 years). In 21 cases it was carcinoma of the drainage bronchus, in 11 cases it was peripheral lung carcinoma and 2 cases it was cavern carcinoma.Conlusion:patients with cured pulmonary tuberculosis represent a group at risk for developing lung carcinoma. Changes in the bronchial and alveolar mucosa which tuberculosis leaves behind in the lungs must be taken as a possible place of later malignant alteration. Patients with any form of pulmonary tuberculosis have to be controlled continuously.

Silent changes of tuberculosis in Iran (2005-2015): A joinpoint regression analysis.

Introduction and Aim:Tuberculosis (TB) poses a severe risk to public health through the world but excessively distresses low-income nations. The aim of this study is to analyze silent changes of TB in Iran (2005–2015): A joinpoint regression analysis.Materials and Methods:This is a trend study conducted on all patients (n = 70) that register in control disease center of Joibar (one of coastal cities and tourism destination in Northern Iran which was recognized as an independent town since 1998) during 2005–2015. The characteristics of patients imported to the SPSS 19 and variation in incidence rate of different forms of pulmonary TB (PTB) (PTB+ or PTB–) and extra-PTB (EPTB)/year was analyzed. Variation in incidence rate of TB for male and female groups and different age groups (0–14, 15–24, 25–34, 35–44, 45–54, 55–64, and above 65 years) was analyzed, variation in trend of this diseases for different groups was compared in intended years, and also, variation in incidence rate of TB was analyzed by Joinpoint Regression Software.Results:The total number of TB was 70 cases during 2005–2015. The mean age of patients was 42.31 ± 21.26 years and median age was 40 years. About 71.4% of patients were PTB (55.7% for with PTB+ and 15.7% with PTB–) and rest of them (28.4%) were EPTB. In regard to classification of cases, 97.1% of them were new cases, 1.45% of them were relapsed cases, and 1.45% of them imported cases. In addition, history of hospitalization due to TB was observed in 44.3%.Conclusion:Despite recent developments of governmental health-care system in Iran and proper access to it and considering this fact that identification of TB cases with passive surveillance is possible. Hence, developing certain programs for sensitization of the covered population is essential.

Level of Macronutrients and Microelements of Blood Plasma in Different Forms of Pulmonary Tuberculosis

By the method of atomic emission spectrometry with inductively coupled plasma, the content of macro and microelements in the blood plasma of 35 practically healthy people living in the Northern region of Azerbaijan and in the Nizhny Novgorod region of the Russian Federation was studied as well as of 23 patients with pulmonary tuberculosis with different phases of the disease. The elemental homeostasis of the blood plasma did not significantly differ depending on the region of residence, except for the potassium level (by 1.3 times greater for Russians) and strontium (by 10 times higher among the inhabitants of the Northern region of Azerbaijan). In patients with focal pulmonary tuberculosis, there were no significant differences in the content of elements in the blood plasma. With pulmonary tuberculosis, accompanied by decomposition processes, the content of calcium, copper, zinc and iron in blood plasma significantly increases in comparison with healthy people. Analysis of the level of these macro- and microelements can be used to determine the transition of the early form of pulmonary tuberculosis to infiltrative and/or cavernous forms, in which the patient becomes epidemiologically dangerous to others.

High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study

ObjectivesThe proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. Study designWe performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. MethodsWe categorised patients as having ‘only PTB’ (infection in the lung parenchyma), ‘EPTB/PTB’ (infection in the lung and an additional site), and ‘only EPTB’ (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. ResultsOne hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P < 0.001), night sweats (10.9% vs 39.3%; P < 0.001), and weight loss (28.3% vs 47.9%; P = 0.023). Patients with some form of EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P < 0.001). ConclusionsEPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.

Primary splenic tuberculosis

Tuberculosis (TB) continues to be a major health problem worldwide, despite considerable advances in the diagnosis and treatment of the disease [1]. This disease presents with diverse clinical symptoms in the form of pulmonary TB and extra-pulmonary TB. Extra-pulmonary TB accounts for almost 15% of all cases. Among the extra-pulmonary forms, splenic TB is an unusual entity. This form of TB is normally seen as a part of miliary TB. In our case study, a patient presented with a rare form of splenic TB and managed successfully. Splenic TB is undetectable as a primary site in the body and is a rare variant of extra-pulmonary TB.

Protection by novel vaccine candidates, Mycobacterium tuberculosis ΔmosR and ΔechA7, against challenge with a Mycobacterium tuberculosis Beijing strain

Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), infects over two billion people, claiming around 1.5 million lives annually. The only vaccine approved for clinical use against this disease is the Bacillus Calmette–Guérin (BCG) vaccine. Unfortunately, BCG has limited efficacy against the adult, pulmonary form of tuberculosis. This vaccine was developed from M. bovis with antigen expression and host specificity that differ from M. tuberculosis. To address these problems, we have designed two novel, live attenuated vaccine (LAV) candidates on an M. tuberculosis background: ΔmosR and ΔechA7. These targeted genes are important to M. tuberculosis pathogenicity during infection. To examine the efficacy of these strains, C57BL/6 mice were vaccinated subcutaneously with either LAV, BCG, or PBS. Both LAV strains persisted up to 16 weeks in the spleens or lungs of vaccinated mice, while eliciting minimal pathology prior to challenge. Following challenge with a selected, high virulence M. tuberculosis Beijing strain, protection was notably greater for both groups of LAV vaccinated animals as compared to BCG at both 30 and 60 days post-challenge. Additionally, vaccination with either ΔmosR or ΔechA7 elicited an immune response similar to BCG. Although these strains require further development to meet safety standards, this first evidence of protection by these two new, live attenuated vaccine candidates shows promise.

Factors of Suppression of Immune Response in Patients with Pulmonary Tuberculosis and Eosinophilia.

We studied possible mechanisms of immunosuppression mediated by regulatory T cells that promotes suppression of antigen-specific immune response to Mycobacterium tuberculosis in patients with pulmonary tuberculosis and eosinophilia. It was shown that the number of CD4(+)CD25(+)Foxp3(+) regulatory T cells with immunosuppressive activity (Treg) increased in the peripheral blood of patients with disseminated destructive forms of pulmonary tuberculosis with multiple resistance of the causative agent to antituberculosis substances and eosinophilia. These changes were accompanied by imbalance in secretion of Treg-associated cytokines (in vitro) manifested in hyperproduction of TGFβ and IL-10 and decreased production of IL-2.

Draft Genome Sequence of Mycobacterium tuberculosis Strain MT43, a Representative of the Manu2 Genotype.

We announce the draft genome sequence of Mycobacterium tuberculosis strain MT43, isolated from a pulmonary form of tuberculosis in French Polynesia. Analyzing its 4,145,007-bp, 65.17% G+C chromosome confirmed a fully antibiotic-susceptible Manu2 spoligotype.

Occurrence of tuberculosis cases in Crato, Ceará, from 2002 to 2011: a spatial analisys of specific standards.

to analyze the spatial distribution of tuberculosis in Crato, Ceará, Brazil, from 2002 to 2011, aiming to check for a point pattern. This is an ecological, temporal trend and hybrid design study, with a quantitative approach. A total of 261 cases of tuberculosis were geo-referenced and 20 (7.1%) were considered as losses due to the lack of address. The profile of patients in 10 years of study was in accordance with the following pattern: men aged between 20 and 59 years, with low schooling, affected by the pulmonary form of tuberculosis and who were cured from the disease. The analysis of the spatial distribution of tuberculosis points out that in the period of study, new cases of the disease were not distributed on a regular basis, indicating a clustered spatial pattern, confirmed by the L-function. The map with the density of new cases estimated by the Kernel method showed that the "hot" areas are more concentrated in the vicinity of the central urban area. The study allowed pointing out areas of higher and lower concentration of tuberculosis, identifying the spatial pattern, but it also recognized that the disease has not reached all of the population groups with the same intensity. Those who were most vulnerable were the ones who lived in regions with higher population densities, precarious living conditions, and with intense flow of people.

ОпЫт пРиМенениЯ кОМпЛекснОГО ВОЗДеЙстВиЯ нескОЛькиХ ФиЗиОтеРАпеВтиЧескиХ Мет ОДОВ ДЛЯ пОВЫШениЯ эФФектиВнОсти ЛеЧениЯ бОЛьнЫХ с ВпеРВЫе ВЫЯВЛеннЫМ ДестРУктиВнЫМ тУбеРкУЛеЗОМ ЛеГкиХ

ОпЫт пРиМенениЯ кОМпЛекснОГО ВОЗДеЙстВиЯ нескОЛькиХ ФиЗиОтеРАпеВтиЧескиХ Мет ОДОВ ДЛЯ пОВЫШениЯ эФФектиВнОсти ЛеЧениЯ бОЛьнЫХ с ВпеРВЫе ВЫЯВЛеннЫМ ДестРУктиВнЫМ тУбеРкУЛеЗОМ ЛеГкиХ

Malabsorption syndrome as a manifestation of systemic effects in advanced forms of pulmonary tuberculosis

As of October 2012 84 countries had reported at least 1 case of extensively drug resistant tuberculosis (EDR TB). In November 2012, the WHO epidemiological surveillance stated: all new TB cases in the world are 3,7 % of multi-drug resistant tuberculosis (MDR TB); 60,0 % of MDR TB among the new cases of TB are documented in Brazil, China, India, and South Africa.

Acute–Phase Inflammatory Response in Patients with Pulmonary Tuberculosis

Summary The main issue in patients with pulmonary tuberculosis (PTB) represents the impossibility of the host immune response to express bactericidal function and the sterilization of lesions depends exclusively on the specific antimicrobial chemotherapy. In order to investigate the value of acute-phase inflammatory response markers in patients with newly confirmed extensive PTB, there was designed a clinical study with 80 patients, of whom 40 had active disease (experimental group), while other 40 had inactive sequellar disease without comorbidity (control group). The examined groups were homogenous with respect to the patient’s general demographic characteristics. In the experimental group, 20.0% of the patients had an initial bacterial infection of the lower respiratory tract, while their average value of acute-phase systemic inflammatory markers was initially, before the antituberculosis treatment, significantly elevated compared to the control group. At the end of the treatment, values of erythrocyte sedimentation rate in the first hour (SE) and serum C-reactive protein (CRP) significantly decreased (SE-p &lt;0.001, CRP-p&lt;0.001), together with the value of the leukocyte count (Le) and serum fibrinogen (Le-p&lt;0.001, fibrinogen-p&lt;0.001). Multivariate linear regression analysis proved a significant correlation between baseline serum fibrinogen level with positive history of contact with active TB patient and initial radiological extent of PTB lung lesions. The values of the acute-phase inflammatory response markers in active PTB have its clinical significance in the assessment of unfavourable course of disease in extensive disseminated form of PTB as well as in the occurrence of complications associated with low respiratory tract bacterial superinfection.

Profiles of resistance of isolated strains of M.tuberculosis in the Khar’kov region

The object of this particular research was to evaluate a ratio between the sensitive and resistant strains of M.tuberculosis isolated from patients with an epidemiologically dangerous pulmonary form of tuberculosis. The results of studying the resistance of the mycobacteria of tuberculosis (MBT) to antituberculous preparations (ATP) have been analyzed in patients with pulmonary tuberculosis (TB) registered from 2009 to 2010 around the Khar’kov region. An analysis has demonstrated an unfavourable tendency of an increase of the total rate of medicamental resistance of MBT and making its amplification structure. A peculiar feature of the modern epidemiological situation connected with tuberculosis is a rise of the frequency of primary medicamental resistance.

Factors Associated with Length of Hospital Stay among HIV Positive and HIV Negative Patients with Tuberculosis in Brazil

ObjectiveIdentify and analyze the factors associated to length of hospital stay among HIV positive and HIV negative patients with tuberculosis in Manaus city, state of Amazonas, Brazil, in 2010.MethodsEpidemiological study with primary data obtained from monitoring of hospitalized patients with tuberculosis in Manaus. Data were collected by interviewing patients and analyzing medical records, according to the following study variables age, sex, co-morbidities, education, race, income, lifestyle, history of previous treatment or hospitalization due to tuberculosis, treatment regimen, adverse reactions, smear test, clinical form, type of discharge, and length of hospital stay. The associated factors were identified through chi-square or t-Student test at a 5% significance level.ResultsIncome from 1 to 3 minimum wages (P = 0.028), pulmonary tuberculosis form (P = 0.011), negative smear test or no information in this regard (P = 0.014), initial 6-month treatment scheme (P = 0.029), and adverse drug reactions (P = 0.021) were associated to prolonged hospital stay in HIV positive patients.ConclusionWe found out that although there were no significant differences in the length of hospital stay in HIV positive patients, all factors significantly associated to prolonged hospital stay occurred in this group of patients. This finding corroborates other studies indicating the severity of tuberculosis in HIV patients, which may also contribute to lengthen their hospital stay.

Frequency of tuberculosis at autopsies in a large hospital in Zagreb, Croatia: a 10-year retrospective study

AimTo assess the frequency and forms of pulmonary tuberculosis at autopsy in a high-traffic hospital in the capital city of a country with a low tuberculosis incidence.MethodsWe performed a retrospective search of autopsy data from the period 2000 to 2009 at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. We also examined patients’ records and histological slides.ResultsOf 3479 autopsies, we identified 61 tuberculosis cases, corresponding to a frequency of 1.8%. Active tuberculosis was found in 33 cases (54%), 23 of which (70%) were male. Of the 33 active cases, 25 (76%) were clinically unrecognized and 19 (76%) of these were male.ConclusionClinically undiagnosed tuberculosis accounted for a substantial proportion of active tuberculosis cases diagnosed at autopsy. Autopsy data may be an important complement to epidemiological data on tuberculosis frequency.

Tuberculosis of Thyroid Gland - A Rare Case Report

Tuberculosis of thyroid gland is a very rare condition even though the incidence of extra pulmonary forms of tuberculosis is increasing. According to literature, frequency of thyroid tuberculosis is 0.1%–0.4%. We report a case of 66year old female patient with primary tuberculosis of thyroid gland. The diagnosis was established on histopathological examination after surgery. Patient underwent combination treatment with anti-tubercular chemotherapy

New tuberculosis vaccines

The current tuberculosis (TB) vaccine, bacille Calmette-Guerin (BCG), is a live vaccine used worldwide, as it protects against severe forms of the disease, saving thousands of lives every year, but its efficacy against pulmonary forms of TB, responsible for transmission of the diseases, is variable. For more than 80 years now no new TB vaccines have been successfully developed. Over the last decade the effort of the scientific community has resulted in the design and construction of promising vaccine candidates. The goal is to develop a new generation of vaccines effective against respiratory forms of the disease. We will focus this review on new prophylactic vaccine candidates that aim to prevent TB diseases. Two are the main strategies used to improve the immunity conferred by the current BCG vaccine, by boosting it with new subunit vaccines, and a second strategy is focused on the construction of new more effective live vaccines, capable to replace the current BCG and to be used as prime vaccines. After rigorous preclinical studies in different animal models new TB vaccine candidates enter in clinical trials in humans. First, a small Phase I for safety followed by immunological evaluation in Phase II trials and finally evaluated in large population Phase III efficacy trials in endemic countries. At present BCG prime and boost with different subunit vaccine candidates are the more advanced assessed in Phase II. Two prime vaccines (based on recombinant BCG) have been successfully evaluated for safety in Phase I trials. A short number of live attenuated vaccines are in advance preclinical studies and the candidates ready to enter Phase I safety trials are produced under current good manufacturing practices.

Spectrum of childhood tuberculosis in BCG vaccinated and unvaccinated children

Childhood tuberculosis remains a major public health problem in India. We evaluated the impact of BCG vaccination on childhood tuberculosis and the underlying risk factors. 100 consecutive children below 12 years diagnosed to have tuberculosis based on the WHO and IAP consensus statement were included in the study. Majority(42%) of children with tuberculosis were below four years of age. History of contact with a case of tuberculosis was present in 41 cases. BCG scar was present in 77 cases indicating a poor coverage/uptake of BCG vaccination. Pulmonary form of tuberculosis was seen in 52 and extra pulmonary form in 41 cases. Tubercular lymphadenitis was seen in seven cases, of which more than 70 % were in BCG vaccinated group. There was no statistically significant difference in the type of tuberculosis (pulmonary or extra pulmonary) and BCG vaccination. In the extra pulmonary form, 13 children had neuro-tuberculosis, of which 66% were in BCG unvaccinated group, which was statistically significant (p=0.011). The underlying risk factors were poor socioeconomic status (62%), malnutrition (61%) and poor immunization coverage. Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.

Diachronic Analysis of Cause-of-Death Terminology

Outmoded terminology, inconsistent usage of terms, and lack of specificity are routinely encountered in death records, making integration of past causes of death difficult. This article summarizes problems encountered during large-scale analysis of nineteenth-century causes of morbidity and mortality. Tuberculosis is likely the most problematic cause of death that is routinely encountered; the different manifestations of this disease, depending on which part of the body it infects, mean that it can have quite diverse pathologies, each accorded a separate term. Following this terminology, changes in tuberculosis among soldiers in the British army from 1830 to 1913 are investigated. Morbidity shows a large contribution by scrofula to the total tubercular diseases from 1830 to 1870. Phthisis, the pulmonary form of tuberculosis, dominates mortality.

THE ANALYSIS OF HOSPITAL MORTALITY AMONG PATIENTS WITH HIV-ASSOCIATED TUBERCULOSIS

The medical and social status, clinical structure are analyzed and the most significant risk factors of mortality among 83 patients who died from HIV-associated tuberculosis are determined. It is found that they are men 30-40 with sharp generalized forms of tuberculosis, resulting in death in the first two years. The most important predictors of mortality of patients stage of HIV-infection, HIV-associated cachexia, a form of pulmonary tuberculosis, the count of leukocytes and CD4 + T-lymphocytes are were.