Resurgence Of Tuberculosis Research Articles

Antiretroviral Treatment as Prevention: Impact of the ‘Test and Treat’ Strategy on the Tuberculosis Epidemic

Antiretroviral therapy (ART) has been remarkably effective in ameliorating Human Immunodeficiency Virus (HIV)-associated morbidity and mortality. The rapid decline in viral load during ART also presents an opportunity to develop a “treatment as prevention” strategy in order to reduce HIV transmission at a population level. Modelling exercises have demonstrated that for this strategy to be effective, early initiation of ART with high coverage of the HIV-infected population will be required. The HIV epidemic has fueled a resurgence of tuberculosis (TB) particularly in sub-Saharan Africa and widespread early initiation of ART could also impact this epidemic via several mechanisms. The proportion of patients with low CD4 cell counts who are at high risk of TB disease from progression of both latent and new TB infection would be greatly reduced. Entry into a life-long ART program provides an ongoing opportunity for intensified TB case finding among the HIV-infected population. Regular screening for HIV infection also presents an opportunity for intensified TB case finding in the general population. The combined effect of reduced progression of infection to disease and intensified case finding could reduce the overall prevalence of infectious TB, thereby further decreasing TB transmission. In addition, decreasing prevalence of HIV infection would reduce the TB-susceptible pool within the population. The ‘test and treat’ strategy therefore has potential to reduce the TB risk at both an individual and a population level. In this paper we explore the expected “TB dividend” of wider access to ART and also explore the potential of the “test and treat” strategy to impact on TB transmission, particularly in the heavily burdened setting of sub-Saharan Africa.

Primary Nasal Tuberculosis—A Rare Clinical Entity

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.

Diversity oriented design of various hydrazides and their in vitro evaluation against Mycobacterium tuberculosis H37Rv strains

Control and prevention of tuberculosis is a major challenge, as one-third of the world's population is infected with Mycobacterium tuberculosis. The resurgence of tuberculosis and the emergence of multidrug-resistance strains of mycobacteria, necessitate the search for new class of antimycobacterial agents. As a part of investigation of new antitubercular agents in this laboratory, we describe the syntheses of various hydrazides of comarins, quinolones and pyrroles and screening against M. tuberculosis (Mtb) H37(Rv) by using rifampin as a standard drug. Among the designed molecules, the most prominent compounds 2a-g, 4a and 9a showed >90% GI at MIC<6.25 μg/mL. Finally, these studies suggests that compounds 2a-g, 4a and 9a may serve as promising lead scaffolds for further generation of new anti-TB agents.

Tuberculosis: Past and Present

Tuberculosis is an infectious disease with a long and established association with human populations. This review discusses and integrates an ethnographic study of public health fieldwork in the 1990s North American resurgence of tuberculosis and a bioarchaeological evaluation of tuberculosis in antiquity. Based on these works, this article explores a series of useful themes of relevance across anthropology, from microbe, to patient, to social structure, to syndemic. These levels of analysis illustrate the complexities of tuberculosis, and highlight the possibilities for engaging further anthropological enquiry. A final section on methodologies briefly compares and contrasts bioarchaeological and ethnographic fieldwork.

2,3-Dideoxy hex-2-enopyranosid-4-uloses as promising new anti-tubercular agents: Design, synthesis, biological evaluation and SAR studies

The alarming resurgence of tuberculosis (TB) underlines the urgent need for development of new and potent anti-TB drugs. Towards this goal we herein report the design and synthesis of 2,3-dideoxy hex-2-enopyranosid-4-uloses as promising new anti-tubercular agents. These easily accessible, small molecules were found to exhibit in vitro activity against Mycobacterium tuberculosis H37Rv in a MIC range of 0.78 μg/mL to 25 μg/mL. A detailed SAR study on these hex-2-enopyranosid-4-uloses led to the identification of compound 5g (S007–724) which on the basis of low MIC (0.78 μg/mL-M. tuberculosis H37Rv; 1.56 μg/mL-MDR, SDR strains of M. tuberculosis; 0.78 μg/mL-inhibition of intracellular replication of M. tuberculosis) and SI value of 13.5 has been identified as a promising lead molecule.

Thibela TB: Design and methods of a cluster randomised trial of the effect of community-wide isoniazid preventive therapy on tuberculosis amongst gold miners in South Africa

Background South Africa has the third highest annual number of new tuberculosis (TB) cases globally. The resurgence of TB which has particularly affected gold miners in South Africa, is attributed to occupational risk factors for TB including silica dust exposure and high HIV prevalence. Isoniazid preventive therapy (IPT) is recommended for individuals at high risk to prevent both HIV-related TB and silicotuberculosis, but global uptake has been poor. We describe the design of a cluster randomised study, “Thibela TB”, which compares routine IPT targeted to those identified as at higher risk of TB (due to HIV infection or silicosis) against a “community-wide” approach in which IPT is offered to all employees. The trial is registered with the Current Controlled Trials: Registration number ISRCTN63327174. Methods We describe the rationale for the intervention of community-wide IPT, drawing on studies conducted in 1950–1960s in the pre-HIV era. The design of the study, including the definition of the cluster, is presented and advantages and limitations of such a design are discussed. Conclusion If successful in reducing TB incidence and prevalence, this trial has potential to make a major contribution to TB control policy in high HIV settings, providing evidence concerning efficacy, and additionally safety and population-level effects on drug susceptibility patterns. Such rigorous evaluation is essential to provide policy makers with an evidence base to guide community-level TB prevention strategies.

Screening for In Vitro Antimycobacterial Activity and Three‐Dimensional Quantitative Structure–Activity Relationship (3D‐QSAR) Study of 4‐(arylamino)coumarin Derivatives

The resurgence of tuberculosis and the emergence of multidrug-resistant strains of Mycobacteria necessitate the search for new classes of antimycobacterial agents. We have synthesized a small library of 50 analogues of 4-(arylamino)coumarins with various aromatic amines at the C(4) - position of the coumarin scaffold. The compounds were evaluated for antimycobacterial activity against Mycobacterium tuberculosis H(37) Rv with rifampicin as the standard. Of the molecules synthesized, compound 9 was found to be most potent with a minimum inhibitory concentration >6.25 μg/mL for 100% inhibition. In an effort to develop new and more effective molecules in this series, the relationship between structure and activity was investigated by comparative molecular field analysis. Various models were generated using comparative molecular field analysis alone and comparative molecular field analysis plus a hydropathy field (HINT). In all, eight models were generated with atom-fit and field-fit alignment strategies. The comparative molecular field analysis models (Models 3a and 4a) based on field-fit alignment were the best with statistically good correlation coefficients (r²) and cross-validated q². The values of r²(pred) for the validation set were 0.469 and 0.516. Based on the comparative molecular field analysis contours, some insights into the structure-activity relationship of the compounds could be gained.

Posterior listhesis of a lumbar vertebra in spinal tuberculosis

The management of spinal tuberculosis, especially in children, is controversial. In children, vertebral destruction is more severe than adults because of the cartilaginous nature of their bone. Modern chemotherapy has significantly decreased mortality in spinal tuberculosis, but morbidity remains high. Without early surgery, patients can develop severe kyphosis leading to respiratory insufficiency, painful costopelvic impingement and paraplegia. Lumbar kyphosis results in early degenerative lumbar canal stenosis and is cosmetically unacceptable. We report a paediatric case of atypical spinal tuberculosis demonstrating the need for early surgical intervention to prevent significant spinal instability and neurologic deficit. A 12-year-old girl presented with increasing ambulatory difficulty and double incontinence 4months after initiating treatment for pulmonary tuberculosis. There was no history of traumatic injury. Examination revealed severe lower limb neurologic deficit, with hypotonia, areflexia, marked sensory loss, and grade 0/5 power in both lower limbs. Plain radiographs and magnetic resonance imaging (MRI) demonstrated grade IV posterior listhesis of the L2 vertebral body over L3, cauda equina compression and bilateral psoas abscesses. Erosion of both the body and pedicle of L2 was observed. Both serology and pus drained from the psoas abscesses were negative for microorganisms. The patient underwent an L2 vertebrectomy via a left retroperitoneal approach. A titanium cage packed with autologous bone graft was inserted, and the spine was stabilized by fixation with screw and rods. Histopathology confirmed a diagnosis of tuberculosis. Eighteen months following the procedure, the patient has regained some power in her right leg and has completed her course of anti-tuberculous chemotherapy, but remains wheelchair-bound. To our knowledge, this is the first reported case of posterior listhesis secondary to spinal tuberculosis. Here, we discuss the possible management options in such a case, and the indications for surgery. As the global HIV/AIDS epidemic causes a resurgence in tuberculosis, increased awareness among the medical community regarding the atypical presentations of spinal tuberculosis is necessitated; both in the developing world where advanced clinical presentations are common, and in the developed world where spinal tuberculosis is an often-neglected diagnosis.

Schiff bases of indoline-2,3-dione (isatin) derivatives and nalidixic acid carbohydrazide, synthesis, antitubercular activity and pharmacophoric model building

Tuberculosis (TB) remains among the world’s great public health challenges. Worldwide resurgence of TB is due to two major problems: the AIDS epidemic, which started in the mid-1980s, and the outbreak of multidrug resistant (MDR) TB. Thus, there is an urgent need for anti-TB drugs with enhanced activity against MDR strains. In recent years, Schiff bases of 1H-indole-2,3-diones are reported to exhibit anti-TB activity. On the other hand, several quinolone antibacterial agents have been examined as inhibitors of TB, as well as other mycobacterial infections. Accordingly, the current work involved design and synthesis of Schiff bases of nalidixic acid carbohydrazide and isatin derivatives ( 5, 6a– f and 7, 8a– c). Structures of the synthesized derivatives were confirmed on the bases of spectral methods of analyses. Anti-TB activity of the synthesized derivatives was investigated against four Mycobacterium strains: Mycobacterium intercellulari, Mycobacterium xenopi, Mycobacterium cheleneo and Mycobacterium smegmatis. Modest anti-TB activity was observed within the investigated compounds, however, compound 5f revealed potent anti-TB activity with MIC 0.625 μg/ml, which is 20 times greater than the reference drug isoniazid, INH, (MIC = 12.5 μg/ml). A hypothetical pharmacophore model was built using Molecular Operating Environment (MOE) program and 10 compounds structurally related to the synthesized ones with reported anti-TB activity. The Pharmacophoric model built revealed the necessity of the following pharmacophoric features for anti-TB activity: aromatic center, hydrogen bond acceptor/metal ligator center, hydrogen bond donor center and aromatic center/hydrophobic area. Theses features were consistent with the found anti-TB activity of the tested compounds.

Virtual screening by high-throughput docking using hydrogen bonding constraints for targeting a protein-protein interface in M. tuberculosis

The resurgence of Tuberculosis, caused primarily by Mycobacterium tuberculosis, and the appearance of drug resistant tuberculosis strains encourage the need for new drugs with alternative mode of actions [1]. An interesting drug-target is the Thioredoxin-Reductase (TrxR)/Thioredoxin (Trx) System of M. tuberculosis, which is responsible for providing reducing equivalents for many cellular processes including bacterial antioxidant defence [2]. We performed a virtual screening approach for identifying novel drugs for the treatment of Tuberculosis that used the hydrogen bonding constraint functionality of GOLD for pre-processing instead of using pharmacophore filtering. Two important hydrogen bonding interactions could be identified at the protein-protein interface of the TrxR-Trx complex. A high-throughput docking was applied to filter the Intervet in-house compound library (~6.5 million compounds) for possible hits that interact with these two hydrogen bonding acceptors. This reduced the number of interesting compounds to 151768 that were redocked without any constraints and more accurate docking settings. Finally, the ranking of the reduced compound set was obtained using a normalisation based on molecular weight [3] and a consensus scoring in a restrictive way using Chemscore and ASPscore. So far, six out of the first 25 of the ranked compound list showed an activity with an IC50 value upto μM range. Especially three compounds with different scaffolds and a low molecular weight are promising candidates for further developments.

Recent Development and Future Perspective of Antitubercular Therapy

Tuberculosis (TB) has remained an enemy of humankind before the beginning of recorded history. Although it is curable and preventable, TB claims the lives of more than 5,000 people every day. Despite of availability of effective chemotherapy and BCG vaccine in 21st century, TB remains one of the most deadly infectious diseases. The concomitant resurgence of TB with the Multi-drug resistant (MDR) or Extremely drug resistant (XDR)-TB and HIV/AIDS pandemic raises the threat posed by untreatable and fatal human TB, exposing the frailties of the current drug armatorium. No new drug is available acting through novel mechanism since last 40 years. The genome of Mycobacterium tuberculosis H37Rv was sequenced in 1998 and reannotated in 2002. This coupled with development of new genetic tools, have greatly contributed to the discovery of potential drug targets for new anti-TB agent. It is increasingly acknowledged that new drugs should not only be active against drug resistant TB, but should also kill persisters and shorten the lengthy TB treatment, which underlies the problem of drug resistance due to poor compliance to the length of therapy. This review article describes the current TB drugs, their merits and demerits as well as the new promising anti-TB agents classified on the basis of molecular framework. It is a comprehensive literature compilation on the present research paradigm of anti-TB drug discovery including advances in the new structural analogs reported in last decade.

Case 154: Pharyngeal and Retropharyngeal Tuberculosis with Nodal Disease

HomeRadiologyVol. 254, No. 2 PreviousNext DIAGNOSIS PLEASECASE 154Case 154: Pharyngeal and Retropharyngeal Tuberculosis with Nodal DiseaseAditya Bharatha, Eric S. Bartlett, Eugene Yu Aditya Bharatha, Eric S. Bartlett, Eugene Yu Author Affiliations1From the Division of Neuroradiology, Department of Medical Imaging, Princess Margaret Hospital, 610 University Ave, 3rd Floor, Room 3–959, Toronto, ON, Canada M5G 2M9.Address correspondence to E.Y. (e-mail: [email protected]).Aditya BharathaEric S. BartlettEugene Yu Published Online:Jan 7 2010https://doi.org/10.1148/radiol.2542081660MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Rangheard AS, Vanel D, Viala J, Schwaab G, Casiraghi O, Sigal R. Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients. AJNR Am J Neuroradiol 2001;22(5):851–857. Medline, Google Scholar2 Moon WK, Han MH, Chang KHet al.. CT and MR imaging of head and neck tuberculosis. RadioGraphics 1997;17(2):391–402. Link, Google Scholar3 Prasad KC, Sreedharan S, Chakravarthy Y, Prasad SC. Tuberculosis in the head and neck: experience in India. J Laryngol Otol 2007;121(10):979–985. Crossref, Medline, Google Scholar4 Lee Y, Park KS, Chung SY. Cervical tuberculous lymphadenitis: CT findings. J Comput Assist Tomogr 1994;18(3):370–375. Crossref, Medline, Google Scholar5 Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. RadioGraphics 2007;27(5):1255–1273. Link, Google Scholar6 Choudhury N, Bruch G, Kothari P, Rao G, Simo R. 4 years’ experience of head and neck tuberculosis in a south London hospital. J R Soc Med 2005;98(6):267–269. Crossref, Medline, Google Scholar7 Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules. I. Morphologic evaluation for differentiation of benign and malignant lesions. RadioGraphics 2000;20(1):43–58. Link, Google Scholar8 Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol 2006;27(1):39–45. Crossref, Medline, Google ScholarArticle HistoryReceived September 17, 2008; revision requested October 15; revision received November 5; accepted November 19; final version accepted December 10.Published online: Jan 7 2010Published in print: Feb 2010 FiguresReferencesRelatedDetailsCited ByMedical RadiologyPailinKongmebhol, Jose FlorencioLapeña2022Some Manifestations of Tuberculosis in Otorhinolaryngology – Case Series and a Short Review of Related Data from South-Eastern EuropeAdela-IoanaMocanu, HoriaMocanu, CosminMoldovan, IoanaSoare, ElenaNiculet, Alin LaurentiuTatu, Claudiu IonutVasile, DanielaDiculencu, Paraschiva APostolache, AlexandruNechifor2022 | Infection and Drug Resistance, Vol. Volume 15Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern IndiaSantosh KumarSwain, Ishwar ChandraBehera, Mahesh ChandraSahu2017 | Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Vol. 18, No. 3Extra nodal ENT tuberculosisWafaAbid, Olfa BenGamra, HanenGhorbal, IbtissamBeji, SarraZribi, InesHriga, ChirazMbarek2014Nov1 | Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Vol. 15, No. 3Primary pharyngeal tuberculosis presenting as a submucosal tumourJ.W.Lee, K.-A.Ryu, K.R.Kwon, B.S.Koo2014 | International Journal of Oral and Maxillofacial Surgery, Vol. 43, No. 8Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apneaAlpen B.Patel, Michael L.Hinni17 October 2012 | European Archives of Oto-Rhino-Laryngology, Vol. 270, No. 1Recommended Articles Imaging Findings in Tuberculous Heart DiseaseRadioGraphics2020Volume: 40Issue: 2pp. 607Extrapulmonary Tuberculosis: Pathophysiology and Imaging FindingsRadioGraphics2019Volume: 39Issue: 7pp. 2023-2037Deep Learning at Chest Radiography: Automated Classification of Pulmonary Tuberculosis by Using Convolutional Neural NetworksRadiology2017Volume: 284Issue: 2pp. 574-582Pulmonary Tuberculosis: Role of Radiology in Diagnosis and ManagementRadioGraphics2017Volume: 37Issue: 1pp. 52-72CT of the Neck: Image Analysis and Reporting in the Emergency SettingRadioGraphics2019Volume: 39Issue: 6pp. 1760-1781See More RSNA Education Exhibits Cystic Cervical Lymph Nodes: A Systematic Approach and Useful Imaging Features for their DifferentiationDigital Posters2020Above and Beyond Hypopharynx Imaging - Understanding Anatomy, Lesions, and StagingDigital Posters2018The Resurgence of Tuberculosis: The Spectrum of TB Pathologies Through the AgesDigital Posters2018 RSNA Case Collection Synovial sarcoma of neckRSNA Case Collection2020Pulmonary Tuberculosis RSNA Case Collection2021Tuberculous spondylitisRSNA Case Collection2020 Vol. 254, No. 2 Metrics Altmetric Score PDF download

The Societal Cost of Tuberculosis: Tarrant County, Texas, 2002

Cost analyses of tuberculosis (TB) in the United States have not included elements that may be prevented if TB were prevented, such as losses associated with TB-related disability, personal and other costs to society. Unmeasured TB costs lead to underestimates of the benefit of prevention and create conditions that could result in a resurgence of TB. We gathered data from Tarrant County, Texas, for 2002, to estimate the societal cost due to TB. We estimated societal costs due to the presence or suspicion of TB using known variable and fixed costs incurred to all parties. These include costs for infrastructure; diagnostics and surveillance; inpatient and outpatient treatment of active, suspected, and latent TB infection (LTBI); epidemiologic activities; personal costs borne by patients and by others for lost time, disability, and death; and the cost of secondary transmission. A discount rate of 3% was used. During 2002, 108 TB cases were confirmed in Tarrant County, costing an estimated $40,574,953. The average societal cost per TB illness was $ 376,255. Secondary transmission created 47% and pulmonary impairment after TB created 35.4% of the total societal cost per illness. Prior estimates have concluded that treatment costs constitute most (86%) TB-related expenditures. From a societal perspective treatment and other direct costs account for little (3.3%) of the full burden. These data predict that preventing infection through earlier TB diagnosis and treatment of LTBI and expanding treatment of LTBI may be the most feasible strategies to reduce the cost of TB.

Identification, Synthesis, and Pharmacological Evaluation of Tetrahydroindazole Based Ligands as Novel Antituberculosis Agents

The resurgence of tuberculosis (TB), the incidence of drug-resistant strains of Mycobacterium tuberculosis (MTB), and the coinfection between TB and HIV have led to serious infections, high mortality, and a global health threat, resulting in the urgent search for new classes of antimycobacterial agents. Herein, we report the identification of a novel class of tetrahydroindazole based compounds as potent and unique inhibitors of MTB. Compounds 6a, 6m, and 6q exhibited activity in the low micromolar range against replicating Mycobacterium tuberculosis (R-TB) phenotype, with minimum inhibitory concentrations (MICs) of 1.7, 1.9, and 1.9 muM, respectively, while showing no toxicity to Vero Ccells. Moreover, studies aimed to assess the in vitro metabolic stability of 6a and 6m in mouse liver microsomes and in vivo pharmacokinetic profiles in plasma levels gave satisfactory results. This research suggests that tetrahydroindazole based anti-TB compounds can serve as a promising lead scaffold in developing new drugs to combat tuberculosis infections.

Reconsidering Some Approved Antimicrobial Agents for Tuberculosis

The case report in this issue by [Forgacs and colleagues][1] ([8][2]) is particularly timely in view of the resurgence of tuberculosis and the promise of new therapeutic approaches ([15][3]). Much of the current attention on tuberculosis has focused on the close association of tuberculosis and human

Meeting the challenges of the Ottawa Charter: comparing South African responses to AIDS and tobacco control

The paper compares the response of the South African Government to HIV and AIDS with the government's policy development concerning the use of tobacco. The high burden of disease from HIV and AIDS in South Africa and the morbidity and mortality from the use of tobacco are outlined. Using the framework of the Ottawa Charter for Health Promotion, the paper reviews and critiques the Government's different stance to building public policy, creating supportive environments, engaging community participation, developing personal skills and re-orienting the health services, for HIV/AIDS and tobacco. The result of these policy choices is described. The lack of adequate implementation of the key elements of the Ottawa Charter has resulted in high morbidity and mortality due to the spread of HIV infection in South Africa. This has also influenced the resurgence of tuberculosis, and the accompanying MDR and XDR TB epidemics. The high prevalence of HIV infection has also meant that the health system is unable to cope with the large numbers of patients requiring anti-retroviral treatment, and the early morbidity and mortality of young economically active people has had devastating social consequences, resulting in the large numbers of orphans. In contrast, South Africa is a signatory to the World Health Organizations' Framework Convention on Tobacco Control, and has successfully implemented many of the policies.

HIV in children: take a moment to make a difference!

You may not know it, but there are 5.5 million HIV-infected people in Africa. More important for paediatric radiologists to know is that there are nearly 2 million HIV-infected children in sub-Saharan Africa. In my home country, South Africa, there are 360,000 HIV-infected children. Now you understand why we have dedicated seven articles in this minisymposium to HIV in children. You may not believe that this affects you as a European or North American radiologist, but if the resurgence of tuberculosis is anything to go by, HIV should be a major concern to you too. The mass migration from Africa, increasing urban poverty and worsening social conditions in parts of cities of many developed nations make Africa at your doorstep. The majority of adults with HIV infection are of childbearing age, and of these, three-quarters are women. This, in turn, translates to both a medical and a social disaster for children. Not only are the bread-winners ill and not able to care for their children, but mothers transmit the disease during pregnancy, delivery and breast feeding to their children. Additionally, parents who are not treated and die leave orphans behind (many of whom are infected with the virus). There are currently over 11 million AIDS orphans! Imaging in HIV infection and AIDS requires skills ranging from interpretation of plain radiographs to MRI scanning of the central nervous system. Children with HIV infection are susceptible to both common and unusual infections, sometimes simultaneously. The radiologist also needs to distinguish changes resulting from HIV infection itself, such as brain shrinkage or cardiomegaly. Furthermore, neurological damage, chronic illness and superinfection compound each other with a variety of complications, such as aspiration and cardiac failure. Neoplasms, such as lymphoma, present radiologically in similar ways to some infections such as TB, when lymphadenopathy can no longer be used as a distinguishing imaging feature. The patient’s condition also affects the diseases that they are most susceptible to, and depending on CD4 levels the composition of a radiological differential diagnosis changes. Moreover, the institution of highly active antiretroviral therapy further complicates image interpretation, especially when the body is able to mount an immune response, resulting in the phenomenon of immune reconstitution inflammatory syndrome (IRIS). Without information from the clinician, the radiologist can become lost in identifying multiple radiological signs without any coherent conclusion and without being able to assist the clinician to manage the patient. Children may be on prophylaxis for pneumocystis, making that an unlikely diagnosis. There may be newonset pyrexia and the suggestion of fungal disease. Coexistent skin lesions may allow the rare diagnosis of Kaposi sarcoma in the lung to be made on radiographic findings. The clinician may depend on radiological identification of lymphadenopathy to start anti-TB treatment. The CD4 count may make some infections or neoplasms less likely and others more likely. Imaging is also useful for follow-up. Disease progression, resolution of acute infections, response to treatment and success of interventions for some complications can be determined this way. Because HIV predominantly affects children in the developing world, imaging research should be geared towards low-cost solutions. However, high-end imaging in Pediatr Radiol (2009) 39:525–526 DOI 10.1007/s00247-009-1279-5

Tuberculomes cérébraux : à propos de six cas

Introduction Despite the resurgence of tuberculosis, partly due to HIV infection, central nervous system involvement remains rare, accounting for only 2 to 5% of all tuberculosis forms. Patients et method We report six cases of brain tuberculomas occurring in patients free of HIV infection and hospitalized between 2001 and 2006 in the internal medicine department of a Tunisian military hospital (Tunis). Results Four patients had an underlying defect. Headache, fever, consciousness disorders, deficit disorder or cerebellar syndrome are the main symptoms. Tuberculomas were multiple and disseminated in four cases and localized in the brain stem in two cases. Positive diagnosis could be established in two cases on the basis of the pathology results of a brain biopsy or detection of Mycobacterium tuberculosis in the cerebrospinal fluid; the diagnosis was presumptive in the other cases. Five patients recovered under antituberculosis treatment maintained on average 13 months (11 to 16 months). Steroid treatment was associated in five patients and tapered off for four to six weeks. One 78-year-old diabetic patient died in a context of cachexia with multiple organ failure.

The resurgence of tuberculosis in the Republic of Ireland: Perceptions and reality

Tuberculosis remained a very significant cause of death in Ireland until the mid-20th century and still occupies a prominent position in the folk memory. As I show with reference to recent Irish media coverage, the global resurgence of tuberculosis is therefore viewed with concern in Ireland. Using data collated by the Health Protection Surveillance Centre between 1998 and 2005 however, I show that the recent increase in tuberculosis incidence in Ireland is less than is popularly perceived. This increase is largely associated with economic immigrants attracted to Ireland by the ‘Celtic Tiger’ economic boom, but there is little evidence to suggest that this has had a negative impact on the Irish-born population. Drug resistance is still a small but growing problem. Whilst vigilance is required, it is argued that the recent increase does not at present indicate a likely return to the situation in the mid-20th century.

Tuberculous ileal perforation in a HIV positive patient: a case report and review of literature.

Tuberculosis is prevalent worldwide. Even in developed countries there is a resurgence of tuberculosis mainly due to increasing HIV infection. Tuberculous ileal perforation is uncommon. It is, however, a potentially fatal complication of intestinal tuberculosis especially in HIV/AIDS patient. To highlight tuberculous ileal perforation as an underestimated complication of intestinal tuberculosis in an HIV patient presenting with acute abdomen. A 42-year-old HIV positive long distance truck driver with tuberculous ileal perforation is presented and related literatures reviewed. Intestinal perforation due to abdominal tuberculosis is an aetiological factor in acute HIV abdomen. High index of suspicion remains the key to diagnosis.