Resurgence Of Tuberculosis Research Articles

Genital Tuberculosis: A New Challenge in an Old Disease

In this issue of the Southern Medical Journal a case of genital tuberculosis (GTB) was reported in a young African refugee woman presenting with primary infertility intermittent pelvic pain and menstrual irregularities. Tuberculosis (TB) is a rare disease in some developed countries but it is a frequent cause of chronic pelvic inflammatory disease (PID) and infertility in other parts of the world. GTB is common in women of childbearing age from developing countries. However GTB is not frequently reported in Southeast Asia including Malaysia which is surprising due to the remarkably high incidence of TB in these areas. This patients HIV status was unknown; however she came from a region that is undoubtedly one of the most affected by the HIV epidemic and the global resurgence of TB. Therefore the incidence of GTB may be higher than one might imagine especially among young women living with HIV/AIDS. It is imperative that clinicians have a high index of suspicion for GTB in young immigrant women presenting with unexplained infertility nonspecific menstrual disturbances/ gynecological problems pain or abdominal distension. Diagnosing GTB remains a challenge for clinicians and is based on clinical grounds and confirmed by laboratory investigations such as a TST. Polymerase chain reaction (PCR) is a rapid sensitive and specific molecular technique for detecting GTB and can be used in combination with other available methods. This technique requires invasively obtained biopsy material and therefore noninvasively obtained samples (eg menstrual blood) are beneficial. Interestingly a few other tests such as the detection of Mycobacterium tuberculosis (MTB) antigens using enzyme-linked immunosorbent assay (ELISA) techniqueor the elevation of serum CA-125 levels have shown promising results. However more studies are warranted to elucidate their usefulness for routine diagnosis. Once GTB is confirmed treatment is straightforward and is basically the same regimen used for pulmonary TB. After completion of treatment 95% of patients are considered cured and the patient should be followed by x-ray urine culture and endometrial sampling.10 Empirical treatment is the other option for treating GTB in women who have the characteristic changes on hysterosalpingogram a positive tuberculin skin test and a strong contact history although such cases lack the classic diagnostic criteria.11 This case report highlights the importance of TB as one of the major causative agents of infertility especially in resource-poor countries. A substantial influx of refugees or migrants from TB-endemic countries may cause a significant increase in the incidence of TB/GTB in the host countries and may potentially impact the future of TB control. (full-text)

Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation

Diseases of the central nervous system (CNS) in patients infected with the human immunodeficiency virus (HIV) result directly from HIV itself or from a variety of opportunistic agents. These infections include progressive multifocal leukoencephalopathy, toxoplasmosis, and cryptococcosis. A resurgence of tuberculosis and neurosyphilis has also been documented. Mass lesions, meningoencephalitis, demyelination, atrophy, and vascular lesions are the commonly encountered imaging findings. The introduction of highly active antiretroviral therapy (HAART) has improved both the clinical and radiologic findings in HIV-infected patients and reduced the number of opportunistic infections. In countries that use HAART, AIDS (acquired immunodeficiency syndrome) dementia complex is becoming the most common neurologic complication of HIV infection, whereas opportunistic infections are still the major cause of neurologic complications in patients from countries that do not commonly use HAART. Immune reconstitution inflammatory syndrome, which occurs in some patients in the weeks to months after the institution of HAART, may alter the typical imaging appearance of infectious diseases involving the CNS. Knowledge of the spectrum of imaging findings of these infectious diseases, as well as the effect that treatment has on imaging appearances, is important in the evaluation of HIV-infected patients.

The Epidemiology of Tuberculosis in the United States

Effective control of tuberculosis (TB) requires an understanding of the changing epidemiology of the disease. An understanding of the epidemiology is needed for public health departments to respond with appropriate program-planning decisions. Following a marked decline in the incidence of tuberculosis in the United States over several decades, the incidence escalated dramatically and peaked in 1992. The resurgence of TB reflected several factors, including deteriorating social conditions, dismantling of the public health infrastructure, dwindling support for tuberculosis clinics and services, the new epidemic of HIV/AIDS with highly susceptible individuals at risk, and immigration of individuals from countries with high rates of TB. Since 1992, there has been a substantial decline in new cases. The success in reducing the tuberculosis burden reflects several factors, including improved public health efforts, physician and patient education, infection control measures, and the use of directly observed therapy (DOT). By 2006, cases of TB in the United States had reached historic lows. Currently, a majority of cases of TB occur in foreign-born individuals, reflecting immigration from countries with high endemic rates of TB. Future efforts to curtail the incidence of TB will require vigilant public health efforts, improving education of patients and health care personnel, identifying mechanisms and routes of transmission, and assuring adequate treatment and prophylactic regimens among infected individuals.

Tuberculosis

A recent resurgence of tuberculosis in the world community has brought the disease into the forefront of communicable disease control. Acknowledging the proven benefits of breast-feeding infants, the question of compatibility arises regarding the safety of breast-feeding an infant in the event of active tuberculosis disease in the mother. This article will discuss the emerging trends of tuberculosis disease and review the evidence that addresses the issues of safety while breast-feeding during tuberculosis treatment.

Impact of HIV on novel therapies for tuberculosis control

The increased risk for tuberculosis in HIV-infected people has fueled a worldwide resurgence of tuberculosis. A major hindrance to controlling tuberculosis is the long treatment duration, leading to default, jeopardizing cure, and generating drug resistance. We investigated how tuberculosis is impacted by reducing treatment duration alone or combined with enhanced case detection and/or cure under different HIV prevalence levels. Our model includes HIV stages I-IV and was calibrated to long-term tuberculosis and HIV data from Kenya. Benefits were assessed in terms of absolute and relative reductions in new tuberculosis cases and deaths. Compared with present-day strategies, at 3-20% HIV prevalence we attain a 6-20% decrease in incidence and mortality in 25 years when reducing treatment duration alone; benefits exceed 300% when combined with increased detection and cure. Benefits vary substantially according to HIV status and prevalence. Challenges arise because in absolute terms the number of infected people and deaths increases dramatically with increasing HIV prevalence, and because the relative efficacy of tuberculosis control policies displays a nonlinear pattern whereby they become less effective on a per capita basis at HIV prevalence levels greater than 15%. Benefits of reducing treatment duration may even be reversed at extreme HIV prevalence levels. Benefits of increasing cure versus detection increase as HIV prevalence increases. Reducing tuberculosis treatment duration, alone or in combination with other control strategies, can provide enormous benefits at high HIV prevalence. Tuberculosis control policies need to account for HIV levels because the efficacy of different interventions varies substantially with HIV prevalence.

Cardiac Tamponade: An Unusual Complication of Simultaneous Treatment of Tuberculosis and HIV

Human immunodeficiency virus (HIV) has caused resurgence in tuberculosis (TB) worldwide. HIV-TB coinfected individuals are at increased risk for complications of TB and HIV treatment, such as adverse drug reactions and immune reconstitution syndrome. A 17-year-old male with HIV-TB coinfection, who developed cardiac tamponade from immune reconstitution during treatment for TB and HIV, is reported in this document.

Tuberculosis Of The Spine In Childhood In Kano, Nigeria

Background: Tuberculosis is a necrotizing bacterial infection with protean manifestation and wide distribution. The involvement of the spine is also increasing because of the resurgence of tuberculosis and HIV. Objectives: The objective of this study is to clinically evaluate the outcome of tuberculosis of the spine in children and to assess the prognosis of the deformity associated with TB spine. Methods: The study was a retrospective chart review of cases with spinal tuberculosis. Cases were those seen in Department of Paediatrics with the diagnosis of tuberculosis of the spine. The methods of management and prognosis were also assessed in the clinic. During follow-up response to treatment as it affects the neurological deficit was assessed. Results: The age distribution was between 8 months and 10 years. The commonest presenting symptoms were swelling at the back in 22 (84.6%). The duration of the swelling before presentation ranged from 4weeks to 2years (mean – 16weeks). Other symptoms included fever, weight loss, anorexia and night sweats. Ninety (73%) of the children were wasted and 22 (84.6%) were febrile. Spinal lesions seen in 22 (84.6%) and there was kyphoscoliosis in 8(30.8%). The most common vertebra involved in the study was the 8th thoracic vertebra. They were all treated conservatively with ant tuberculosis drugs. The deformity in the patients was not cured. Sixteen (61.5%) had spastic paraplegia at presentation while 6 (23.1%) had spastic paraperesis. Two (7.7%) had flacid paraperesis and the other 2 (7.7%) had flaccid paraplegia. Conclusion: Tuberculosis of the spine is still common in children with tuberculosis and treatment does not reverse the deformity associated with it There is therefore a need to explore other ways of managing these cases. Keywords : childhood. spinal, tuberculosis. Highland Medical Research Journal Vol. 4 (2) 2006 pp. 39-43

Epidemiological features of drug resistant tuberculosis in Harare, 1994 to 1996.

To characterise the prevalence, clinical and radiological features of drug resistant tuberculosis in selected patients with pulmonary tuberculosis in Harare between 1994 and 1996. A retrospective review of medical and microbiological records. Beatrice Road Infectious Diseases Hospital, Harare, Zimbabwe. 381 smear-positive tuberculosis patients who had samples submitted to the National Tuberculosis Reference Laboratory for culture and susceptibility testing. Prevalence of resistance of isolated cultures of Mycobacterium tuberculosis to anti-tuberculosis drugs; clinical, radiological and microbiological response to treatment with recommended anti-tuberculosis regimens. Resistance to one or more drugs was detected in 16 isolates (16/165, 9.7%), single drug resistance in five (3.0%) and resistance to two or more drugs in 11 (6.7%). There were no distinctive clinical or radiological features of drug-resistant tuberculosis, although a higher percent of drug resistant cases had evidence of pleural disease (25% vs 2.5%, p = 0.005). Neither past history of tuberculosis or known or suspected HIV infection was associated with the presence of drug resistance. In spite of the resurgence of tuberculosis and the high prevalence of HIV infection in Zimbabwe, the rates of drug resistance have remained relatively low, even among a selected population at high risk of resistance. A significant proportion of cases of drug-resistant tuberculosis appear to be due to new transmission of drug resistant strains, which reinforces the importance of maintaining a surveillance system for the monitoring of drug susceptibility. Ongoing prospective studies should provide more reliable estimates of the prevalence and determinants of drug resistance in Zimbabwe.

Endometrial tuberculosis in the Nigerian middle belt: an eight-year review

Endometrial tuberculosis (TB) is a known cause of infertility in women which, because of the global increase in the spread of TB, should always be considered when investigating the cause of infertility. We undertook this review in order to determine its incidence among infertile women in the Nigerian middle belt. This is a retrospective study of all histopathological slides of infertile women seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1997 and 2004 who were evaluated for infertility by endometrial biopsy. The slides were reviewed and, where necessary, new sections were cut from tissue blocks and stained with haematoxylin and eosin. Ziehl-Neelsen stain used to demonstrate acid-fast bacilli. Clinical reports were extracted from histopathological request form. A total of 661 patients were included in the study. Primary infertility constituted 30%, secondary 69% and unspecified cases 1%. TB endometritis was seen in 0.45%. Endometrial TB is not a frequent cause of infertility in our set-up. However, with the worldwide resurgence of TB, its possible presence should always be taken into consideration.

Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence

BackgroundTuberculosis (TB) remains a major cause of mortality in developing countries, and in these countries diabetes prevalence is increasing rapidly. Diabetes increases the risk of TB. Our aim was to assess the potential impact of diabetes as a risk factor for incident pulmonary tuberculosis, using India as an example.MethodsWe constructed an epidemiological model using data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk of tuberculosis associated with diabetes. We evaluated the contribution made by diabetes to both tuberculosis incidence, and to the difference between tuberculosis incidence in urban and rural areas.ResultsIn India in 2000 there were an estimated 20.7 million adults with diabetes, and 900,000 incident adult cases of pulmonary tuberculosis. Our calculations suggest that diabetes accounts for 14.8% (uncertainty range 7.1% to 23.8%) of pulmonary tuberculosis and 20.2% (8.3% to 41.9%) of smear-positive (i.e. infectious) tuberculosis.We estimate that the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-positive tuberculosis incidence in urban than rural areas – over a fifth of the estimated total difference.ConclusionDiabetes makes a substantial contribution to the burden of incident tuberculosis in India, and the association is particularly strong for the infectious form of tuberculosis. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions, especially in urban areas. This potentially carries a risk of global spread with serious implications for tuberculosis control and the achievement of the United Nations Millennium Development Goals.

Growth Inhibition of Mycobacterium bovis, Mycobacterium tuberculosis and Mycobacterium avium In Vitro: Effect of 1-β-d-2‘-Arabinofuranosyl and 1-(2‘-Deoxy-2‘-fluoro-β-d-2‘-ribofuranosyl) Pyrimidine Nucleoside Analogs

The resurgence of tuberculosis and the emergence of multiple-drug-resistant strains of Mycobacteria necessitate the search for new classes of antimycobacterial agents. We synthesized a series of 1-beta-D-2'-arabinofuranosyl and 1-(2'-deoxy-2'-fluoro-beta-D-ribofuranosyl) pyrimidine nucleosides possessing diverse sets of alkynyl, alkenyl, alkyl, and halo substituents at the C-5 position of the uracil and investigated their effect on activity against M. tuberculosis, M. bovis, and M. avium. Among these molecules, 5-alkynyl-substituted derivatives emerged as potent inhibitors of M. bovis, M. tuberculosis, and M. avium. Nucleosides 1-beta-D-2'-arabinofuranosyl-5-dodecynyluracil (5), 1-(2'-deoxy-2'-fluoro-beta-D-ribofuranosyl)-5-dodecynyluracil (24), and 1-(2'-deoxy-2'-fluoro-beta-D-ribofuranosyl)-5-tetradecynyluracil (25) showed the highest antimycobacterial potency against M. bovis and M. tuberculosis. The MIC90 exhibited by compounds 5, 24, and 25 was similar or close to that of the reference drug rifampicin. The most active compounds 5, 24, and 25 were also found to retain sensitivity against a rifampicin-resistant strain of M. tuberculosis H37Rv at similar concentrations. Some of these analogs also revealed in vitro antimicrobial effect against several other gram-positive pathogens.

Tuberculosis: combating a growing problem

In the past few years there has been much concern over the resurgence of tuberculosis (TB) which has lead to initiatives from the chief medical officer, much press coverage in the lay press, National Institute for Health and Clinical Excellence (NICE) guidance, the setting up of an All-Party Parliamentary Group and most recently a large meeting in London addressed by the chief medical officer and the director of public health for the London Strategic Health Authority to which all chief executives were invited, emphasizing the priority that control of TB now has within the capital.

Tuberculin Testing to Detect Latent Tuberculosis in Developing Countries

Despite the multiple studies done over several decades that have established the utility of the tuberculin skin test (TST) for the diagnosis of latent tuberculosis, the test is rarely used in developing countries experiencing a resurgence of tuberculosis. Nevertheless, several clinical trials have found that treatment of HIV-positive or HIV-negative persons with latent tuberculosis is effective in the prevention of the clinical activation of tuberculosis. Clinicians commonly justify their failure to diagnose and treat latent tuberculosis with the belief that BCG vaccine, even when it is used in infancy, will cause false positive reactivity in the TST. The important study by Gustafson and colleagues from Guinea-Bissau in this issue of the journal refutes this belief. In this study only persons with a history of BCG who also had household contact with an active case of tuberculosis had increased rates of TST positivity. Although the current emphasis is on directly observed therapy, short course (DOTS) to control tuberculosis is necessary and critically important, it is not always sufficient to control the tuberculosis epidemic in some countries with major epidemics of HIV. In many of these countries, early diagnosis of active tuberculosis and prevention of activation of latent tuberculosis will also be needed. The evidence from the Guinea-Bissau study suggests that a history of BCG vaccination should not be an obstacle to the diagnosis and treatment of latent tuberculosis.

Impact of Mobile Radiographic Screening on Tuberculosis among Drug Users and Homeless Persons

In 2002, a mobile radiographic screening program was started in Rotterdam to respond to high rates of tuberculosis (TB) among illicit drug users and homeless persons. We studied trends and characteristics of TB among these risk groups and assessed the impact of the screening program on transmission, using molecular typing. Description of trends, and of demographic and disease-related characteristics of tuberculosis cases among these risk groups between 1993 and 2005. TB was considered to result from recent transmission if the mycobacterial DNA fingerprints of cases were identical to those of other cases in the risk groups in the previous 2 years. During the study period, 206 individuals with TB among illicit drug users and homeless persons were notified, representing 11.4% of the total case load of 1,811 in Rotterdam. The annual number of tuberculosis cases declined from 24 at the start of the screening program to 11 cases in 2005. The screening program identified 28 cases (a prevalence rate of 327 per 100,000 radiographs), of which 12 were smear positive. In 1997-2002, more than 80% of the illicit drug users or homeless persons with TB were infected with one of the Mycobacterium tuberculosis strains prevalent among these risk groups. After nearly 4 years of systematic radiographic screening this proportion declined to 45% in 2005. DNA fingerprinting can be a useful tool to evaluate the impact of a TB screening program. We advocate that screening of illicit drug users and homeless persons should be continued to prevent a resurgence of TB.

A Single Surgical Unit’s Experience with Abdominal Tuberculosis in the HIV/AIDS Era

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has resulted in a resurgence of abdominal tuberculosis in South Africa, and these patients often present to general surgeons. We describe a single-hospital experience in a region of high HIV prevalence. A prospective database of all patients with suspected abdominal tuberculosis was maintained from January 2003 until July 2005. There were 67 patients (20 men, 47 women) with an average age of 32 years (range 27-61 years). The erythrocyte sedimentation rate was universally elevated (105 +/- 23). Altogether, 23 patients were HIV-positive and 7 were HIV-negative. The status was unknown in the remainder. Chest radiographs demonstrated an abnormality in 17 patients (22%). Abdominal ultrasonography was performed in 59 patients and computed tomography in 12. Twelve laparotomies were performed, seven as emergencies. None in the elective laparotomy group died, whereas the mortality rate in the emergency group was 60%. Laparoscopy was insufficient for a variety of reasons. Two patients underwent appendectomy and two excision of a perianal fistula. Two patients underwent biopsy of a palpable subcutaneous node, which confirmed the diagnosis in both cases. A definitive diagnosis was achieved in all 12 patients subjected to laparotomy and at colonoscopic biopsy in 2, lymph node biopsy in 2, appendectomy in 2, perianal fistulectomy in 2, and percutaneous drainage in 2. In the remaining 47 patients the diagnosis was made on the basis of the clinical presentation and radiologic imaging. The patients were commenced on antituberculous therapy. The in-hospital mortality in this group was 10%. Therapy was continued at a centralized tuberculosis facility independent of the hospital. Surgical follow-up was poor, with only five (7%) patients completing the 6-month review at a surgical clinic. A resurgence in tuberculosis during the HIV era produces a new spectrum of presentations for the surgeon. Emergency surgery is associated with high mortality. Bacterial and histologic evidence of infection are difficult to obtain, and indirect clinical and imaging evidence are used to commence a trial of therapy. A short-term clinical response is regarded as proof of disease. Lack of follow-up means that the efficacy of this strategy is unproven. Health policy changes are needed to enable appropriate surgical follow-up to determine the most effective management algorithm.

Primary nasal Tuberculosis — A case report

During the past two decades, Tuberculosis - both pulmonary and extrapulmonary have re-emerged as a major health problem worldwide. Nasal tuberculosis may be primary, or secondary to pulmonary tuberculosis or facial lupus. However all of them are rare entities. Nasal tuberculosis should be considered in the differential diagnosis of chronic nasal granulomas. We report a case of primary nasal tuberculosis in an adult female who presented with a polypoidal lesion in the nasal cavity. The diagnosis was based upon smear study, histopathology, culture & polymerase chain reaction. The patient successfully responded to antituberculous therapy and is presently disease free. Given the resurgence of tuberculosis in recent times, it is important that otolaryngologists remain aware of this rare clinical entity.

Schwannoma with concomitant tuberculosis in the adrenal gland

Schwannoma is a rare primary tumor originating in the neural sheath with a good prognosis. The management is surgical. We present a case in which a retroperitoneal mass arising from the adrenal gland was excised and histopathology revealed a schwannoma with coexisting tuberculosis. This case report highlights the need to be aware of the potential coexistence of tuberculosis in any case of incidentaloma, especially due to resurgence of tuberculosis as a global epidemic with the increasing incidence of HIV and AIDS. To the best of our knowledge, this is the first reported case of a schwannoma and tuberculosis coexisting in the adrenal gland.

Isolated tuberculosis of Achilles tendon

Although uncommon in developed world, tuberculosis is one of the most dreaded diseases in the under-developed and developing countries. Resurgence of tuberculosis and its increasing incidence, with widespread HIV infection has lead to the reporting of infections at unusual sites. Tubercular tenosynovitis not involving bone is an extremely rare and perplexing presentation. A rare case of isolated tuberculosis of Achilles tendon without any evident primary contiguous or distant focus in a 55-year-old immunocompetent male is presented.

Cutaneous tuberculosis in children and adolescents: a clinicohistological study

Resurgence of tuberculosis (TB) in the era of human immunodeficiency virus (HIV) has rejuvenated the interest in this global health problem. Cutaneous TB, an important extra-pulmonary form in children, is commonly seen in our dermatological practice. As detection of acid-fast bacillus (AFB) on smear or culture is not always positive, histopathology is necessary to help in diagnosing and classifying the variants of skin TB. The current study was conducted to analyse the clinicopathological characteristics of cutaneous TB in children and adolescents. This prospective study included 103 patients (age<19 years). A detailed history and clinical examination was followed by complete investigative work up including fine needle aspiration cytology and culture. Histopathological evaluation was performed specifically noting the epidermal and dermal features. The patients were followed up regularly for one year after the start of treatment. The different patterns of cutaneous TB seen were, scrofuloderma 38 (36.9%), lichen scrofulosorum 34 (33%), lupus vulgaris 22 (21.3%), TB verrucosa cutis 4 (3.9%), papulonecrotic tuberculid 4 (3.9%) and erythema nodosum 3 (2.9%). Systemic associations were seen in 55 (53.4%) patients, namely TB lymphadenitis in 30 (29.2%), pulmonary TB in 13 (12.6%), abdominal TB in 6 (5.8%) and TB arthritis in 6 (5.8%). The histopathological corroboration of clinical diagnosis was seen in 65.7% of cases of scrofulodermas, 72.7% of cases of lupus vulgaris and 67.6% of cases of lichen scrofulosorum. A large spectrum of clinical patterns and histological characteristics of cutaneous TB exists in children. Lichen scrofulosorum is more commonly seen in comparison to adults. Systemic involvement was a feature in a major proportion of our patients.

Tuberculosis and HIV Infection

istorically, the unprecedented resurgence of tuberculosis (TB) in the nited States (U.S.), peaking in the early 1990s, coincided with the rowing human immunodeficiency virus (HIV) epidemic. Since that ime, with the introduction of highly active antiretroviral therapy HAART) and successful implementation of treatment and infection ontrol measures, the number of patients infected with HIV and TB is eclining in the U.S. However, worldwide rates remain impressively igh with approximately one-third of the 40 million HIV-infected persons o-infected with TB. In 2006, TB still remains a major opportunistic nfection in HIV-infected patients, often the first indication of immunoeficiency. Several important factors associated with HIV have characteristically romoted the spread of TB, including the atypical clinical presentations of B, the reduced sensitivity of the tuberculin skin test (TST) in HIVnfected persons, lack of compliance with and toxicity of chemotherapy, nadequate infection control, and the emergence of drug-resistant strains f Mycobacterium tuberculosis. However, unlike other opportunistic nfections associated with HIV, TB is unique in that it may be readily ransmitted to immunocompetent individuals via the respiratory route, can ccur at any stage of HIV infection, and maintenance therapy is not ecessary after an adequate course of therapy. Physicians should be aware hat the epidemiology, clinical manifestations, and management of uberculosis are altered in HIV-infected patients. HIV testing is recomended for all suspected or confirmed cases of TB.