Anti-tuberculosis Drug Treatment Research Articles

Recurrent Hemoptysis Post Re-Embolization in a 49 Year-Old Male with Post Tuberculosis Lung Disease (PTLD) and Bronchiectasis

Introduction: Hemoptysis is a symptom of lung disease, could be caused by lung infections, structural disorders of the lung, malignancy or disorders from outside of the lung. One of the pulmonary intervention for hemoptysis is embolization with a success rate > 70%, but the recurrence rate reaches 10-55%. The prognosis is poor depending on the amount of bleeding (untreated cases can have a mortality risk of over 50%), etiology and presence of recurrences.
 Case Illustration: A 49-year-old Male came to the policlinic with recurrent hemoptysis for a year. Non-smoker. History of Lung Tuberculosis (TB), completed treatment 15 years ago. Imaging result showed widening of the right subcostal artery, right posterior intercostal artery, bronchiectasis, active lung tuberculosis and left pulmonary emphysema. First embolization was done during Anti-Tuberculosis Drug (ATD) treatment for 6 months. Symptom of hemoptysis reappeared, then second embolization and fiber optic bronchoscopy (FOB) was performed. From the evaluation, he was diagnosed with infected bronchiectasis and PTLD, therefore given antibiotic medications for 2 weeks.
 Discussion: Embolization had been done twice in this case, no significant result. Based on literature, recurrent hemoptysis can still occur with a percentage about 10-55% after embolization and in this case, it might be caused by previous lung structural disorder and lung infections (Lung TB and Infected bronchiectasis).
 Conclusion: Although embolization has a success rate of > 70% for hemoptysis treatment, recurrence can still occur and highly dependent on the cause itself and patient's previous lung condition.
 Keywords: Hemoptysis, Embolization, Bronchiectasis, FOB, Lung TB, PTLD, ATD

Effect of Intensive Phase Anti-tubercular Treatment on Hematological Parameters in Pulmonary Tuberculosis in Children

Aim and objectives: To study the effect of intensive phase ATI on various hematological parameters in pulmonary TB in children. Material and methods: Study design: Prospective observational study. Children were chosen at random from children who were identified and diagnosed at the Dr. Ram Manohar Lohia Hospital in New Delhi's Atal Bihari Vajpayee Institute of Medical Sciences using a straightforward sampling technique. Every patient is diagnosed with pulmonary tuberculosis based on RNTCP standards. The research was conducted from November 2019 to March 2021 (one year four months). Results: Hemoglobin count (t-value -2.914), Red Blood Cells (t-value -4.338), Platelet Count (t-value -4.762), Lymphocytes (t-value -4.472), Monocyte (t-value 5.991),ESR count (t-value 5.118), Packed Cell Volume (t-value -4.228), Mean Corpuscular Volume (t-value -3.418), Platelet Large Cell Ratio (t-value -4.254), C-reactive count (t-value 3.131), Ferritin (t-value 4.747), X-ray (t-value 5.213) significant at <0.05 level respectively. Conclusion: The various parameters used in the study as the inflammatory process have an extremely important part in the TB pathogenesis. These parameters can be used as markers can be used for prognosis, response to treatment, and follow-up purposes. It can increase the predicting accuracy of treatment outcomes as ones can monitor the TB cases objectively in addition to subjective parameters (improvement in clinical symptoms and examination findings, weight gain, Increase in appetite). Anti-tuberculosis Drug Treatment (ATT) is highly successful in enhancing hematological parameters, which suggests that responders' immune responses have improved in an indirect manner.

Assessment of Factors Associated With Anti-Tubercular Treatment Compliance in Children: A Cross-Sectional Study.

Objective. This study aims to investigate compliance and the influencing factors related to pediatric tuberculosis patients who are undergoing treatment with anti-tuberculosis drugs in the Sichuan Province of China. Methods. A questionnaire survey was conducted between March 2019 and March 2021. The survey was distributed to caregivers of children aged 0 to 14 who had been diagnosed with pulmonary tuberculosis. These children had been receiving oral anti-tuberculosis drug treatment for more than 1 month. The survey was administered at the pediatric infection departments of West China Second University Hospital, Sichuan University, and The First People's Hospital of Ganzi Prefecture. Results. The study revealed a notable lack of medication adherence among the pediatric patients. Through multiple linear regression analysis, it was determined that several factors played a role in influencing medication adherence among children with tuberculosis. These factors include the educational level of the parents, the frequency of daily anti-tuberculosis drug prescriptions, and the parents' comprehension of the disease. All of these factors showed statistically significant influence on medication adherence among pediatric tuberculosis patients (all P < .05). Conclusion. In order to enhance adherence among pediatric patients undergoing anti-tuberculosis treatment, it is imperative to focus on reinforcing health education, particularly for parents with lower educational attainment and limited understanding of the disease.

Pengkajian Tingkat Kepatuhan Pasien Dewasa tentang Pengobatan Penyakit Tuberkulosis

This study aims to assess the suitability of adult patients at Unggul Karsa Medika Hospital with their TB treatment. The research method used is descriptive quantitative research relying on numerical data collected, clarified based on the actual situation in the field, and ultimately used as a basis for drawing conclusions. This research is survey research. Research results from 56 respondents; 52 (or 93%) of these people were following the prescribed anti-tuberculosis drug treatment, whereas only 4 (or 7%) of these people were not. The conclusions from the results of the questionnaire show that Unggul Karsa Medika Hospital personnel have done a good job in educating and guiding TB patients in undergoing treatment. Based on the data, pulmonary TB patients at Unggul Karsa Medika Hospital are in the compliant category.&#x0D; &#x0D; Keywords: Compliance, Anti-TB, Tuberculosis

Management of Extensive Subcutaneous Emphysema with Blow Hole Infraclavicular Incision and Continuous Suction Installation

Background: Subcutaneous emphysema often occurs in cases of implanted pneumothorax chest tubes and must always be evaluated. Subcutaneous emphysema is a condition where air or gas is found in the tissue under the skin.&#x0D; Case presentation: A 49-year-old man was treated for sudden shortness of breath that occurred after a violent cough accompanied by pain and heaviness in the chest area 1 day before admission to the hospital. The patient had previously received anti-tuberculosis drug treatment for 6 months based on chest X-ray results in 2022, and the patient had undergone a rapid molecular test (TCM) examination, mycobacterium tuberculosis (Mtb), and obtained Mtb results not detected. Lung auscultation obtains sound intensity breath weakness until it disappears in both lung fields. Palpation of the skin revealed widespread crepitus on the face, neck, upper extremities, back, chest, and abdomen. The range of motion areas of the neck, shoulders, and hands are limited due to pain with movement. Evaluation of the chest tube obtained: the chest tube was installed in the anterior axillary line on the right at the level of the 5th intercostal space with number 10 attached to the chest wall and the chest tube well fixed to the chest wall. The end chest tube has been connected to the WSD bottle, and evaluation of the WSD shows that there are undulations and bubbles.&#x0D; Conclusion: The patient was admitted with spontaneous pneumothorax secondary to tuberculosis and was implanted with a chest tube.

Near-infrared molecular sensor for visualizing and tracking ONOO- during the process of anti-tuberculosis drug-induced liver damage.

Isoniazid (INH) and pyrazinamide (PZA) are both the first-line anti-tuberculosis drugs in clinical treatment. It is notable that there are serious side effects of the drugs along with upregulation of reactive nitrogen species, mainly including peripheral neuritis, gastrointestinal reactions, and acute drug-induced liver injury (DILI). Among them, DILI is the most common clinical symptom as well as the basic reason of treatment interruption, protocol change, and drug resistance. As vital reactive nitrogen species (RNS), peroxynitrite (ONOO-) has been demonstrated as a biomarker for evaluation and pre-diagnosis of drug-induced liver injury (DILI). In this work, we developed a red-emitting D-π-A type fluorescence probe DIC-NP which was based on 4'-hydroxy-4-biphenylcarbonitrile modified with dicyanoisophorone as a fluorescent reporter and diphenyl phosphinic chloride group as the reaction site for highly selective and sensitive sensing ONOO-. Probe DIC-NP displayed a low detection limit (14.9 nM)and 60-fold fluorescent enhancement at 669 nm in the sensing of ONOO-. Probe DIC-NP was successfully applied to monitor exogenous and endogenous ONOO- in living HeLa cells and zebrafish. Furthermore, we verified the toxicity of isoniazid (INH) and pyrazinamide (PZA) by taking the oxidative stress induced by APAP as a reference, and successfully imaged anti-tuberculosis drug-induced endogenous ONOO- in HepG2 cells. More importantly, we developed a series of mice models of liver injury and investigated the hepatotoxicity caused by the treatment of anti-tuberculosis drugs. At the same time, H&E of mice organs (heart, liver, spleen, lung, kidney) further confirmed thecompetence of probe DIC-NP for estimating the degree of drug-induced liver injury, which laid a solid foundation for medical research.

Comparison of Sputum Evaluation Conversion of Pulmonary TB patients with DM and non-DM in High Burden Setting

ABSTRACT&#x0D; Background&#x0D; Tuberculosis (TB) remains a global health problem and is one of the leading causes of death worldwide. By 2022, an estimated 10 million people will suffer from TB worldwide. Based on data from the Global Tuberculosis Report in 2022, Indonesia ranks second as a high-burden country in the world after India. An estimated 1.5 million people die from tuberculosis, becoming the 13th leading cause of death worldwide and the second most deadly infectious disease after COVID-19.&#x0D; Currently, many new cases of TB are influenced by several risk factors, one of which is Diabetes Mellitus (DM). Pulmonary TB is a potential opportunistic infection for people with Diabetes Mellitus. TB patients with DM are at risk of sputum conversion failure after TB treatment, 1.69 times higher risk of treatment failure, 1.24 times higher risk of anti-TB drug resistance, 3.89 times higher risk of relapse, and 4.95 times higher risk of death during treatment compared to TB patients.&#x0D; Aim of Study&#x0D; To evaluate the sputum smear conversion results at the end of the second month of treatment of patients with Tuberculosis with Diabetes Mellitus (TB-DM) and Tuberculosis Non-Diabetes Mellitus (TB-NDM).&#x0D; Methods&#x0D; This research was analytical with a retrospective cohort design by taking secondary data from the Tuberculosis Information System (SITB). The data were recorded in SITB and registered as TB patients undergoing Anti-Tuberculosis Drug treatment and screening for Diabetes Mellitus in all districts in West Nusa Tenggara Province in 2022.&#x0D; Results&#x0D; Among 200 patients with TB in this study, male patients dominated 62% of TB patients. TB patients are mostly found in the age group 46-55 years with 28,5%. Generally, TB patients come from Mataram, with an 18% percentage. Most TB patients were diagnosed using GeneXpert (80,5%). The sputum conversion rate at the end intensive phase in TB-DM patients reached 95%, while in TB-NDM patients, only 85%. The comparative test showed a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM (p-value: 0.018, p&lt;0.05).&#x0D; Conclusion &#x0D; There is a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM.&#x0D; &#x0D; Keywords : Diabetes, diabetes mellitus, sputum conversion, tuberculosis, TB, DM

A nomogram model to predict the risk of drug-induced liver injury in patients receiving anti-tuberculosis treatment.

Objectives: To establish an individualized nomogram to predict the probability of drug-induced liver injury (DILI) in tuberculosis patients receiving anti-tuberculosis treatment. Methods: The clinical information of patients admitted to a tertiary hospital between January 2010 and December 2022 was retrospectively reviewed from the clinical records. Patients with baseline liver diseases (hepatis B or C infection and fatty liver) or taking liver protective drugs were excluded. The maximum values in liver function test within 180days after anti-tuberculosis treatment were collected to determine the occurrence of DILI. The candidate variables used for establishing prediction model in this study were the last results within the 30days before the treatment onset. The final variables were included after univariate and multivariate logistic regression analyses and applied to establish the nomogram model. The discrimination power and prediction accuracy of the prediction model were assessed using the area under the receiver operating characteristic (AUC) curve and a calibration chart. The clinical effectiveness was assessed via decision curve analysis (DCA). The established model was validated in two validation groups. Results: A total of 1979 patients with 25 variables were enrolled in this study, and the incidence of DILI was 4.2% (n = 83). The patients with complete variables were divided into training group (n = 1,121), validation group I (n = 492) and validation group II (n = 264). Five variables were independent factors for DILI and included in the final prediction model presented as nomogram: age (odds ratio [OR] 1.022, p = 0.023), total bilirubin ≥17.1μmol/L (OR 11.714, p < 0.001), uric acid (OR 0.977, p = 0.047), neutrophil count (OR 2.145, 0.013) and alcohol consumption (OR 3.209, p = 0.002). The AUCs of the prediction model in the training group, validation group I and validation group II were 0.833, 0.668, and 0.753, respectively. The p-values of calibration charts in the three groups were 0.800, 0.996, and 0.853. The DCA curves of the prediction model were above the two extreme curves. Conclusion: The nomogram model in this study could effectively predict the DILI risk among patients under anti-tuberculosis drug treatment.

Perbandingan Kadar HB Sebelum dan Sesudah Pengobatan Oat Fase Intensif pada Penderita Tuberkulosis Paru di Puskesmas Petanahan Kebumen Tahun 2021

Treatment of tuberculosis with main anti-tuberculosis drugs (OAT) includes isoniazid (INH), rifampin (RIF), ethambutanol (EMB), streptomycin (SM), and pyrazinamide (PZA). Although most Anti-Tuberculosis Drugs (OAT) are acceptable in therapy, they have potential side effects, including the side effects of hematological reactions such as anemia. This study's purpose was to compare HB levels before and after the intensive phase of Anti-Tuberculosis Drugs treatment in TB patients at Petanahan Public Health Care Center, Kebumen Regency. This was an analytic observational study with a cross-sectional design. The sample in this study was 28 people. The result showed that the average Hb level of pulmonary TB patients at Petanahan Public Health Care Center before and after the treatment were 11.05 g/dl and 11.6 g/dl, respectively. Therefore there was an effect of comparing Hb levels before and after the intensive phase of Anti-Tuberculosis Drugs treatment in pulmonary TB patients at the Petanahan Public Health Center in 2021. The increase in the average Hb levels of patients with pulmonary TB before and after the treatment was 0.55. The sig values obtained from the analysis of Hb levels before and after the treatment were a = 0.200 (p0.005) and 0.023, respectively. Due to the P value (0.023 &lt; 0.05), Ho was rejected. It meant that there was a difference in Hb levels before and after the Intensive Phase of Anti-Tuberculosis Drugs treatment in patients with pulmonary TB at Petanahan Public Health Care Center, Kebumen Regency.

A novel predictive model of perioperative blood transfusion requirement in tuberculous spondylitis patientsundergoing posterior decompression and instrumentation.

Retrospective study. The aim of this study was to develop apredictive model for determining perioperative blood transfusion in tuberculous spondylitis patients undergoingposterior decompression and instrumentation. Tuberculous spondylitis is a common infection found in the spine. This condition may result in the need of surgical treatment, especially when there is a delay in diagnosis with inadequate antituberculosis drug treatment. The procedure results in high amount of bleeding on many occasions, leading to the higher rate of intraoperative transfusion.We develop a predictive model that can be used to determine blood transfusion requirement in spinal tuberculosis surgery. We reviewed the medical records of 83 tuberculous spondylitis patients who underwent posterior decompression and instrumentation. The clinical characteristics of the patients were analyzed using bivariate and multivariate regression test. The impact and strength of these variables was assessed to predict the probability of intraoperative red blood cell transfusion presence based on unstandardized beta, standard error, receiver operating characteristic, and confluence of sensitivity and specificity curve analyses. Furthermore, validation of this newly proposed predictive scoring system was performed using a set of 45 patients. The factors that significantly affect the need of blood transfusion during posterior spondylitis tuberculosis surgery were BMI (p = 0.005), pre-operative Hb (p < 0.001), number of affected segments (p = 0.042), and duration of surgery (p = 0.003). Our predictive model showed good sensitivity and specificity values based on a large area under the curve (0.913) and strong Pearson's r testing (correlation coefficient of 0.752). Validation set also resulted a large area under the curve (0.905) and strong correlation coefficient of 0.713. BMI, pre-operative Hb, number of affected segments, and duration of surgery became the significant factors which correlated to the presence of red blood cell transfusion in patients undergoing posterior spondylitis tuberculosis surgery. This predictive scoring system can be used to further adjust blood matching and inventory, determine intraoperative blood management, and ensure the safety of surgery in a comprehensive manner.

Ocular Mycobacterium haemophilum infection originating in the cornea: a case report

BackgroundMycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised population or in children. Primary infection of the healthy adult cornea is rare. The special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical manifestation and treatment process of corneal infection and notify the awareness of M. Haemophilus keratitis among clinicians. This is the first case report of primary M. haemophilum infection in the cornea of healthy adults reported in the literature.Case presentationA 53-year-old healthy goldminer presented with left eye redness and a history of vision loss for four months. The patient was misdiagnosed with herpes simplex keratitis until M. haemophilum was detected using high-throughput sequencing. Penetrating keratoplasty was performed, and a large number of mycobacteria were detected by Ziehl-Neelsen staining of the infected tissue. Three months later, the patient developed conjunctival and eyelid skin infections that manifested as caseous necrosis of the conjunctiva and skin nodules. After excision and debridement of the conjunctival lesions and systemic antituberculosis drug treatment for 10 months, the patient was cured.ConclusionM. haemophilum could cause primary corneal infection in healthy adults, which is an infrequent or rare infection. Owing to the need for special bacterial culture conditions, conventional culture methods do not provide positive results. High-throughput sequencing can rapidly identify the presence of bacteria, which aids in early diagnosis and timely treatment. Prompt surgical intervention is an effective treatment option for severe keratitis. Long-term systemic antimicrobial therapy is crucial.

Thyroid Profile of Childhood Tuberculosis Treated with Anti Tuberculosis Drug During Intensive Phase

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The incidence is 10 % in children. Tuberculosis has high morbidity and mortality which needs adequate treatment. The side effects of FDC is thyroid hormone dysfunction which can interfere children's quality of life. However, research about the effect of FDC therapy on thyroid hormone profile in children with TB are very limited. Objective: To determine the effect of anti-tuberculosis drug treatment on thyroid hormone profile in paediatric tuberculosis. Methods: A one group pretest-posttest design study of 50 patients was conducted at the Semarang Health Center for the period January 2021-June 2021. Thyroid function tests of TSH, FT4 and T3, in TB children were measured before FDC therapy and 2 months after administration. The data were analysed descriptively and a comparative test was performed using SPSS 25.Results: There were no significant differences in TSH, FT4 and T3 serum levels before FDC therapy and 2 months of FDC administration. Thyroid hormone levels before treatment and 2 months after administration of FDC, respectively, euthyroid in 44 vs 42 patients.Conclusion: Two months of tuberculosis treatment in children decreased the serum FT4 and T3 level but no changes in the serum TSH level before and after the treatment.

Pulmonary TB in Pregnancy

Objective : To report a case of pulmonary TB in pregnancyMethod : A case reportCase : Presented a case of cpulmonar TB in pregnancy on 33-year-old patient. This is fifth pregnancy with twice history of abortion, malnutrition and pulmonary TB (in treatment). The result of chest x-rays was pulmonary TB. The patient was on treatment for anti-tuberculosis drugs for second month. Patient had BMI was 16,88 kg/m2 which is underweight category. There were bronchovesicular and ronchi from both side of lung from auscultation examination. From laboratory findings there was decrease of albumin serum levels to 2,1 gr%. From ultrasound got impression 16-17 weeks of pregnancy. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE). During hospitalization treatment, patient was given some nutrition consultation and high calories and high protein diet and also extra 3 egg whites per day. Total calories are 2250 kcal. Patient also got 1 infuse bottle of albumin and albumin supplementation.Discussion : . The incidence of TB in pregnancy was 1/10,000 pregnancies. .. Provision of an appropriate and adequate chemotherapy regimen will improve the quality of life of the mother, reduce the side effects of anti-tuberculosis drugs (OAT) on the fetus and prevent infection in newborns. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE) which is no difference theraphy with no-pregnant patient. Patient was not given pyridoxine as adjuvant drugs along with the anti- tuberculosis drugs. Pyridoxine supplementation must be given with the dose of 50 mg/day and is suggested for every pregnant woman who consumes isoniazid because the deficiency often happens in pregnancy than general population.Conclusion The diagnosis of this patient was correct based on anamnesis, physical examination, and supporting test . Active TB treatment in pregnancy doesn’t have any difference with non-pregnant. The management of this patient is not correct because the patient didn’t get pyridoxine supplementation, didn’t undergo sputum test in second month, and wasn’t done culture M. Tuberculosis as a gold standard.Â

Clinical Efficacy of Dexamethasone in the Treatment of Patients with Tuberculous Meningitis: A Meta-Analysis.

Objective This study aimed to systematically evaluate the clinical efficacy of dexamethasone in patients with tuberculous meningitis (TBM) through meta-analysis. Method PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and the Wanfang Databases were searched, and all relevant Chinese and English literature from 2000 to 2021 were retrieved from each database. We collected randomized controlled trials of conventional antituberculosis drugs combined with dexamethasone treatment (treatment group) and conventional antituberculosis drug treatment or combined with placebo treatment (control group) in TBM patients. Meta-analysis was performed with Stata16.0 software. Results A total of 1645 articles were retrieved, and 11 articles were finally included in the study. Meta-analysis results showed that the treatment group had a significantly higher response rate and lower incidence of adverse reactions compared with the control group. Additionally, compared with the control group, the postoperative cerebrospinal fluid cell count, protein content, and glucose in the treatment group were significantly lower, while the chloride level increased. Conclusion Conventional antituberculosis drugs combined with dexamethasone therapy can improve cerebrospinal fluid cell count, protein content, glucose, and chloride levels in patients with TBM. This treatment can improve the treatment effective rate and reduce the incidence of adverse reactions, which is considered an effective treatment for TBM. Our results provide strong evidence for enhancing existing treatment regimens and developing novel combination therapy to improve TBM treatment efficacy.

Hip Tuberculosis at Stage IV: Outcomes and Some Conditions for Total Hip Replacement

Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.

Musculoskeletal Tuberculosis

Tuberculosis (TB) remains the most common cause of death from infectious disease world-wide. In the UK, the incidence of TB has risen by 25% over the last 10 years; and almost one third of all case of tuberculosis are found in South East Asia. Extrapulmonary diagnosis remains challenging and can be delayed. This study evaluates the all aspect of musculoskeletal tuberculosis. To know an overview of general musculoskeletal tuberculosis; indentify the characteristic of patien with musculoskeletal tuberculosis; knowing the prevalance of musculoskeletal tuberculosis and how to treat musculoskeletal tuberculosis patien properly. This reserch use Literatur-Review method. Extra-pulmonary TB and is most often found in the spine, which is about 50% of all cases of tuberculosis of the musculoskeletal system. The common lesions in skeletal TB consist of osteomyelitis and arthritis. The most common signs and symptoms are spinal pain accompanied by weakness of the legs and neurological deficits. In addition, gibbus, swelling and limitation of motion in the joints can occur. Management in cases of musculoskeletal tuberculosis is treat the main etiologic in this case usually mycobacterium tuberculosis with anti-tuberculosis drug treatment

DNA Methyltransferase HsdM Induce Drug Resistance on Mycobacterium tuberculosis via Multiple Effects.

Besides the genomic variants, epigenetic mechanisms such as DNA methylation also have an effect on drug resistance. This study aimed to investigate the methylomes of totally/extensively drug-resistant M. tuberculosis clinical isolates using the PacBio single-molecule real-time technology. The results showed they were almost the same as the pan-susceptible ones. Genetics and bioinformatics analysis confirmed three DNA methyltransferases—MamA, MamB, and HsdM. Moreover, anti-tuberculosis drug treatment did not change the methylomes. In addition, the knockout of the DNA methyltransferase hsdM gene in the extensively drug-resistant clinical isolate 11826 revealed that the motifs of GTAYN4ATC modified by HsdM were completely demethylated. Furthermore, the results of the methylated DNA target analysis found that HsdM was mainly involved in redox-related pathways, especially the prodrug isoniazid active protein KatG. HsdM also targeted three drug-targeted genes, eis, embB, and gyrA, and three drug transporters (Rv0194, Rv1410, and Rv1877), which mildly affected the drug susceptibility. The overexpression of HsdM in M. smegmatis increased the basal mutation rate. Our results suggested that DNA methyltransferase HsdM affected the drug resistance of M. tuberculosis by modulating the gene expression of redox, drug targets and transporters, and gene mutation.

Appendicular Tuberculosis as Manifestation of Gastrointestinal Tuberculosis: A Case Report

Introduction: Gastrointestinal tuberculosis (GI TB) is quite rare with 3% incidence of all extrapulmonary involvement. Appendicular TB may occur in 0.1 - 3% of cases. Diagnosis is often difficult because the patient usually complains about chronic abdominal pain and fever. A definite diagnosis is based on histopathological examination of resected specimens from the appendectomy procedure.Case: We present a 37-year-old male patient admitted to the hospital with chronic abdominal pain, fever, nausea, and loss of body weight. The patient never had a persistent cough, hemoptysis, or night sweating. Physical examination showed pain and muscular rigidity in the right iliac area during palpation with Blumberg's sign and Rovsing's sign positive. Abdomen ultrasound imaging showed an appendicular abscess. The patient underwent appendectomy afterwards with histopathology result showing TB. The patient was treated with first category anti-tuberculosis drugs (ATD).Discussion: Diagnosis of appendicular TB is difficult due to unspecific clinical presentations. Appendicular TB patients often complain of signs and symptoms which are similar to acute appendicitis. These conditions can delay ATD treatment because the definitive diagnosis could be made after histopathological examination.Summary: Appendicular TB is a rare case of extrapulmonary TB. It can present as acute appendicitis. The definitive diagnosis is based on the histopathological examination. It is recommended to check the appendicectomy specimens histopathologically to exclude TB or other diseases.

Pulmonary TB in Pregnancy

Objective : To report a case of pulmonary TB in pregnancyMethod : A case reportCase : Presented a case of cpulmonar TB in pregnancy on 33-year-old patient. This is fifth pregnancy with twice history of abortion, malnutrition and pulmonary TB (in treatment). The result of chest x-rays was pulmonary TB. The patient was on treatment for anti-tuberculosis drugs for second month. Patient had BMI was 16,88 kg/m2 which is underweight category. There were bronchovesicular and ronchi from both side of lung from auscultation examination. From laboratory findings there was decrease of albumin serum levels to 2,1 gr%. From ultrasound got impression 16-17 weeks of pregnancy. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE). During hospitalization treatment, patient was given some nutrition consultation and high calories and high protein diet and also extra 3 egg whites per day. Total calories are 2250 kcal. Patient also got 1 infuse bottle of albumin and albumin supplementation.Discussion : The incidence of TB in pregnancy was 1/10,000 pregnancies. Provision of an appropriate and adequate chemotherapy regimen will improve the quality of life of the mother, reduce the side effects of anti-tuberculosis drugs (OAT) on the fetus and prevent infection in newborns. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE) which is no difference theraphy with no-pregnant patient. Patient was not given pyridoxine as adjuvant drugs along with the anti- tuberculosis drugs. Pyridoxine supplementation must be given with the dose of 50 mg/day and is suggested for every pregnant woman who consumes isoniazid because the deficiency often happens in pregnancy than general population.Conclusion The diagnosis of this patient was correct based on anamnesis, physical examination, and supporting test . Active TB treatment in pregnancy doesn’t have any difference with non-pregnant. The management of this patient is not correct because the patient didn’t get pyridoxine supplementation, didn’t undergo sputum test in second month, and wasn’t done culture M. Tuberculosis as a gold standard.Keywords: tuberculosis, pulmonary TB, pregnancy, anti tuberculosis drugs, pyridoxine

Rifapentine Polylactic Acid Sustained-Release Microsphere Complex for Spinal Tuberculosis Therapy: Preparation, in vitro and in vivo Studies

PurposeSpinal tuberculosis has been a common clinical extrapulmonary tuberculosis in recent years. The general anti-tuberculosis drug treatment cycle is long, with unsatisfactory efficacy. This study focused on the preparation and evaluation of rifapentine polylactic acid sustained-release microsphere complex for spinal tuberculosis therapy.MethodsRifapentine polylactic acid sustained-release microspheres (RPSMs) were prepared through the double emulsion solvent evaporation method, and RPSMs were combined with hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) composite material to obtain drug-loaded, sustained-release complex. We evaluated the complex for dynamics of drug release and osteogenic ability using in vitro release test, alkaline phosphatase and alizarin red staining, real-time PCR and Western blot. A rabbit model of a spinal tuberculosis defect was established and repaired using HA/β-TCP or complex. The ability of anti-tuberculosis and tissue repair effects of the complex were evaluated through in vivo experiments.ResultsThe complex constructed of RPSMs and HA/β-TCP demonstrated a long drug release time, with no significant inhibition of cell osteogenic differentiation in vitro experiments. Postoperative macroscopic observation, immunohistochemical staining and Nilsson histological scores showed that the complex has good effects on the tissue repair. Moreover, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), important indexes of inflammation, decreased to normal levels in the complex group.ConclusionIn vitro and in vivo experiments demonstrated that the complex constructed of RPSMs and HA/β-TCP effectively treated spinal tuberculosis. Therefore, the complex represents a promising approach for the treatment of spinal tuberculosis.