Tubercular Infection Research Articles

Poncet′s disease (tubercular rheumatism): a narrative review

Poncet's disease or tubercular rheumatism is uncommon, and there are not many related studies. No consensus has been achieved with respect to its etiopathogenesis. The low prevalence of this Poncet's disease even in endemic regions suggests hidden mechanisms that require further research to fully comprehend this enigmatic disorder. Careful identification of primary focus of tubercular infection, clinical suspicion and knowledge of this disorder is crucial for prompt identification and treatment. This article aims to provide an overview of the recently published articles about Poncet's disease. The article attempts to highlight key features of the disease for better understanding of this peculiar disorder.

Исследование отношения подростков с туберкулезной инфекцией к родителям

The presented article is devoted to the study of the relationship of adolescents with tubercular infection to their parents. Tuberculosis is known to be a serious somatic infectious disease. Its treatment is carried out in a hospital and outpatiently for a long time. The prognosis of the course and cure of the disease is not always clear and predictable. The severity of the disease, side effects of drugs, changes in conditions and quality of life, disruption of social contacts, uncertainty of near and distant health prognoses, disruption of family relationships, social and material distress significantly affect attitudes toward the disease, treatment and cure for tuberculosis. Adolescence is one of the most difficult periods in every person’s life. The disease has a significant effect on the adolescent’s growing up, their ideas of future. Parental support is especially important for young people who have to be treated for a long time, who are aware of the severity of their disease, its social danger. Relations with parents play an important role in adapting to the disease, in forming adherence to treatment. However, often parents themselves become a source of infection for their child, the formation of multiple drug resistance. Improper upbringing, inadequate attitude to the child’s disease and its treatment lead to disruption of the medical-diagnostic and medical-rehabilitation processes aimed at treating tuberculosis.

Compliance to Directly Observed Treatment Short Course (DOTS) Chemotherapy among the Patient of Pulmonary Tuberculosis in Banke District of Nepal

Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. High bacterial infectivity, transmissibility, increasing drug resistance and non compliance to the therapy have been adding up challenges to prevention and control of tuberculosis. This study was conducted to observe the treatment compliance pattern among new pulmonary sputum smear positive cases of tuberculosis. A cross sectional study was carried out in the year 2009. The 114 new smear positive pulmonary tuberculosis patients registered in the six selected DOTS centres of the Banke Disrtict were randomly selected. Participants were selected from each DOTS centre by probability proportionate sampling methods. Data were analyzed by SPSS (11.0 Version) and P< 0.05 was considered as significant. Overall compliance to DOTS was 86.80 percent; of these, 57.00 percent showed excellent and regular compliance followed by nearly 30 percent good compliance. And 13.20 percent participants were non complaint to DOTS therapy. Positive Family behaviors were positively associated with compliance while alcohol consumption was found to be negatively associated with compliance however; age, sex and income were found to be non significant factors for compliance. Feeling of getting cure even before the course of DOTS therapy (feeling better after 2-3 months regular treatment) and drinking habits were found to be the major causes of non compliance. Supportive family behaviors and avoidance of alcohol consumption may promote the compliance. Excellent treatment compliance in the face of many odds is highly encouraging and the pattern can be useful in treatment despite little non compliances; furthermore compliance can be enhanced by acting on these causes of non compliances.
 Key words: Pulmonary, Tuberculosis, DOTS, Banke, Nepal

Factors Associated with Treatment Compliance among Tuberculosis Patients Receiving Directly Observed Treatment Short Course Therapy

Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. This study was carried out to identify the factors associated with treatment compliance among Tuberculosis Patients Receiving DOTS in 11 centres of Pokhara valley. A cross-sectional descriptive study design was used to collect information from 142 Tuberculosis patients. Purposive sampling method was used and chi-square test was used at 5% level of significance. Pattern of compliance was categorized as; compliance and non-compliance. Out of 142 respondents, majority (94.37%) of respondents was compliant and minority (5.63%) was non-compliant. Among non-compliant patients, (75.0%) of respondents missed their medicine in intensive phase and the reasons for non-compliance were carelessness of patients, forgetfulness of patients, confusion of staff, side effects of medicines and agitation by political parties. The study found no significant association of treatment compliance with demographic factors, patient related factors, health service factors and social factors (p>0.05). The finding was satisfactory that the compliance of TB patients was high i.e. (94.37%) of respondents were compliant. About (6.00%) of respondents were non-compliant. The reasons for non-compliance were due to their own cause rather than health service factors. They themselves were responsible for being non-compliant. Tuberculosis, being a major public health problem; six percent non-compliance is still a serious health problem and being non-compliant; these patients can transmit tuberculosis to many other healthy people in the family and community. Therefore, tuberculosis patients should be more conscious on treatment compliance to improve their health as well as of family and community.
 Key words: Compliance, non-compliance, DOTS Therapy

A prospective Study on Wrist Tuberculosis: Challenges in Diagnosis and Management

Introduction: Wrist Joint is an uncommon site for tubercular infection. However, it is more commonly seen in south-east Asia than in developed parts of the world. The diagnosis is often delayed, because of its rarity and hence many patients have to live with long term sequale of stiffness and pain.

Sputum Negative Tubercular Adults Spread Infection and Disease to Their Household Children

To examine whether tuberculosis sputum negative adults can spread disease to their household children. A patient based study was conducted over a time period of one year, on children of those adults who were suspected case of “sputum smear positive” as well as “sputum smear negative” diagnosed with pulmonary tuberculosis at JNMCH, India. Various investigations like tuberculin test, chest X-ray, fine needle aspiration cytology (FNAC) of lymph nodes, gastric aspirate, acid-fast bacilli (AFB) sputum smear examination and others were done to attain the goal of this study. Out of 129 children, 69 were in household contact of sputum smear positive and 60 in contact of sputum smear negative adults. Forty children were found to be Mantoux positive; of which the ratio of children that were in contact of sputum positive adult to those in contact of sputum negative adult was 2:1 (27 vs 13). A small percentage (6%) of asymptomatic children was found to be diseased. Sputum positivity, low socio-economic status as well as less than 3 years of age exhibited strong association with infection as well as disease; nonetheless the number of infected and diseased children in sputum smear negative group is not negligible. A considerable number of screened children that were in contact with sputum negative tubercular adult were found to be infected as well as diseased; hence this group should not be ignored. A portion of Mantoux positive children were found to be asymptomatic and one-third of diseased children were Mantoux negative, so Mantoux cannot be taken as a gold standard for diagnosis of tuberculosis.

Multifocal Skeletal Tuberculosis Mimicking Metastatic Bone Disease: A Dilemma on Bone Scintigraphy

Objective: Multifocal skeletal tuberculosis is a rare condition in immunocompetent patient even in a tuberculosis endemic area. Diagnosis of such atypical cases is challenging to the physicians and treatment is delayed in majority of cases. The objective of this case report was to present a patient with tuberculosis with skeletal lesions.
 Case report: A case of 60 years male was presented – with bony pain. His 99m Tc methylene diphosphonate (MDP) scan showed multiple foci of increased radiotracer resembling a metastatic bone disease. However, aspiration cytology and biopsy from the focal lesions and subsequent therapeutic response to anti-tubercular treatment indicated that the lesions were from tubercular infection.
 Conclusion: Multiple bony lesions from tuberculosis may mimic metastatic lesions in bone scan.
 Bangladesh J. Nuclear Med. 21(2): 118-121, July 2018

Outcomes and risk factors for spontaneous spondylodiscitis: Case series and meta-analysis of the literature

Despite recent improvements in surgical and antimicrobial therapies, few generally applicable guidelines exist for spondylodiscitis management. We reviewed a consecutive series of patients as well as the past 18 years of the literature and analyzed outcomes for either conservative or surgical treatment. We analyzed a consecutive series of adults with spontaneous spondylodiscitis treated at our institution over the last 6 years. We analyzed predictors for neurological deficits, vertebral collapse, and surgical treatment. We also performed a meta-analysis of the literature between 2000 and 2018, stratifying the results between surgical and conservative treatment outcomes. A younger age at diagnosis, cervical location, tubercular infection, coexistence of morbidities, and vertebral collapse were predictors of surgical intervention. Cervical spondylodiscitis, vertebral collapse, and epidural collection were associated with a higher risk of developing neurological deficits, while tubercular spondylodiscitis was associated with a higher risk of vertebral collapse. Based on the current literature, conservative treatment has success rates similar to those of surgical treatment but lower complication and mortality rates. In cases without an absolute indication for surgery, a conservative approach should be considered as the first-line treatment. A closer diagnostic and clinical follow-up should be recommended in patients with cervical tract or tubercular spondylodiscitis because of the higher risk of developing bone collapse and neurological deficits.

Pediatric tuberculosis in close contacts: prospective study

Introduction: Tuberculosis continues to be a major cause of morbidity and mortality among children in developing country like India. Early detection and treatment of infection can reduce morbidity and mortality. Screening of children in close contact with high risk groups is universally recommended but seldom practiced in resource limited settings. Aims and objectives: Primary objective to find prevalence of tubercular infection in children who are household contacts of PTB, and HIV-PTB co-infected adults. To identify subset of contacts who are at higher risk of contacting infection. Settings and Design: Prospective study conducted in tertiary care center. Children aged <10years in contact with adult PTB and PTB with HIV were enrolled and evaluated for tuberculosis infection by clinical, radiographic, and tuberculin testing. Transverse in duration of greater than 10 mm was defined as positive tuberculin test suggestive of tubercular infection. Results: About 33.6% of contacts exposed were found to be infected. Tuberculin test was found to be significantly positive in contacts exposed to PTB and HIV-PTB co-infected adults groups (p > 0.0001, with an odds ratio of 0.36 (1.10 - 1.74)), P>0.0001, 2.77 (1.33 - 5.79). Majority of children exposed to HIV negative PTB adults were infected compared to contacts exposed to HIV-PTB co-infected adults (35 vs 14) and the difference is statistically significant (p>0.001). Absence of scar is not associated with any significant risk. Conclusions: Prevalence of tuberculosis is high in contacts with high risk groups. HIV-PTB co-infected adults transmit infection less in comparison to HIV negative TB adults. Young children and those with severe malnutrition need to be targeted in contact screening.

Simultaneous Adalimumab and Antitubercular Treatment for Latent Tubercular Infection: An Experience from Nepal.

Introduction In Nepal, adalimumab is the most common agent being used, but in a disease activity-based dose tapering to address the economic constraints. Another constraint is the high risk of reactivation of tuberculosis in countries with high burden, especially with the use of tumor necrosis factor blocking agents. Though there are recommendations for screening and treatment of latent tuberculosis infection (LTBI) before using adalimumab, data is not clear regarding the appropriate screening schedule and the timing of initiation of biologic therapy. Methodology This retrospective review of prospectively followed cohort of spondyloarthropathy patients aimed to evaluate the efficacy of simultaneous initiation of adalimumab with LTBI treatment. Patients fulfilling either the modified New York criteria for ankylosing spondylitis or Assessment in SpondyloArthritis international Society criteria and who were refractory to oral treatment were screened with Mantoux (≥10mm) and interferon gamma release assay (QuantiFERON) to detected LTBI. Those who tested positive were started on rifampicin/isoniazid combination for 3 months and adalimumab treatment on the same day. The patients were followed up at 2 weeks, 4 weeks, 12 weeks, and then every 3 months for 2 years. Results Out of 784 patients diagnosed, 92 were receiving adalimumab. LTBI was detected by positivity of either Mantoux or QuantiFERON in 29.3% patients. None of the patients with LTBI who were started on the 2 drug regime simultaneous with adalimumab developed activation of tuberculosis. However, two patients testing negative for both the tests developed tubercular pleural effusion during treatment. Conclusions Our findings indicate that screening for LTBI should be more frequent in patients from high tuberculosis burden countries; treatment of LTBI with rifampicin/isoniazid combination for 3 months is effective in preventing reactivation even when adalimumab is started simultaneously.

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.

Arthroscopic management for early-stage tuberculosis of the ankle

BackgroundDue to atypical clinical presentation, wide use of antibiotics, and lack of specificity in diagnosis, diagnosis of tubercular (TB) infection in joints is increasingly difficult, and misdiagnosis is common. The use of arthroscopy for the diagnosis and treatment of early-stage ankle TB has rarely been reported. This case series intended to present the clinical outcomes of arthroscopic management for early-stage ankle TB.MethodsFifteen patients with chronic synovitis of the ankle and suspicious cause of early-stage ankle TB underwent arthroscopic treatment from April 1, 2010, to March 31, 2016. These cases all failed to confirm diagnosis of TB by ankle arthrocentesis. They included seven males and eight females with an average age of 37.5 (8 to 70) in the study. Among them, five cases had history of pulmonary tuberculosis, and six had history of trauma. The procedure included synovial membrane biopsy and debridement. The diagnosis was confirmed by pathologic examination and culture. The treatment was combined with systemic anti-tuberculous drugs. Follow-up measurements included VAS score, AOFAS score, ESR, CRP, and MRI.ResultsAfter arthroscopic management, 13 cases confirmed TB by pathologic examination and culture, and two cases still remained clinically suspected TB; the rate of confirmed case was 87%. The incision healed well in all cases, and no serious complications were observed. There were significant differences in VAS scores, AOFAS scores, ESR, and CRP between before and after treatment (P < 0.01). Joint swelling disappeared or was relieved after 2 months in most patients. Ankle swelling and pain in one patient was improved after changing anti-tuberculous drugs. MRI suggested that all patients had effusion in the articular cavity, accompanied by bone edema of the distal tibia and talus before the treatment. After the surgery, the effusion was significantly reduced, and the signal of bone edema almost disappeared. No recurrent TB was found during the follow-ups.ConclusionArthroscopic management for early-stage ankle TB is minimally invasive, safe, and reliable. It can easily obtain samples from specific area of TB for further confirmation of the diagnosis, while the debridement can also assist in local disease control. For cases of highly suspicious joint TB, arthroscopic biopsy and debridement after transient anti-TB treatment is recommended.Level of evidenceLevel IV, therapeutic case series

Evaluation of QuantiFERON-TB Gold test for the diagnosis of tubercular infection in children

BackgroundTuberculin skin test (Mantoux test) is a known intradermal skin prick test for detection of tubercular infection in children and adult population. A new diagnostic test QuantiFERON-TB (QFT) Gold developed in 2005 and approved by the US Food and Drug Administration has good sensitivity and specificity for diagnosis of tubercular infection. MethodsIn this prospective study, 125 children who were being evaluated for tubercular infection or disease were administered Mantoux test and at the same time a blood sample was drawn for the interferon gamma estimation and evaluated by this new diagnostic assay, i.e., QFT Gold assay. ResultsSensitivity and specificity of QFT test calculated was 96.4% and 81% respectively, whereas the negative predictive value and positive predictive value were 91.9% and 90.9% respectively. The sensitivity and specificity of the Mantoux test was found to be 89.2% and 59.5% respectively. The Cohen Kappa coefficient between the Mantoux test and QFT Gold assay for diagnosis of tubercular infection was found to be 0.627 (95% confidence interval: 0.474–0.779; p = 0.0001) in our study, indicating a good agreement between the two tests. ConclusionQFT Gold assay is an effective tool in diagnosing tuberculosis infection in a pediatric population. False positive reactions with tuberculin skin test are common as there is cross-reactivity with non-tubercular mycobacteria (NTM) and BCG vaccination. Both sensitivity and specificity of QFT test were better than those of the tuberculin skin test. Therefore, it is better than the tuberculin skin test, and the diagnostic yield is better. However, this test should not be used as gold standard for diagnosis of tubercular disease in children.

Assessment of Endometrial Specimens for Tubercular Infection among Infertile Women using DNA-PCR

Assessment of Endometrial Specimens for Tubercular Infection among Infertile Women using DNA-PCR

CD3, CD4, CD8, CD19 and CD16/CD56 positive cells in tuberculosis infection and disease: Peculiar features in children.

Pathogenesis of mycobacterial infection has been extensively studied determining the fundamental role of host immunocompetence in disease progression. Cellular adaptive immunity, in particular CD4+ cells, has shown to be crucial in the host defence. A role of cytotoxic lymphocytes and humoral immunity has also been established. However, few studies have been performed in low endemic countries on immunological correlates of tuberculosis in paediatric patients. The present study aims to fill this gap analysing the distribution and the absolute values of the main lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+ and CD16+/CD56+) in the different stages of tubercular infection in human immunodeficiency virus–negative children living in low tubercular endemic countries. Results obtained in children with latent tuberculosis, active tuberculosis and healthy controls were compared. Moreover, quantitative analysis of interferon-γ levels of mitogen-induced response was carried out within the different study groups. The aim of this analysis was to enforce the comprehension of immune modifications subsequent to Mycobacterium tuberculosis infection. The major finding of our study was CD3+ and CD4+ absolute and percentage depletion in children with active tuberculosis versus healthy controls. Moreover, severe forms of active tuberculosis showed a marked reduction in the CD4+ percentage in the context of a systemic impairment which affects globally the absolute count of all peripheral lymphocyte subsets tested. A relative increase of natural killer cells was proved in infected patients, whereas no differences in B cells among the study groups were detected. Mitogen-induced interferon-γ levels were significantly higher in children with latent tuberculosis when compared to active tuberculosis and healthy controls, demonstrating effective immune activation in those patients able to control the infection.

Diagnostic utility of urinary lipoarabinomannan in pulmonary tuberculosis

Background Urinary lipoarabinomannan (LAM) detection is a promising approach for the rapid diagnosis of active tuberculosis (TB). Objective to assess the diagnostic accuracy of quantitative urine Lipoarabinomannan (LAM) test in the diagnosis of pulmonary tuberculosis and evaluate its efficacy as a follow up test after 3 months of the first line of antituberculous therapy. Methods This study was carried out on 40 patients (32 male and 8 female) with active tubercular infection LAM level was measured in urine by enzyme-linked immunosorbant assay (ELISA). Results Patients with smear positive specimens had higher urine LAM level: grade 1+ (mean ± SD of 1.47 ± 0.85 ng/ml), grade 2+ (1.63 ± 1.05 ng/ml), grade 3+ (4.32 ± 2.56 ng/ml) than that of smear negative (1.42 ± 0.50 ng/ml) (P Conclusion Our finding showed that the urine LAM test is simple, rapid, and reliable diagnostic modality for active pulmonary tuberculosis. Quantitative LAM detection results increased progressively with bacillary burden. Urine LAM testing may be an accessible method to monitor response to anti-TB therapy among active pulmonary tuberculosis patients.

The modern characteristic of biology and diagnostics prospect M. tuberculosis

Features of biology M. tuberculosis are considered the including modern data about features of morphology, the antigen structures of the various nature defining virulence of activators of tuberculosis. Based on the method data spoligothipirovanie genetic distinctions of families Mycobacteriaceae, and among them strains genotype Beijing, different by wide prevalence in the Russian Federation and high medicinal stability are especially characterised. Based on difficult antigens structure M. tuberculosis features of the development of the immune answer which allow predicting a current of the infectious process are reflected. The presented characteristics reflect considerable heterogeneity strains M. tuberculosis which is combined with a variety of an immune homeostasis of the carriers which were ill and by that essentially complicates laboratory diagnostics of tuberculosis. Among the considered modern methods of diagnostics of a tubercular infection, the most perspective can be immunologic. One of the ways of improvement serodiagnostic the tests promoting an increase of sensitivity serodiagnostic of tuberculosis is creation polyepitopes chimeric antigens by chemical synapsis fibres with carbohydrate molecules. Creation of a composition from several immunodominant antigens M. tuberculosis can become other direction of increase of sensitivity. that will allow lowering considerably number false-positive results. Creation of hybrid fibers will allow avoiding an inevitable decrease in affinity of antibodies of the way of the blood, arising at the use of several antigens simultaneously.

Evaluation and Management of Pyogenic and Tubercular Spine Infections.

To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection. Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.

Isolated Tuberculoma Mimicking Foramen Magnum Meningioma in the Absence of Primary Tuberculosis: A Case Report.

Central nervous system tuberculosis is a devastating complication of systemic tuberculosis. Intradural extramedullary (IDEM) tuberculoma at the foramen magnum is rare, and mimics en plaque meningioma. We report the case of a 53-year-old woman who presented with dysesthesia of the tongue and lower cranial nerve (CN) palsy, with onset 4 months prior to admission. The neurologic examination revealed left upper-limb weakness and hypoesthesia on the sole and dorsum of the left foot. Other physical examinations revealed no features of tubercular infection. Laboratory investigations likewise showed no signs of infection or inflammation. Magnetic resonance imaging of the brain showed an IDEM mass originating from the left intradural surface at the foramen magnum extending to the C2 segment and compressing the brainstem and upper cervical cord. The mass was isointense/hypointense on T1- and T2-weighted images and homogeneously-enhanced on postcontrast images. The lesion also exhibited the dural-tail sign and was preoperatively diagnosed as en plaque meningioma. The patient underwent surgery via the left transcondylar fossa approach with partial laminectomy of the atlas. Intraoperatively, the mass exhibited a dural origin and encased the vertebral artery and lower CNs, with strong adhesions. While the histopathological study of the mass was strongly suggestive of tuberculoma with multifocal granulomas, caseous necrosis, and Langerhans giant cells, extensive diagnostic studies failed to detect Mycobacterium tuberculosis itself. Although the patient had recurrence with multisystem involvement, she responded well to antitubercular treatment. IDEM tuberculoma of the foramen magnum may present as en plaque meningioma. Histopathology is required for a definitive diagnosis. Prompt surgical resection and decompression with adequate antitubercular treatment yield better neurological outcomes.

Infected charcot spine arthropathy.

Charcot spinal arthropathy (CSA), a destructive spinal pathology, is seen in patients with impaired sensation. Superimposed infection in the affected spinal segments can lead to a challenge in the diagnosis and management. Spinal cord injury (SCI) is the leading cause of CSA as persons with SCI have significantly impaired sensation. Though infection of the CSA is rare, SCI persons are prone to superimposed infection of the Charcot spine. We report atypical presentations of three cases of CSA with superimposed infection. A 47-year-old male with complete T7-8 SCI developed symptoms suggestive of infection and CSA. He was managed with a posterior vertebral column resection (PVCR) of T12 and intravenous antibiotics as the intraoperative culture showed the growth of E. coli and Pseudomonas. A 26-year-old male with T12 complete paraplegia, post status post open reduction and internal fixation with subsequent implants removal developed infection and CSA over the pseudo-arthrotic lesion with destruction of T12 and L1 vertebrae and an external fistulous track. He was managed with debridement and anterior column T11-L1 reconstruction with a Titanium cage and four-rod pedicle screw stabilization construct. A 25-year-old male with complete paraplegia with CSA at L4-S1. He underwent PVCR of L5 and L3-S2 posterior stabilization. The intraoperative culture and histopathology were suggestive of tuberculous infection. Pyogenic or tubercular infection of CSA should be considered as a diagnostic possibility in persons with SCI who are more prone to infections. The management includes aggressive debridement and circumferential fusion along with appropriate medications to control the infection.