Tuberculin Units Research Articles

Intralesional immunotherapy of cutaneous warts using tuberculin purified protein derivative and vitamin D3 – A randomized comparative study

Objectives: Numerous studies have been conducted on the clinical efficacy of immunotherapeutic agents in the treatment of cutaneous warts showing variable results. The present study aimed to compare the clinical efficacy and safety of intralesional tuberculin purified protein derivative (PPD) and Vitamin D3 therapy in recurrent and recalcitrant extra-genital cutaneous warts. Material and Methods: This study was conducted as a prospective, randomized, comparative, and single-blind study. A total of 104 patients were randomly distributed into two treatment groups: Group A (Tuberculin PPD, n = 53) and Group B (Vitamin D3, n = 51). Each patient in Group A received an intralesional injection of 0.1 mL tuberculin PPD (5 Tuberculin Units), while each patient in Group B received an intralesional injection of 0.2 mL Vitamin D3 (Cholecalciferol containing 120,000 IU). The injections were given at the initial visit (week 0) and after every 2 weeks for a maximum of four sessions (weeks 2, 4, and 6). The largest wart was selected for intralesional therapy. The categorization of clinical response was done based on the percent reduction in the size of warts into complete (appearance of normal skin), marked (>50% reduction), moderate (<50% reduction), and inadequate (no change in warts) responses. Adverse effects (if any) were recorded during each patient visit. The final response was evaluated at 6 months follow-up from the last treatment session. Results: Regarding the response of patients to tuberculin PPD therapy, out of a total of 53 patients, 40 (75.5%) showed a complete response. Regarding the response of patients to Vitamin D3 therapy, out of a total of 51 patients, 36 (70.6%) showed a complete response. However, the difference in the response to the treatment between the two groups was statistically insignificant (P = 0.402). Conclusion: Both intralesional tuberculin PPD and Vitamin D3 are effective and safe in the treatment of all recurrent and recalcitrant extra-genital cutaneous warts.

Factors of postembryonic ontogeny: relationship with the effectiveness of tuberculosis chemoprophylaxis in children

Background. A child’s body as a functional system is formed starting from the fetal period. Therefore, analysis of even distant in time situations allows to identify factors that affect the functioning of the child’s body in the present time and, possibly, the effectiveness of chemoprophylaxis in children. Materials and methods. To study the presence of a correlation between factors of postembryonic ontogeny and the effectiveness of chemoprophylaxis of tuberculosis in children, an analysis was carried out of 300 patients aged 0 to 17 years in the early period of primary tuberculosis infection, who underwent a 3-month course of chemoprophylaxis with isoniazid. The dynamics of shin sensitivity according to the Mantoux test with 2 tuberculin units was used as a criterion for the effectiveness of chemoprophylaxis. Depending on the latter, the exa­minees were divided into two groups: a group with effective chemoprophylaxis (n = 200), in which the size of a wheal after the end of the course decreased by 4 mm or more, and a group with ineffective chemoprophylaxis, in which skin sensitivity to tuberculin increased or remained at the previous level or decreased in the size of a wheal by 3 mm or less. Results. The analysis showed that in the group with ineffective chemoprophylaxis compared to the alternative group, the following occurred significantly more often: short-term (up to 4 months) breast feeding, a history of acute bronchitis (p < 0.001) in a child, acute obstructive bronchitis. In addition, the following were characteristic of this group: the presence of tuberculosis contact (p < 0.001), tuberculosis contact with a patient with confirmed bacterial excretion (p < 0.001), age of child under 6 years (p < 0.001), the number (two and more) of concomitant pathologies (p < 0.001), a single BCG vaccination (p < 0.001), as well as the winter seasona­lity of chemoprophylaxis (p < 0.05). Conclusions. Significant correlations have been found between many factors of postembryonic ontogeny and the effectiveness of tuberculosis chemoprophylaxis in children, which allows them to be used for prognostic purposes. The closest connections with the effectiveness of chemoprophylaxis of tuberculosis in children was revealed for the presence of tuberculosis contact (ϕ = 1.08; p < 0.001), especially with a patient with confirmed bacterial excretion (ϕ = 1.72; p < 0.001), as well as the number of concomitant pathologies in a child (ϕ = 0.70; p < 0.001) and manifestations of allergy (ϕ = 0.67; p < 0.001).

Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis.

Neonates are at risk of nosocomial tuberculosis (TB) infection from health care workers (HCWs) in neonatal care facilities, which can progress to severe TB diseases. Tuberculin skin test (TST) is commonly used for TB diagnosis, but its accuracy in neonates is influenced by various factors, including bacilli Calmette-Guérin (BCG) vaccination. This study aimed to identify predictors of positive TSTs in neonates exposed to HCWs with pulmonary TB. A retrospective observational study was conducted to compare the frequency of predictors between TST-positive and TST-negative neonates. Demographic, epidemiological, and clinical data of neonates exposed to TB, along with that of HCW and household contacts, were collected retrospectively through contact investigations with the Korean National TB Surveillance System (KNTSS) database. TSTs using 2 tuberculin units of purified protein derivative RT23 were performed on exposed neonates at the end of preventive TB treatment. Firth logistic regression was performed to identify predictors of TST positivity. Contact investigations revealed that 152 neonates and 54 HCWs were exposed to infectious TB index cases in 3 neonatal care facilities. Of 152 exposed neonates, 8 (5.3%) had positive TST results. Age of 6 days or more at the initial exposure is a statistically significant predictor of positive TST (Firth coefficient 2.1, 95% confidence interval 0.3-3.9, P = 0.024); BCG vaccination showed no statistical significance in both univariable and multivariable analysis. Sex, prematurity, exposure duration, duration from initial exposure to contact investigation, and isoniazid preventive treatment duration were not significant predictors. Age at the initial exposure is a significant predictor of positive TST in neonates exposed to active pulmonary TB. Given the complexities of TST interpretation, including false positives due to BCG vaccination, careful risk assessment is necessary for appropriate decision-making and resource allocation in the management of neonatal TB exposure.

The role of phenotypic factors in predicting the effectiveness of chemoprophylaxis in children

Background. The purpose was to study the prognostic role of some phenotypic factors in the effectiveness of tuberculosis chemoprophylaxis in children at present stage. Materials and methods. To study the role of phenotypic factors in predic­ting the effectiveness of tuberculosis chemoprophylaxis, an analysis was performed of dermatoglyphic indicators, gender, and the inactivation phenotype of isonicotinic acid hydrazide (IAH) in 76 children with tuberculin skin test conversion who underwent a 3-month course of preventive therapy with isoniazid. Dermatoglyphics of fingers and palms was determined according to the standard method [5]. The dynamics of skin sensitivity to tuberculin PPD-L according to the Mantoux test with 2 tuberculin units was used as a criterion for the effectiveness of chemoprophylaxis. According to the latter, the examinees were divided into two groups: the first one consisted of 52 children in whom the size of a wheal decreased by 4 mm or more after the end of a course (effective chemoprevention); the second one included 24 patients in whom skin sensitivity to tuberculin increased or remained at the previous level or decreased by a wheal size for 3 mm or less (ineffective chemoprevention). Results. The conducted statistical analysis revealed a significant difference in 7 indicators between the groups (p < 0.05). Determination of their prognostic informativeness made it possible to rank the prognostic significance of phenotypic signs, namely: the size of the atd angle on the left palm (J = 1.7), the number of ulnar loops on the right hand (J = 1.4), the type of IAH inactivation (J = 1.3), the number of whorls on the right hand (J = 1.2), the total number of whorls (J = 1.1), the atd angle on the right palm (J = 0.7), the number of whorls on the left hand (J = 0.5). The correlation analysis between the dermatoglyphic indicators and the type of IAH inactivation showed that there are reliable connections between them (p < 0.05), but their number differs significantly in groups. In patients with ineffective chemoprophylaxis, the number of correlations (n = 13) exceeded that of the alternative group (n = 2) by more than 6 times, which indicates significant structural phenotypic differences. Conclusions. There were significant correlations between the type of IAH inactivation and dermatoglyphic indicators, but the number of such connections was 6 times higher in children with ineffective chemoprophylaxis than in the alternative group. This indicates that a more pronounced integration of dermatoglyphic genes and the ability to neutralize IAH is a favorable moment in general, but negative in relation to the effectiveness of tuberculosis prevention.

Issues of interdisciplinary interaction during detection and diagnosis of tuberculosis in children and adolescents: a literature review and comments

Interdisciplinary interaction between phthisiatricians and pediatricians on the issues of detection and diagnosis of tuberculosis provides basis for the reduction of duration of the diagnostic process and the early identification of disease progression. The purpose of this review and comments is to systematize the knowledge of pediatricians about the detection and diagnosis of tuberculosis in children and adolescents in primary health care (PHC) facilities to improve the diagnostic process. We have performed an analysis and systematization of the current directive and methodological documents, articles on the detection and diagnosis of tuberculosis in PHC facitlities. The significance of skin immunological tests (Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L and a test with recombinant tuberculosis allergen (RTA)) during mass and selective screening to form groups at high risk for Tuberculosis and detect the disease is emphasized. The doctor’s actions based on the current guiding documents and laws are presented for cases when parents/legal representatives or the patient himself refuses from immunological skin tests. Positions that determine the need for interdisciplinary interaction for pediatricians on the issues of detection, diagnosis and differential diagnosis of tuberculosis are clearly articulated. The pathway to diagnosis begins with the formation of groups at high risk for tuberculosis in PHC facilities and with seeking medical help from a pediatrician in the presence of clinical signs similar to those of tuberculosis. Particular attention is paid to the detection of the disease when patients with clinical symptoms similar to those of tuberculosis seek medical help, and the missed opportunities for its early diagnosis are presented. Predictors allowing pediatricians to suspect tuberculosis and promptly refer a patient to a phthisiatrician to confirm / exclude the disease are provided.

Tuberculin test versus interferon gamma release assay in pregnant women with household contacts of tuberculosis patients.

Pregnant women who live in tuberculosis (TB)-affected households are more likely to develop latent TB infection (LTBI), which often escapes treatment. This study aims to determine if Interferon-gamma release (IGRA) is reliable in screening for LTBI in pregnant women, compare to the tuberculin skin test (TST). It was a cross-sectional study that involved 60 pregnant women with TB contact history as a proxy for LTBI and 30 pregnant women without contact history. Latent TB was detected using the TST 5 tuberculin units and IGRA using the QuantiFERON Gold Plus TB Test kit (QFT-Plus). The sensitivity and specificity of the two diagnostic methods and the agreement between them were estimated using SPSS version 20.0. The sensitivity 95% (95% confidence interval [CI]: 86.08%-98.96%) and specificity 26.7% (95% CI: 12.28%-45.89%) of TST were compared to that of the IGRA with 60% (95% CI: 46.54%-72.44%) and 73.3% (95% CI: 54.11%-87.72%) sensitivity and specificity, respectively in detecting LTBI in pregnancy. Although there was a significant difference (P < 0.05) between TST and IGRA, the agreement was fair (kappa 0.39; 95% CI: 0.24-0.45). TST assay is more sensitive than IGRA; however, the specificity of IGRA was superior to the TST method. In this study, a fair agreement of TST and IGRA was observed for detecting latent TB infection in pregnant women with household contact with TB patients.

Thyroid tuberculosis: rare location or rarely diagnosed? Literature review

Objective — to study of the frequency, clinical picture, diagnosis and treatment of tuberculosis of thyroid gland.&#x0D; Materials and methods. Analyses the date of the world experience and own observations.&#x0D; Results and discussion. Thyroid tuberculosis is a less frequent localization of this disease. Currently, most authors believe that thyroid tuberculosis is diagnosed in 0.1–1 % of all known cases of tuberculosis. Clinical observations have found that the thyroid gland is more often involved in the tuberculous process with a generalized miliary process, and, as previously thought, in this case there are no clinical signs of damage to the thyroid gland. A variable clinical presentation of thyroid tuberculosis was demonstrated. It is usually presented with local symptoms associated with diffuse enlargement of the thyroid gland. It is difficult to estimate the quantity of diagnosed cases due to insufficient knowledge of the doctors about this pathology and difficulties of tuberculosis etiology diagnosis. Tuberculous etiology must be ruled out in all lesions on the median surface of the neck. Fine-needle biopsy can help to confirm the diagnosis of thyroid tuberculosis, but the final diagnosis is possible only with histological or cytological studies. The diagnosis of thyroid tuberculo­sis requires the use of most of all the methods used in the diagnosis of tuberculosis: from the simplest (such as X-ray or Mantoux test (with 2 international units of tuberculin) methods to modern rapid molecule-genetic tests XpertMTB/Rif that detect specific fragments of MTB DNA in serum or plasma). Ultrasound and computer tomography also help the clearing of the diagnosis. Surgical treatment in combination with antimycobacterial chemotherapy is effective. &#x0D; Conclusions. Further investigations are needed to understand the definition, diagnosis and treatment of tuberculosis among other diseases of thyroid.

ВАЛИДНОСТЬ ОТРИЦАТЕЛЬНОГО РЕЗУЛЬТАТА КОЖНОГО ТЕСТА С АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ ДЛЯ ИСКЛЮЧЕНИЯ АКТИВНОГО ТУБЕРКУЛЕЗА У ДЕТЕЙ

Detection of tuberculosis (TB) infection and prophylactic anti-tuberculosis treatment in order to prevent cases of the disease is a current priority in phthisiatry. The effective screening of the TB infection requires the availability of effective tests with high sensitivity and specificity. The purpose of the study was to assess the concordance of a negative result of a recombinant tuberculosis allergen (RTA) test and the absence of specific changes on multi-slice computed tomography (MSCT) of the chest organs in children aged 3 to 14 years old who are not at risk for the TB development in territories with a low incidence of TB. Materials and methods of the study: a multicenter cohort retrospective study of children 3 to 14 years old who do not belong to risk groups for the TB development, without clinical symptoms of any disease and with a negative RTA test result. An analysis of the data of the objective examination of the child, of the general blood test study, of the results of previous immunodiagnostics, and of the results of MSCT of the chest organs (the presence of changes of any nature in the lungs and intrathoracic lymph nodes) was performed. Results: 43 children were included in the study, 65% (28) males. The average age of children was 7.0 [6.0; 11.0] years. Two age groups of children were studied - 3 to 7 and 8 to 14 years old. In the group of children aged 3 to 7 years old, only 68% had information about a previous tuberculinogram, on the basis of which it was possible to judge the presence of a possible active TB infection. In 14 children of this age group, pronounced reactions to tuberculin were noted, which was an indication for the Mantoux test with 2 tuberculin units (2TU) for an in-depth examination and consultation with a phthisiatrician (increase in tuberculin sensitivity). The concordance of the negative result of the RTA test and the negative result of the Mantoux test with 2TU was 50% - the value is random, while in all children according to MSCT of the chest organs, there were no specific changes. The concordance of a negative result of the RTA test and the absence of specific changes on MSCT of the chest organs was 100%. Conclusion: in children who do not belong to the risk group for the TB development, a negative result of the RTA test was accompanied by the absence of changes in the MSCT of the chest organs (100% concordance). The tuberculin diagnostics using the Mantoux test with 2TU has significant limitations for detection of the TB infection in children under 7 years of age. For children aged 3 to 7 years old who have been diagnosed with mycobacterium TB infection and do not need to be re-introduced with BCG vaccine, it is reasonable to screen for TB using the RTA test.

Latent tuberculosis infection in family members in household contact with active tuberculosis patients in Semarang City, Central Java, Indonesia.

A quarter of the world’s population is infected with Mycobacterium tuberculosis (M.tb), 10% of cases develop active tuberculosis (TB), and 90% have a latent TB infection. Family members of TB patients have the highest potential for latent TB infection. This study aims to identify latent TB infection and risk factors in family members within the household contacts of active TB patients. This study used a crosssectional study design with a contact tracing method. The selected subjects were 138 people from 241 total family members of 112 active TB patients. Subjects underwent a tuberculin skin test (TST), using 2 units of tuberculin (TU) purified protein derivative (PPD) 0.1 mL (PT. Bio Farma Persero, Bandung, Indonesia). Data risk factors were collected during home visits. Data were analyzed using the chi-square test and multiple logistic regression. A total of 63.8% (88/138) of family members of active TB patients’ household contacts had latent TB infection. The type of occupation of laborers/ farmers/fishers is the most dominant risk factor associated with latent TB infection (AOR: 7.04; 95% CI: 1.70–29.02), followed by unqualified bedroom density (<8 m2/2 people) (AOR: 5.33; 95% CI: 2.44– 12.71) and contact duration ≥5 hours/day (AOR: 4.70; 95% CI:1.33–16.66). Latent TB infection in family members of active TB patients’ household contacts was quite high. Occupation type, contact duration, and bedroom density were simultaneously confirmed as the main risk factors related to latent TB infection. Therefore, it is recommended to identify and prevent latent TB infection in family members in household contact with active TB patients.

Directive and guidance documents on the use of skin immunological tests for screening tuberculosis infection in children and adolescents: phthisiologist's review and comments

Skin immunological tests are the main method for detecting tuberculosis infection in children and adolescents. A Mantoux test with two tuberculin units (TU) PPD-L has been one of the most effective methods for detecting tuberculosis in the pediatric group over a period of many decades. The development of a new test - a recombinant TB allergen diagnostic test - has changed approaches to screening for tuberculosis infection in children. Today, both tests are used but with differentiation according to the age category of children (Mantoux test - from 1 year to 7 years, recombinant tuberculosis allergen - from 8 to 17 years). This approach was enshrined in the current directive and guidance documents in 2014. However, there is no single document that could serve as a desk book on this issue for a paediatric practitioner. Moreover, the article presents one of the most difficult issues that require knowledge of the relevant legislation and ability to conduct health education work on the part of the practitioners - the legal aspects of tuberculosis immunodiagnosis in children and adolescents in case of refusal of skin immunological testing. The low health and sanitary literacy regarding tuberculosis and its prevention in the population can also be viewed as a result of the use of mass media on the issue by non-professionals. It should be noted that some of the documents are published on the website of the Russian Society of Phthisiologists as guidance manuals and clinical recommendations, which are overlooked by practitioners of general medical institutions. The summation of directive and guidance documents on all issues of the use of skin immunological tests with comments is aimed at enhancing knowledge and, accordingly, the effectiveness of their use.

Direct Benefit Transfer Scheme for Tuberculosis Patients – Performance Challenges observed by the Providers and Patients

Introduction: Government of India launched an Aadhar-linked Direct Benefit Transfer (DBT) scheme from 1st April, 2018. Under this scheme, all notified TB patients would receive Rs 500 per month (~US$7) throughout the course of their treatment for nutritional support. Aim and Objectives: To determine the challenges faced by the health providers and patients in the implementation of Direct Benefit Transfer scheme. Methods: This was a mixed method cross-sectional study conducted on all public and private TB patients notified during the year 2019 under RNTCP (now NTEP) in district Amritsar, Punjab. Quantitative data about the availability and validation of bank accounts was obtained from the Nikshay portal after having permission from the District TB Officer. Qualitative data was obtained from the focus group discussion and in-depth interviews with the involved staff members (17) and patients (20) registered in Tuberculin units of Amritsar. Results: From the Nikshay reports, it was observed that there was significant difference between the public and private sector and between rural and urban areas. Focus group discussion was done with the TB Health Visitor (TBHV) and Senior TB supervisors (STS) and asked about the hurdles they faced. Items were identified and tabulated. In-depth interviews were conducted on 20 patients, 10 each from public and private sector respectively. Data collected was transcribed and arranged as per the themes or questions and then the information was recorded under those sub-headings. Conclusion: The major challenges observed by the providers were lack of support from the private sector, lack of awareness among people, technical issues and more work burden. Patients mostly mentioned about confidentiality issues, lack of awareness, social stigma of the disease, less amount and long and complex process.

Tuberculin skin tests following Bacille Calmette Guerin vaccination in Africa: a protocol for systematic review and meta-analysis.

Tuberculin reactivity following tuberculin skin test which is the most common measure of the effect of the Bacille Calmette Guerin (BCG) vaccination has remained complex. This protocol is aimed to assess the effect of BCG vaccine on tuberculin skin test in Africa as a guide to better understanding or resolving this complexity. A search strategy is developed using MeSH, key words, text words, and entry terms. Five databases will be searched, including PubMed, African Journals Online (AJOL), Google Scholar, Research Gate, and Cochrane Library. Only observational studies conducted in Sub-Saharan Africa and retrievable in English language will be included. The primary measurable outcome of this study is pooled prevalence of positive tuberculin skin tests. Secondary outcomes are factors that influence Tuberculin Skin Test (TST) positivity such as BCG type, the dose of BCG, age at BCG vaccinates, time/interval between BCG vaccination and TST, and type of tuberculin unit used for TST. Identified studies will be screened and selected based on inclusion criteria. Data will be extracted into Zotero, Microsoft Excel and CMA software. Both quality scores and the risk of bias for individual studies will be reported. Studies will be assessed for methodological, clinical, and statistical heterogeneity. Funnel Plots will be used for assessing publication bias. The results will be presented in tabular format in addition to a narrative synthesis. The pooled prevalence of effect of BCG vaccine on TST in Africa will be examined in relation to factors that influence TST positivity.

Impact of Latent Tuberculosis on Severity and Outcomes in Admitted COVID-19 Patients.

BackgroundThere is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI).MethodologyWe analyzed data of admitted COVID-19 patients evaluated for LTBI to examine the impact of LTBI on severity, laboratory parameters, and COVID-19 outcome. Prospectively collected data were analyzed for 60 patients who were administered the Mantoux tuberculosis skin test (TST) using five tuberculin units of purified protein derivative. All patients were administered TST irrespective of Bacille Calmette-Guérin (BCG) vaccination status. Comorbidities, clinical features, radiologic involvement, laboratory parameters, and clinical course were analyzed concerning LTBI.ResultsThe mean age was 45.9 (±15.2) years, and 35 (58.3%) patients had non-severe disease. The vast majority (n = 56/60; 93.3%) had been vaccinated with single-dose BCG in infancy or early childhood, as per national immunization guidelines. LTBI was diagnosed in 15 (25%) patients. LTBI prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients. LTBI patients had lower percentage neutrophil count, higher lymphocyte percentage, higher monocyte count, lower neutrophil-lymphocyte (NL) ratio, lower alanine aminotransferase, lower C-reactive protein, and lesser radiologic involvement compared to those without LTBI (p < 0.05). Similarly, among the mild COVID-19 subgroup, those with LTBI had higher lymphocyte and monocyte counts and lesser radiologic involvement than those without LTBI (p < 0.05).ConclusionsLTBI patients appear to have milder disease, higher lymphocyte and monocyte count, higher NL ratio, and lesser radiographic involvement. This observation needs to be studied in larger studies using interferon release assays.

Туберкулез ЛОР-органов у детей раннего возраста

The identification of millions of newly infected with tuberculosis while maintaining a sufficiently high mortality rate, despite the existing treatment protocols, confirms the urgency of the problem of diagnosing this disease and dictates the need for an interdisciplinary approach to this problem. In the overwhelming majority of cases, tuberculosis is associated with lung damage, but its “extrapulmonary” manifestations are also possible, in particular with localization in the head and neck region (about 10%), including in the ENT organs. According to the literature, the incidence of tuberculous lesions is maximum for the larynx (from 14,5 to 15–37%), minimum for ear diseases (from 0,04–0.09% to 2,4–4,18%). To focus the attention of otorhinolaryngologists on the problem of “extrapulmonary tuberculosis” of ENT localization in pediatric practice, this study analyzes the case histories of 496 patients of tuberculous pulmonary pediatric department No. 1 of the Moscow Research and Clinical Center for Tuberculosis Control. Tuberculous lesion of ENT localization against the background of a generalized process was found in 7 patients (1.4%) aged from 2,5 months to 1 year 9 months. Tuberculous otitis media was most often detected (4 patients (0.6%)), in single cases – tuberculosis of the larynx, tuberculosis of the pharynx, tuberculosis of the salivary gland, including in combination with other organic ENT pathology (for example, papillomatosis and tuberculosis of the larynx). Thus, the lesion of the head and neck (including the ENT organs) is one of the “underestimated” extrapulmonary localizations of tuberculosis, and the diagnosis and verification are delayed. Among the “extrapulmonary” ENT manifestations of tuberculosis in young children, according to our data, otitis media prevails. To verify the diagnosis of “Tuberculosis” of any localization, it is necessary to inoculate Mycobacterium tuberculosis and be sure to consult the material obtained with histologists. Doctors of various specialties should not forget about the possibility of setting Mantoux tests with 2 tuberculin units (TU) and adenosine triphosphate (ATP) test for diagnostic purposes, despite the absence of a routine immunological examination in the national immunization schedule for children of the first year of life. Tuberculosis is curable, the main thing is to remember the need for early and timely diagnosis and adequate long-term treatment.

Measurement of serum interleukin 17 level in patients with genital warts before and after intralesional tuberculin injection

Introduction and aim: Genital wart infection is a distressing sexually transmitted infection that causes marked fear and stress to both males and females. Tuberculin Purified protein derivative (PPD) injection is an upcoming safe and effective modality for the treatment of genital warts. Interleukin 17 (IL-17) was found to be lower in wart patients than controls. This study aimed at measurement of serum level of IL-17 in genital warts patients before and after PPD injection. Patients and methods: The study was carried out as case-control interventional study on 63 patients (37 males and 26 females) with genital warts attending Dermatology and Andrology Clinics, faculty of medicine, Suez Canal University hospitals. 50 controls were enrolled in the study. All patients have injected 10 tuberculin units of PPD intradermally in the mother or largest warts every 2 weeks till 6 sessions. Serum level of IL-17 was measured by Sandwich ELISA technique to all patients before and after PPD injection and to all control subjects. Results: The mean age of patients was 30.8 years, the mean duration of warts was 4.73 months, the mean number of warts was 9.76 warts and 14.3% of patients experienced side effects to PPD. (58.7%) of patients were completely recovered from warts. Mean serum IL-17 was 81.1 ± 64.2 pg/mL versus 118.9 ± 93.8 pg/mL in genital wart patients versus controls respectively (P &lt; 0.05) and 81.1 ± 64.2 pg/mL versus 107.1 ± 66.8 pg/mL before and after PPD injection respectively (P &lt; 0.05). Conclusion: IL-17 serum level was significantly lower in genital wart patients than normal controls. IL-17 serum level had been increased significantly after PPD intralesional injection than pretreatment levels and significantly related to clinical response to PPD. IL-17 suggested having a role in the clinical efficacy of PPD in the treatment of genital warts.

Interpretation of tuberculin skin test in bacillus calmette–guerin-vaccinated children

Objective: The objective was to determine the sensitivity and specificity of tuberculin skin test (TST) in Bacillus Calmette–Guerin (BCG)-vaccinated children for diagnosis of tuberculosis (TB). Materials and Methods: This observational study was conducted at a single tertiary care center over a period of 32 months from March 2012 to November 2014. All children up to 15 years of age who had received BCG at birth, suspected of TB, and referred to pediatric TB clinic were enrolled in the study. All patients were given TST by 5 Tuberculin Unit Purified Protein Derivative-Standard. The diagnosis of TB was based on either clinical, histopathological, or bacteriological grounds. Results: Out of 371 patients, 341 (91.91%) had TB. TST was positive in 227 (61.2%) and negative in 144 (38.8%) patients. The sensitivity of TST to detect active TB was 62.8% and specificity was 56.7%. TST cutoff as ≥15 mm increased specificity of TST to 73.3%, but sensitivity decreased to 25.8%. Age, gender, and contact with TB patients did not affect TST results. Conclusion: The accuracy of TST for the diagnosis of TB is low with low sensitivity and specificity. By increasing the cutoff for positive TST to >15 mm, the number of false-positive TST can be reduced.

Detection and differential diagnosis of tuberculosis in patients of the pulmonary department with community-acquired pneumonia and chronic obstructive pulmonary disease

The purpose of the present work was to study the problem of tuberculosis detection in patients with chronic obstructive pulmonary disease (COPD) in the anamnesis and the role of Mantoux test and Diaskintest in diagnosing tuberculosis in patients hospitalized in the pulmonary department of the multidisciplinary emergency hospital. Materials. According to the results of analysis of 122 medical records of inpatient patients (form 003/u) hospitalized are divided into 2 groups: 1 st – patients admitted to hospital with the diagnosis of community-acquired pneumonia (CAP), 2 nd – patients with acute COPD, CAP at the follow-up of which was diagnosed in 73% of cases. Results. The age of patients with acute COPD was found to be 48.0 ± 1.9 and 69.9 ± 2.7 years respectively (z = –1.44; p = 0.149). Acute onset, duration and intensity of coughing, and pronounced shortness of breath were observed in patients with COPD in the clinical picture, but a CAP was detected in the follow-up survey. Coughing, fever, leukocytosis and accelerated sedimentation rate were more common symptoms in patients without COPD. Tuberculosis was detected in 10.7% of patients in the pulmonary department, while DNA of mycobacteria tuberculosis in the epithelial lining fluid was found in 30.8% of cases. Positive results of simultaneous immunodiagnostics (Mantoux test and Diaskin-test) were recorded in 76.9% of cases. Conclusion. Patients with COPD exacerbation, as well as patients with CAP, are a potential risk group for tuberculosis, need additional examination in the pulmonology department of the hospital according to the CAP standard to exclude or early diagnosis of pulmonary tuberculosis. If 2 diagnostic tests are used simultaneously (Mantoux test with 2 tuberculin units and Diaskintest), the accuracy and timeliness of tuberculosis diagnosis increases, including in case of exacerbation of COPD.

Tuberculin skin test positivity among HIV-infected alcohol drinkers on antiretrovirals in south-western Uganda.

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH), and current evidence suggests that heavy alcohol users have an increased risk of developing TB disease compared to non-drinkers. Not known is whether the increased risk for TB disease among alcohol users may reflect higher rates of latent TB infection (LTBI) among this population. We assessed the latent TB infection prevalence based on tuberculin skin testing (TST) and examined association with current alcohol use among HIV-infected persons on antiretroviral therapy (ART) in south-western Uganda. We included PLWH at the Mbarara Regional Hospital HIV clinic, who were either current alcohol consumers (prior 3 months) or past year abstainers (2:1 enrolment ratio). Participants were recruited for a study of isoniazid preventive therapy for LTBI. TST was performed using 5 tuberculin units of purified protein derivative. The primary outcome was a positive TST reading (≥5mm induration), reflecting LTBI. We used logistic regression analyses to assess the cross-sectional association between self-reported current alcohol use and a positive TST. Of the 295 of 312 (95%) who returned for TST reading, 63% were females and 63% were current alcohol drinkers. The TST positive prevalence was 27.5% (95% confidence interval [CI]: 22.6% - 32.9%). The odds of a positive TST for current alcohol users compared to abstainers was 0.76 (95% CI: 0.41, 1.41), controlling for gender, age, body mass index, history of smoking, and prior unhealthy alcohol use. The prevalence of LTBI among PLWH on ART in south-western Uganda was moderate and LTBI poses a risk for future infectious TB. Although alcohol use is common, we did not detect an association between current drinking or prior unhealthy alcohol use and LTBI. Further studies to evaluate the association between LTBI and different levels of current drinking (heavy versus not) are needed.

Diagnosis and Risk Factors of Latent Tuberculosis Infection among Healthcare Workers Using Whole Blood Human Interferon-gamma Release Assay and Tuberculin Skin Testing

This study established the diagnosis and risk factors of latent tuberculosis infection (LTBI) among health-care workers in an endemic population using Tuberculin skin test (TST) and Quantiferon TB-gold. A total of 609 Healthcare workers from tuberculosis treatment facilities in Akwa Ibom State, Nigeria were studied. The Interferon-gamma release assay was performed using 3ml of whole blood by ELISA according to the manufacturer’s instruction (Cellestis Ltd., Carnegie, Australia) after which 0.1 ml of 5 tuberculin units of Purified Protein Derivative (PPD) was administered intra-dermally to each subject. TST results were read after 72 hours by measuring the size of indurations in millimetres. Data were analysed using SPSS version 17 (SPSS Inc., Chicago, Illinois). At the threshold of 10 mm, the prevalence of LTBI by TST was 45.8% and 24.8% at the IGRA diagnostic value of ≥ 0.351 IU. Laboratory staff and ward orderlies as well as being in service for &gt;10 years, were more significantly associated with LTBI. A moderate agreement of 76.7%, k = 0.51 was obtained between TST at 10 mm, and QFT. Neither previous exposure to TST nor BCG vaccination affected the prevalence of LTBI in the study population. The difference of 54% prevalence of LTBI between TST and QFT may be due to non-tuberculous mycobacterium (NTM) since TST is non-specific. This may have grave implications of drug toxicity and development of resistance to anti-TB drug among individuals harbouring NTM, but receiving anti-TB medication. The 76.7% agreement between the two tests is an indication that the 10 mm cut-off induration for TST is still relevant in the diagnosis of LTBI.

Lichen planus and multifocal choroiditis - A diagnostic dilemma.

A 24-year-old gentleman had a right headache and MFC; for 1 year [Fig. 1a]; being on AKT for 3 weeks with further worsening. Fundus fluorescein angiography (FFA) [Fig. 1b]; optical coherence tomography (OCT), [Fig. 1c] and B-Scan [Fig. 1d] had been done. Serum angiotensin-converting enzyme (ACE), serum uric acid, and QuantiFERON TB Gold Test were normal. Mantoux was 19 mm [48 h/5 tuberculin units (TU)]. Oculus sinister (OS) was normal. On presentation to us, OD had finger counting close to face with congestion; mild relative afferent pupillary defect (RAPD); painful movements; disc edema; peripapillary sub-retinal exudation, and MFC [Fig. 1e]. We did contrast magnetic resonance imaging (MRI) brain/orbit, venereal disease research laboratory (VDRL), antinuclear antibody (ANA), antineutrophil cytoplasmic autoantibody (ANCA), and HIV, which were normal. Paradoxical worsening of TB choroiditis (3 weeks AKT) was considered and intravenous methylprednisolone was used. Repeat history-taking, caused him to recall having skin biopsy-proven LP; treated with oral prednisolone; just prior to ocular symptoms; 1 year back. Pursuing the possibility of flare-up of occult systemic TB; after the use of oral steroids to treat LP, a contrast chest CT was done, which was normal. A previously reported; LP associated intraocular inflammation[1] led us to use of azathioprine. One of the treatment protocols could have been the continuation of AKT, but our physician stopped AKT to avoid hepatotoxicity. Intraocular inflammation resolved within 2 months of azathioprine, [Fig. 1f]; which was continued for 9 months. At 16 months post cessation of azathioprine; he stays in remission.Figure 1: (a) Fundus showing fulminant MFC on treatment with tapering oral steroids for one year. (b) FFA showing late hyperfluorescence; pooling; disc leakage. (c) OCT showing choroidal elevation with macular thickening. (d) B-Scan showing grossly thickened choroid with sub-tenons fluid in macular area. (e) Fundus showing disc edema with peripapillary sub retinal exudation and MFC. (f) Fundus showing resolution of inflammation; 2 months on azathioprineDiscussion Ocular LP is largely extraocular and involves conjunctiva, cornea, and lacrimal drainage system.[2] The role of cellular immunity in LP and retinal vasculitis[34] was believed to be the cause of their once previously reported association.[1] In our patient; there is a diagnostic dilemma of the mere coexistence of LP and MFC with a temporal dissociation (LP occurring just prior to the onset of ocular symptoms) vs possible association between these two otherwise separate immune-mediated clinical entities. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement The authors wish to acknowledge Dr. Avinash Pathengay, for his technical help in the management of this patient.