Tuberculosis In Immunocompetent Patient Research Articles

Primary Infection by Pericardial Tuberculosis in Immunocompetent Patient

The high prevalence of pulmonary tuberculosis, which is endemic in some countries, is the main cause of pericardial tuberculosis, a figure that increases even more in immunocompromised patients, but nevertheless the incidence of primary pericardial infection by tuberculosis is low and therefore there are only case reports in literature. The prevalence of pericardial effusion secondary to tuberculosis in immunocompetent patients is low and only case reports have been found, perhaps due to low suspicion, so we intend to provide more evidence to the literature. For diagnosis we have imaging studies, culture, Xpert MTB/RIF system, Adenosine Aminase.

Disseminated Tuberculosis in an Immunocompetent Adult: A Rare Clinical Presentation and Diagnostic Challenge

Disseminated tuberculosis (TB) is a rare and life-threatening form of TB, particularly when it occurs in immunocompetent individuals. A 52-year-old diabetic male presented with tachypnea, tachycardia, and chronic low back pain. Comprehensive imaging revealed pulmonary involvement, lumbosacral vertebral destruction (L5-S1), genitourinary TB, hepatitis, and psoas abscesses. Ultrasound-guided drainage and CB-NAAT analysis confirmed Mycobacterium tuberculosis. Given the patient's deranged liver function tests, a modified antitubercular therapy regimen, including levofloxacin, amikacin, and ethambutol, was administered. The patient demonstrated significant clinical improvement, with resolution of symptoms and normalization of liver function on follow-up. This case underscores the diagnostic complexity of disseminated TB in immunocompetent patients, highlighting the importance of early detection and individualized treatment. Further research is needed to develop standardized treatment protocols, particularly for cases involving multi-organ involvement and liver dysfunction.

Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature

A paradoxical reaction (PR) during the treatment of tuberculosis was defined as the worsening of preexisting disease either clinically or radiologically or the appearance of a new tuberculous lesion. These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.

Intracranial, spine leptomeningeal and radicular tuberculosis in immunocompetent patient

Intracranial, spine leptomeningeal and radicular tuberculosis in immunocompetent patient

Multifocal Tuberculosis in Immunocompetent Patients through a Clinical Case at Mohamed V Rabat Military Hospital, Urology Department

Tuberculosis is a real public health problem still rampant in an endemic fashion in developing countries. Multifocal forms are observed in immunocompromised patients but can also be observed in immunocompetent subjects. Often misleading aspects, and which can mislead the diagnosis. The authors reported the case of a 32-year-old young man with no particular medical history, immunocompetent, received with acute obstructive renal failure from the outset anuric associated with orchiepididymitis, pulmonary and vertebral involvement on CT scan without physical signs, progressing well under treatment. This form of multifocal tuberculosis can be life-threatening and requires early diagnosis and urgent management.

Isolated chest wall tuberculosis in immunocompetent patients.

Chest computed tomography scan demonstrated inflammatory lesion in and around the right sixth rib costochondral junction.

Endoscopic ultrasonographic diagnosis of pancreatic tuberculosis in immunocompetent patients—A case series from eastern India

Tubercular involvement of pancreas is rare. It presents as a focal lesion of pancreas on cross sectional imaging. Endosonography with fine-needle aspiration (EUS-FNA) is crucial for a timely presurgical diagnosis. A retrospective review was conducted on 117 cases of pancreatic focal mass undergoing EUS-FNA at our institution over a period of 3 years, and 5 cases with pancreatic tuberculosis (TB) were detected. The clinical presentation varied from obstructive jaundice, recurrent acute pancreatitis to incidentaloma of pancreas. All patients received antitubercular therapy and were followed up for at least 6 months. In conclusion, pancreatic tuberculosis is a differential of a pancreatic focal lesion and EUS-FNA is the method for diagnosis ofthis conditionthat may obviate surgical exploration.

Central Nervous System Tuberculoma in the Corpus Callosum Mimicking a Butterfly Glioma: Literature Review of Radiological Findings and Our Experience.

Context:Central nervous system (CNS) tuberculoma is the most common form of intracranial parenchymal tuberculosis (TB) which accounts for approximately 40% of misdiagnosed brain lesions mimicking intracranial tumors. The most common sites are the cerebral hemispheres, basal ganglia, cerebellum, and brainstem.Materials and Methods:Radiological findings of corpus callosum tuberculomas have been described and set in relation with the available literature.Results:Corpus callosum tuberculomas are extremely rare, with only five cases reported in the current literature. Even though isolated CNS tuberculoma of the corpus callosum without systemic TB in immunocompetent patients occurs rarely, as in our case, it should be considered in the differential diagnosis of solitary corpus callosum lesions.Conclusions:Careful evaluation of the neuroradiological images with adequate clinicoradiological correlation allows for accurate diagnosis and ensures the proper and timely care.

Unusual presentations of primary head and neck tuberculosis and review of literature

Background/PurposeThe diagnosis of TB in the head & neck region is challenging due to diverse presentations and due to changing clinical pictures. The aim of this article is to report three unusual primary cases of head and neck tuberculosis in immunocompetent patients presenting to our hospital with description of their clinical presentation, appropriate diagnostic methods used and treatment response of these patients. MethodsThree clinical cases were of primary tuberculosis of the lacrimal system, the thyroid gland and of the temporal space were clinically worked up. The aspirate from the swellings were sent for Cytology and Gene Xpert tests. ResultsThe Gene Xpert tests were positive in these unusual cases and aided the Cytology in promptly confirming the diagnosis which otherwise would be missed if staining for AFB is negative. ATT was started and responded well to the treatment. ConclusionThese cases demonstrate the importance of having a high index of suspicion for tuberculosis as a cause of head and neck swellings, especially in developing countries. It also illustrates the value of needle aspiration in such swellings and sending it for cytology and Gene Xpert for early diagnosis of tuberculosis.

Unusual and Rare Cases of Tuberculosis In Immunocompetent Patients

Introduction: Tuberculosis is a major health issue across the world. Extraperitoneal manifestations of tuberculosis have a varied presentation masquerading with other common pathologies. Though it is widespread, diagnosing tuberculosis at unusual sites forms a challenge even in the hands of experienced because of the variance and atypical presentations of tuberculosis at these sites, no standard diagnostic definitions and difficult accessibility of tissue samples. Case series: We report a case series of very rare cases of tuberculosis at unusual sites, treated at our hospital. The period of follow-up ranged from 3 months to one and a half years. All the patients included in this series show signs of improvement at follow-up. Conclusion: High index of suspicion is required to diagnose tuberculosis at unusual sites even in endemic countries. This helps in getting investigations done in the right direction without delay. While CBNAAT and culture are the gold standards for diagnosing M. Tuberculosis, histopathological examination, ADA, CT scan along clinical features can help in correct diagnosis and timely treatment. Reporting of such unusual and rare cases forms a key source of information on research in tuberculosis and collectively make the base for optimization of diagnostic criteria for early detection and treatment.

A CASE OF MILIARY TB IN A YOUNG IMMUNOCOMPETENT FEMALE

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Miliary tuberculosis (TB) refers to the hematogenous spread of Mycobacterium tuberculosis bacilli. It is a rare disease with only 2% of the 9,000 cases of tuberculosis reported annually accounting for miliary TB. Classically, it occurs in the lungs with radiologic findings of millet sized nodules scattered diffusely throughout the lung parenchyma. Miliary TB is usually only observed in young children or in severely immunocompromised adults, especially those with Human Immunodeficiency Virus (HIV). We present arare case of miliary TB in an immunocompetent adult female. CASE PRESENTATION: A 23-year-old Honduran born female with a past medical history of asthma presented to the hospital with symptoms of chest pain, shortness of breath, productive cough, fever and night sweats for two weeks duration. Of note, three months prior she had been admitted to the hospital with abdominal pain and diarrhea. CT of the abdomen and pelvis at that time demonstrated inflammation of the terminal ileum and sigmoid colon suspicious for enterocolitis. Bilateral peribronchial infiltrates were noted at the lung bases on CT of the abdomen and pelvis. A dedicated CT of the chest was performed which demonstrated scattered nodular densities bilaterally, some of which appeared cavitary. Antibiotics for pneumonia and enterocolitis were initiated and she was discharged home. Despite improvement in her diarrhea, she reported a 25 pound weight loss over the following months. A repeat CT of the chest was obtained on the current admission given her respiratory complaints. Worsening bilateral nodular infiltrates with enlargement of the cavitary lesions and bilateral hilar adenopathy highly suspicious of miliary tuberculosis was demonstrated. Sputum cultures were obtained with Mycobaterium tuberculosis complex isolated on all three acid fast bacillus (AFB) cultures. Rifampin, pyrazinamide, isoniazid and ethambutol (RIPE) were initiated along with pyridoxine (vitamin B6). Serology for HIV was negative and the patient was not on any immunosuppressant therapies. DISCUSSION: Misdiagnosis of miliary TB is common with up to 50% of cases discovered post mortem. Our case highlights that regardless of immune status, miliary TB should be considered in immigrants from tuberculosis endemic regions with pulmonary symptoms and radiologic findings of nodular densities with cavitation. Although not confirmed, our patient’s episode of enterocolitis may have been anextrapulmonary manifestation of tuberculosis involving the small bowel and colon. CONCLUSIONS: Disseminated TB usually occurs in the context of impaired cell mediated immunity, however, in the absence of HIV or immunosuppressive therapy as in our patient, the disease can occur in immunocompetent individuals. It is therefore imperative to maintain a high index of clinical suspicion in order to initiate antitubercular treatment in a timely manner to avoid morbidity and mortality. Reference #1: Global tuberculosis report 2019. Geneva: World Health Organization; 2019. License: CCBY-NC-SA3. 0IGO Reference #2: Ates Guler S, Bozkus F, Inci M, F, Kokoglu O, F, Ucmak H, Ozden S, Yuksel M: Evaluation of Pulmonary and Extrapulmonary Tuberculosis in Immunocompetent Adults: A Retrospective Case Series Analysis. Med Princ Pract 2015;24:75-79. doi: 10.1159/000365511 Reference #3: Pereira D, Sequeira T, Rocha S, Ferreira B (2015) Disseminated Tuberculosis in Immunocompetent Patients, Case Reports. J Infect Pulm Dis 1(1): doi http://dx.doi. org/10.16966/2470-3176.104 DISCLOSURES: No relevant relationships by Rhea Farquhar, source=Web Response No relevant relationships by Aileen Hocbo, source=Web Response No relevant relationships by Natalie Millet, source=Web Response No relevant relationships by Azka Sadiq, source=Web Response No relevant relationships by Sivashankar Sivaraman, source=Web Response

Tuberculosis pericárdica en paciente inmunocompetente: a propósito de un caso

Tuberculosis pericárdica en paciente inmunocompetente: a propósito de un caso

Unusual presentation of Primary Multi Drug Resistant Tuberculosis in immunocompetent patient: Rapid radiological deterioration - A case report

Unusual presentation of Primary Multi Drug Resistant Tuberculosis in immunocompetent patient: Rapid radiological deterioration - A case report

Massive choroidal granuloma as the presenting feature of disseminated tuberculosis in immunocompetent patients

Massive choroidal granuloma as the presenting feature of disseminated tuberculosis in immunocompetent patients

Isolated splenic tuberculosis in immunocompetent patient: A rare occurrence

Globally millions of people are affected by tuberculosis (TB) each year and India has the largest number of TB cases both pulmonary and extrapulmonary. Extrapulmonary TB affecting spleen is quite rare and occurs mostly as a part of miliary tuberculosis in immunocompromised patients. In the Immunocompetent patients, isolated splenic tuberculosis is extremely rare. Herein, we present the case of an immunocompetent female with isolated splenic tuberculosis.

Splenic tuberculosis in immunocompetent patient: A case report and literature review

Splenic tuberculosis (TB) is usually seen as part of disseminated TB, especially in immunocompromised patients. We report such a case in a 23-year-old immunocompetent male patient who presented with a 10-day history of left-sided abdominal pain and fever. Computed tomography (CT) of the abdomen showed an enlargement of the spleen with multiple hypodense lesions, some of them with septations, the largest measuring 6.9 cm × 5.4 cm, in addition to multiple lymph nodes. Chest X-ray showed left apical fibronodular infiltrate with prominent left hilar region suggestive of enlarge lymph node. Sputum for acid-fast bacilli was positive, and the patient was initiated on 4-drug anti-tuberculous treatment. The diagnosis of splenic TB was retrospectively confirmed based on a complete regression of the splenic lesions on the follow-up CT of the abdomen.

Extra-pulmonary tuberculosis in immunocompetent patients: Case series and mini review of the literature

Introduction: Tuberculosis (TB) is still one of the most frequent infectious diseases, causing 2 million deaths a year worldwide. The prevalence of TB has increased in both immunocompetent and immunocompromised and virtually, it can affect any organ. Up to 25% of tuberculosis cases present extra-pulmonary involvement. The diagnosis of extra-pulmonary TB (EPTB) is difficult, often requiring biopsy. Material and methods: We present two cases of EPTB in immunocompetent young women. The first case is about a 15-years old female who presented with persistent high fever, ascites and an increased CA-125 serum level. Biochemical analysis of ascites fluid revealed a high value of adenosine deaminase (ADA), negative Ziehl-Neelsen stain and undetectable Mycobacterium tuberculosis at PCR assay. The peritoneal biopsy confirmed the diagnosis of peritoneal TB. The second case, a 29-years old female with a seven-month history of cervical lymph nodes swelling, with drainage and excision biopsy performed, misdiagnosed as cats-scratch disease based on the histological description as granulomatous lymphadenitis, which turned out to be tuberculous lymphadenitis at the second histopathological opinion. In conclusion, these cases highlight the need for tuberculosis consideration in the differential diagnosis of extra-pulmonary involvement, even in immunocompetent individuals, in order to decrease the misdiagnoses and complications rates.

Diagnosis challenges of peritoneal tuberculosis in immunocompetent patients: case report and short-review of the literature

Diagnosis challenges of peritoneal tuberculosis in immunocompetent patients: case report and short-review of the literature

Diagnosis of mediastinal tuberculosis: two clinical cases of patients coming from Pakistan

Tuberculosis (TB) is a common disease in Pakistan with 18 % of extra-pulmonary cases. Pakistan ranks fourth amongst high burden countries for TB in the world. Mediastinal involvement is rare in particular in the forms of lymphadenitis without lung damaging. The typology of the migration flows has modified the tuberculosis’ epidemiological distribution and the number of the extrapulmonary cases are increasing in Europe and in Italy. Diagnosis of mediastinal tuberculosis is difficult as the clinical presentation lacks specificity, imaging studies do not provide conclusive information and the differential diagnosis is a common challenge in clinical practice. The suspect of tuberculosis must be considered including acid-fast bacilli (AFB) staining (Ziehl-Nielsen and auramine), cultures and nucleic acid technology methods. We report two cases of mediastinal tuberculosis without a pulmonary tuberculosis in immunocompetent patients. This last condition, makes our cases even more rare. The first case is a man of 48-years-old presented with syncope, arrhythmia and weight loss of 20 kg during the last four months. The second case is a man of 29-years-old presented with fever (102 °F), dry cough and nocturnal sweating. The process that lead to the diagnosis of mediastinal tuberculosis, particularly in immunocompetent patients and without a concurrent diagnosis of pulmonary tuberculosis, is difficult to implement in a general clinical practice. These cases require a close examination of the differential diagnosis and the different and complex clinical pictures related to Mycobacterium tuberculosis must not be excluded. Moreover, it is needed to adopt and coordinate both mini-invasive diagnostic systems (e.g. Endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA) and mycobacterial tests (microscopy, cultures and nucleic acid amplification techniques, NAAT) able to confirm or exclude the diagnosis of tuberculosis with an acceptable precision. Our cases demonstrated the key role of mycobacterial cultures in the diagnosis of these rare forms of mediastinal tuberculosis.

Tuberculosis ‘The Great Imitator’: A usual disease with unusual presentations

BackgroundA number of infectious diseases have been referred to by the phrase ‘The Great Imitator’, of which the oldest is syphilis; others include Lyme disease, nocardiosis, etc. Tuberculosis has been described as the second great imitator as it can imitate various other disease processes. An awareness of the atypical clinical manifestations of tuberculosis is important, especially in regions where tuberculosis continues to be a major public health problem, such as India. Extrapulmonary tuberculosis (EPTB) constitutes about 15–20% of all cases of tuberculosis in immunocompetent patients and accounts for more than 50% of the cases in human immunodeficiency virus (HIV)-positive individuals. MethodsWe hereby report 4 cases of tuberculosis at unusual sites, which were not suspected clinically and were subsequently diagnosed by pathological examination and by ancillary techniques. Observations and resultsIn all the four cases, the involvement was extrapulmonary in nature and at unusual sites. Three cases were diagnosed by a positive Ziehl Neelsen stain while culture for Mycobacterium tuberculosis was positive in three cases. All the four patients tested negative for HIV status on serology. Conclusions and implicationsUnusual presentations, which mimic many diverse conditions, as seen in this series, highlight the importance of a high index of suspicion in the timely diagnosis of tuberculosis. Evidence of systemic or lung involvement may not always be present and laboratory and radiological findings play an important role.