Tuberculosis Lymphadenitis Research Articles

341. GeneXpert Ultra for the Diagnosis of Extrapulmonary Lymphnode Tuberculosis – A Diagnostic Study from High Tuberculosis Burden Country

Abstract Background Extrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 13.1%. Diagnosis of EPTB is often challenging as it resembles other granulomatous conditions pathologically. TB culture remains the gold standard for definitive diagnosis, but it takes longer time and WHO has recommended the use of GeneXpert Ultra for rapid diagnosis. This study aims the utility of GeneXpert Ultra for diagnosis of tubercular adenitis. Methods This prospective study included the suspected tubercular adenitis patients with lymphnode size of ≥ 20mm. Patients diagnosed with other aetiology of adenitis were excluded. Excision biopsy was performed in all patients. Tissue samples were sent for Ziehl Neelson (ZN) stain, GeneXpert Ultra, histopathology and mycobacterial culture (BACTEC). The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results. Results A total of 85 patients Lymph node were included, of which 60% (n=51) had cervical LN, 15%(n=13) abdominal LN, 12%(n=11) mediastinal LN, and 15%(n=11) others. Most of the patients (97%) HPE findings of granulomatous inflammation of which only 20%(n=17) were ZN stain Positive. TB culture showed positivity of 56.47%(n=48) . Mycobacterial tuberculosis was detected in 69%(n=59) of patients by GeneXpert Ultra & none of them showed Rifampicin resistance. The Sensitivity, specificity, PPV & NPV for GeneXpert Ultra were found 85.4%, 51.3%, 25.06% and 94.8%, respectively. Conclusion GeneXpert Ultra showed excellent sensitivity and negative predictive value for the diagnosis of TB Lymphadenitis. Further this method detects Rifampin sensitivity which is crucial for initiation of appropriate antitubercular drugs. Disclosures All Authors: No reported disclosures.

More than Mycobacterium tuberculosis: site-of-disease microbial communities, and their functional and clinical profiles in tuberculous lymphadenitis

BackgroundLymphadenitis is the most common extrapulmonary tuberculosis (EPTB) manifestation. The microbiome is important to human health but uninvestigated in EPTB. We profiled the site-of-disease lymph node microbiome in tuberculosis lymphadenitis...

Clinicopathological study of head and neck swellings in patients attending ENT OPD

A thorough clinical history and a good clinical examination including the findings of inspection and palpation are key factors for near accurate provisional diagnosis but histopathological examination is the only gold standard for confirmation of diagnosis till date for the head neck swellings. It has been observed that there was slightly higher ratio of female patients attending the OPD with complaints of neck swelling. Fine needle aspiration cytology is a quick, convenient, easy to perform, and fairly accurate method for cytological diagnosis on an outpatient basis. Importance of this study, particularly in the context of neck masses, lies in the fact that a preoperative cytological diagnosis of a benign lesion in a high-risk patient may obviate the need of a surgical intervention. Preoperative diagnosis of certain conditions like lymphoma and inflammatory pathology may also escape from unnecessary surgeries. It can be concluded that lymph node swellings are the most common amongst the neck swelling by far and on its cytological examination reactive lymphadenitis being the prevalent one. It can also be said that FNAC is the most reliable method for diagnosing the TB lymphadenitis and thyroid swellings.

Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance.

Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

Comparison of immunohistochemistry with conventional histopathology for evaluation of lymphnodes

Background: Lymph node specimens are routinely used for the evaluation of lymphadenopathies. Tuberculosis and reactive lymphadenitis are the major causes of lymphadenopathy in developing countries. A panel for Immunohistochemistry is decided based on differential diagnosis through histopathology. Immunohistochemistry helps in the sub typing of the lymphomas and metastatic lesions. Materials and Methods: The present study was carried out on 50 patients. Types of samples include lymph node specimens received in histopathology section of the pathology department. The cases were diagnosed based on light microscopy and confirmed by Immunohistochemistry. Aims and Objectives:  To determine the histopathological spectrum of lymphadenopathy by evaluation of the specimen.  To study the incidence of lymph node lesions with respect to age and sex.  To use Immunohistochemistry for subtyping of various neoplastic lesions. Results: A total of 50 lymph node specimens were studied. Age distribution varied from 7 to 80 years with female preponderance. Non – Neoplastic lesions were common comprising of 27 cases (54%) while neoplastic lesions were 23 (46%). Among non neoplastic lesions reactive lymphadenitis (26%) was common followed by tuberculous lymphadenitis (20%). In neoplastic lesions, metastatic diseases (20%) predominated. Conclusion: Reactive lymphadenitis and tuberculosis are the most common diagnosis in lymph node specimens. Histopathology with IHC on lymph node specimens are diagnostic and reliable investigations to differentiate non-neoplastic lesions from neoplastic lesions, and further classify the disease in both cases.

Evaluation of Fine-needle Aspiration Cytology (FNAC) Sensitivity Compared to PCR for Diagnosing Tuberculosis Lymphadenitis

Background: Tuberculosis (TB) is a major healthcare burden in Sudan and other developing countries, it is considered the second most common cause of death from infectious diseases after those due to AIDS. In Sudan, TB lymphadenitis (TBLA) remains one of the major health problems. This descriptive cross-sectional study was conducted at the University of Medical Sciences and Technology (UMST) and Total Labcare Diagnostic Center (TDC). The study aims to compare the sensitivity of Fine Needle Aspiration Cytology (FNAC) smears with that of the Polymerase Chain Reaction (PCR) for the diagnosis of TBLA.
 Materials and Methods: Fifty-five dry smears were obtained using fine-needle aspiration (FNA) from an enlarged lymph node. PCR was applied to detect the target gene (IS6110). May-Grunwald-Giemsa (MGG) or Diff quick stains were used.
 Results: Two (4%) patients with TBLA were non-necrotic, while fifty-three of them (96%) were necrotic. Moreover, 17 (30%) fine-needle lymph node aspiration specimens were confirmed by PCR to be positive for Mycobacterium tuberculosis complex (MTB complex) while 38 (70%) of them were negative.
 Conclusion: There was no significant difference between the sensitivity of PCR and that of FNAC (P-value = 0.33).

A rare presentation of extra pulmonary tuberculosis in neck (isolated level-VI cervical lymph node tuberculosis)

<p class="abstract">One of the most common varieties of extra pulmonary tuberculosis is tuberculosis lymphadenitis. This was the case report of a 40-year-old female who presented with complaint of neck swelling and voice change and was later diagnosed with an isolated extra-pulmonary level-VI cervical lymph node tuberculosis. The diagnosis was made by histopathology and PCR and patient was then started with anti-tuberculosis therapy.</p>

Cutaneous diffuse large B cell lymphoma mimicking extrapulmonary tuberculosis

The differential diagnosis for an adult cervical lymphadenopathy often includes infectious diseases and malignancy. Extrapulmonary tuberculosis (TB) is an infectious disease that can manifest with cutaneous lesions or tuberculosis lymphadenitis, which can present as a neck mass. Among other cancers, B cell lymphoma can also first present with cervical lymphadenopathy that appears as a firm neck mass. However, TB and B cell lymphomas differ in most other presenting signs and symptoms. In this case report, we present an unusual case of a patient who first presented with bulky, necrotizing masses, lymphadenopathy, and cutaneous lesions suspicious for extrapulmonary TB and was partially responsive to RIPE therapy. However, this patient was later diagnosed with atypical diffuse large B cell lymphoma (DLBCL) with cutaneous involvement, showing that cutaneous DLBCL can closely mimic the common signs of extrapulmonary TB.

Xpert MTB/RIF Ultra outperformed the Xpert assay in tuberculosis lymphadenitis diagnosis: a prospective head-to-head cohort study

ObjectivesXpert Mycobacterium tuberculosis/rifampin (MTB/RIF) Ultra (Xpert-Ultra) has shown better sensitivity in comparison with Xpert MTB/RIF (Xpert) in extrapulmonary tuberculosis (TB), whereas the head-to-head comparison of these methods in TB lymphadenitis had barely been performed. MethodsPatients with undiagnosed lymphadenopathy were recruited prospectively and consecutively, and fine-needle aspiration (FNA) biopsy or lymph node tissue was collected. The specimen was subjected to smear, culture, Xpert, and Xpert-Ultra assays. Culture and/or smear for acid-fast bacilli (AFB) or AFB observed on histopathology were performed as a reference. ResultsA total of 106 participants were recruited, including 41 confirmed TB, 33 probable TB, and 32 non-TB lymphadenopathies. The head-to-head comparison for MTB detection showed that Xpert-Ultra produced the highest sensitivity when compared with smear, culture, and Xpert (75.7% vs 5.4 %, 13.5%, and 48.7%). When Xpert-Ultra outcomes were integrated for diagnosis, the percentage of confirmed TB lymphadenitis cases increased from 55.4% (41/74) to 85.1% (63/74). The sensitivities of Xpert-Ultra and Xpert on tissue were 73.6% (95% CI: 59.4-84.3) and 39.6% (95% CI: 26.8-54.0), respectively. The sensitivity of Xpert-Ultra on FNA samples (81.0%, 95% CI: 57.4-93.7) was higher than that of Xpert (71.4%, 95% CI: 47.7-87.8). ConclusionXpert-Ultra detected significantly more TB lymphadenitis cases than Xpert or culture. This superiority was particularly distinct using lymph node tissue than FNA detection.

Refractory bilateral choroiditis due to presumed ocular tuberculosis responding to intravitreal moxifloxacin

A rare presentation of bilateral refractory choroiditis due to presumed ocular tuberculosis with dramatic response to intravitreal moxifloxacin is described in this report. A 32-year-old lady with a past history of bilateral choroiditis due to presumed ocular tuberculosis and biopsy-proven tubercular lymphadenitis four years ago came to us with reactivation of inflammation refractory to antitubercular therapy, systemic steroids, vitrectomy and intravitreal anti-VEGF injections. The lesions responded dramatically to intravitreal injections of moxifloxacin and dexamethasone. Following this dramatic response, she also received oral moxifloxacin 800 mg/day along with ATT for a year. At two-year follow-up, she is doing well with no further recurrences. To the best of our knowledge, no cases of tubercular choroiditis responding to moxifloxacin have been reported (MEDLINE search). This case highlights the usefulness of intravitreal moxifloxacin in refractory tubercular choroiditis.

Bayesian latent class analysis produced diagnostic accuracy estimates that were more interpretable than composite reference standards for extrapulmonary tuberculosis tests

BackgroundEvaluating the accuracy of extrapulmonary tuberculosis (TB) tests is challenging due to lack of a gold standard. Latent class analysis (LCA), a statistical modeling approach, can adjust for reference tests’ imperfect accuracies to produce less biased test accuracy estimates than those produced by commonly used methods like composite reference standards (CRSs). Our objective is to illustrate how Bayesian LCA can address the problem of an unavailable gold standard and demonstrate how it compares to using CRSs for extrapulmonary TB tests.MethodsWe re-analyzed a dataset of presumptive extrapulmonary TB cases in New Delhi, India, for three forms of extrapulmonary TB. Results were available for culture, smear microscopy, Xpert MTB/RIF, and a non-microbiological test, cytopathology/histopathology, or adenosine deaminase (ADA). A diagram was used to define assumed relationships between observed tests and underlying latent variables in the Bayesian LCA with input from an inter-disciplinary team. We compared the results to estimates obtained from a sequence of CRSs defined by increasing numbers of positive reference tests necessary for positive disease status.ResultsData were available from 298, 388, and 230 individuals with presumptive TB lymphadenitis, meningitis, and pleuritis, respectively. Using Bayesian LCA, estimates were obtained for accuracy of all tests and for extrapulmonary TB prevalence. Xpert sensitivity neared that of culture for TB lymphadenitis and meningitis but was lower for TB pleuritis, and specificities of all microbiological tests approached 100%. Non-microbiological tests’ sensitivities were high, but specificities were only moderate, preventing disease rule-in. CRSs’ only provided estimates of Xpert and these varied widely per CRS definition. Accuracy of the CRSs also varied by definition, and no CRS was 100% accurate.ConclusionUnlike CRSs, Bayesian LCA takes into account known information about test performance resulting in accuracy estimates that are easier to interpret. LCA should receive greater consideration for evaluating extrapulmonary TB diagnostic tests.

Utility of cartridge based nucleic acid amplification test in diagnosis of tubercular lymph nodes on fine needle aspiration and its comparison with zeihl-neelsen staining and concentration bleach method

Tuberculosis (TB) is one of the oldest disease known to humanity and among the deadliest epidemics and is in the top 10 causes of death worldwide. The incidence of tuberculosis in India has dramatically increased and contributing to it is Human Immunodeficiency Virus (HIV). Various diagnostic methods are available for detection of tubercular bacilli. Only full proof criteria for diagnosis of TB is to demonstrate the bacilli from affected tissue. This study was planned in extra pulmonary tuberculosis cases to evaluate different staining methods for demonstration of mycobacterium on FNAC material. To evaluate efficacy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in the initial cytodiagnosis of Tubercular Lymphadenitis 147 clinically suspected cases of extra pulmonary tuberculosis mainly TB lymphadenitis who attended cytology OPD were selected irrespective of age and sex. FNAC was performed. Slides stained for PAP, ZN and concentration bleach. Material remained in hub was sent for CBNAAT. PAP stained slides were observed for various morphological pattern.Six morphological patterns were observed. Positivity for acid fast bacilli by ZN staining, concentration bleach method and CBNAAT were compared. Detection of acid-fast bacilli by CBNATT was found more as compared to ZN and Concentration bleach method.

The Correlation between Tuberculous Lymphadenitis and Nutritional Status in Children

Tuberculous lymphadenitis may cause weight loss and lead to malnutrition in children.This study analyzes the correlation between tuberculous lymphadenitis and nutritionalstatus in children. It was an analytic observational study with a cross-sectional design.The population was pediatric patients under 18 years old with lymphadenitis, outpatientand inpatient admitted from January 2018 to December 2020 in dr. Soebandi publichospital, Jember, Indonesia. The samples were 76 respondents with total sampling. There were 52 tuberculosis lymphadenitis patients in the case group, while 24 were non-tuberculosis in the control group. The body weight data was from the medical record when the first diagnosis of lymphadenitis. Instruments were weight-for-age z-scorecurves (WHO, 2007) for under 60 months old children, while CDC Growth Charts 2000for more than five-year-old children. Then, data analysis used the Chi-square test.Mostly, tuberculous lymphadenitis patients were girls (65.4%), 12-17 years old (67.3%),not underweight (61.5%), and lived in rural areas (73%). Furthermore, all of them weregiven isoniazid, rifampicin, and pyrazinamide. In addition, 100% of them had successfultreatment. Meanwhile, most of the non-tuberculous lymphadenitis patients were boys(54.2%), 6-11 years old (58.3%), lived in the rural areas (79%), and were notunderweight (66.7%). Treatment of the non-tuberculous lymphadenitis group consistedof antibiotics, analgesics, vitamins, and symptomatic medicine. The Chi-square testresults obtained p=0.667 (p>0.05). In conclusion, tuberculosis lymphadenitis in theearly incubation period

Fine Needle Aspiration Cytology: A Reliabe Diagnostic Approach in Supraclavicular Lymph Node Swelling: A Study at Pumhs-W, Nawabshah, Sind, Pakistan

Objective: This study was conducted with the aim to approach the diagnostic accuracy of fine needle aspiration cytology in supraclavicular lymph node swelling at outpatient department.
 Methods: The study is cross-sectional, descriptive conducted at General Surgery department Unit-III, of PUMHSW, Nawabshah, Sind, from 1st January 2019 to 31st December 2020. After the written permission from ethical Review Committee of PUMHS-W, all the patients attending Surgical/Medical outpatient department with supraclavicular lymph node swelling and sent for cytological examination from 1st January 2019-31st December 2020 were entered in SPSS-20, after filling of specially designed proforma. All the variables/demographic details were entered and analyzed by SPSS version 20.
 Results: Total of 153 cases diagnosed at the Department of Pathology, PUMHS-W, and Nawabshah during the two-year period. The most commonly lesion was TB Lymphadenitis 58(38%),and 43(28%) were cases of Reactive Hyperplasia, while the malignant metastatic lesions were 38(25%) and Lymphoma and NHL were positive in 5(3%) cases.
 The metastatic lesion were most commonly involve the left side 23(60.5%) and less commonly the bilateral 3(8%) involvement. The common metastatic malignancy found was squamous cell carcinoma 14(37%) followed by adenocarcinoma, undifferentiated carcinoma, small cell carcinoma, papillary thyroid carcinoma, ductal carcinoma breast, hepatocellular carcinoma and seminoma, 10(%), 5(% ),2(%), 2(%), 1(%), 1(%), 1(%) respectively.
 The most commonly involved age group by mixed lesions were 41-50 years of age, and less common group involved was above 70 years of age. The metastatic malignant lesion were commonly found in 61-70 years of age group and lymphoma and Non Hodgkin Lymphoma were seen up to 60 years of all age groups.
 Conclusion: Fine Needle Aspiration Cytology is a reliable diagnostic tool as it is cheap, less invasive, and timed modality for diagnosing the supraclavicular lymph node inflammation/metastatic and nodular malignancies.

Integration of cytopathology with molecular tests to improve the lab diagnosis for TBLN suspected patients.

BackgroundTuberculosis lymphadenitis (TBLN) diagnosis is often challenging in most resource poor settings. Often cytopathologic diagnosis of TBLN suspected patients is inconclusive impeding timely clinical management of TBLN suspected patients, further exposing suspected patients either for unnecessary use of antibiotics or empirical treatment. This may lead to inappropriate treatment outcome or more suffering of suspected patients from the disease. In this study, an integrated diagnostic approach has been evaluated to elucidate its utility in the identification of TBLN suspected patients.MethodsA cross-sectional study was conducted on 96 clinically diagnosed TBLN suspected patients, where fine needle aspirate (FNA) samples were collected at the time of diagnosis. FNA cytology, Ziehl-Neelsen (ZN), Auramine O (AO) staining, GeneXpert MTB/RIF and Real time PCR (RT-PCR) were performed on concentrated FNA samples. Considering culture as a gold standard, the sensitivity, specificity, positive and negative predictive values were calculated. Cohen’s Kappa value was used to measure interrater variability and level of agreement and a P-value of <0.05 was considered as statistically significant.ResultOut of the 96 FNA sample, 12 (12.5%) were identified to have Mycobacterium tuberculosis (Mtb) using ZN staining, 27 (28.1%) using AO staining, 51 (53.2%) using FNAC, 43 (44.7%) using GeneXpert MTB/RIF, 51 (53.1%) using Real time PCR (RT-PCR) and 36 (37.5%) using Lowenstein-Jensen (LJ) culture. Compared to LJ culture, the sensitivities of GeneXpert MTB/RIF, RT-PCR, and FNAC were 91.7%, 97.2%, and 97.2%, respectively and the specificities were 83.3%, 73.3%, and 68.3%, respectively. GeneXpert MTB/RIF and RT-PCR when combined with FNAC detected 61 (63.5%) cases as having Mtb, and the sensitivity and specificity was 100% and 58.3%, respectively.ConclusionFNA cytology and RT-PCR detected more TBLN cases compared to other Mtb detection tools and the detection sensitivity even improved when FNA cytology was combined with GeneXpert MTB/RIF, performed on concentrated FNA sample, suggesting the combined tests as an alternative approach for improved diagnosis of TBLN.

Mycobacterium tuberculosis Affects Protein and Lipid Content of Circulating Exosomes in Infected Patients Depending on Tuberculosis Disease State.

Tuberculosis (TB), which is caused by the bacterium Mycobacterium tuberculosis (Mtb), is still one of the deadliest infectious diseases. Understanding how the host and pathogen interact in active TB will have a significant impact on global TB control efforts. Exosomes are increasingly recognized as a means of cell-to-cell contact and exchange of soluble mediators. In the case of TB, exosomes are released from the bacillus and infected cells. In the present study, a comprehensive lipidomics and proteomics analysis of size exclusion chromatography-isolated plasma-derived exosomes from patients with TB lymphadenitis (TBL) and treated as well as untreated pulmonary TB (PTB) was performed to elucidate the possibility to utilize exosomes in diagnostics and knowledge building. According to our findings, exosome-derived lipids and proteins originate from both the host and Mtb in the plasma of active TB patients. Exosomes from all patients are mostly composed of sphingomyelins (SM), phosphatidylcholines, phosphatidylinositols, free fatty acids, triacylglycerols (TAG), and cholesterylesters. Relative proportions of, e.g., SMs and TAGs, vary depending on the disease or treatment state and could be linked to Mtb pathogenesis and dormancy. We identified three proteins of Mtb origin: DNA-directed RNA polymerase subunit beta (RpoC), Diacyglycerol O-acyltransferase (Rv2285), and Formate hydrogenase (HycE), the latter of which was discovered to be differently expressed in TBL patients. Furthermore, we discovered that Mtb infection alters the host protein composition of circulating exosomes, significantly affecting a total of 37 proteins. All TB patients had low levels of apolipoproteins, as well as the antibacterial proteins cathelicidin, Scavenger Receptor Cysteine Rich Family Member (SSC5D), and Ficolin 3 (FCN3). When compared to healthy controls, the protein profiles of PTB and TBL were substantially linked, with 14 proteins being co-regulated. However, adhesion proteins (integrins, Intercellular adhesion molecule 2 (ICAM2), CD151, Proteoglycan 4 (PRG4)) were shown to be more prevalent in PTB patients, while immunoglobulins, Complement component 1r (C1R), and Glutamate receptor-interacting protein 1 (GRIP1) were found to be more abundant in TBL patients, respectively. This study could confirm findings from previous reports and uncover novel molecular profiles not previously in focus of TB research. However, we applied a minimally invasive sampling and analysis of circulating exosomes in TB patients. Based on the findings given here, future studies into host–pathogen interactions could pave the way for the development of new vaccines and therapies.

Diagnostic delay and out of pocket expenditure in extra pulmonary tuberculosis patients: a cross sectional study in DOTS centre of a tertiary care hospital in South India

Background: Extra pulmonary tuberculosis (EPTB) accounted for 15% of the cases. Diagnosing EPTB is challenging as it frequently has non-specific clinical presentation and it may simulate other conditions, which may contribute towards delay in diagnosis. Delay in diagnosis and treatment could lead to increased disease severity, increased complications and economic burden for the patient and the families affected.Methods: This Descriptive cross-sectional study was conducted in directly observed therapy short-course (DOTS) center, Mandya institute of medical sciences (MIMS), India. Patients who are diagnosed with EPTB with age &gt; 18 years were selected, informed consent was taken from 60 patients before collecting data. Data was analysed using Epi-Info (version 3.5.1) software. Descriptive statistics like mean, standard deviation and proportion are usedResults: Of the 60 patients, majority 76.7% were in the age group 18-45 years, 68.3% were male, 75% from rural background and 55% belonged to class III socioeconomic status. Statistically significant diagnostic delay was seen with respect to female sex (total delay = 75.1±9.1 days), age group 18 to 30 years (74.5±5.1 days), lower socio-economic status (74.0±4.5 days), negative HIV status (72.7±4.4 days) and site of tuberculosis. Out of pocket expenditure was significantly higher in male sex (Rs. 22,839.0±5,174.7), age group more than 45 (Rs. 34,335.7±5,134.1) and among higher socioeconomic status Conclusions: Many EPTB patients, presenting to DOTS center, experience a long delay in the initiation of treatment, particularly patients with TB lymphadenitis. The patient delay is the major contributor to the total delay.

Alteration of Endocrine Hormones and Antibody Responses in Different Spectrum of Tuberculosis Disease.

Effective control of Mycobacterium tuberculosis (Mtb) infection is mediated by multifaceted factors that involve both the endocrine and immune system. Profiling hormones and antibodies in different stages of TB provides insight in the pathogenesis of the disease. In this study, we profiled endocrine hormones (dehydroepiandrosterone (DHEA), cortisol, testosterone, estradiol, growth hormone and leptins) and Mtb strain H37RV lipoarabinomannan (LAM)-specific antibody levels in plasma samples, collected from pulmonary TB (PTB) patients, TB lymphadenitis (TBLN) patients and latently infected (QFT-positive) or uninfected (QFT-negative) apparently healthy individuals using ELISA. Plasma levels of leptin and DHEA were significantly low in PTB and TBLN patients compared to healthy controls (P<0.0001 and P=0.02, respectively), whereas these levels significantly increased following anti-TB treatment (P=0.002 and P=0.0001, respectively) among TB patients. The levels of estradiol and testosterone significantly improved following anti-TB treatment (P=0.03 and P=0.0003, respectively), whereas cortisol and growth hormones declined significantly (P <0.05). Similarly, LAM-specific IgG, IgM and IgA were significantly higher in PTB patients compared to other groups, whereas levels of IgG1 subtype were significantly higher among LTBI groups compared to both TB patients and QFT-negative individuals (P<0.0001). Overall, we observed significantly variable levels of endocrine hormones as well as immunoglobulins across the spectrum of TB illness and such profiling has a significant contribution in selection of effective biomarkers that have roles in TB treatment monitoring or diagnostics. Although this study did not show a functional association between hormones and antibodies, alterations in the levels of these biomarkers suggest the key roles these markers play in TB pathogenesis.

Profile and histopathology features of top three cases of Extra Pulmonary Tuberculosis (EPTB) in West Nusa Tenggara: A retrospective cross-sectional study

BackgroundTuberculosis (TB) is an infectious disease that might threaten life with a high incidence rate globally, especially in developing countries such as Indonesia. Although some TB cases are found in the lungs, the incidence of patients with extra-pulmonary TB infection also shows a significant number. However, these cases are still underreported, especially in Indonesia. Histopathological examination is one of the gold standards for diagnosing EPTB. Materials and methodsThis is a cross-sectional retrospective descriptive study. This study uses data from medical records and histopathological examination results of extra-pulmonary TB patients at two hospitals in West Nusa Tenggara between May 2010 and February 2020. The inclusion criteria for this study were patients diagnosed with EPTB histopathologically and had complete paraffin block. In addition, the exclusion criteria were patients with incomplete data in the medical record. The data recorded include gender, age, organ location, area of residence, and histopathological features. ResultsThere were 1.817 cases of extra-pulmonary TB in West Nusa Tenggara from May 2010 to February 2020. The top three organs were from the neck (84.7%), breast (14.1%), and colon (1.2%), with a total of 1362 cases. Women dominate the top three cases of EPTB with 894 patients (65.7%) and in the age group 21–30 (28%). Central Lombok has the most EPTB patients (450; 33.07%). Microscopic examination revealed well-organized granulomas in 988 patients (72.6%) and poorly organized granulomas in 374 patients (27.4%). ConclusionThe three most frequent cases of EPTB found in West Nusa Tenggara are cervical lymphadenitis TB, mastitis TB, and colitis TB, with the majority of cases being well-organized granulomas. Further studies dealing with better designs and larger sample sizes need to be considered. The results of this study are significantly needed to determine the intervention strategies to reduce morbidity and mortality due to EPTB.

A Case of Psoriatic Arthritis Using Anti-Tumor Necrosis Factor-Alpha Diagnosed with Tuberculosis Lymphadenitis Under Preventive Treatment

Psoriatic arthritis (PsA) is a multisystemic inflammatory condition that can lead to disability and impaired quality of life. Anti-tumor necrosis factors (TNFs) are approved drugs for PsA with good control of symptoms and inhibition of disease progression. Latent tuberculosis infection reactivation is one of the important complications observed after treatment with TNF-α inhibitors. Here we present a case of PsA that was treated with 2 different types of anti-TNF drugs who was diagnosed with tuberculosis lymphadenitis even though receiving a 9-month preventive therapy. This case report emphasizes the importance of close follow-up and careful examination of the patients with rheumatological diseases using anti-TNF treatment.