Manifestation Of Tuberculosis Research Articles

Research Trends of Ocular Tuberculosis: A Bibliometric Analysis

ABSTRACT Purpose Ocular tuberculosis (OTB), an extrapulmonary manifestation of tuberculosis (TB), significantly impacts vision acuity and presents challenges in diagnosis and treatment. With ongoing research efforts, new insights into its pathogenesis and treatment have emerged. This study employed bibliometric methods to investigate key research areas and emerging trends, aiming to provide a comprehensive overview of the field. Methods The documents about OTB from January 1, 2003 to December 31, 2023, were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer, CiteSpace, R package bibliometrix, and GraphPad were utilized to analyze the data and visualize the network of the country, organization, author, journal, and keyword related to the field of OTB. Results 300 articles in the past 21 years were included in this research. The overall number of annual publications exhibits an upward trend. The most productive country, institution, author, and journal were India, Post Graduate Institute of Medical Education & Research (PGIMER), Gupta Vishali, and Ocular Immunology and Inflammation. The main keywords focused on ocular tuberculosis, intraocular tuberculosis, and uveitis. The time trend of keyword occurrences indicated that “T cells” and “aqueous humor” have become new hotspots. Burst detection analysis of keywords shows that “pattern” and “standardization” have emerged as new focal points. Conclusions This study represents the first bibliometric analysis on OTB, offering insights into hot topics and emerging trends within this field. T cells and aqueous humor are identified as novel directions for ongoing research endeavors. The latest research focus is on the standardization of OTB in diagnosis, treatment, and other aspects.

Uncommon association of tuberculosis with deep vein thrombosis in a child: a case report

Tuberculosis (TB) is a major global health issue, particularly in developing countries. While TB commonly affects the lungs, it can spread to nearly any organ system, leading to a range of complications. One rare extrapulmonary manifestation of TB is deep vein thrombosis (DVT), which is even more rarely reported in children. We report a case of a 13-year-old girl with progressive, painful swelling in right lower limb, accompanied by fever, cough and lymphadenopathy. Diagnostic imaging identified DVT in the right external iliac vein. Further investigation confirmed Mycobacterium tuberculosis infection. She was treated with anti-tubercular medication and therapeutic anticoagulation. Although uncommon, this case underscores the importance of recognizing this serious complication and need for timely diagnosis and treatment.

Gastrointestinal Tuberculosis: 8-year Experience from a Tertiary Care Hospital in North India.

Introduction: Tuberculosis (TB) represents a significant communicable disease on a global scale. The clinical manifestations of abdominal TB frequently resemble those of various gastrointestinal disorders, potentially leading to delays in accurate diagnosis. Materials and methods: From January 2012 to December 2019, consecutive patients aged 12 years and older, diagnosed with gastrointestinal TB at a tertiary care center in North India, were enrolled. Demographic and clinical data, radiological imaging findings, gastrointestinal endoscopy results, and histopathological findings were meticulously recorded. Antitubercular treatment was administered, and gastrointestinal endoscopy was performed upon the completion of treatment. Results: During the study period, 234 patients with gastrointestinal tuberculosis were enrolled, of which 151 (64.5%) were male and 83 (35.5%) were female. The most common presenting symptoms included weight loss (94.9%), abdominal pain (85.9%), fever (51.7%), and diarrhea (30.8%). The ileocecal region was the most frequently affected site (76.1%), followed by segmental colonic TB (17.1%). The most common finding on computed tomography (CT) of abdomen was thickening of the bowel wall with/without local or mesenteric lymphadenopathy. The most common endoscopic lesions were ulcerations (82.0%) followed by nodularity (73.9%), deformed cecum and ileocecal valve (41.9%) and strictures (11.1%). Histopathological examination of endoscopic biopsy revealed, well-formed granulomas in 94 (40.2%), collection of epithelioid cells with Langhans giant cells in 66 (28.2%), and chronic nonspecific inflammatory changes in 74 (31.6%). All patients responded to the antitubercular treatment. Follow-up colonoscopy in 171 (73.1%) patients showed regression of lesions. Conclusion: Gastrointestinal tuberculosis (GiTb) presents with nonspecific symptoms such as weight loss, fever, and abdominal pain, with ileocecal region being most commonly involved. Gastrointestinal endoscopy shows ulceration, nodularity, and strictures as prominent findings. Histopathology and culture were helpful for making diagnosis in almost half of the patients with GiTb. Majority of the patients responded well to antitubercular treatment.

Generalized tuberculosis with intestinal lesion in an adolescent. Case report

In the two recent decades a decrease in tuberculosis (TB) incidence has been observed worldwide, according to the World Health Organization, while the incidence of extrapulmonary TB, including TB of the intestine, is growing. Generally, diagnosis of TB in children and adolescents is difficult due to its subclinical course in a significant part of patients. A special diagnostic challenge is extrapulmonary TB, including abdominal TB. Abdominal TB has entered the top five most frequent manifestations of extrapulmonary TB along with TB of the peripheral lymph nodes, urogenital TB, bone and joint TB, and TB of the central nervous system. Lack of specific clinical signs of the disease results in late diagnosis of abdominal TB. We described a case of generalized TB with intestinal lesion in an adolescent. We detected mistakes in the follow-up of the female patient with double exposure to household TB, which resulted in late diagnosis of the disease. We demonstrated the challenges in diagnosing intestinal TB under the guise of appendicitis, which led to the development of complications – spilled peritonitis and abdominal abscess. The tactics of management of the female patient at high risk for developing bowel obstruction was represented. Interdisciplinary interactions with extrapulmonary TB specialists were accented for cases of generalized TB.

A rare case of peritoneal tuberculosis mimicking peritoneal carcinomatosis: the ongoing challenge

Tuberculosis (TB) is a serious infection that can involve any organ system and present in various forms. About one-third of the world’s population are carriers of latent TB. Although most cases are from a pulmonary origin, there is a rising prevalence of abdominal TB. Patients with pulmonary or extrapulmonary TB are treated similarly through the use of pharmacological therapy. Nonspecific clinical manifestations of TB have made it difficult for clinicians to diagnose. Peritoneal tuberculosis (PTB) is a serious concern as its symptoms overlap with that of many other chronic conditions, especially in those who are immunocompromised. The lack of highly sensitive and specific testing methods has made early intervention difficult, therefore a high index of suspicion is crucial in the progression of the disease. Here, we present a case of a 71-year-old female with a history of abdominal pain, fever, and weakness. Initial investigation with computed tomography (CT) imaging revealed omental fat stranding that pointed towards peritoneal carcinomatosis (PC) from possible recurrence of her ovarian cancer. Further investigation with a peritoneal biopsy was remarkable for caseating granulomas with fat necrosis confirming extrapulmonary TB. This report highlights a rare case of PTB mimicking PC in an elderly patient who is immunocompromised from the use of long-term corticosteroids who continued to decline after pharmacological treatment of the disease.

Possibilities of Immunogenetic Methods in Testing the Activity of Tuberculosis Infection in Children

The objective: to test the TREC/KREC DNA levels in children with various manifestations of tuberculosis infection.Subjects and Methods. A prospective, cross-sectional study was conducted in 2022-2024. Observation Group consisted of 115 children aged 6 (5; 7) years, of them 25 were diagnosed with tuberculosis, 63 were diagnosed with latent tuberculosis infection, 27 were not infected with Mycobacterium tuberculosis (conditionally healthy). Results. Findings of the study were as follows: among children with LTBI and a positive response to TRA, only 18.2% had the high TREC DNA concentration which corresponded to the level in the children ill with tuberculosis (t = 0.971; p = 0.342), there was a direct relationship between the TREC DNA and KREC DNA levels in children with LTBI; in 21.2% of children the level was low and indicative of immunodeficiency. If the positive response to TRA persisted in children for two years or more, there was a decrease in the average TREC DNA level, which was statistically significant compared to that in children with TRA+ for less than 2 years. Taking into account the results obtained, the TREC DNA level in children with LTBI can be considered as an additional criterion to assess activity of tuberculosis infection and can be an evidence to justify preventive anti-tuberculosis therapy if studied further. We also found a direct correlation between the TREC and KREC DNA levels in children with LTBI, r = 0.48 (by Spearman). When the positive response to TRA persisted for more than two years, a statistically significant decrease in the TREC DNA level was noted versus the results in children with the first positive response to TRA (t = 2.965; p = 0.005).Conclusion. Taking into account the results obtained, the TREC DNA level in patients with various manifestations of tuberculosis infection can be considered as an additional criterion of infection activity, which will allow differentiated approach to preventive treatment being an important evidence to justify anti-tuberculosis therapy.

Tuberculous calcific constrictive pericarditis in an adult female with a past history of abdominal tuberculosis.

Tuberculous pericarditis, one of the rarer extrapulmonary manifestations of tuberculosis, remains a challenge in endemic countries such as India. As the clinical presentation of tuberculous pericarditis is highly variable, the diagnosis is often missed, delayed, or incorrectly diagnosed. Constrictive pericarditis (CP) is one of tuberculous pericarditis's most serious and advanced sequelae. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP in suspected cases. This study reports the case of an Indian adult female with a past history of previously treated abdominal tuberculosis diagnosed anew with tuberculous calcific constrictive pericarditis.

S3123 Gastrointestinal Manifestations of Extra-Pulmonary Tuberculosis in a Previously TB-Treated Patient

S3123 Gastrointestinal Manifestations of Extra-Pulmonary Tuberculosis in a Previously TB-Treated Patient

Spectrum of Ocular Tuberculosis in Tertiary Care Hospitals of Khyber Pakhtunkhwa Peshawar

Purpose: To describe the spectrum of ocular tuberculosis (TB), highlight the difficulty in diagnosis and treatment of such cases encountered in a tertiary care hospital of Peshawar, Pakistan. Study Design: Descriptive Case series. Place and Duration of Study: Khyber teaching hospital MTI Peshawar from Jan 2021 till July 2022. Methods: Eleven cases with Ocular tuberculosis are described. At presentation, complete history was taken and detailed examination was done including fundus examination and OCT macula. For diagnosis, a combination of Tuberculin skin test (TST) and Quantiferon-Gold was performed. On the basis of results of both tests Anti-TB treatment (ATT) was started and continued for an average of 9 months. Results: This study highlights the diverse ocular manifestations of TB in patients, even without a known history of systemic disease. Among 11 patients, 3 presented with panuveitis, 6 with posterior uveitis, and 2 with serpiginous-like choroidopathy with uveitis. Notably, only 2 had a known history of systemic TB. The patients were treated primarily with Anti-Tuberculosis Therapy (ATT) along with steroids or other adjunct therapies. Most cases showed improved vision and stable disease post-treatment, with visual acuity ranging from 6/24 to 6/6. However, two patients were lost to follow-up, leaving their outcomes unknown. Conclusion: In this case series, we explore different cases of Ocular Tuberculosis (OTB) seen at a busy hospital in Peshawar, Pakistan. There are variety of symptoms with which the patients present. The combined use of TST and Quantiferon-Gold proved an effective and affordable approach for diagnosis and timely initiation of ATT in ocular TB.

Anal tuberculosis presented as chronic perianal abscess in an immunocompetent adult: A rare case report

ABSTRACT There are reported 7.5 million cases of extra pulmonary tuberculosis (TB) (EPTB) worldwide and 19% in the South-East Asia region. Anal TB represents an exceedingly uncommon extra pulmonary manifestation of TB), occurring in fewer than 1% of individuals who acquire TB. The occurrence of perianal illness is extremely rare, accounting for 1% of the gastrointestinal (GI) tract, while GI TB makes up less than 1% of all TB cases. The most prevalent manifestation is the development of a fistula in the anus, while the presentation as a perianal abscess is uncommon. We present a case of isolated perianal TB with no associated GI or pulmonary dissemination in the immunocompetent.

Survey of spinal tuberculosis in Basrah

Background. Tuberculous spondylitis (TS) or spinal tuberculosis is secondary either to pulmonary or intestinal tuberculosis and may be the initial manifestation of tuberculosis (TB). Spinal TB also called Pott’s disease is by definition, an advanced severe disease, requiring accurate evaluation and aggressive systemic therapy. Objective. This study was conducted to demonstrate the prevalence and clinical, laboratory, and management characteristics of patients with spinal tuberculosis in Basrah governorate. Methods. A cross-sectional descriptive retrospective and prospective study was conducted during the period of March 2020 to December 2021. All cases either registered at the tuberculous center / Basrah Health Director were viewed by phone calling or recall or newly diagnosed with spinal tuberculous which attended to Basrah Teaching Hospital. Those patients were followed after diagnosis and treatment initiation for any clinical improvement, worsening or no improvement after diagnosis. Results. Among 51 enrolled patients with spinal tuberculosis in this study, the age distribution was 20-39 years old 23 (45.09%). Most of the patients were males (32) with rates 62.74%. The most common site of vertebral involvement is dorsal segment 29 (56.86%). The most common presenting complaints were: back pain in 49 patients (96.07%). Regarding the examination findings, 2(13.33%) with deformity either kyphotic or gibbous deformity. Most of the examined patients had a power grade 1-3/5 (93.33%) in the lower limbs. Out of the 4 cases of cervical tuberculosis, all of them had been managed conservatively, while 6 out of 16 cases (37.5%) diagnosed with lumber lesions were managed conservatively, and 10 cases (62.5%) were managed surgically. Conclusion. The prevalence and characteristics of patients with spinal TB follow the global trend, although some differences were recorded, but it was not that significant. The surgical approach is still superior to the conservative one in the improvement of neurological deficits.

Ethambutol induced optic neuropathy: A remerging ocular emergency needing strict vigilance and screening

: To investigate the clinical manifestations and incidence of ethambutol induced optic neuropathy (EON) and identify its risk factors.: A cross sectional, hospital based observational study was conducted in 100 patients, who were on anti-tubercular drugs (ATT) and complained of diminution of vision. The following data was collected in every patient regarding age, gender, co-morbid conditions, clinical manifestation of (tuberculosis)TB, duration and dose of ethambutol. Complete ophthalmic examination was conducted in every patient including best corrected visual acuity (BCVA), color vision, relative afferent pupillary defect (RAPD), fundus examination, visual field analysis and OCT RNFL & GCL. Statistical analysis of the data was done and represented suitably using appropriate statistical tests that included Chi Square test for checking associations and T test for comparing quantitative data with the help of SPSS ver. 26.0 software. All p-values reported were two sided and a value less than 0.05 was considered significant. :Out of 100 patients, only 18 patients were diagnosed with EON and calculated incidence was 1.8%. The most common presenting feature of EON was bilateral diminution of vision (89%) followed by abnormal color vision (11%). On examination, RAPD was seen in 40% cases because of asymmetrical optic nerve involvement and disc abnormality was present in 66% cases. The duration and dose of ethambutol medication, advanced age (>65 years), hypertension, chronic smoking and presence of renal dysfunction were shown to be positively correlated with EON development.:At present, there is no effective treatment for EON except supplementation of zinc, copper, methylcobalamine and pyridoxine. Therefore, early detection and discontinuation of ethambutol is only way to prevent permanent loss of vision, as in early stage it is reversible.

Challenges and Insights in the Diagnosis and Management of Orbital Tuberculosis: A Systematic Review of 113 Cases.

Orbital tuberculosis (O-TB) is an extremely rare manifestation of extra-pulmonary tuberculosis (TB), which affects orbital structures and causes very complex clinical scenarios that may simulate other pathologies affecting the orbit. Its diagnostic and therapeutic challenges are due to its rarity and lack of specificity on symptoms. This systematic review aims to give an in-depth analysis regarding the presentation of clinical features, diagnosis methods, treatment outcomes, and complications, enhancing the current understanding and management of O-TB.A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature searches were conducted in PubMed and Scopus up to August 2024. The literature review included case series, case reports, and retrospective studies focusing on O-TB and involved a total of 113 cases from 12 studies. The extracted data were qualitatively synthesized regarding patient demographics, clinical presentations, diagnostic methods, treatment regimens, and the ensuing outcomes. The review found that O-TB mostly affects subjects with a mean age of 37.75 years, although there is a very wide age range of reported cases: 2-82 years with an almost equal gender distribution. The most common symptoms were vision impairment at71.68%, eyelid swelling at 9.73%, and exophthalmos at 5.31%. Imaging, especially with computed tomography (CT) scans in 60.18% of patients, along with histopathological confirmation and molecular biological confirmation positive in 46.02%, was the principal tool for diagnosis. In most cases, antitubercular therapy (ATT) was the mainstay of treatment, leading to complete resolution. However, 30.09% of these cases had some complications like glaucoma and cataracts that point to careful management and follow-up. O-TB still remains a diagnostic challenge due to its rarity and changing clinical presentations. Early diagnosis and identification, presently mainly through imaging and histopathological examination, is important for the management. This review shows the effectiveness of ATT in the treatment of O-TB but also brings out the need for better diagnostic facilities and uniformity in treatment protocols so that complications can be prevented and outcomes improved. Future studies must be directed toward the development of more sensitive diagnostic tools and the elucidation of immune responses in O-TB guiding better clinical practice.

Imaging panorama of pediatric central nervous system tuberculosis.

Central nervous system tuberculosis (CNS TB) is the most dreaded manifestation of systemic tuberculosis in the pediatric age group. It is associated with high morbidity and mortality due to severe neurological complications and sequelae. Knowledge about the imaging spectrum of CNS TB will help in early presumptive diagnosis and prompt treatment, reducing the development of complications. Imaging also plays a vital role in monitoring the progression of disease after the initiation of antituberculosis therapy. Advanced magnetic resonance imaging (MRI) techniques have recently improved the diagnostic efficacy manifold.In this review, we describe the imaging characteristics, the role of advanced imaging techniques, and follow-up imaging in various types of CNS TB in the pediatric population.

Manifestation of ocular tuberculosis in a north Indian tertiary care centre: Case series

Ocular tuberculosis acts as a challenge throughout the world, and its pathophysiology, diagnosis, and treatment are a topic for debate. The present case series represents retrospective study focusing on the variable clinical presentations, the diagnostic and therapeutic characteristics of ocular tuberculosis. We report 12 patients of ocular tuberculosis with variable presentations. : Retrospective analysis of records of patients diagnosed with ocular tuberculosis from August 2022 till March 2023 was done. Diagnosis of ocular tuberculosis was based on detailed ocular and systemic examination including best corrected visual acuity (BCVA), Slit lamp examination, fundus examination, OCT. The patients presenting with features suggestive of ocular tuberculosis were further investigated with complete blood count (CBC), erythrocyte sedimentation rate (ESR), Monteaux test, Chest X-ray, Cartridge Based Nuclear Amplification Test (CBNAAT) and rheumatological work up. Out of 12 of ocular tuberculosis patients, 4 were diagnosed with active retinal vasculitis, 3with choroiditis, 3 had panuveitis, and remaining 2 patients had unilateral nodular episcleritis. The diagnosis was based on compatible clinical picture, highly positive Tuberculin skin test and dramatic response to anti-tuberculous drugs. All 12 cases were strongly Mantaux test positive (2 developed injection site ulceration). All cases were started on ATT immediately with pulmonologist consultation and showed clinical improvement after 1 month. Ocular tuberculosis can have myriad presentations. Positive Mantaux test plays an important role in supporting diagnosis of ocular tuberculosis.

Imaging in Abdominal Tuberculosis

AbstractDiagnosis of abdominal tuberculosis is challenging due to its variable imaging appearance, which can mimic several other conditions. This review covers the imaging spectrum of tubercular involvement of abdominal lymph nodes, peritoneum, solid abdominal viscera, and the gastrointestinal tract. Tubercular lymphadenitis is the most frequent manifestation of abdominal tuberculosis and may show necrosis. Peritoneal tuberculosis is the next most commonly involved site in the abdomen and can be of wet, fibrotic, and dry forms. The ileocecal region is the most common site of involvement in gastrointestinal tuberculosis. Solid visceral involvement mostly affects the liver and spleen causing hepatosplenomegaly with a micronodular or macronodular imaging pattern. Awareness of the spectrum of imaging manifestations and a high index of suspicion is required to reach the correct diagnosis.

The course of tuberculosis infection in hyper-susceptible mice carrying the <i>H2</i>ᵛ haplotype

Genetic regulation of the host susceptibility to Mycobacterium tuberculosis (Mtb) and severity of tuberculosis (TB) infection remain incompletely investigated. Identification of particular genes and involved in TB control and immune reactions regulated by these genes is essential for our understanding of pathogenesis of the disease, discovery of drug targets and rational vaccine development. We have shown that mice of the B10.SM (H2ᵛ) strain are extremely TB susceptible; meanwhile, the general genome structure of this mouse strain and the H2ᵛ haplotype itself are poorly characterized. We selected a pool of Mit genetic markers differentiating B10.SM mice from Chr. 17-congenic mice of the B10 strain by the PCR products motility in the electrophoresis setting. TB susceptibility of B10 mice is much lower than that of B10.SM. In the model of infection triggered by two different dosed of Mtb (100 and 600 CFU per mouse) administered via respiratory tract we demonstrated that B10.SM mice have significantly shorter survival time and significantly higher lung mycobacterial multiplication compared to B10 mice. We demonstrated (intracellular staining and ELISA) that IFNγ production in the lungs of infected mice of the two strains corresponds well to their disease phenotypes. Thus, more resistant B10 mice possess significantly more lung IFNγ-positive CD4⁺ T cells and a higher level of IFNγ secretion. We have established (B10х B10.SM) F1 hybrids and demonstrated that the post-infection phenotypes of survival time, lung mycobacterial multiplication and IFNγ production in these mice are intermediate compared to parental mice. Thus, we deal with the genetic trait with incomplete dominance expression. These data were confirmed in F2 hybrids by segregation genetic analysis. To characterize the phenotype of B10.SM mice in more detail, we vaccinated these mice with the BCG vaccine before TB challenge. Vaccination significantly prolonged survival time, diminished mycobacterial multiplication in the lungs and the degree of lung tissue pathology. Thus, a high level of susceptibility to primary infection did not interfere with BCG vaccination efficacy. We intend to continue genetic and immunologic analyses of TB-hyper-susceptible B10.SM mice. Experimental data regarding the cause of extreme disturbances in protection against infection are prerequisite for our better understanding causality of the wide spectrum of TB manifestations in human populations, as well as for rational search for novel vaccines and medications against TB infection.

Challenging urological reconstruction in post-tuberculosis contracted bladder and renal complications: A rare case report

Genitourinary Tuberculosis (GUTB) represents a manifestation of extrapulmonary tuberculosis associated with significant urinary tract complications, such as contracted bladder and renal insufficiency. This report delineates a rare instance of GUTB culminating in considerable urological impairment, necessitating complex reconstructive procedures.

Changes in the epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong.

Human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains an important health challenge worldwide. Although TB prevalence has decreased in the general population, there is limited information regarding temporal trends in the incidence of HIV-associated TB in Hong Kong. There are also insufficient data regarding changes in clinical manifestation patterns among HIV-associated TB patients over time. This study aimed to describe temporal trends in the epidemiology and clinical manifestations of HIV-associated TB in Hong Kong. We retrospectively reviewed data regarding HIV-associated TB patients that were reported to the TB-HIV Registry of the Department of Health during the period 2007 to 2020. Trends of TB as a primary acquired immunodeficiency syndrome (AIDS)-defining illness, as well as changes in demographic features and clinical manifestations of HIV-associated TB during this period were examined using Cochran-Armitage trend test. A decreasing trend was observed in the proportion of all reported cases of AIDS in which TB was a primary AIDS-defining illness during the study period. The proportions of female patients and patients with extrapulmonary involvement significantly increased, whereas the proportions of ever-smokers and patients with sputum smear positivity significantly decreased during the same period. A decreasing trend was observed in the proportion of patients with pulmonary TB in which the lower zone was the predominant site of lung parenchymal lesions. Among patients with a diagnosis of HIV infection before TB, an increasing trend was observed in the proportion of patients receiving antiretroviral therapy. Important temporal changes were observed in the epidemiology and clinical manifestations of HIV-associated TB. These results highlight the need for continued surveillance regarding the patterns of demographic features and clinical manifestations to inform policymakers when planning control strategies for HIV-associated TB.

Ulcerated nodular swelling in an immunocompetent child.

We present a case of an ulcerated nodular swelling in an immunocompetent child. The rarity of lesions such as this presents a diagnostic challenge, underscoring the need for a comprehensive clinical and histopathological evaluation to differentiate it from dermatological conditions such as lupus vulgaris, fixed cutaneous sporotrichosis, phaeohyphomycosis and botryomycosis, among others.