Manifestation Of Tuberculosis Research Articles

Infectious Lesion Simulating Malignant Neoplasm. Clinical Case and Literature Review

The extrapulmonary manifestations of tuberculosis (TBC) that affect the Central Nervous System (CNS), by hematogenous dissemination, are an infrequent entity. Intracranial tuberculomas are the least common form of tuberculosis in CNS. Represent a granulomatous inflammatory process with cerebral involvement. The prognosis is related to the early diagnosis, the degree of surgical resection and the complemen-tary treatment with antituberculous drugs. We describe an infrequent clinical case of cerebral tuberculoma that simulated a malignant neoplasm, and also performed a literature review. A clinical case about a 31-year-old female with no relevant medical history. She described a sud-denly diplopia, without previous trauma. The patient was evaluated by Ophthalmology, which iden-tified papillary edema, with no other alterations. In this context was performed a Brain CT/MRI, which showed an intra-axial, left frontobasal lesion with perilesional edema, ring contrast enhancement and a hypodense/hypointense central area. Spectroscopy showed a reduction in n-acetylaspartate (NAA) with a peak in creatine and choline, suggestive of a malignant tumor. The patient underwent surgery, having performed a frontal left craniotomy and complete excision of a nodular, capsulated, avascular lesion with a spongy consistency. Subsequently, the histological diagnosis of tuberculoma was confirmed. We describe an infrequent clinical case of cerebral tuberculoma which, due to the characteristics presented in the preoperative studies, was suggestive of a malignant tumor that was not confirmed, which is the particularity of this case. The patient presents a good clinical and imaging evolution during the follow-up period.

Primary Parotid Tuberculosis in a Toddler

Tuberculosis (TB) of the parotid gland is a rare disease and occurs less frequently in children. Re-emergence is seen amongst immunocompromised individuals whose diagnosis may be overlooked, leading to unnecessary surgery. Diagnosis is challenging in the absence of systemic constitutional symptoms and depends mainly on the treating physician having a strong suspicion. We report a rare extrapulmonary manifestation of TB involving the parotid gland in an otherwise immunocompetent child. A 2-year-old girl presented with a mass in the right parotid region that had been present for 3 months. A similar swelling was treated with an antibiotic 3 months prior, but it recurred. The mass was painful, firm, erythematous, and located in the infra-auricular region. Symptoms persisted after 2 courses of antibiotics, after which ultrasonography was performed and the intra-parotid collection was aspirated, which was positive for acid-fast bacilli (AFB). The patient was placed on anti-TB treatments. Although uncommon, TB should be considered in patients with a solitary mass in the parotid gland to avoid unnecessary surgery.

Tibiotalocalcaneal arthrodesis in a rare case of tuberculosis of the talus

<p><strong>Aim <br /></strong>To assess our personal experience of a case of tuberculosis of the talus, and to provide an overview of the literature about this tuberculosis manifestations, including all its aspects: epidemiology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.<br /><strong>Methods</strong> <br />We present our experience in a case of a 34-year-old patient, who came to our attention with difficulty in walking and<br />pain due to a talar tuberculosis, with consequent bone disruption and reabsorption, and foot deformities.<br /><strong>Results</strong> <br />A tibiotalocalcaneal arthrodesis with retrograde nail and bone graft was performed after antibiotic therapy. Today, almost<br />two years after treatment, the patient can walk independently with no major limitations in everyday life.<br /><strong>Conclusion</strong> <br />Tibiotalocalcaneal arthrodesis with bone graft showed good functional results in this case study, with complete graft fusion and good functional and radiological outcomes.</p>

Clinical and epidemiological features of the detection and course of the infectious disease tuberculosis depending on the presence of concomitant pathology

The article is devoted to the most pressing issues of studying the clinical and epidemiological features concerning the detection and course of tuberculosis infection in patients with concomitant pathologies. Such pathologies include cancer, diseases of the endocrine system, of the respiratory system (chronic bronchitis, pneumoconiosis), gastric ulcer, pathology of the urinary system, exhaustion due to insufficient nutrition, smoking. Using genetically engineered biological drugs (GEBPs) in practice reduces the activity of inflammatory phenomena due to suppression of the immune response, but increases the risk of developing infectious diseases, primarily tuberculosis. Immunosuppressive therapy in organ transplant patients is also associated with the risk of developing tuberculosis. A special nature of immune disorders develops during HIV infection, a comorbid disease in patients with tuberculosis. The diseases listed above create a medical risk group in patients with immunocompromise, which is the basis for the development of tuberculosis. In addition to the risk of developing infection, patients with concomitant diseases have unfavorable results from treatment of tuberculosis, which does not allow achieving abacillation in a short time, thereby maintaining a reservoir of infection in society. In this regard, the purpose of our research was to study the clinical and epidemiological features of the detection and course of tuberculosis infection in patients with concomitant pathology A study was conducted using a continuous sampling method for the period from December 2020 to August 2021. 67 medical records of an inpatient at the state budgetary healthcare institution “Republican Clinical Anti-TB Dispensary” (Ufa) were analyzed. The groups were formed based on the detection of concomitant pathology (main, n=33) and its absence (control, n=34). To achieve the goal of the study, a comparative analysis of methods for detecting tuberculosis and clinical manifestations of tuberculosis was performed; prevalence of the process, detection of the fact of bacterial excretion and drug sensitivity from December 2020 to August 2021. 67 case histories of Mycobacterium tuberculosis (MBT) in patients of the studied groups were analyzed. Statistical data processing was performed using licensed software Statistica 6.0 when calculating two types of data: discrete and interval. To assess the chances of detecting the studied factor in both groups, the indicator (OR) was used to calculate the 95% confidence interval (CI). Interval indicators were studied by t-test for independent samples, with Livigne's correction.

Cutaneous tuberculosis-management

Since antiquity, people have been plagued by tuberculosis (TB), and its effects are likely older than recorded history. For many centuries, TB was the most significant human infection due to its devastating mortality and morbidity rates and global prevalence. In developed nations, there is less evidence of Mycobacterium tuberculosis infections as a result of improved socioeconomic status. In developing nations like India, it is still regarded as a significant cause of morbidity and mortality. Cutaneous TB occurs worldwide and it comprises only a small proportion of all cases of TB, but considering the high prevalence of TB in many developing countries like India these numbers become significant. Cutaneous TB is a form of extra pulmonary TB and is characterized by a spectrum of multiple distinct clinical and histopathological presentations. It is imperative that the treating dermatologist is aware of the varied manifestations of cutaneous TB which would significantly prevent the morbidity and complications. This review aims to discuss the epidemiology, clinical, histopathological features, diagnosis, differential diagnosis and treatment options, especially in the Indian context.

Tuberculous Pericarditis: Clinical, Diagnostic, and Therapeutic Features

Introduction: Tuberculous pericarditis is a rare manifestation of extrapulmonary tuberculosis. Due to the infrequency of this condition, the most effective management approach has not been clearly established. Our study analyzed 14 cases with tuberculous pericarditis treated at Ibn Rochd Hospital in Casablanca over two years from 2020 to 2022. Methods: Medical records of tuberculous pericarditis patients were reviewed. Data on demographics, clinical presentation, diagnostic methods, and treatments were collected. Results were expressed in terms of frequencies, averages, and percentages. Results: The mean patient age was 37.7 years, with 64% males. Common symptoms included fever (50%), chest pain (57%), and dyspnea (92.8%). Clinical signs included right heart failure (35%) and muffled heart sounds (57%). ECG findings showed sinus tachycardia (71.4%) and low voltage (57%). Echocardiography revealed pericardial effusion (78%) and other abnormalities. Pericardial fluid was mostly citrine yellow (64%) and serohemorrhagic (36%). Adenosine deaminase was positive in 57% of cases. GeneXpert confirmed 71% of cases, while pericardial biopsy confirmed 29%. All received antitubercular treatment, with corticosteroids in three cases. In-hospital, 92% showed pericardial effusion regression, but one death due to tamponade occurred. Long term, 21% had effusion recurrence, and 35% transitioned to constrictive pericarditis. Conclusion: Tuberculous pericarditis presents diagnostic challenges. Clinical, radiological, and biological evidence is crucial for diagnosis. Antitubercular treatment is effective, but the risk of constrictive pericarditis remains high, necessitating further research into corticosteroid therapy's role in prevention.

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

Cerebral tuberculomas: manifestation of extrapulmonary tuberculosis in an immunocompromised patient. A case report

Tuberculosis (Tb) is, currently, the deadliest infectious disease and is caused by organisms of the Mycobacterium tuberculosis complex; the most common clinical manifestation is pulmonary involvement; however, it can also manifest as extrapulmonary affection in immunocompromised patients, especially in patients with human immunodeficiency virus (HIV) chronic infection up to 20% of the cases, despite being on adequate antiretroviral therapy. Within the extrapulmonary manifestations, affection of the central nervous system by hematogenous dissemination occurs in up to 5%, however, the finding of tuberculomas, which is a form of central nervous system involvement, is rare and an important cause in secondary hydrocephalus in these patients. We present the case of a male patient with a history of HIV infection and meningeal tuberculosis, who presented dysfunction of his ventriculoperitoneal shunt and in the imaging study multiple tuberculomas were found, a cerebrospinal fluid study was performed where multi-resistant tuberculosis (MDR) was documented, therefore despite adequate management of Tb, tuberculomas developed.

Turkey ear as a cutaneous manifestation of tuberculosis

Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. Classical lupus lesions are often seen in the head and neck region. Turkey ear is a clinically descriptive term, previously being used for the earlobe with reddish indurated plaque lesions, which recently can be a sign for lupus vulgaris.

Observer Performance Evaluation of a Deep Learning Model for Multilabel Classification of Active Tuberculosis Lung Zone-Wise Manifestations.

Background Chest X-rays (CXRs) are widely used for cost-effective screening of active pulmonary tuberculosis despite their limitations in sensitivity and specificity when interpreted by clinicians or radiologists. To address this issue, computer-aided detection (CAD) algorithms, particularly deep learning architectures based on convolution, have been developed to automate the analysis of radiography imaging. Deep learning algorithms have shown promise in accurately classifying lung abnormalities using chest X-ray images. In this study, we utilized the EfficientNet B4 model, which was pre-trained on ImageNet with 380x380 input dimensions, using its weights for transfer learning, and was modified with a series of components including global average pooling, batch normalization, dropout, and a classifier with 12 image-wise and 44 segment-wise lung zone evaluation classes using sigmoid activation. Objectives Assess the clinical usefulness of our previously created EfficientNet B4 model in identifying lung zone-specific abnormalities related to active tuberculosis through an observer performance test involving a skilled clinician operating in tuberculosis-specific environments. Methods The ground truth was established by a radiologist who examined all sample CXRs to identify lung zone-wise abnormalities. An expert clinician working in tuberculosis-specific settings independently reviewed the same CXR with blinded access to the ground truth. Simultaneously, the CXRs were classified using the EfficientNet B4 model. The clinician's assessments were then compared with the model's predictions, and the agreement between the two was measured using the kappa coefficient, evaluating the model's performance in classifying active tuberculosis manifestations across lung zones. Results The results show a strong agreement (Kappa ≥0.81) seen for lung zone-wise abnormalities of pneumothorax, mediastinal shift, emphysema, fibrosis, calcifications, pleural effusion, and cavity. Substantial agreement (Kappa = 0.61-0.80) for cavity, mediastinal shift, volume loss, and collapsed lungs. The Kappa score for lung zone-wise abnormalities is moderate (0.41-0.60) for 39% of cases. In image-wise agreement, the EfficientNet B4 model's performance ranges from moderate to almost perfect across categories, while in lung zone-wise agreement, it varies from fair to almost perfect. The results show strongagreement between the EfficientNet B4 model and the human reader in detecting lung zone-wise and image-wise manifestations. Conclusion The clinical utility of the EfficientNet B4 models to detect the abnormalities can aid clinicians in primary care settings for screening and triaging tuberculosis where resources are constrained or overburdened.

ENDOBRONCHIAL TUBERCULOSIS: A CASE BASED APPROACH

Endobronchial tuberculosis is defined as tuberculous infection of the tracheobronchial tree. Although clinical features differ between various types and stages of endobronchial tuberculosis, common symptoms are cough, hemoptysis, sputum production, wheezing, chest pain, fever and dyspnea. Although endobronchial lesions usually result in sputum positivity for acid fast bacilli (AFB), a false negative sputum or absence of radiological lesions may result in delayed diagnosis. On the other hand, sputum positivity with presence of signs on chest radiology may lead to consideration of parenchymal TB as the primary diagnosis and the coexistence of endobronchial lesions may be missed until sequelae of the latter ensue. Bronchoscopy is essential for confirmation of endobronchial TB. This write up aims to summarize various clinico-radiological manifestations of endobronchial tuberculosis which were encountered in 45 years of clinical practice and will help respiratory clinicians in future for early and prompt diagnosis and management of the same.

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N=740,815). Across surveys, 15.1%-56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27-2.40) and symptomatic TB (OR 1.49, 95% CI 1.34-1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17-2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55-1.55). For alcohol drinking≥twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70-3.62) for subclinical TB and OR 1.43, 95% CI 0.59-3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0-85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB. None.

Pancreatic tuberculosis misdiagnosed for surgical treatment: clinical analysis of 3 cases and literature review

The incidence rate of pancreatic tuberculosis (PT) is low, and it is difficult to distinguish from pancreatic malignant tumor before operation. We present 3 patients diagnosed after surgical treatment. All 3 cases involved female patients who were admitted due to primary manifestation of abdominal pain. These patients did not exhibit symptoms such as jaundice or back pain, and their tumor markers were within normal range. The surgical interventions employed included partial resection of the tumor in 1 case, mass resection in another, and pancreaticoduodenectomy in the third. Preoperative puncture biopsy is essential for diagnosing PT, and it should be actively conducted on patients with suspected cases. We summarize several common manifestations of PT to find the possibility of tuberculosis during preoperative evaluation and avoid misdiagnosis and unnecessary surgery.

Diagnosis and Management of Tuberculous Meningitis in Children- an Update

UPDATE ON THE DIAGNOSIS AND MANAGEMENT OF TUBERCULOUS MENINGITIS IN CHILDREN: Ronald van Toorn, Regan Solomons Seminars in Pediatric Neurology Volume 21, Issue 1, March 2014, Pages 12-18 Tuberculous meningitis (TBM), the most devastating manifestation of tuberculosis, is often missed or overlooked because of nonspecific symptoms and difficulties in diagnosis. It continues to be an important cause of neurologic handicap in resource-poor countries. Owing to the suboptimal performance of diagnostic tests of TBM, diagnosis relies on thorough history, clinical examination, and relevant investigations. The development of affordable, accurate diagnostic tests for TBM in resource-poor settings remains a priority. Short intensified treatment is safe and effective in both human immunodeficiency virus (HIV)-infected and HIV-uninfected children. Treatment of tuberculous hydrocephalus depends on the level of the cerebrospinal fluid obstruction. Corticosteroids reduce risk of neurodisability and death in HIV-uninfected children. Thalidomide should be considered in children compromised by tuberculosis abscesses and tuberculous-related optochiasmic arachnoiditis. In resource-poor countries, home-based TBM treatment after initial in-hospital stabilization is feasible in carefully selected patients. Early diagnosis and treatment of TBM is the single most important factor determining outcome.

Tumor-Like Mass in Patient with Tuberculosis : Is It Really a Malignancy? a Case Report

ABSTRACT Tuberculosis (TB) is not all about chronic cough or hemoptysis. The clinical manifestation of TB could be pulmonary and extrapulmonary, with the later defined as any site other than the lung, affected by the TB. The global burden for tuberculosis is still heavy, standing as the second leading infectious killer after COVID-19 (above HIV/AIDS), TB holds the 13th place of the leading cause of death. The World Health Organization (WHO) predicted around 1.6 million people died from TB, and 10.6 million people fell ill with TB worldwide in 2021. Due to the various manifestations and limitations of the diagnostic tools, determining the diagnosis and treatment of TB has always been a challenge since a long time ago. To give appropriate therapy, making an accurate diagnosis is crucial. It is known that extrapulmonary tuberculosis manifestation often mimics malignancy, both clinically and radiologically. The treatment for these cases should include treatment for the infection and the affected organ or site, following the recommended therapy dose and duration. Neurological examination should be evaluated, especially for tuberculosis of the spine. Surgical approach should be considered for cases with neurological deficits, patient with spine-at-risk, progressive spinal deformity, severe pain, spinal instability, or uncertain diagnosis. Physical therapy could be considered to improve respiratory function, improving muscle strength, reducing the pain, repair/improve the range of motion, sensory function, improve quality of life, and prevent other complications. Keywords: Extrapulmonary Manifestation, Mimics Malignancy, Tuberculosis

Retraction statement: The pattern of neurological manifestations of tuberculosis among adult Sudanese patients attending multi-neurological centers and hospitals in Sudan: A hospital-based cross-sectional study.

[This retracts the article DOI: 10.1002/hsr2.1068.].

Detection of serum Aspergillus-specific IgM and IgG antibody levels for the diagnosis of chronic pulmonary aspergillosis developed in patients with tuberculosis.

Chronic pulmonary aspergillosis (CPA) is common among individuals with underlying lung diseases. The clinical manifestations of CPA include systemic symptoms (e.g., weight loss, fatigue, fever), chronic productive cough, chest discomfort, and occasional haemoptysis, which are similar to the manifestations of pulmonary tuberculosis (PTB) and are often misdiagnosed as PTB. Considering the striking similarities between CPA and PTB in clinical manifestations and imaging features, more specific microbiological and serological detections are needed for a definitive diagnosis. This study aimed to explore the clinical characteristics of CPA in TB as well as the diagnostic significance of Aspergillus-specific IgG and Aspergillus-specific IgM.A total of 140 patients diagnosed with TB by culture between December 2017 and February 2019 were included. Enrolled patients were categorized into two groups (CPA group and non-CPA group) according to CPA diagnostic criteria. All collected specimens were subjected to Aspergillus-specific IgG and IgM detection testing.The median concentration of Aspergillus-specific IgG in the CPA group (211.04 AU/ml) was significantly higher than that in the non-CPA group (77.88 AU/ml) (Z value - 6.397, P < 0.001). The sensitivity and specificity of Aspergillus-specific IgG for CPA diagnosis were 81.82% and 72.97%, respectively. In the chronic cavitary pulmonary aspergillosis (CCPA) group, the IgG positivity rate (≥ 120 AU/ml) was 96.2%, which was 21.4% in the non-CCPA patients (P < 0.001).The detection of Aspergillus-specific IgG serological changes is feasible and facilitates reliable differentiation between Aspergillus and Mycobacterium tuberculosis infection. However, Aspergillus-specific IgM has limited diagnostic value, with unsatisfactory sensitivity results.

Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review.

Tuberculosis is an ancient disease that humanity struggled with for centuries and continues to struggle with. The bacteria Mycobacterium tuberculosis often infects the lungs through respiratory transmission and manifests itself through various symptoms, including cutaneous infections. Cutaneous tuberculosis (CTB) comprises about 1% to 1.5% of all extrapulmonary manifestations and is often accompanied by polymorphous lesions, including papules, nodules, plaques, ulcers, gummas, and verrucous lesions. CTB is most commonly observed in low-income, HIV, and immunosuppressed populations, similar to intrapulmonary manifestations. The main pathogen for CTB is M. tuberculosis but less commonly with M. bovis and BCG vaccine, and the modes of transmission are largely classified into exogenous and endogenous CTB. Current treatment options for CTB include oral therapy of antibiotic medications such as rifampicin, streptomycin, ethambutol, isoniazid, and pyrazinamide, which is occasionally combined with surgical intervention.

Isolated Tubercular Liver Abscess: A Rare Case Report

Background: Tuberculosis (TB) continues to be a global public health problem, particularly in the developing countries [1]. It usually involves organs like lungs and/or gastrointestinal (GI) tract [2]. Hepatic involvement is usually associated with miliary tuberculosis which is one of the most characteristic manifestations of tuberculosis. Isolated liver abscess without any primary infection is a rare clinical entity. It is more difficult for a clinician to diagnose as in most cases it is frequently confused with pyogenic or amoebic liver abscess or a hepatoma [3]. Only a few cases have been reported in Bangladesh till date [4-7]. Recently we came across tubercular liver abscess in an immunocompromised patient without any primary foci of infection which was really a diagnostic challenge for us. Objectives: The objective of reporting this case is to aware clinicians about the uncommon presentation of a common disease like tuberculosis. This will be an eye-opening experience for clinicians and help in formulating differentials in the workup of patient with pyrexia due to non-resolving liver abscess.

Clinical characteristics and outcome of Tuberculosis lymphadenitis in a tertiary center from Saudi Arabia

IntroductionTuberculosis is among the deadliest infectious diseases. Lymphadenitis is an inflammation of the lymph nodes which is the most common extrapulmonary manifestation of tuberculosis. Saudi Arabia is rated as a country with a low incidence of tuberculosis. The study’s objective is to describe the clinical characteristics and outcome of TB lymphadenitis (TBL) at a large tertiary care center in Riyadh, Saudi Arabia. MethodAll patients 18 years and older diagnosed with TB lymphadenitis between 2010 and 2021 at a single tertiary center in Riyadh, Saudi Arabia, were reviewed retrospectively for their clinical presentation, diagnostic yield, therapy, and outcome. Result107 patients were included in the final analysis. The distribution of males and females were nearly equal, at 50.5 % and 49.5 %, respectively. The average age was 45. During the ten-year period of our investigation, the number of confirmed TBL ranged from 19 (the highest in 2010) to as little as one patient in 2021. 72.8 percent of patients presented with TBL affecting the neck. The most commonly used diagnostic method was histopathological examination of the tissue sample, granulomatous inflammations were found in 89.2 % of cases of theses necrotizing granuloma. 10.7 % of our isolates had resistance. The average duration of anti-TB treatment was 6.8 months with a cure rate of 72.9 %. ConclusionThe majority of patients in this study had cervical lymphadenopathy, with histopathology being the mainstay of diagnosis. 90 % of TBL cultures were susceptible to first-line anti-TB therapy.