Manifestation Of Tuberculosis Research Articles

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.

Relevance of CBNAAT in the early diagnosis of suspected tubercular swelling

Abstract Background: Globally, tuberculosis is a prevalent disease, with an estimated 10.5 million cases. According to the World Health Organization, extrapulmonary tuberculosis, caused by Mycobacterium tuberculosis, affects tissues and organs outside the lungs and constitutes 20%–25% of all tuberculosis cases. The delayed diagnosis of this form of tuberculosis is expected due to challenges in obtaining representative samples and lower bacterial loads in the samples obtained. Despite the availability of various diagnostic tests, the current lack of a proper diagnostic algorithm poses a daily challenge for clinicians in accurately identifying extrapulmonary tuberculosis. Cartridge-based nucleic acid amplification test (CBNAAT) has emerged as a promising and faster option for diagnosis. In light of these issues, a study has been initiated to evaluate the manifestations of otorhinolaryngological tuberculosis and develop a protocol that enables early diagnosis of this specific form of extrapulmonary tuberculosis. The goal is to enhance the timely detection and management of otorhinolaryngological tuberculosis. Materials and Methods: During the study period, 39 samples were collected, and the research received ethical approval from the Institutional Ethics Committee. Results: Of the 39 cases examined, the sensitivity and specificity of CBNAAT were determined to be 78.3% and 100%, respectively. The positive predictive value (PPV) was also 100%, whereas the negative predictive value was 20%. Conclusion: For any suspected neck swelling indicative of tuberculosis, CBNAAT should be the primary investigation. It offers ease of use, delivers faster results within a few hours, and boasts a 100% PPV.

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.

Surgical manifestations of hepatobiliarypancreatic tuberculosis

Surgical manifestations of hepatobiliarypancreatic tuberculosis

Tuberculosis revisted: classic imaging findings in childhood

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.Graphical

Tryptophan metabolism determines outcome in tuberculous meningitis: a targeted metabolomic analysis.

Cellular metabolism is critical for the host immune function against pathogens, and metabolomic analysis may help understand the characteristic immunopathology of tuberculosis. We performed targeted metabolomic analyses in a large cohort of patients with tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, focusing on tryptophan metabolism. We studied 1069 Indonesian and Vietnamese adults with TBM (26.6% HIV-positive), 54 non-infectious controls, 50 with bacterial meningitis, and 60 with cryptococcal meningitis. Tryptophan and downstream metabolites were measured in cerebrospinal fluid (CSF) and plasma using targeted liquid chromatography-mass spectrometry. Individual metabolite levels were associated with survival, clinical parameters, CSF bacterial load and 92 CSF inflammatory proteins. CSF tryptophan was associated with 60-day mortality from TBM (hazard ratio [HR] = 1.16, 95% confidence interval [CI] = 1.10-1.24, for each doubling in CSF tryptophan) both in HIV-negative and -positive patients. CSF tryptophan concentrations did not correlate with CSF bacterial load nor CSF inflammation but were negatively correlated with CSF interferon-gamma concentrations. Unlike tryptophan, CSF concentrations of an intercorrelating cluster of downstream kynurenine metabolites did not predict mortality. These CSF kynurenine metabolites did however correlate with CSF inflammation and markers of blood-CSF leakage, and plasma kynurenine predicted death (HR 1.54, 95% CI = 1.22-1.93). These findings were mostly specific for TBM, although high CSF tryptophan was also associated with mortality from cryptococcal meningitis. TBM patients with a high baseline CSF tryptophan or high systemic (plasma) kynurenine are at increased risk of death. These findings may reveal new targets for host-directed therapy. This study was supported by National Institutes of Health (R01AI145781) and the Wellcome Trust (110179/Z/15/Z and 206724/Z/17/Z).

The Imaging Features and Diagnostic Value of Computerised Tomography in Seminal Duct Tuberculosis.

To analyse the computerised tomography (CT) imaging features and diagnostic value of seminal duct tuberculosis (TB). The imaging data of male patients with ejaculatory duct TB who underwent surgical treatment in our hospital from 1 January 2019 to 31 December 2019 were retrospectively analysed. Through CT images, seminal duct TB was divided into different types, and the CT image features of different types of TB were analysed. The differences in diagnosis between CT and pathological results were compared. According to the CT manifestations of TB of the intrapelvic segment of seminal duct TB, this disease could be divided into an intra-tubular calcification type, a lumen dilatation and effusion type and a wall thickening type, among which 6 cases (15.8%) were intra-tubular calcification types, 14 cases (36.8%) were lumen dilatation and effusion types and 18 cases (47.4%) were wall thickening types. The diagnostic efficacy of CT in the diagnosis of ejaculatory duct TB: sensitivity = 63.89% (23/36), specificity = 80.01% (44/53), accuracy = 75.28% (67/89), positive predictive value = 51.87% (43/109), negative predictive value = 77.19% (44/57) and kappa = 0.558. CT has high sensitivity and specificity in the diagnosis of seminal duct TB. The classification of seminal duct TB using CT images is of great significance for the diagnosis and treatment of the disease.

Ultrasound Guided Complete Thoracentesis, Precluding Residual Pleural Thickening in Pleural Tuberculosis: A Case-Control Study

Introduction: Pleural effusion is the commonest extra-pulmonary manifestation of tuberculosis in endemic populations. This is managed in routine, by diagnostic aspiration and treated with anti-TB medicines. A significant number of treated patients remain visiting pulmonology and thoracic surgery departments, for chest pain, abnormal chest x-ray, and shortness of breath due to residual pleural thickening (RPT). Aims &amp;Objectives: The study was conducted to determine the usefulness of complete thoracentesis under ultrasound guidance over diagnostic aspiration in preventing residual pleural thickening. Place and duration of study: This case-control study was conducted from 01-07-21 to 30-06-2022 at Pulmonology- OPD of Gulab Devi Teaching Hospital Lahore-Pakistan. Material &amp; Methods: After approval from IRB and informed consent, 300 consecutive patients with age 14-85 years, diagnosed TB-pleural effusion, willing for intervention and participation in study were included in the study while pediatric patients, non-TB effusions and unwilling for aspiration or participation were excluded. Two groups of 150 each were allocated through odd and even numbers. Therapeutic aspiration under ultrasound guidance for interventional group and diagnostic aspiration of 50-100 ml for control group was performed. All patients were treated with same standard and followed up according to the principles of DOTS. Pleural thickness was measured utilizing ultrasonography at day 0, 60 and 180. Outcome was compared in both groups. SPSS-24, software was utilized for analysis. p ? 0.05 was taken as significant. Results: Only 31/150 patients (20.66%) from interventional group displayed residual pleural thickening while148/150 cases (98.66%) with residual pleural thickening were noted in control group. The P-value was 0.00001 Conclusion: Complete thoracentesis under ultrasound guidance is a tremendous tool for precluding residual pleural thickening in tubercular pleural effusions.

Diagnosis and treatment of tuberculosis presenting as uveitis based on stochastic simulation in systems biology

ABSTRACT Tuberculous uveitis can be a manifestation of extrapulmonary tuberculosis or an allergic reaction to tuberculosis infection. The clinical signs and symptoms of other uveitis causes are generic, making a false diagnosis simple. We present a brief introduction to theoretical modelling and simulation in systems biology and explore the consequences of TB uveitis if left untreated. Patients were admitted to our hospital with recurrent fever. They had a previous definitive diagnosis of binocular uveitis and a positive interferon gamma release assay (IGRA) test result. At the time, there was no antituberculosis medicine available, and immunosuppressive and glucocorticoid therapy did not work. After the admission, their pleural fluid tested positive for Mycobacterium tuberculosis. No other causes to explain the fever were found. A diagnosis of tuberculosis was made, and their body temperature normalized after antituberculosis treatment and closed chest drainage. Vigilance should be exercised to rule out tuberculous uveitis in cases of unexplained uveitis; this calls for IGRA screening, tuberculin skin testing, and cyst imaging. For patients with latent tuberculosis infections, it is recommended to administer antituberculosis treatment, after excluding other possible causes, and to avoid using glucocorticoids in isolation.

Intracranial Aneurysm In a Case of Tubercular Meningoencephalitis, a Rare Presentation (P3-10.001)

<h3>Objective:</h3> NA <h3>Background:</h3> In this era of advanced medical science and technology, tuberculosis remains as a major health problem in developing countries like India. While pulmonary TB is the most common manifestation of TB, incidence of extrapulmonary TB is also gradually increasing. Affliction of central nervous system is considered one of the most severe forms of extrapulmonary tuberculosis. Central nervous system (CNS) tuberculosis(TB) comprises 15%–20% of the total cases of extra-pulmonary TB and it is associated with a high mortality rate. Surprisingly a little less than 5% of patients with pulmonary TB develop CNS TB and not all patients with CNS TB have pulmonary TB. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger and immunocompromised patients. Central nervous system tuberculosis may present as tubercular meningitis, meningoencephalitis, tuberculoma, tubercular abscess. Vasculitis, secondary to TBM can cause infarcts commonly but development of an intracranial tuberculous aneurysm is a rare complication. <h3>Design/Methods:</h3> NA <h3>Results:</h3> <h3>Case Report:</h3> A 33-year-old male presented with a low grade fever, meningism for weeks, diagnosed to have tubercular meningoencephalitis after supportive brain imaging and CSF assay. During course of hospitalization developed left ptosis, binocular horizontal diplopia, dimness of vision of left eye with diminished left periorbital sensation suggestive of a left anterior cavernous sinus syndrome. Brain imaging with angiogram of cerebral vasculature revealed an aneurysm at left ICA-MCA junction, probably a sequalae of granulomatous vasculitis <h3>Conclusions:</h3> <h3>Discussion:</h3> This case report shows an unusual case of intracranial tuberculomas complicated by intralesional haemorrhage due to an infective tubercular aneurysm. During disease course, MTB may colonize the arterial wall and erode its entire thickness with caseating necrosis, forming an aneurysm. These aneurysms are prone to rupture with fatal complications. Early identification of the disease with proper treatment is critical for the prevention of fatal complications. <b>Disclosure:</b> Dr. Biswas has nothing to disclose. Dr. Das has nothing to disclose. Dr. Chintha has nothing to disclose. Dr. Bhattacharya has nothing to disclose. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for INTAS Pharmaceuticals. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for lupin Limited. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Diagnostic. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Health N U. Dr. Chakraborty has nothing to disclose.

Assessment of the Diagnostic Utility of GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) Assay in the Suspected Cases of Tuberculous Meningitis.

Tuberculous meningitis (TBM) is a manifestation of extrapulmonary tuberculosis (EPTB) caused by Mycobacterium tuberculosis (MTB). The central nervous system is involved in about 1%-2% of all current tuberculosis (TB) cases and about 7%-8% of all EPTB. if not treated early, TBM leads to a high rate of neurological sequelae and mortality. This study aimed to assess the diagnostic performance of the GeneXpert MTB/rifampicin (RIF) assay in patients with TBM. A total of 100 suspected TBM cases were enrolled from various departments at tertiary care hospital, Bhopal, Madhya Pradesh, India, and classified as definite, possible, or probable TBM. The clinical samples were tested for microbiological and other cerebrospinal fluid(CSF) testing. Out of 100 cases, 14 (14%) were classified as definite TBM, 15 (15%) were having probable TBM, and 71 (71%) were having possible TBM.Out of a total of 100 participants, all were negative for acid-fast bacilli (AFB) staining. Of the 100 cases, 11 (11%) were positive by mycobacterium growth indicator tube (MGIT) culture, of which only four (36.36%) were positive by GeneXpert MTB/RIF. GeneXpert MTB/RIF detected three (3%) cases that were negative by MGIT culture. Ten (90.9%) of the 11 MGIT-positive culture isolates were found to be RIFsensitive while one (9.1%) was found to be RIF resistant. Three cases tested positive/sensitive by the GeneXpert MTB/RIF but negative by MGIT culture. Six (85%) of the seven GeneXpert MTB/RIF positive cases were RIF sensitive while one (15%) was RIF resistant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 36.36% (95% Confidence Interval (CI) (10.93% to 69.21%)), 96.63% (95% CI (90.46% to 99.30%)), 57.14% (95% CI (25.50% to 83.85%)), 92.47% (95% CI (88.70% to 95.06%)) and 90% (95% CI (82.38% to 95.10%)) for GeneXpert MTB/RIF assay, compared with MGIT culture as the reference standard. Our study found that the sensitivity is lower when compared to culture, so using GeneXpert MTB/RIF alone is not recommended. Overall performance of GeneXpert MTB/RIF assay is noteworthy. The GeneXpert MTB/RIF assay is a potentially accepted test for obtaining an earlier diagnosis, and if it tested positive, the treatment should begin immediately. However, culture must be performed in GeneXpert MTB/RIF negative cases.

Unilateral hearing loss: case report on the insidious consequence of nasopharyngeal tuberculosis

BackgroundNasopharyngeal tuberculosis constitutes 1% of the head and neck manifestation of extra-pulmonary tuberculosis. The rarity of the disease along with its non-specific presentation may pose a challenge in diagnosis.Case presentationWe present a case of a 33-year-old patient who presented with a gradual onset of unilateral hearing loss. Endoscopic examination revealed leukoplakic lesions over the bilateral torus tubarius with audiological assessment revealing a mixed hearing loss in the left ear. Patient completed a 6-month course of anti-tuberculous therapy with a complete resolution of nasopharyngeal lesions and hearing loss.ConclusionWe hypothesize that tuberculosis of the nasopharynx may not only lead to impaired middle ear ventilation but also damage to the ossicular chain and inner ear structures.

BCG-Vaccinated Children with Contact to Tuberculosis Patients Show Delayed Conversion of Mycobacterium tuberculosis-Specific IFN-γ Release.

Mycobacterium (M.) bovis BCG vaccination is recommended for healthy babies after birth in several countries with a high prevalence of tuberculosis, including Ghana. Previous studies showed that BCG vaccination prevents individuals from developing severe clinical manifestations of tuberculosis, but BCG vaccination effects on the induction of IFN-γ after M. tuberculosis infection have hardly been investigated. Here, we performed IFN-γ-based T-cell assays (i.e., IFN-γ Release Assay, IGRA; T-cell activation and maturation marker assay, TAM-TB) in children who had contact with index tuberculosis patients (contacts). These contacts were classified as either being BCG vaccinated at birth (n = 77) or non-BCG-vaccinated (n = 17) and were followed up at three timepoints for a period of one year to determine immune conversion after M. tuberculosis exposure and potential infection. At baseline and month 3, BCG-vaccinated contacts had significantly lower IFN-γ levels after stimulation with M. tuberculosis-specific proteins as compared to non-BCG-vaccinated contacts. This resulted in decreased proportions of positive IGRA results (BCG-vaccinated: 60% at baseline, 57% at month 3; non-BCG-vaccinated: 77% and 88%, respectively) at month 3. However, until month 12, immune conversion in BCG-vaccinated contacts led to balanced proportions in IGRA responders and IFN-γ expression between the study groups. TAM-TB assay analyses confirmed higher proportions of IFN-γ-positive T-cells in non-BCG-vaccinated contacts. Low proportions of CD38-positive M. tuberculosis-specific T-cells were only detected in non-BCG-vaccinated contacts at baseline. These results suggest that BCG vaccination causes delayed immune conversion as well as differences in the phenotype of M. tuberculosis-specific T-cells in BCG-vaccinated contacts of tuberculosis patients. These differences are immune biomarker candidates for protection against the development of severe clinical tuberculosis manifestations.

Parenchymal Pseudotumoral Tuberculosis

Worldwide, tuberculosis (TB) remains an important public health problem and one of the main causes of death. Pseudotumoural pulmonary TB is a rare radiological manifestation of pulmonary TB, mimicking lung carcinoma. Herein, we report four immunocompetent adults who presented with large masses and were diagnosed to have parenchymal pseudotumoral tuberculosis, followed at the Pneumology Department of University Hospital Center Mohammed VI of Marrakesh in Morocco between April 2019 and January 2022. five cases were included in the study. All patients initially presented with general and respiratory symptoms, with radiological findings simulating lung carcinoma. Tuberculosis was diagnosed from microbiological testing and/or histological examination results. All patients were immunocompetent. All patients were treated successfully with antimycobacterial therapy.