Manifestation Of Tuberculosis Research Articles

Uncommon manifestation of disseminated tuberculosis with metastatic skin abscesses in an immunocompromised adult patient: A case report

Background: Cutaneous lesions account for less than 2% of all extrapulmonary manifestations of tuberculosis (TB). Metastatic tuberculous abscesses (tuberculous gummas), uncommon forms of cutaneous TB, typically result from the bacillus spreading hematogenously from the main site of infection to the subcutaneous tissue when the body's cell mediated immunity is compromised and present with one or more non-tender and fluctuant subcutaneous nodules. Case Presentation: A 51-year-old male presented with dry cough of one month duration associated with loss of appetite, easy fatigability and vomiting of ingested matter. He had left armpit and lower back skin swellings of similar duration. Physical findings were remarkable for whitish coat over the dorsal part of the tongue, crepitation over the lower two-third of bilateral posterior chest, and non-tender fluctuant masses over the left axilla and lower back region. Chest X-ray revealed multiple bilateral air space nodules and abdominopelvic U/S showed numerous hypoechoic splenic lesions. Urine lipoarabinomannan and Xpert MTB/RIF (mycobacterium tuberculosis/rifampicin) assay from the axillary skin abscess were positive for MTB. He was started on anti-tuberculous therapy and showed marked improvement after a month of follow up. Conclusion: It is worth considering the uncommon manifestations of tuberculosis including metastatic skin abscesses in the appropriate clinical context, to avoid misdiagnosis and underreporting in high tuberculosis burden countries. We strongly advise the utilization of Xpert MTB/RIF assay and/or urine lipoarabinomannan for the diagnosis of different forms of tuberculosis including cutaneous TB in HIV positive patients, especially in the absence of sputum for microbiologic tests, like in our patient

Epileptic seizure as the first manifestation of tuberculosis in a young male

Epileptic seizure as the first manifestation of tuberculosis in a young male

Evaluating the efficacy of adenosine deaminase in pleural fluid as an early indicator for tuberculous pleural effusion

Background: Tuberculous pleural effusion (TPE) is a prominent clinical manifestation of extrapulmonary tuberculosis (TB). Traditional diagnostic markers often face challenges in sensitivity or specificity, necessitating the exploration of newer, more effective biomarkers. Aims and Objectives: This study aimed to evaluate the diagnostic potential of adenosine deaminase (ADA) in pleural fluid as an early indicator for TPE and to analyze its correlation with interferongamma (IFNγ) levels. Materials and Methods: We conducted a case–control study involving 100 patients: 50 diagnosed with TPE (cases) and 50 with non-TPE (controls). Pleural fluid samples from these patients were subjected to ADA and IFNγ level assessments using standardized protocols. Routine TB markers were concurrently examined. Results: The findings indicated significantly heightened ADA levels compared to controls in cases. IFNγ levels were similarly elevated in patients versus controls. A weak positive correlation was established between ADA and IFNγ in cases with an R-value of 0.1016. Conclusion: Our study underscores the potential of ADA in pleural fluid as a promising early diagnostic marker for TPE. Although the correlation with IFNγ is weak, it reinforces the proposition of combining multiple biomarkers to enhance diagnostic precision.

Massive Gastrointestinal Bleeding as a clinical manifestation of Miliary Tuberculosis

Tuberculosis is still a public health problem today and can have acute and chronic manifestations challenging clinics for various medical specialties. Because it’s a disease of multisystem potential, it is often overlooked when outside the respiratory clinical context. As a result, a clinical case report was carried out at the Hospital de Clínicas de Porto Alegre, in 2020, of a patient with voluminous gastrointestinal bleeding as severe acute clinical manifestation of Miliary and Intestinal Tuberculosis. Due to the potential severity of undiagnosed and untreated tuberculosis, high suspicion is suggested at all levels of health systems (whether public or private) with a view to early diagnosis, treatment and prevention of complications resulting from the disease.

Indolent ulcer and discharging sinus on the eyelid of healthy Indian children and an adult: Orbital tuberculosis, a spot-diagnosis

Five cases of tuberculous osteomyelitis of the fronto-zygomatic (F-Z) region presented with a non-healing ulcer or discharging sinus in the eyelid skin in healthy children and an adult. Lack of awareness about peri-ocular manifestations of extra-pulmonary tuberculosis and delayed referral to specialists, along with poor compliance to long-term ATT, could be the reason for its underreporting in India.

Radiological Findings in a Patient Presenting with Chronic Abdominal Pain as a Secondary Manifestation of Pulmonary Tuberculosis

Radiological Findings in a Patient Presenting with Chronic Abdominal Pain as a Secondary Manifestation of Pulmonary Tuberculosis

Manifestações raras de apresentação de tuberculose em crianças: série de casos

Tuberculosis (TB) is an infectious and contagious disease that poses a challenge in pediatric practice, since children can present rare manifestations, which makes their diagnosis difficult. Five cases of uncommon manifestations of TB are presented in children vaccinated with BCG at birth and with no history of previous contact with bacilliferous adults. The difficulty and importance of the diagnostic suspicion of TB in rare cases of the disease in children is emphasized.

Manifestações raras de apresentação de tuberculose em crianças: série de casos

Tuberculosis (TB) is an infectious and contagious disease that poses a challenge in pediatric practice, since children can present rare manifestations, which makes their diagnosis difficult. Five cases of uncommon manifestations of TB are Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-598 presented in children vaccinated with BCG at birth and with no history of previous contact with bacilliferous adults. The difficulty and importance of the diagnostic suspicion of TB in rare cases of the disease in children is emphasized.

Radiographic manifestations of tuberculosis in HIV-co-infected patients and correlation of the findings with CD4 counts

Background: Chest X-ray plays a vital role in diagnosis of tuberculosis (TB) in HIV infection. These patients present with variable chest radiographic presentation, making diagnosis and treatment of TB notoriously challenging and increasing the risk of treatment failure, relapse, and even death. Aims: The objective of this study was to identify various radiological patterns of TB in HIV-TB-co-infected patients and to correlate with CD4 count. Setting and Design: This was an analytical cross-sectional study conducted in a tertiary care center in the southern part of Rajasthan, India. Materials and Methods: In our study, 110 consecutive patients with pulmonary TB-HIV co-infection were subjected to chest radiographs and evaluated for the types of lesion/TB; anatomical distribution, and type of radiological shadows. The findings were correlated with CD4 counts and sputum acid-fast bacilli (AFB) status. The main outcome measures were radiological shadows and their correlation with level of immune suppression. The sample size was 110 patients. Results: Patients of Group I (CD4 <200) had significantly more involvement of mid and lower zones than Group II (CD4 >200). Nodular shadow (54.1% vs. 46.9%), consolidation (28.4% vs. 25.0%), hilar lymphadenopathy (23.0% vs. 9.4%), and miliary shadow (9.5% vs. 3.1%) in Group I, while cavitation (25.0% vs. 20.3%) and pleural effusion (18.8% vs. 16.2%) were more frequent in Group II. In Group I, consolidation (44.8% vs. 17.8%, P = 0.012) while in Group II, both consolidation (46.2% vs. 10.5%, P = 0.038) and cavitation (46.2% vs. 10.5%, P = 0.038) were present in significantly higher proportion in AFB-positive cases. Conclusion: A wide spectrum of radiographic shadows in consonance with varying CD4 counts was observed in the study. Along with well-known atypical radiological findings, some features were present throughout spectrum of CD4 counts, indicating that TB should be considered in this group of patients with these radiographic presentations, regardless of CD4 count. The small study population, majority of the patients' already hospitalized indicating serious nature of illness. In addition, no prospective follow-up of the study population to identify over the time changes in radiological pattern.

Assessment of respiratory muscle strength and inspiratory drive in patients with pulmonary tuberculosis

Respiratory muscles (RM) are a part of the respiratory system that enables ventilation. RM dysfunction exacer-bates breathing insufficiency. The aim: to study the RM strength and inspiratory drive in pulmonary tuberculo-sis (PT). Materials and methods. In 247 patients with verified PT we measured the maximal occlusion inspira-tory (PImax), expiratory (PEmax) pressures and shut off airways during the first 100 ms of inspiration (P0.1). Cli-nical manifestations of tuberculosis, computed tomog-raphy and perfusion scintigraphy data were evaluated. Results. The decrease of PImax was in 49.6%, PEmax — in 17.8%, both — in 32.6%. PEmax had weak negative dependence on the disease duration, contralateral lung blood flow, and a weak direct dependence with BMI. Statistically significant dependence was not found be-tween PImax and the clinical and instrumental charac-teristics of PT. A moderate dependence of P0.1 was with the PT clinical form, its duration, total volume of foci, blood flow disorders in the lung, the weak dependence of P0.1 was with BMI and the contralateral lung blood flow. The frequency of RM dysfunction in different PT forms did not differ. An increase of P0.1 in patients with fibrosis and cavities was 3–3.5 times more frequent than in the others patients. There were no statistically signifi-cant differences in PImax, PEmax, P0.1 in the group of fi-brosis and cavities and group of infiltrative foci with the same total lesion volume. Conclusion. The RM strength and inspiratory drive were significantly dependent on the duration of the disease, the extent of the lesion and the state of the pulmonary blood flow

The pattern of neurological manifestations of tuberculosis among adult patients attending multineurological centres and hospitals in Sudan: A hospital-based cross-sectional study.

Tuberculosis (TB) can involve almost any organ of the body. In the central nervous system (CNS), it can cause Pott's disease, meningitis, tuberculoma, abscess, or other manifestations. Tuberculosis is rampant in the developing world and has become a significant public health menace with the human immunodeficiency virus (HIV) dissemination. This study aimed to determine the frequency of neurological manifestations of tuberculosis among adult Sudanese patients. A hospital-based cross-sectional study carried out in the period from September to December 2020 at multineurological centers and hospitals in Khartoum State, including Ibrahim Malik Teaching Hospital, Alshaab Teaching Hospital, Bashier, Abu Anga, Omdurman Teaching Hospitals, included adult patients diagnosed with tuberculosis-associated neurological manifestations. The data were collected by predesigned questionnaire, and then analyzed by computer using SPSS-version 25. A total of 43 patients were evaluated, male patientswere 24 (55.8%)and female patientswere 19 (44.2%). About 31 (72.1%) of the participants had extra-pulmonary TBand 12 (27.9%) had pulmonary and extrapulmonary TB. The neurological manifestations of tuberculosis include Pott's disease in 29 (67.4%) patients (with thoracic spine most affected part), tuberculoma was second-most, occurring in 8(18.7%) patients (with a single lesion in most of the patients), whereas tuberculous meningitis was found in 6 (13.9%). Clinical presentation was headache in 14 (32.6%) patients, convulsions in 10 (23.3%), loss of consciousness in 9 (20.9%), hemiparesis in 7 (16.3%) patients, and paraparesis in 23 (53.5%). Cranial nerve affected in 5 (11.6%) patients. All patients received antituberculosis medication and steroids, and 10 (23.2%) received anticonvulsants. Neurological tuberculosis should be ruled out in any young male from an endemic area who exhibits abnormalities in motor, sensory, special sense, or higher mental function. To avoid potentially fatal complications, diagnosesand treatments should be initiated as soon as possible.

Cutaneous Adverse Drug Reaction Among HIV-Infected Patients Starting Antituberculosis Treatment

Introduction. Treatment of tuberculosis (TB) in HIV patients is complicated due to numerous comorbidities and possible adverse effects. One of which is cutaneous adverse drug reaction (CADR). This adverse event is often difficult to manage because of multiple medications the patients get. The objective of this study was to know the prevalence and risk factors of CADR among HIV-infected patients starting anti-TB treatment. Methods. This retrospective study reviewed data from medical records of new patients at Working Group on AIDS outpatient clinic at Cipto Mangunkusumo Hospital, Indonesia in January 2008-December 2010 that had started anti-TB treatment. Risk factors of CADR among HIV patients treated with antituberculosis drugs evaluated were sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ cell count. Numeric data were analyzed using independent T-test if normally distributed, otherwise Mann Whitney U test were used. Chi-square or Fisher’s exact test were used for categorical data. p-value was considered significant if below 0.05. Results. Of 454 HIV-infected patients that started anti-TB treatment, median age was 30 years. Most patients were male and intravenous drug users/IDU. Median baseline CD4+ cell count was 61 cells/ μL. There were 10.6% subjects that developed CADR. Most common manifestations were maculopapular rashes (66.7%), followed by erythema multiforme (14.6%), and Stevens Johnson Syndrome (8.3%). Anti-TB drugs were stopped and then re-challenge was conducted in 54.2% patients. Anti-TB drugs were continued and only the suspected drug was stopped in 29.2% patients. The offending drugs were cotrimoxazole (41.7%), rifampicine (41.7%), ethambutol (16.7%), pyrazinamide (14.6%), pyrimethamine (12.5%), isoniazide (10.4%), streptomycin (8.3%), efavirenz (8.3%), fixed dose combination of antituberculosis drugs (8.3%), and nevirapine (4.2%). The proportion of CADR was higher in woman than man (12% vs. 10.3%, p=0.66), non-IDU than IDU (13% vs. 9.2%, p=0.20), without extrapulmonary TB than extrapulmonary TB (11.1% vs. 9.4%, p=0.29), but the associations weren’t statistically significant. Median age was higher (31 vs. 30 years, p=0.32) and CD4 cell count (59.5 vs. 62 sel/μL, p=0.96) was lower in CADR group than non CADR group. Conclusion. The prevalence of CADR among HIV-infected patients starting anti-TB treatment was 10.6%. Sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ did not have statistically significant association with CADR.

Clinicodemographic and Laboratory Characteristics of Cutaneous Tuberculosis at Tertiary Referral Hospital in West Java, Indonesia

Background: Cutaneous tuberculosis (TB) is a chronic infectious disease affecting the skin caused by Mycobacterium tuberculosis (M. tuberculosis). It constitutes 1–1.5% of extrapulmonary TB, with Indonesia being the third-highest TB burden country worldwide. Cutaneous TB is difficult to diagnose due to its varied presentations. This study aimed to describe the clinicodemographic and laboratory characteristics of cutaneous TB in a tertiary referral hospital in West Java, Indonesia. Methods: This was a descriptive retrospective cross-sectional study. Data were obtained from the medical record of patients with cutaneous TB in the Tropical Dermatology Clinic of Hasan Sadikin Hospital Bandung, West Java, Indonesia from January 2017 to December 2019 using total sampling method. Results: Of the 15 data retrieved, tuberculosis verrucosa cutis (n=5) was the most common type of cutaneous TB. Most of patients were males (n=8), between 15–24 years of age (n=6), were students (n=5), with the highest education level of primary school (n=5). Clinically, most of the cases presented as plaques and ulcers (n=6, respectively), had multiple lesions (n=9), located on lower limb (n=6). Acid-fast staining was negative in 8/8 cases, and culture was negative in 4/4 cases. The DNA of M. tuberculosis was detected in 2/5 polymerase chain reaction tests, while granuloma with caseous necrosis was found in 3/5 histopathological examinations. Conclusion: Patients with cutaneous TB have a variety of characteristics. The results of laboratory examinations are often negative, and diagnosis may depend on clinical morphology. Therefore, clinicians should be familiar with the diverse clinical manifestations of cutaneous TB.

CASE REPORT: TUBERCULOUS SCLERITIS A CHALLENGING DIAGNOSTIC

Scleritis is a severe painful inflammatory process localized in the sclera. Scleritis may be the revealer of many systemic diseases so that it is important to exclude multisystem disease. We present a case of non-necrotizing antero-posterior scleritis revealing a systemic tuberculosis which is an uncommon manifestation of tuberculosis. Diagnosing and managing the disease can be difficult. However, a good anamnesis, a careful clinical evaluation, an adequate interpretation of the investigations and an appropriate management allow a good prognosis.

Predictors for False-Negative Interferon-Gamma Release Assay Results in Hemodialysis Patients with Latent Tuberculosis Infection.

The present study aimed to clinically evaluate the effect of T-cell dysfunction in hemodialysis (HD) patients with latent tuberculosis (TB) infection (LTBI) who were false-negatives in the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Whole blood samples from a total of 20 active TB patients, 83 HD patients, and 52 healthy individuals were collected, and the QFT-GIT test was used for measuring Mycobacterium tuberculosis (MTB)-specific interferon gamma (IFN-γ) level. The positive rate of the IFN-γ release assays (IGRAs) in HD patients was lower than the negative rate. The mean value of MTB-specific IFN-γ level, which determines the positive rate of the IGRA test, was highest in active TB, followed by HD patients and healthy individuals. Among HD patients, phytohemagglutinin A (PHA)-stimulated IFN-γ levels of approximately 40% were 10.00 IU/mL or less. However, there was no low level of PHA-stimulated IFN-γ in the healthy individuals. This reveals that T-cell function in HD patients was reduced compared to healthy individuals, which leads to the possibility that QFT-GIT results in HD patients are false-negative. The clinical manifestations of TB in patients on HD are quite non-specific, making timely diagnosis difficult and delaying the initiation of curative treatment, delay being a major determinant of outcome.

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...

CASE REPORT: A CASE OF INTRACRANIAL TUBERCULOMA MASQUARADING AS A NEUROCYSTICERCOTIC LESION

Central nervous system manifestations of tuberculosis are the worst kind of manifestations of tuberculosis and should be ruled out . Since it can be critical to patient's diagnosis. Thus , we present to you such a case where we were able to diagnose the patient in the early stage. A 26 year old male patient , presented to the emergency medicine department with history of 1 episode of loss of consciousness , 1 episode of seizures and right sided weakness in an irritable state. He was also a known alcoholic and also consumed a mixed diet . The patient was admitted to the ICU in view of drowsiness and headache and was observed there for 24 hours..His CT Scan done outside showed showed calcied granulomas in the left parietal lobe suggesting ?Neurocysticercosis. His other investigations were found to be within normal limits. His Fundus did not reveal any evidence of oculocysticercosis or papilledema. CSF was found to be normal. He was started on Tab Albendazole intended for a course of 30 days , Inj Dexamethasone , Inj Mannitol, Inj levetiracetam Inj Ceftriaxone, and other medications . His MR Spectroscopy suggested a well dened conglomerated , ring enhancing lesion with heterogeneously T2/FLAIR iso to high and T1 hypodensity seen in left parietal lobe with surrounding edema and mass effect. Features favouring granulomatous infective etiology,differential diagnosis: 1]Tuberculoma 2] Neurocysticercosis.. The choline is to creatinine ratio was high to differentiate it from a neurocysticercosis lesion yet not too markedly elevated to be called a malignancy and hence conrmed that the ring enhancing lesion was tuberculoma . Glioma was ruled out as the ring enhancing lesions of the glioma kind usually have irregular margins and are usually mixed density. However, here .[2] Thus , he was started on anti tubercular treatment , presently the patient is doing well.

Lumbosacral tuberculosis, a rare manifestation of Pott's disease – How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis

The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.

Clinically encountered growth phenotypes of tuberculosis-causing bacilli and their in vitro study: A review.

The clinical manifestations of tuberculosis (TB) vary widely in severity, site of infection, and outcomes of treatment-leading to simultaneous efforts to individualize therapy safely and to search for shorter regimens that can be successfully used across the clinical spectrum. In these endeavors, clinicians and researchers alike employ mycobacterial culture in rich media. However, even within the same patient, individual bacilli among the population can exhibit substantial variability in their culturability. Bacilli in vitro also demonstrate substantial heterogeneity in replication rate and cultivation requirements, as well as susceptibility to killing by antimicrobials. Understanding parallels in clinical, ex vivo and in vitro growth phenotype diversity may be key to identifying those phenotypes responsible for treatment failure, relapse, and the reactivation of bacilli that progresses TB infection to disease. This review briefly summarizes the current role of mycobacterial culture in the care of patients with TB and the ex vivo evidence of variability in TB culturability. We then discuss current advances in in vitro models that study heterogenous subpopulations within a genetically identical bulk culture, with an emphasis on the effect of oxidative stress on bacillary cultivation requirements. The review highlights the complexity that heterogeneity in mycobacterial growth brings to the interpretation of culture in clinical settings and research. It also underscores the intricacies present in the interplay between growth phenotypes and antimicrobial susceptibility. Better understanding of population dynamics and growth requirements over time and space promises to aid both the attempts to individualize TB treatment and to find uniformly effective therapies.

Recent Developments in Mycobacteria-Based Live Attenuated Vaccine Candidates for Tuberculosis.

Vaccination is an excellent approach to stimulating the host immune response and reducing human morbidity and mortality against microbial infections, such as tuberculosis (TB). Bacillus Calmette-Guerin (BCG) is the most widely administered vaccine in the world and the only vaccine approved by the World Health Organization (WHO) to protect against TB. Although BCG confers "protective" immunity in children against the progression of Mycobacterium tuberculosis (Mtb) infection into active TB, this vaccine is ineffective in protecting adults with active TB manifestations, such as multiple-, extensive-, and total-drug-resistant (MDR/XDR/TDR) cases and the co-existence of TB with immune-compromising health conditions, such as HIV infection or diabetes. Moreover, BCG can cause disease in individuals with HIV infection or other immune compromises. Due to these limitations of BCG, novel strategies are urgently needed to improve global TB control measures. Since live vaccines elicit a broader immune response and do not require an adjuvant, developing recombinant BCG (rBCG) vaccine candidates have received significant attention as a potential replacement for the currently approved BCG vaccine for TB prevention. In this report, we aim to present the latest findings and outstanding questions that we consider worth investigating regarding novel mycobacteria-based live attenuated TB vaccine candidates. We also specifically discuss the important features of two key animal models, mice and rabbits, that are relevant to TB vaccine testing. Our review emphasizes that the development of vaccines that block the reactivation of latent Mtb infection (LTBI) into active TB would have a significant impact in reducing the spread and transmission of Mtb. The results and ideas discussed here are only based on reports from the last five years to keep the focus on recent developments.