Tuberculous Research Articles

POS-077 RISK FACTORS AND OUTCOMES OF TUBERCULOSIS IN INDIAN KIDNEY TRANSPLANT RECIPIENTS

Tuberculosis (TB) is one of the commonest opportunistic infections in kidney transplant recipients and can have diverse clinical presentations leading to a delay in the diagnosis. We evaluated risk factors, clinical presentation, impact of TB on patient, and the graft outcomes. We studied 703 kidney transplant recipients from 1985-2018 at a tertiary care centre in western India. Demographic details, past history of TB, immunosuppression regimens, time to diagnosis of tuberculosis post-transplant, clinical presentations, duration of treatment, adverse effects of treatment, and its outcome on patient and graft were studied. Tuberculosis was diagnosed in 103 recipients (14.6%) post-transplant. The mean (SD) age of recipients was 35.12±10 years, with 93 (90.2%) being males and 102 recipients (99.1%) from a living donor. Nineteen recipients (18.4%) had tuberculosis before transplant. The median (IQR) time to diagnosis of TB post-transplant was 24 months (8-48). In 41(39.8%) recipients, development of tuberculosis was preceded by anti-rejection therapies. Pulmonary involvement was the most common organ involvement in 72 recipients (69.9%), extrapulmonary in 31 (30%) and disseminated in 2 (1.9%). Among the extrapulmonary involvements, gastrointestinal involvement was seen in 9 recipients (8.7%) followed by musculoskeletal in 7(6.8%), lymphadenitis in 6 (5.8%), central nervous system in 3 (2.9%), cutaneous involvement in 2 (1.9%), genitourinary TB in 1 (0.9%) and transplant kidney in 1 (0.9%). The median (IQR) duration of treatment was 12 months (5-18). Four recipients had relapses after completion of treatment. Adverse effects of treatment included transaminase elevation seen in 38 (38.6%) recipients followed by acute gastritis in 19 (18.4%), hyperuricemia in 17 (16.5%) and sensorineural hearing loss in 3 (2.9%). Multidrug-resistant TB was diagnosed in 3 recipients (2.9%). The pre-transplant median (IQR) dialysis vintage was 8 months (6-12). New onset diabetes after transplant was the most common comorbidity observed in 28 (27.18%) recipients, followed by Hepatitis C in 16 (15.55%), Hepatitis B in 12 (11.6 %), Cytomegalovirus (CMV) in 6(5.8%) and HIV in 2 recipients (1.9%). Immunosuppressive regimens at time of transplant included azathioprine in 61 recipients (59.2%), mycophenolate mofetil in 40(38.8%), tacrolimus in 38(36.8%), cyclosporine in 26(25.2%) and steroids in 103(100%) recipients. Acute graft dysfunction during treatment was seen in 42 recipients (40.7%). Three recipients (2.9%) developed graft failure. Seventy-two recipients (69.9%) survived after treatment, 16 (15.5%) expired due to TB, and 15(14.5%) were lost to follow-up. Tuberculosis remains a common infectious complication after kidney transplant and is associated with significant morbidity and mortality.

Extrapulmonary tuberculosis presentation in the form of a chest wall abscess with no pulmonary involvement in the UK: a case report

The presentation of an extrapulmonary manifestation of tuberculous (TB) infection to a tertiary care facility in the UK is a rare event given its low prevalence. This case report focuses on an atypical presentation of an extrapulmonary tuberculosis (EPTB) infection in the form of a chest wall abscess. This was recognized and managed appropriately. This case however elucidates vital learning as migration from around the globe would contribute to an increasing number of TB/EPTB infections. The wide array and indolent nature of their presentation creates diagnostic and treatment challenges. Appreciation for the epidemiology, risk factors, effective and prompt treatment with follow up protocols would help develop pathways for better care. Within the UK, despite it being a low-risk country for TB, there is need for increased awareness, education with established management pathways and governance for TB and EPTB infections.

Diagnostic yield of CBNAAT in the diagnosis of extrapulmonary tuberculosis: A prospective observational study.

Extrapulmonary Tuberculosis (EPTB) accounts for 15%-53% of all TB cases. In recent years, cartridge-based nucleic acid amplification test (CBNAAT) has emerged as an important diagnostic tool since the diagnostic yield is higher. We conducted this study to evaluate the diagnostic yield of CBNAAT in EPTB. One hundred and four patients with EPTB were included in the study. Samples were subjected to CBNAAT, AFB smear, culture for Mycobacterium tuberculosis and histopathology examination (HPE). Yield of each was estimated as compared to a composite reference standard (CRS). The most common EPTB was lymph node TB (48.1%). CBNAAT was positive in 30.76% of EPTB cases. The highest yield was for bone and joint TB (35.7%), followed by lymph node TB (34%) and abdominal TB (33.3%). Taking CRS as the gold standard, sensitivity of CBNAAT was 32.3%, that of AFB culture was 33.3% and that of HPE was 87.2%. When taken as a single diagnostic tool, HPE had highest sensitivity in diagnosing EPTB when compared to CBNAAT and AFB culture. Use of CBNAAT alone for diagnosis of EPTB may result in missing the diagnosis. A combined modality incorporating CBNAAT, histopathology and AFB culture is the best approach for diagnosis of EPTB.

Differentiating Pyogenic Brain Abscesses and Tuberculous using Magnetization Transfer MR Imaging and in Vivo Proton MR Spectroscopy

Objective: To find whether in vivo proton MR spectroscopy and magnetization transfer (MT) MR imaging can be used to differentiate between tuberculous brain abscess and pyogenic brain abscess. Study Design: Retrospective Place and duration: Radiology Department of Ibn_e_Sina Hospital Multan from January 2021 to January 2022. Methodology: The study included 15 subjects with brain abscesses who underwent in vivo MR spectroscopy, MT MR imaging and conventional MR imaging. Those with other systemic diseases were excluded. These techniques were also performed on 10 sex and age-matched control subjects for comparing MT ratios in normal and diseased parenchymal locations. 13 tuberculous abscesses were found in 4 patients, and 20 pyogenic abscesses were found in 11 patients. MT MR imaging and in vivo MR spectroscopy were used to evaluate suspected brain abscesses. Results: The mean MT ratio of the pyogenic brain abscesses was 25.55±1.60.MR spectroscopy showed that in pyogenic abscesses level of amino acids (valine, isoleucine, leucine) was 0.8 ppm and lipid and lactate was 1.2 ppm. Additionally, acetate, 1.91 ppm; glycine, 3.55 ppm; succinate,2.40 ppm and alanine, 1.47 pm were also seen. Four patients had 13 tuberculous abscesses. The mean MT ratio obtained from tuberculous abscesses was 19.87±1.54, which was significantly lower compared to the cortical grey matter, deep grey matter, white matter and pyogenic abscess (p<.001). Conclusion: MT ratios in tuberculous brain abscesses were lower than in pyogenic abscesses. In vivo, MR spectroscopy in pyogenic abscesses did not show amino acids. Tuberculous brain abscess can be differentiated from the pyogenic abscess by using both in vivo MR spectroscopy and MT MR imaging. Keywords: Pyogenic brain abscess, tuberculous brain abscess, MR spectroscopy

General Seizures Due to Brain Abscess Causa Suspected Intracranial Tuberculosis at Prof Aloei Saboe Hospital Gorontalo

Introduction: Seizures are a severe clinical condition with complications of brain abscess. This report will describe the rare occurrence of generalized seizures due to Mycobacterium tuberculosis (MTB) brain abscess.Case: Male, 57 years old, admitted to the emergency department with two episodes of generalized seizures one hour before admission. The patient had a history of pulmonary tuberculosis during four months of treatment and was treated with an anti-tuberculosis fixed drug combination (FDC) 3. The patient was in a state of delirium and had lower extremity weakness. The chest radiograph shows a multifocal patchy opacity in the right upper lobe with thickening in the right pericardium. Pre-Contrast MSCT-Scan of the brain showed multiple hypodense lesions in the left frontal lobe, right frontoparietal, left basal ganglia, and pons. Post-contrast shows multiple low-attenuation, oval-shaped lesions with peripheral enhancement (double rim sign) with vasogenic edema. Finally, the patient was diagnosed with a tuberculous brain abscess.Discussion: CNS tuberculosis is a rare cause of seizures and is often followed by a history of pulmonary tuberculosis. Tuberculosis appears on the Contrast MSCT Scan Brain as an avascular mass lesion of low density and sometimes more significant than expected around cerebral edema. End-stage tuberculosis is well encapsulated and has peripheral ring enhancement with vasogenic edema.Conclusion: Pre-Post Contrast Brain MSCT is the diagnostic imaging of choice for suspected tuberculous brain abscess.

Nursing of a patient with tuberculous subcutaneous abscess misdiagnosed as phlebitis after peripheral venous indwelling needle placement

Nursing of a patient with tuberculous subcutaneous abscess misdiagnosed as phlebitis after peripheral venous indwelling needle placement

Evaluation of the retinal and choroidal microvasculature changes in cases of sarcoid and tuberculosis-associated posterior uveitis using OCT angiography

PurposeUsing optical coherence tomography angiography (OCTA) to evaluate retinal microvascular changes in sarcoid and tuberculous (TB) posterior uveitis.MethodsCross-sectional observational study includes 30 eyes. FFA and OCTA images were acquired. OCTA images were analyzed for areas of capillary hypo-perfusion, disorganization of the superficial and deep capillary plexuses (SCP and DCP) and intraretinal cystoid spaces and for measuring the size of the foveal avascular zone and vessel density (VD) in the SCP and DCP.ResultsA total of 11 eyes were associated with TB and 19 with sarcoidosis. By OCTA, 100% had areas of capillary non-perfusion, 36.7% choroidal voids, 30% disorganization of the SCP and DCP and 26.6% intraretinal cystoid spaces. The VD of the DCP was significantly lower in the TB group. On comparing OCTA and FFA, parafoveal ischemia was detected more frequently on OCTA and macular edema more frequently on FFA (P = < 0.001). The BCVA was not significantly correlated with the VD of the SCP or DCP.ConclusionOCTA can be used in detection of early microvascular changes, segmenting retinal layers and localizing abnormalities. The presence of these changes may aid in the diagnosis of TB and sarcoid uveitis, for prognosis, follow-up and may be the only choice when FFA is contraindicated.

A rare case of primary disseminated multi-drug resistant tuberculosis

Tuberculosis (TB) is the commonest cause of infection-related death globally. Disseminated tuberculosis (TB) is a life-threatening disease which results from the hematogenous spread of Mycobacterium tuberculosis. Genitourinary tuberculosis (GUTB) is usually caused as a result of the hematogenous spread of the mycobacteria during the initial infection. The patient's clinical presentation may vary from asymptomatic to non-specific symptoms related to the organ involved and may also overlap with urinary tract infections caused by other pathogens hence delaying the diagnosis. Here we report one such case where the vague symptoms of the patient and absence of respiratory symptoms delayed the diagnosis of primary disseminated multi-drug resistant (MDR) tuberculosis.

Isolated Tuberculous Epididymitis: A Case Report and Review of the Literature

In 2021, tuberculosis remains a world health problem. It is still the first cause of mortality by infectious disease in the world [1]. Fortunately, in developed countries, tuberculosis is a very rare pathology. Genitourinary tuberculosis has been reported to account for 20% to 73% of all cases of extrapulmonary tuberculosis in the general population [2]. The epididymal involvement accounts for only about 20% of the genitourinary tuberculosis [3]. Isolated genitourinary tuberculosis (GUTB) is a rare and unusual presentation of tuberculosis that occurs in young male or female adults and that can cause infertility [4]. Most of the time, infertility is due to the inflammation and scarring that follow the infection, resulting in distortion of the normal anatomy and causing obstruction of the excretory tract [5]. The disease typically develops slowly. Early diagnosis is difficult, therefore delayed diagnosis and misdiagnosis are common [6].

632 A Rare Case of Genitourinary Tuberculosis Presenting as Occult Compensated Renal Failure

Abstract It is acknowledged in the literature that genitourinary TB is a diagnostic challenge due to its rarity and insidious presentation. We herein report a case of a 64-year-old gentleman originally from Peru with an unremarkable past medical history that attended his GP practice on multiple occasions complaining of recurrent left sided loin pain, headaches, and microscopic haematuria. Abdominal ultrasonography revealed an atrophic left kidney and dilated renal pelvis. This was interpreted to either be a complication of chronic renal calculi, or secondary to malignancy. Further investigations including CT urogram, MAG3 renogram, cystoscopy and anterograde pyelogram effectively ruled out malignancy, revealing hydronephrosis and loss of cortical thickness. And although this was initially dismissed, further deterioration prompted more robust investigations. A complication of testicular pain and swelling with an associated lack of response to prolonged courses of antibiotics and associated scrotal abscess on ultrasonography prompted rapid surgical decompression and drainage. Histopathological results reported findings of acute necrotising granulomatous inflammation with positive acid-fast bacilli on Ziehl-Neelsen staining – consistent with tuberculosis. Routine follow up since commencing anti-TB therapy showed marked improvement with no further episodes of haematuria or flank pain, and kidney function remained at baseline. By raising awareness of potential imaging features as well as more subtle clinical presentations, it is hoped that clinicians can consider genitourinary tuberculosis as a differential, if there is no improvement with conventional antimicrobial agents.

К ВОПРОСУ О ВЫЯВЛЕНИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У ПОДРОСТКОВ ПРИ ПРОВЕДЕНИИ ПЛАНОВОЙ ФЛЮОРОГРАФИИ: ВЗГЛЯД ФТИЗИАТРА

The scheduled, routine fluorography does not allow detecting of the primary small forms of tuberculosis (TB) and the limited prevalence processes without bacterial excretion. The purpose of the study was to evaluate the contribution and the informative content of the scheduled fluorography as a screening method for the early detection of TB in adolescents. Materials and methods: a single-center retrospective cohort study of 142 disease history cases of adolescents admitted for treatment at the Children's and Adolescents Department with the Central Research Institute of Tuberculosis (Moscow, Russia) at the age of 15 to 17 years old, of which 74 (52.1%) were girls, and 68 (47.9%) boys, with respiratory TB. The continuous sample from 2015 to 2020, 34 (24.0%) of which were identified with the scheduled, routine fluorography. The data for inclusion in the study was obtained from medical records submitted upon admission. Results: according to the routine fluorography results, the infiltrative TB of the respiratory organs was diagnosed statistically significantly more often compared to the results of skin immunological tests: in 76.5% and 20.5% of cases, respectively, р˂0.001; the lung tissue decay in 58.8% and 15.4% of cases, respectively, p˂0.001; and the bacterial excretion in 58.8% and 5.1% of cases, respectively, p˂0.001. This indicates a high epidemic risk of patients. Conclusion: the routine fluorography in adolescents does not correspond to the concept of screening for TB infection, the essence of which is the early detection of the disease. From the authors’ point of view, the expediency of fluorography in this age group should be considered primarily as the first - and not the only - stage for diagnostic approach in the acute period of a pulmonary disease.

The diagnostic challenge of a tuberculous cold abscess of the epididymis: a case report

BackgroundWhile genitourinary tuberculosis is a common form of extra-pulmonary tuberculosis, cold abscess of the epididymis is rare with our literature search finding no reports from the West African subregion. Where the index of suspicion is low, diagnosis is missed and unnecessary surgery may be performed on suspicion of a tumour. The aim of this case report is to highlight the diagnostic challenges of this condition in resource-limited settings in order to create awareness within the health community, increase the chance of appropriate diagnosis, thereby facilitating early commencement of treatment so as to avoid needless testicular loss or complications, such as infertility.Case presentationA 33-year-old Black African College-educated public service employee resident in Abuja, Nigeria, presented with a one-week history of right scrotal pain and swelling. Genital examination revealed a firm, non-tender epididymal mass which was initially mistaken for a malignancy. There were no constitutional symptoms, and the contralateral testis was normal. The swelling involved only the epididymis. The testis was distinctly palpable but not oedematous. There was some hemi-scrotal oedema. Blood count and urine cultures were normal. Ultrasound scan showed a hypoechogenic, uniformly enlarged epididymis. Testicular tumour markers were negative. However, CT-abdomen showed enlarged para-caval and pelvic nodes which were thought to be due to secondary deposits from a testicular tumour. Scrotal swelling was later found to be due to an abscess of the epididymis at surgery. Histology showed caseous granulomas typical of Mycobacterium tuberculosis. Gene-Xpert, a cartridge-based nucleic acid amplification test, later confirmed that patient had tuberculosis, for which he is being treated.ConclusionThe differential diagnosis of an epididymal cold abscess from testicular tumour or chronic epididymitis can be challenging. Therefore, a high index of suspicion as well as a complete tuberculosis screen is essential in an apparently healthy patient presenting with a chronic epididymal swelling.

Unilateral Tb Epididymo-Orchitis with Scrotal Fistula- A Case Report

Tuberculosis is one of the most common worldwide diseases that remain almost unaltered in prevalence for the past few years. Genitourinary tract tuberculosis is common, but when associated with scrotal fistula it is a rare presentation. A 50 years old male came to the hospital with the complaints of pricking pain and swelling in the left side of scrotum for the past 2 months. He had history of smoking for past 40 years, on examination swelling of size approximately 6x5 cm present in left side of scrotum, globular in shape; penis pushed to right side was present, lower part of the swelling was firm to hard in consistency, left cord thickness was present and fixity to skin was also present. There was a small fistulous opening present in the left side of scrotum with no active discharge. Bilateral inguinal lymph nodes were palpable. This is a rare case presentation of tuberculous epididymo-orchitis with scrotal fistula leading to testis removal. Initially emperical treatment was started for TB epididymoorchitis which turned unresponsive, so he was then proceeded for surgery to avoid further disease progression. This case was managed radiologically, clinically and pathologically. This case report shows how the case was managed and followed up.Since symptoms of TB epididymo-orchitis are milder when compared to the symptoms of pyogenic epididymo-orchitis, they appear to physicians in later advanced stages. Tuberculosis should be considered in Patients with mild symptoms of epididymo-orchitis, mainly in those with HIV, immunosuppressive conditions and endemic areas.

Endoscopic Diagnosis of Bronchial Tuberculosis in Pulmonary Tuberculosis Patients with Different HIV Status

The objective: to compare the effectiveness of endoscopic diagnosis of bronchial tuberculosis in pulmonary tuberculosis patients with different HIV status.Subjects and Methods. The data obtained during tracheobronchoscopy in 371 respiratory tuberculosis patients from 2018 to 2020 were retrospectively studied. The indication for bronchoscopy was the presence of clinical and radiological symptoms characteristic of bronchial tuberculosis in a pulmonary tuberculosis patient. All patients were divided into two groups: HIV+ and HIV-.Results. In pulmonary tuberculosis patients with clinical and radiographic findings characteristic of bronchial tuberculosis, the frequency of endoscopic confirmation of bronchial tuberculosis in HIV+ Group was 57/71 (80.3%), in HIV- Group – 138/300 (46.0%), p &lt; 0.01; χ2 = 27.06.Most often, in HIV-positive patients, the infiltrative form of bronchus tuberculosis was detected – 27 (47.4%) patients, and the fistulous form – 23 (40.4%) patients, bronchial lesions in HIV negative tuberculosis patients were mainly infiltrative – 94 (68.1%) or ulcerative – 24 (17.4%).The frequency of microbiological detection of the causative agent of tuberculosis increased when bronchobiopsy was performed versus sputum microscopy, especially in HIV negative tuberculosis patients (from 39.9 to 91.3%), and among HIV positive patients from 15.7 to 47.4%.

Multicentric Castleman Disease a Diagnostic Dilemma: A Case Series of Three Patients Seen at a Tertiary Health Facility in Zambia

Background: Castleman disease (CD) is a heterogeneous group of lymphoproliferative disorders of uncertain cause presenting with lymphadenopathy. There are three generally described immunological disorders of CD that occur in individuals of all ages and share a similar microscopic lymph node appearance but different immunohistochemical profile. Oftentimes, diagnosis can be challenging where histology is not done, with most patients being presumptively treated as tuberculous (TB) adenitis.&#x0D; Method &amp; Results: We present three case reports of CD, one is of an Human Immunodeficiency Virus (HIV) naive patient, the other two are in HIV positive patients. All three patients presented with fever, recurrent anemia and generalized lymphadenopathy. W hole body Computed Tomography (CT) scans as well as excision biopsies (for histopathology and immunohistochemical staining for Human Herpes Virus-8 (HHV-8) were done on all three patients.&#x0D; Case 1: Idiopathic Multicentric Castleman Disease in a 20 year old male patient who also developed TAFRO syndrome (Thrombocytopenia, Ascites, myelo Fibrosis, Renaldys functionand Organomegaly) in the course of the illness. Case 2 &amp; 3: HHV-8 associated Multi centric Castleman Disease in HIV positive 42 year and 27 year old female patients respectively. The 42 year old received chemotherapy for six months, and had symptomatic relief and remission, while the 27 year old was yet to commence chemotherapy.&#x0D; Discussion: Most cases of CD go undiagnosed or mostly misdiagnosed for other common causes of lymphadenopathy in Zambia. These are the first case reports in our hospital, with notable backgrounds of physicians having suggested TB treatment from the referring facilities.&#x0D; Conclusion: Both HHV-8 and none-HHV-8 associated CD may be very common in our population, and there is need for prompt biopsy, reporting and treatment of all patients presenting with lymphadenopathy in our hospitals.

Multicentric Castleman Disease a Diagnostic Dilemma: A Case Series of T hree Patients Seen at a Tertiary Health Facility in Zambia

Background: Castleman disease (CD) is a heterogeneous group of lymphoproliferative disorders of uncertain cause presenting with lymphadenopathy. There are three generally described immunological disorders of CD that occur in individuals of all ages and share a similar microscopic lymph node appearance but different immunohistochemical profile. Oftentimes, diagnosis can be challenging where histology is not done, with most patients being presumptively treated as tuberculous (TB) adenitis.&#x0D; Method &amp; Results: We present three case reports of CD, one is of an Human Immunodeficiency Virus (HIV) naive patient, the other two are in HIV positive patients. All three patients presented with fever, recurrent anemia and generalized lymphadenopathy. W hole body Computed Tomography (CT) scans as well as excision biopsies (for histopathology and immunohistochemical staining for Human Herpes Virus-8 (HHV-8) were done on all three patients.&#x0D; Case 1: Idiopathic Multicentric Castleman Disease in a 20 year old male patient who also developed TAFRO syndrome (Thrombocytopenia, Ascites, myelo Fibrosis, Renaldys functionand Organomegaly) in the course of the illness. Case 2 &amp; 3: HHV-8 associated Multi centric Castleman Disease in HIV positive 42 year and 27 year old female patients respectively. The 42 year old received chemotherapy for six months, and had symptomatic relief and remission, while the 27 year old was yet to commence chemotherapy.&#x0D; Discussion: Most cases of CD go undiagnosed or mostly misdiagnosed for other common causes of lymphadenopathy in Zambia. These are the first case reports in our hospital, with notable backgrounds of physicians having suggested TB treatment from the referring facilities.&#x0D; Conclusion: Both HHV-8 and none-HHV-8 associated CD may be very common in our population, and there is need for prompt biopsy, reporting and treatment of all patients presenting with lymphadenopathy in our hospitals.

Burden of infectious diseases among undocumented migrants in France: Results of the Premiers Pas survey.

IntroductionAn increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France.MethodologyThe Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software.ResultsA total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure.ConclusionThis original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.

Tuberculous pericarditis

Tuberculous (TB) pericarditis, a severe extrapulmonary manifestation of Mycobacterium tuberculosis, is notorious for its challenging presentation. We report a case of effusive-constrictive pericarditis due to tuberculosis infection.

Changes and Trend Disparities in Life Expectancy and Health-Adjusted Life Expectancy Attributed to Disability and Mortality From 1990 to 2019 in China.

ObjectiveThis study aims to investigate sex, age, and cause-specific contributions to changes and trend disparities in life expectancy (LE) and health-adjusted life expectancy (HALE) attributed to disability and mortality from 1990 to 2019 in China, which provides insight into policy-making, health systems planning, and resource allocation.MethodsContributions of disability and mortality to changes and trend disparities in LE and HALE were estimated with standard abridged life table, Sullivan's method, and decomposition method, using retrospective demographic analysis based on mortality and years lived with disability (YLD) rates extracted from Global Burden of Disease Study 2019 (GBD 2019).ResultsFrom 1990 to 2019, LE and HALE increased by 10.49 and 8.71 years for both sexes, mainly due to noncommunicable diseases (NCDs) (5.83 years, 55.58% for LE and 6.28 years, 72.10% for HALE). However, HIV/AIDS and sexually transmitted infections had negative effects on changes in LE (−0.03 years, −0.29%) and HALE (−0.05 years, −0.57%). Lung cancer and ischemic heart disease caused the biggest reduction in LE (−0.14 years, −1.33%) and HALE (−0.42 years, −4.82%). Also, cardiovascular diseases (−0.08 years, −0.92%), neurological disorders (−0.08 years, −0.92%), diabetes and kidney diseases (−0.06 years, −0.69%), and transport injuries (−0.06 years, −0.69%) had main negative disability effects in HALE. Moreover, life expectancy lived with disability (LED) increased by 1.78 years, mainly attributed to respiratory infections and tuberculosis (1.04 years, 58.43%) and maternal and neonatal disorders (0.78 years, 43.82%).ConclusionThe LE and HALE in China have grown rapidly over the past few decades, mainly attributed to NCDs. It is necessary to further reduce the negative mortality effect of HIV/AIDS, lung cancer, colon and rectum cancer, pancreatic cancer, and ischemic heart disease and the negative disability effect of stroke, diabetes mellitus, and road injuries. In addition, the signs of disparities in mortality and disability of different sexes and ages call for targeted and precise interventions for key groups such as males and the elderly. According to the decomposition results, we may better determine the key objects of health policies that take into account substantial cause-specific variations to facilitate the realization of “healthy China 2030” plan.

Effectiveness of antiepidemic events in tuberculosis in context of changing epidemic process trend

Objective. To study the features of the formation of the epidemic situation for tuberculosis and to evaluate the effectiveness of antiepidemic events in separate age groups.&#x0D; Materials and methods. A retrospective analysis of the incidence of tuberculosis in Rostov-on-Don from 1992 to 2017 was conducted. The dynamics of the incidence of active tuberculosis, respiratory system tuberculosis and forms with bacillus discharge with the determination of the trend and its quantitative assessment was studied; the age structure of tuberculosis patients was analyzed depending on the direction and severity of the trend.&#x0D; Results. The incidence of tuberculosis has been increasing in Rostov-on-Don since 1993, and from 2003 to 2008, the average long-term incidence of active tuberculosis, respiratory tuberculosis and forms with bacillus excretion was maximum. Since 2009, the direction of trends has changed, the period from 2009 to 2013 is characterized by a "pronounced" downward trend and since 2014, the incidence rates have been minimal. In the age structure of patients with active tuberculosis, the proportion of persons aged 40-49 is decreasing, and in 20142017, the proportion of persons aged 5059 years is also falling. Since 2009, the proportion of persons aged 1829 has increased, and in 20092013 the proportion of children has grown. In 20142017, the proportion of persons over 60 years of age increased among those who fell ill.&#x0D; Conclusion. The most effective events are carried out in the group of 4059 years, less effective among children and persons aged 1517 and 3039 years. The results of the research will allow us to adjust preventive measures among children, teenagers and young people.