Tuberculous Lesions Research Articles

Immediate and postponed results of surgery of tuberculosis in patients with HIV infection

The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.

Histological and immunohistochemical features suggesting aetiological differences in lymph node and (muco)cutaneous feline tuberculosis lesions.

To identify and describe histological and immunohistochemical criteria that may differentiate between skin and lymph node lesions associated with Mycobacterium (M.) bovis and M. microti in a diagnostic pathology setting. Archived skin and lymph node biopsies of tuberculous lesions were stained with haematoxylin and eosin, Ziehl-Neelsen and Masson's Trichrome. Immunohistochemistry was performed to detect the expression of calprotectin, CD3 and Pax5. Samples were scored for histological parameters (i.e. granulomas with central necrosis versus small granulomas without central necrosis, percentage necrosis and/or multinucleated giant cells), number of acid-fast bacilli (bacterial index) and lesion percentage of fibrosis and positive immunohistochemical staining. Twenty-two samples were examined (M. bovis n=11, M. microti n=11). When controlling for age, gender and tissue, feline M. bovis-associated lesions more often featured large multi-layered granulomas with central necrosis. Conversely, this presentation was infrequent in feline M. microti-associated lesions, where small granulomas without central necrosis predominated. The presence of an outer fibrous capsule was variable in both groups, as was the bacterial index. There were no differences in intralesional expression of immunohistochemical markers. Differences in the histological appearance of skin and lymph node lesions may help to infer feline infection with either M. bovis or M. microti at an earlier stage when investigating these cases, informing clinicians of the potential zoonotic risk. Importantly, cases of tuberculosis can present with numerous acid-fast bacilli. This implies that a high bacterial index does not infer infection with non-zoonotic non-tuberculous mycobacteria.

Investigation of Mycobacterium bovis and Metastrongylus sp. co-infection and its relationship to tuberculosis lesions’ occurrence in wild boars

Animal tuberculosis (aTB) is a zoonotic disease characterized by granulomatous lesions on affected tissues, occurring as a consequence of immunological response to infection. Mycobacterium bovis, the main causative agent of aTB, was investigated in Brazilian wild boars with 37.7 % (29/77) positivity. Among these animals, most had no macroscopic tuberculosis-like lesions (89.6 %; 26/29). The existence of co-infections, which may alter an individual's immune response to an immunological challenge, could influence the formation of tuberculosis lesions. Therefore, we investigated Metastrongylus sp. and aTB co-infection to seek an explanation for the absence of macroscopic lesions in aTB. Of the tested animals, 77.9 % (60/77) had Metastrongylus sp., however, there was no association between its occurrence and the pattern of aTB lesions. The absence of tuberculous lesions in infected animals is worrisome, especially to hunters who handle their carcasses, potentially assuming that the animal is healthy. Studies evaluating other possibilities that can explain the absence of lesions in infected animals should be carried out to better understand these findings.

Differentiated Approach to the Diagnosis and Treatment of Tuberculous Spondylitis in Adults

The purpose of this study is to generalize the results of a complex clinical-laboratory, radiological and immunological study of patients with spinal tuberculosis. A comprehensive examination analysis was carried out in 192 patients with tuberculous spondy litis who were in the department of surgery for osteoarticular tuberculosis of the Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology in Tashkent, Uzbekistan. Severe degrees of spinal disorders were found in 48.7% of patients. Magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) allow establishing the stage and activity of a specific process in the spine, as well as complications. Spinal column instability was detected in 143 (74.5%) patients, paravertebral abscesses in 116 (60.4%) patients, and epidural abscesses in 75 (39.0%) patients. Changes in immunological parameters in patients with spinal tuberculosis were associated both with impaired regulation of immunogenetic and with the direct influence of the immune system at various stages of the process. The detection of certain patterns of immune system disorders in patients with tuberculous lesions of the spine allowed us to make a differentiated approach to their treatment in order to increase the effectiveness of the treatment. It can be concluded that at present, tuberculosis of bones and joints, especially the spine, is detected in an advanced stage in 50-80% of cases and has a widespread and complicated character with profound anatomical and functional changes and the presence of severe spinal disorders in 48.7% patients in Uzbekistan. Regarding spondylitis, it is immensely important to make an accurate diagnosis based on the clinical presentations, laboratory, radiological and immunological findings and by periodic assessment of the response to treatment, which is essential in atypical cases.

Sporotrichoid distributed tuberculous panniculitis as a late complication of intravesical bacillus Calmette–Guérin (BCG) immunotherapy

An 82-year-old man presented with unilateral oedema of the right lower limb overlaid with multiple sporotrichoid distributed panniculitis lesions. These symptoms appeared in a context of immunodepression and were associated with significant weight loss and a deterioration in general condition. The patient’s medical history, the histological findings, PCR testing, and bacterial culture led to a diagnosis of cutaneous tuberculosis due to Mycobacterium bovis. This infection occurred as a late complication of intravesical bacillus Calmette–Guérin (BCG) instillations that the patient had received as an adjunctive immunotherapy for bladder cancer. This is an unusual clinical presentation and aetiology of cutaneous tuberculosis. Indeed, the observed sporotrichoid pattern is uncommon for tuberculous mycobacteria. Moreover, the occurrence of tuberculous skin lesions after intravesical BCG instillations is extremely rare, with only a few cases described, and, to the authors’ knowledge, none with such a clinical presentation. This case report suggests that a medical history of BCG immunotherapy should always be considered when assessing any infectious-type cutaneous lesions and that skin should be regarded as a possible late localization of infectious complications of this treatment.

Surgical treatment of children with a combination of congenital lung malformations and tuberculosis

Congenital malformations of the bronchopulmonary system in combination with tuberculosis are extremely rare in practice, but they usually require surgical treatment. This combination often causes diagnostic difficulties.Characteristics of children and research methods. We have analyzed the experience of surgical treatment of a combination of various congenital lung defects and tuberculosis in 20 children. 9 (45%) children had lung sequestration, 4 (20%) children had lung hypoplasia, 5 (25%) children had congenital bronchiectasis, 1 (5%) child had arteriovenous malformation, and 1 (5%) child had a congenital lung cyst. There were 3 segmental resections, 15 lobeand bilobectomies, and 3 pneumonectomies. All surgeries were performed using minimally invasive approaches (VATS).Results. 11 (55%) patients had diagnostic difficulties of concomitant pathology. Only in 5 (25%) cases they found mycobacteria in sputum before surgery. Postoperative study of material from tuberculous lesions helped to establish multidrug resistance of mycobacterium tuberculosis and to change the chemotherapy regimen in 3 (15%) patients. There were no postoperative complications or deaths. All surgeries were effective. Long-term results were studied in 16 (80%) of 20 patients over a period from 1 to 10 years. No cases of reactivation of tuberculosis or disability.Conclusion. Resection surgery for combination of tuberculosis and congenital lung defects allowed to clarify the diagnosis and to achieve a direct effect in all patients by clarifying the drug resistance of mycobacterium tuberculosis and to optimize postoperative chemotherapy.

Single cervical spinal extramedullary tuberculous lesion in a young female – case report

Skeletal tuberculosis is the main extrapulmonary site for Mycobacterium tuberculosis infection disemination. As for the nervous sistem tuberculosis or spinal tuberculous disease in particular, the osseos elements are more frequently involved than the cerebral tissue or the spinal cord. We present the case of a previously healthy 32 year old female with no known TB history, reffered to our clinic for neck pain thought to be due to degenerative spinal disc disease. In the absence of general signs of the disease, the right surgical management and biopsy were the key factors for corect diagnosis.

Morphological studies of the surgical material to determine the form­phase and the degree of activity of the tuberculosis process when using minimally invasive surgical treatment techniques

Objective — to analyze the morphological studies of the operating material with the determination of the form-phase and the level of activity of the tuberculous process using minimally invasive methods of surgical treatment.
 Materials and methods. A retrospective analysis of data for a five-year period was conducted in our clinic. A total of 165 cases of pulmonary or pleural tuberculosis were treated. Patients were of different age groups. The men were 88 (53.3 %), women — 77 (46.6 %). All patients underwent morphological examination of the surgical material. Morphological determination of the degree of activity of specific inflammation in the lung tissue was carried out according to the previously developed working classification of the degree of activity. The morphological definition of the phase of pleural tuberculosis was determined according to previously developed criteria. Investigated histological preparations of lung tissue and tissue of the parietal pleura, stained by the traditional method with hematoxylin and eosin.Microbiological examination of biological material (sputum and/or fragments of surgical material) in each case to identify mycobacterium tuberculosis was carried out using various methods, regulated by Order of the Ministry of Health of Ukraine N 45.
 Results and discussions. The largest share of surgical interventions was in patients with pulmonary tuberculoma — 46.6 % of cases, with tuberculomas more often there was a moderate degree of activity of a specific inflammatory process. With various forms of pulmonary tuberculosis, moderate activity of the inflammatory process is more often determined — 51.8 %, in 13.4 % of cases the progression of specific inflammation is established. The share of microbiological detection of MBT at the time of surgery in cases of tuberculous lesions of the lungs was 27.7 % of cases, the share of multi-resistant MBT strains or strains with extended resistance was 61.3 %. In tuberculous pleurisy, the result of a microbiological study showed M. tuberculosis in 90.6 % of cases, more often susceptible MBT strains were determined — 58.5 %.
 Conclusions. Morphological study of surgical material in VATS provides an objective biological determination of the form of the phase of tuberculous lesion and determination of the degree of activity of a specific inflammatory process, which is extremely necessary for the further appointment of adequate treatment of patients.

Secondary diseases of the thoracic organs in HIV-­infected patients of phthysiopulmonological profile: 5­-year observation (according to a highly specialized hospital)

Objective – to establish the spectrum of secondary pathology of the thoracic organs in HIV-infected patients of phthisiopulmonary profile with inpatient treatment in the last 5 years, taking into account the appointment of antiretroviral therapy (ART) and the level of CD4+ T-lymphocytes in peripheral blood.
 Materials and methods. A cohort retrospective study was carried out. The group included 434 indivi-duals who were hospitalized in the clinic of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMN of Ukraine» in the period 2015—2019, with a confirmed diagnosis of HIV infection. Anamnestic, and clinical and laboratory data of patients were obtained from paper out patient and inpatient case histories, the electronic database of the Institute EMCIMED.Results and discussion. The data on the number of cases and the time of ART administration, the established CD4+ cell level, and final diagnoses of secondary diseases of various thoracic organs in hospitalized patients with HIV were analyzed and compared. On the whole, an unsatisfactory situation with the appointment of ART was established in accordance with the latest WHO and Ukrainian protocols on the medical management of people living with HIV. Surgical mini-invasive therapeutic and diagnostic manipulations and surgical interventions were performed in 183 (42.2 %) patients. Low levels of CD4 cells were determined in all patients, regardless of the type of established secondary disease. In 53.2 % of cases with various types of tuberculous lesions (lungs, pleura, peripheral lymph nodes) and when TB is combined with other secondary diseases, the level of CD4 T-lymphocytes was less than 200 cells/µL. In the spectrum of secondary diseases, TB of one or more organs of the thorax predominated, 75.8 % of cases. Among other secondary diseases, Pneumocystis pneumonia and lymphadenitis took the second and third places in the frequency of detection.
 Conclusions. In the structure of secondary diseases of thoracic organs among hospitalized patients with HIV infection in the last five years, as before, tuberculosis is in the lead. Among all patients with HIV and secondary diseases of the thorax organs, regardless of the type of diseases, cases with an average CD4-lymphocyte level less than 400 cells/µL prevailed.Only 53.0 % of patients received ART, and more than a third of them were prescribed ART during hospitalization at the Institute’s clinic. In another third of cases, specific therapy was not prescribed at all.

CROSS SECTIONAL STUDY ON BOVINE TUBERCULOSIS AT GHMBI MUNICIPAL ABATTOIR

Across sectional study to determine the prevalence of bovine tuberculosis at Ghmbi municipal abattoir was carried out on 400 heads of cattle from October 2008 to April 2009.Post mortem examination was used as a tool to establish the prevalence and culture and Ziehl-Neelsen staining to characterize mycobacterium. Tuberculous lesion was observed in a total of 31 animals and this give an overall prevalence of 7 .75 %.The tubercle lesion was detected in 21 (67.7%) mediastinal , 4 (12.9%) trachibronchial , 3 ( 9.67%) mesenteric and 1 (3.2%) hepatic lymph nodes and 2 (6.45%) lung tissues. The highest detection rate was recorded in mediastinal and the lowest in hepatic lymph node. In this study a total of 2 lung tissues and 29 lymph node samples were collected and cultured to isolate mycobacterium, of these 4 (12.90%) samples were found positive for mycobacterium.The risk factors such as sex, age, and body condition were assessed in relation to the occurrence of bovine tuberculosis and found significantly (p<0.05) associated with the occurrence of this disease. In conclusion, the present study shows the potential risk of the disease for both animals and human beings live in the study area, and being female, old and medium body condition animal is more risk to be infected with bovine tuberculosis.

Three-dimensional low shear culture of Mycobacterium bovis BCG induces biofilm formation and antimicrobial drug tolerance

Mycobacteria naturally grow as corded biofilms in liquid media without detergent. Such detergent-free biofilm phenotypes may reflect the growth pattern of bacilli in tuberculous lung lesions. New strategies are required to treat tuberculosis, which is responsible for more deaths each year than any other bacterial disease. The lengthy 6-month regimen for drug-sensitive tuberculosis is necessary to remove antimicrobial drug tolerant populations of bacilli that persist through drug therapy. The role of biofilm-like growth in the generation of these sub-populations remains poorly understood despite the hypothesised clinical significance and mounting evidence of biofilms in pathogenesis. We adapt a three-dimensional Rotary Cell Culture System to model M. bovis BCG biofilm growth in low-shear detergent-free liquid suspension. Importantly, biofilms form without attachment to artificial surfaces and without severe nutrient starvation or environmental stress. Biofilm-derived planktonic bacilli are tolerant to isoniazid and streptomycin, but not rifampicin. This phenotypic drug tolerance is lost after passage in drug-free media. Transcriptional profiling reveals induction of cell surface regulators, sigE and BCG_0559c alongside the ESX-5 secretion apparatus in these low-shear liquid-suspension biofilms. This study engineers and characterises mycobacteria grown as a suspended biofilm, illuminating new drug discovery pathways for this deadly disease.

The method of coding and quantitative evaluation of tuberculosis lesions in the lungs

To evaluate the degree of tuberculous lesions of the lungs, the method has been developed for coding and quantitative assessment of chest computed tomography results (chest CT) based on the presence of the following signs in each lobe of the lung: infiltrative and/or small focal changes – +1 point, focal formations (tuberculomas) – +2 points, cavitary changes (cavities) – +4 points. If there are all elements in the lobe, the maximum score is given – 7. The X-ray signs of tuberculous changes in the lungs are recorded in the form of a five-digit code "* * * | * *", where * corresponds to the lung lobe and is replaced by a figure corresponding to the total score calculated for this lobe. The arithmetic mean of the numbers in the code allows estimating the dissemination of tuberculosis: the higher the value, the more severe pathological changes in the lungs. The authors experimentally found that in the treatment of multiple and extensive drug resistant pulmonary tuberculosis with, the timing of sputum conversion (r s = 0.442; p &lt; 0.01) and healing of cavities (r s = 0.575; p &lt; 0.05) directly depended on the severity of tuberculous changes in the lungs, revealed by chest CT and evaluated using the proposed method.

PULMONARY TUBERCULOSIS-AS AN UPPER LOBE MASS A RARE CASE REPORT.

Tuberculosis is the worldwide serious health problem. Pulmonary tuberculosis is most commonly seen in India. The usual manifestation of tuberculosis is in the form of consolidation in upper lobe or superior segment of lower lobe.(1) But sometimes the disease has variable atypical presentation such as a mass. The diagnosis of Pulmonary tuberculosis or malignancy can be easily made when observed with CT or chest radiography.However some tuberculous lesions may clinically and radiographically mimic a neoplasia(2) This may lead to misdiagnosis or delayed treatment. Here we discuss a similar case of a 24 year old female.

Prevalence of suspected tuberculous lesions in cattle slaughtered in Cross River State Abattoirs

Granulomatous lessons in liver intestine, spleen, lung and lymph nodes (mediastinal, bronchial, retropharynged and mesenteric) were collected from slaughtered cattle in each of the main abattoirs in Bakoko, Ikom and Ogoja respectively in Cross River State South, Central and North senatorial cones during a one year (April, 2002 - March 2003) study period. 8,990 cattle were slaughtered and examined during the period. Of this number, tuberculous organs collected from 120 (1.3%) of the slaughtered cattle tested positive by the Ziehl-Neelsen (acid-fast) technique. There was no significant difference (P&gt;0.05) between the prevalence of tuberculous lesions during the dry and rainy seasons, although a slightly higher prevalence was found during the former (1.5%) than the later (1.1%) season. Of the 120 tuberculous lesions found 71(1.6%) occurred in females while 19 (1.1%) occurred in males. The organs affected most were the lungs 73 (55.7%) and lymph nodes 40 (30.58%) while the least affected organ was the disphragmatic muscle 1(0.76%). It was concluded that the overall prevalence of 1.3% of tuberculous lesions in organs of slaughter cattle in the state is of epidemiological importance and further studies are needed to isolate and type the acid-fast organisms in order 10 properly assess their public health significance.

Prevalence of bovine tuberculosis and distribution of tuberculous lesions in cattle slaughtered at Gondar, Northwest Ethiopia

ABSTRACT Background In Ethiopia, bovine tuberculosis (BTB) is a neglected disease that affects the economy and livelihoods of farmers. However, the available data is limited due to insufficient disease surveillance in the country. Therefore; this study aimed to assess the prevalence and distribution of lesions of BTB in cattle slaughtered at Gondar, Northwest Ethiopia. Methods Postmortem examinations were used to detect tuberculous lesions, while smear microscopy and histopathology were performed for the identification of acid-fast bacilli (AFB). Results Of 497 inspected slaughtered cattle, 45 (9.1%, 95%CI; 0.0668–0.1193) were diagnosed with BTB suggestive tuberculous lesions. A higher proportion of gross lesions was recorded in lymph nodes of lungs; at the mediastinal (14, 31.1%) and bronchial (10, 22.2%) lymph nodes, and followed by mesenteric lymph nodes (9, 20%). Of 45 tuberculous lesions; only 2 (4.4%) were identified as AFB positive by smear microscopy and histopathology. In the overall statistical analysis, body conditions of slaughtered cattle were found to be significantly associated with BTB tuberculous lesions (p < 0.05). Conclusion This finding provides the prevalence of BTB and distribution of tuberculous lesions in cattle slaughtered at the abattoir and highlights the need for a practicable control strategy of the disease in the region.

Туберкулез ЛОР-органов у детей раннего возраста

The identification of millions of newly infected with tuberculosis while maintaining a sufficiently high mortality rate, despite the existing treatment protocols, confirms the urgency of the problem of diagnosing this disease and dictates the need for an interdisciplinary approach to this problem. In the overwhelming majority of cases, tuberculosis is associated with lung damage, but its “extrapulmonary” manifestations are also possible, in particular with localization in the head and neck region (about 10%), including in the ENT organs. According to the literature, the incidence of tuberculous lesions is maximum for the larynx (from 14,5 to 15–37%), minimum for ear diseases (from 0,04–0.09% to 2,4–4,18%). To focus the attention of otorhinolaryngologists on the problem of “extrapulmonary tuberculosis” of ENT localization in pediatric practice, this study analyzes the case histories of 496 patients of tuberculous pulmonary pediatric department No. 1 of the Moscow Research and Clinical Center for Tuberculosis Control. Tuberculous lesion of ENT localization against the background of a generalized process was found in 7 patients (1.4%) aged from 2,5 months to 1 year 9 months. Tuberculous otitis media was most often detected (4 patients (0.6%)), in single cases – tuberculosis of the larynx, tuberculosis of the pharynx, tuberculosis of the salivary gland, including in combination with other organic ENT pathology (for example, papillomatosis and tuberculosis of the larynx). Thus, the lesion of the head and neck (including the ENT organs) is one of the “underestimated” extrapulmonary localizations of tuberculosis, and the diagnosis and verification are delayed. Among the “extrapulmonary” ENT manifestations of tuberculosis in young children, according to our data, otitis media prevails. To verify the diagnosis of “Tuberculosis” of any localization, it is necessary to inoculate Mycobacterium tuberculosis and be sure to consult the material obtained with histologists. Doctors of various specialties should not forget about the possibility of setting Mantoux tests with 2 tuberculin units (TU) and adenosine triphosphate (ATP) test for diagnostic purposes, despite the absence of a routine immunological examination in the national immunization schedule for children of the first year of life. Tuberculosis is curable, the main thing is to remember the need for early and timely diagnosis and adequate long-term treatment.

Radiation semiotics of tuberculous lesions of the hip joint

SummarySpecific tuberculous lesion of the hip joint is the second most common lesion among all forms of osteoarticular tuberculosis. Diagnosis of this lesion causes significant difficulties both in the presence and absence of the pul-monary process. This is due to the non-specificity of clini-cal and anamnestic signs, which leads to the erroneous diagnosis, viz. degenerative joint damage (coxarthrosis), and prolonged unjustified monitoring and treatment of such patients. Over the past 10 years, the widespread in-troduction of modern high-tech methods of radiation ex-amination (such as computer tomography and magnetic resonance imaging) into clinical practice allows for more detailed imaging of specific and non-specific changes in the hip joint, in contrast to radiography. The article presents the long-term experience of the Saint-Peters-burg State Research Institute of Phthisiopulmonology, Ministry of Healthcare, Russian Federation, modern diag-nostics of tuberculosis lesions of the hip joint, describes the features of the pathomorphology of the joint lesion (including in children of different age groups) which is the basis for radiation imaging of pathology. In adults, the primary localization of tuberculous granuloma is in the bones forming the acetabulum, where the red bone marrow is preserved, while in children, TB granuloma is formed in any of the bones forming the hip joint. The pos-sibilities of modern radiological methods of visualization of this pathology are described for their correct selection by the treating physicians in case of suspected hip tuber-culous lesion. Differential diagnostic signs of the most common hip diseases are presented: non-specific coxitis, aseptic necrosis of the femoral head, coxarthrosis, which will allow treating physicians and radiologists to correctly interpret the changes detected by radiation imaging methods when assessing changes in the hip joint.

Deep venous thrombosis with multifocal tuberculosis in an immunocompetent patient

A 33-year-old woman with no notable history who consults for a tuberculous gumma lesion in the elbow dating back 1 month with concurrent concomitant low back pain and all this in a context of night sweats and unencrypted weight loss. The cutaneous biopsy revealed granulomas with absence of caseous necrosis. The radiological assessment based on lumbar CT scan showed L5-S1 mirror images with an anterior vertebral collection engulfing the large retroperitoneal vessels and the angio-scan confirmed the thrombosis of the inferior vena cava, the scanned-guided biopsy confirmed the diagnosis of tuberculous spondylo-discitis. The remainder of the report showed a positive intradermal reaction (IDR) with negative VIH serology. The diagnosis of multifocal tuberculosis involving cutaneous, osteoarticular and pulmonary involvement in an immunocompetent patient was selected and the patient was placed on anti-TB drugs under the 2 months of streptomycin, rifampicine, isoniazid and pyrazinamide followed by rifampicine and isoniazid for 10 months, with good clinical evolution. The multifocal forms of tuberculosis represent 9 to 10% of cases and are the preserve of immunocompromised patients mainly carriers of VIH. Their prognosis is poor with a mortality rate of 16 to 25%. They also pose a real problem of diagnosis, given its clinical polymorphism and the diversity of organs that can be affected, which is the cause of the delay in diagnosis.

ФАКТОРЫ РИСКА РАЗВИТИЯ КРИТИЧЕСКИХ СОСТОЯНИЙ, ТРЕБУЮЩИХ ГОСПИТАЛИЗАЦИИ В ОТДЕЛЕНИЕ ИНТЕНСИВНОЙ ТЕРАПИИ И РЕАНИМАЦИИ, У ПАЦИЕНТОВ С ТУБЕРКУЛЕЗОМ

The mortality rate among tuberculosis patients requiring intensive care is high. The development of severe conditions in patients with tuberculosis may be associated with the course of the underlying disease and with concomitant pathology. The aim of this work was to study the risk factors for the development of severe conditions in patients with tuberculosis to prevent death. A retrospective study of risk factors for the development of critical conditions, depending on the nature of the tuberculosis process, co-infection, concomitant diseases and bad habits, was carried out in 154 patients with pulmonary tuberculosis and extrapulmonary tuberculosis hospitalized in the intensive care unit. In a cohort of patients admitted to the intensive care unit and intensive care unit, statistically significant factors influencing the development of critical conditions were: the presence of extrapulmonary localization of the tuberculous process; the presence of bilateral tuberculous lung lesions; the presence of destructive forms of tuberculosis; the presence of tuberculous meningitis/encephalitis; the presence of multidrug-resistant and extensively drug-resistant tuberculosis; application of the traditional "old" treatment regimen; the presence of concomitant HIV infection with a CD4 cell count of less than 200/ul; the presence of concomitant diabetes.

Solitary tuberculous lesion involving the spinous process of the cervical vertebra

The higher incidence and prevalence of tuberculosis (TB) is a common health problem particularly in developing countries like ours. The most common site of TB is the pulmonary region followed by lymph nodes and osteoarticular TB. In the spine, the dorsal spine is the most commonly affected region and the paradiscal being the most common type, posterior elements being the least involved, particularly in isolation. Of the posterior elements, the most common to be involved are the laminae. Here, we are presenting the case of the tubercular osteomyelitis involving the spinous process of the C6 vertebra in isolation. A young female presented to our outpatient department with pain and swelling on the posterior side of the neck. The swelling was nontender, without any signs of acute inflammation, cystic in consistency, and lying deep to the muscles. X-ray of the cervical spine and contrast enhanced magnetic resonance imaging (MRI) suggested the diagnosis of tubercular osteomyelitis. Pus was aspirated. Cartridge-based nucleic acid amplification test revealed Mycobacterium tuberculosis. The patient was given anti-tubercular drugs as per the index TB guidelines of the WHO and was cured. This, to the best of our knowledge, is the only case reported from India. Though the TB of the spinous process is extremely rare, still the diagnosis should be kept in mind when examining a posterior neck swelling, especially in country like ours, where the incidence of TB is high. X-ray and MRI are good tools to reach a diagnosis. Antitubercular regimen should be started for treatment.