Tuberculous Mycobacterial Infections Research Articles

Radical Surgery for Successful Management of Axillary Hidradenitis Suppurativa Complicated by Mycobacterial Infections

Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-yearold female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last 5 years. Earlier, she had received a 6 month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for 3 months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical excision of all the tracts, fistulae, and sinuses over her axilla was performed under ultrasound guidance. Wide excision resulted in a significant axillary defect that was reconstructed with large advancement flaps aided by progressive tension sutures. Postoperatively, a 7 year follow-up period of the patient was disease-free with the patient taking all necessary precautions. After 7 years, the affected axilla appeared nearnormal with some areas of stretched scars that did not bother the patient. To conclude, HS with Non tuberculous mycobacteria is rare, and a proper antimicrobial therapy with early en bloc excision under ultrasound guidance produced a complete cure.

Prevalence of non tuberculous mycobacterial infection in surgical site infections and their antibiotic susceptibility profile

BackgroundSurgical site infections (SSIs) are one of the leading causes of hospital-acquired infections contributing to about 20% of all cases, thereby causing an increase in morbidity and financial burden. Causative organisms associated with SSIs have not changed greatly over the last 10–15 years; however, the proportions of different types of causative organisms have changed with an increase in case reports of rare organisms such as non-tuberculous mycobacteria (NTM). MethodsSamples received from patients with SSI were simultaneously cultured for the isolation of NTM along with routine bacteriological examination. On isolation of NTM, identification was carried out by biochemical tests, and further antibiotic susceptibility profile was determined by using RAPMYCO kit. ResultsSSI occurred in 3.95% of the 7675 surgeries performed during the study period of which 10.9% were caused owing to NTM. Only rapidly growing NTM were isolated of which, Mycobacterium fortuitum was the most common (51.51%) and had least resistance to drugs. Other isolates were Mycobacterium abscessus and Mycobacterium chelonae having high degree of antimicrobial resistance. ConclusionNTM are an important cause of SSI having delayed presentation, are difficult to diagnose and often not treated correctly. Identification and susceptibility testing is important as different species respond differently to antimicrobial agents.

ADRENAL TB AS A CAUSE OF PRIMARY ADRENAL INSUFFICIENCY

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Addison’s disease refer to a chronic endocrine disorder characterized by primary adrenal insufficiency. Adrenal involvement in tuberculosis is most often the result of hematogenous spread of Pulmonary tuberculosis. Isolated Adrenal Tuberculosis was noted in only 1- 2% of Addison’s Disease and one such rare case is presented here CASE PRESENTATION: A 36 yr old male, admitted with complaints of weight loss, generalised fatigue and discoloration of the body for past 6months. On admission, his BP 80/60mmHg, HR 64/min, temperature 101F & RR 22/min. His skin over the face, arms, palms and soles were darkly pigmented. Clinical examination of respiratory, cardiac, abdominal and nervous system were normal. Blood results revealed RBS 76mg/dl, urea 37, creatinine 2.2, serum Na 126mEq/L, serum K 6.5 and other parameters were normal. Serum Cortisol is 2.57 μg/dl [ 6.2 to 19.4] and ACTH is >1250 pg/ml [7.2to 63.3]. A chest radiograph and chest CT revearled no abnormalities. Bronchial wash CBNAAT MTB not detected. Mantoux 11mm. CECT of abdomen showed bilateral diffuse thickening of adrenal glands without calcifications. CT guided biopsy of Adrenals showed granulamatous adrenalitis thus confirming the diagnosis of primary adrenal tuberculosis DISCUSSION: PAI is caused by destruction of Adrenocortical tissue due to Autoimmume ds.,TB, Cryptococcosis, Fungal infections, Primary or Metastatic tumours,etc. The symptoms of PAI manifests when >90% of the Adrenals have been destroyed. Primary Tubercular Adrenalitis is a rare clinical entity & based on the clinical, serological, radiological & biopsy findings diagnosis was made. A prompt clinical & radiological response was seen in our patient. CONCLUSIONS: Isolated adrenal tuberculosis is a rare cause of Addison’s disease especially with enlargement of adrenal glands causing diagnostic problems and require differentiation from primary or secondary neoplastic disease. It is a rare but important disease entity that must be identified early and treated promptly and aggressively Reference #1: Textbook of Tuberculosis by Surendra K Sharma, 2nd Edition Reference #2: Textbook of Tuberculosis & Non Tuberculous Mycobacterial Infections by David Schlossberg, 5th Edition Reference #3: Nakaoka K, Branch J, Ozeki T, et al (2012) Acase of Primary Adrenal TB – Endocrinal Metabolic Syndrome DISCLOSURES: No relevant relationships by ALLWYN VIJAY GOWRI SHANKAR, source=Web Response No relevant relationships by Sathya Natarajan, source=Web Response

A Rare Case of Cat-Scratch Disease Presenting as Axillary Lymphadenopathy with Non Tuberculous Mycobacterial Infection

A Rare Case of Cat-Scratch Disease Presenting as Axillary Lymphadenopathy with Non Tuberculous Mycobacterial Infection

Paradoxical Lymphadenopathy after Successful Treatment of Tuberculous Pleuritis

Tuberculous lymphadenopathy can paradoxically increase in size after initial clinical improvement. This paradoxical reaction during tuberculosis treatment is more common among HIV positive than non-HIV patients. However paradoxical reaction must not be primary diagnosis and it is crucial to be sure about patients ˋ good compliance in using antituberculosis medications as well as having sensitive mycobacterial strain. In addition other pathological problems (eg. neoplasia, other non tuberculous mycobacterial infections) should be excluded. We report a case of pleural tuberculosis, complicated by cervical lymphadenopathy near the end of her treatment.

Infections récurrentes à mycobactéries atypiques chez l’adulte : attention aux autoanticorps anti-interféron-gamma !

IntroductionDisseminated non-tuberculosis mycobacterial infections are associated with a defect of the cellular immune response. They have been mainly reported in AIDS patients. Cases related to the presence of anti-interferon-γ autoantibodies are rare. Case reportWe report a non HIV-infected 45-year-old Thai woman, with a past medical history of Graves’ disease. She presented with recurrent disseminated and severe non-tuberculous mycobacterial infections that were related to the production of anti-interferon-γ autoantibody. The diagnosis was suspected in the presence of a negative interferon-γ release assay (IGRA) including with the positive control, and evidenced by the identification of specific antibodies. ConclusionAnti-interferon-γ autoantibody production is a rare cause of non tuberculous mycobacterial infection. Such a mechanism should be suspected in non HIV-infected patients and especially in those having an Asiatic ethnicity or an associated immune disorder. A negative IGRA (including with the positive control) is a reliable diagnostic tool and should be completed with the identification of specific autoantibodies.

AIDS: “It’s the bacteria, stupid!”

Acid-fast tuberculous mycobacterial infections are common in AIDS and are regarded as secondary "opportunistic infections." According to the National Institute of Allergy and Infectious Diseases, TB is the major attributable cause of death in AIDS patients. Could such bacteria play a primary or causative role in AIDS? Certainly, In screening tests for HIV, there is frequent, up to 70%, cross-reactivity, between the gag and pol proteins of HIV and patients with mycobacterial infections such as tuberculosis. By 1972, five years before gays started dying in the U.S., Rolland wrote Genital Tuberculosis, a Forgotten Disease? And ironically, in 1979, on the eve of AIDS recognition, Gondzik and Jasiewicz showed that even in the laboratory, genitally infected tubercular male guinea pigs could infect healthy females through their semen by an HIV-compatible ratio of 1 in 6 or 17%, prompting him to warn his patients that not only was tuberculosis a sexually transmitted disease, but also the necessity of the application of suitable contraceptives, such as condoms, to avoid it. Gondzik's solution and date of publication are chilling; his findings significant. Since 1982 Cantwell et al found acid-fast bacteria closely related to tuberculosis (TB) and atypical tuberculosis in AIDS tissue. On the other hand molecular biologist and virologist Duesberg, who originally defined retroviral ultrastructure, has made it clear that HIV is not the cause of AIDS and that the so-called AIDS retrovirus has never been isolated in its pure state. Dr. Etienne de Harven, first to examine retroviruses under the electron, agrees. In 1993 HIV co-discoverer Luc Montagnier reported on cell-wall-deficient (CWD) bacteria which he called "mycoplasma" in AIDS tissue. He suspected these as a necessary "co-factor" for AIDS. Remarkably, Montagnier remained silent on Cantwell's reports of acid-fast bacteria which could simulate "mycoplasma" in AIDS tissue. Mattman makes clear that the differentiation between mycoplasma and CWD bacteria is difficult at best and cites Pachas's 1985 study wherein one mycoplasma was actually mistaken for a CWD form of a bacterium closely related to the mycobacteria. It is important to realize that the statement "HIV is the sole cause of AIDS" is just a hypothesis. There are unanswered questions and controversy concerning the role of HIV "as the sole cause of AIDS." And until they are resolved, a cure is not possible. This paper explores the possible role of acid-fast tuberculous mycobacteria as "primary agents" in AIDS.

Disseminated tuberculosis with multiple intracerebral tuberculomas in a patient with anorexia nervosa

Multiple tuberculous mycobacterial infections infrequently occur in immunocompromised patients. The malnutrition resulted from anorexia nervosa may contribute to the significant impairment of immunity. The authors present a 23-year-old female patient initially diagnosed with anorexia nervosa. Immunological study revealed that helper T-cell (CD4) and cytotoxic T-cell (CD8) comprised 25 and 32%, respectively, with a CD4 to CD8 ratio of 0.78. Brain magnetic resonance imaging revealed various multiple rings enhancing lesions with edematous change in both cerebral and cerebellar hemispheres. Open biopsy disclosed palisading epithelioid granuloma surrounded by inflamed granulation tissue. After anti-tuberculous therapy for 12 months, her weight was completely restored, but multiple intracranial tuberculomas were not completely disappeared. Disseminated tuberculous mycobacterial infections including multiple intracranial tuberculomas may be attributed to immunocompromised status in anorexia nervosa.

Syndrome de susceptibilite mendélienne aux infections mycobacteriennes : défauts de l’axe Interleukine-12 - Interféron

Environmental non tuberculous mycobacteria and Bacillus Calmette-Guerin vaccines are weakly virulent mycobacteria. Nevertheless they may cause severe diseases in otherwise healthy children with no overt immunodeficiency. Parental consanguinity and familial forms are frequently observed among these patients, therefore this syndrome was named "Mendelian Susceptibility to Mycobacterial Disease". In the last nine years, fife genes have been found to be mutated in patients with this syndrome: IFNGR1, IFNGR2, STAT1, IL12B, IL12RB1. Allelic heterogeneity accounts for ten distinct genetic disorders. Clinical phenotype differs between patients. The spectrum of disease extends from early-onset overwhelming mycobacterial infection to adult-onset localized disease and tuberculosis. Impaired IFN-gamma-mediated immunity is the common mechanism of the disease, outlining its major role in mycobacterial immunity. Better understanding of these disorders reveals an expanding clinical phenotype which justifies studying adult patients with pulmonary non tuberculous mycobacterial infection without known risk factors, severe BCGitis and recurrent tuberculosis. Molecular diagnosis makes it possible to introduce a specific regimen based on physiopathology.

False Negative Result of Ga-67 Scintigraphy in Tuberculous Spondylitis: Report of a Case

Tuberculous spondylitis is a difficult condition to diagnose clinically. However, Ga-67 scintigraphy can playa useful role in its detection. A false negative result of Ga-67 scintigraphy was demonstrated in a case of tuberculous spondylitis in this report. A 79-year-old female had fever of unknown origin (FDO) and severe low back pain for- several months. Abnormally increased radioactivity was noted in the L3/41evels on Tc-99m MDP bone scan; however, normal uptake of radioactivity was noted on Ga-67 scintigraphy. Finally, tuberculous mycobacterial infection involving the vertebral bones of L3/4 levels was diagnosed by histologic evaluation. We emphasize that tuberculous spondylitis has to be considered in the condition of a positive Tc-99m MDP bone scan while negative on Ga-67 scintigraphy.

Les infections à mycobactéries non tuberculeuses au cours du Sida: 46 observations

We report a retrospective analysis of 46 cases of non tuberculous mycobacterial infections in AIDS. This complication occurs in advanced stages of HIV infection and is often due to Mycobacterium avium. Therapy with new anti-mycobacterials like clarithromycin and rifabutin seems capable to prolong survival.