Tuberculous Origin Research Articles

Epidemio-clinical aspects and neuro-meningeal tuberculosis prognosis in Batna

Neuromeningeal tuberculosis is rare, affecting around 1-2% of all tuberculosis cases and 5% of extra pulmonary tuberculosis cases. Our aim is to describe the epidemio-clinical, prognostic and evolutionary aspects of neuromeningeal tuberculosis. Materials and methods: To determine the spectrum of etiological agents of HIV-negative encephalitis and meningoencephalitis in Batna, we conducted a prospective study using an expanded testing approach. Patients were recruited from three departments (intensive care unit, infectious diseases department, pediatrics) during the period from April 1, 2012, to August 31, 2015. Data were collected according to the FLIPS case definition with a standardized form. We sought to identify etiological pathogens following a standardized procedure and to describe the epidemiological, clinical and biological features and outcomes associated with different causes. Results: A total of 141 patients with infectious encephalitis and meningoencephalitis were included in the study. Bacterial etiology was determined in 65/141 (46.1%) of whom 30 cases (21.3%) were of tuberculous origin; 21 confirmed and/or probable cases 9 possible cases with high clinical, epidemiological and radiological probability. The median age was 30.5 (0-83), predominantly female 12/18, 23.3% comorbidity with a frequency of motor deficits (86.7%) and psychiatric disorders (26.8%), respiratory involvement was present in 60% of cases, pleocytosis was present in 22/25 (73.4%). hyperalbuminorachy in 66. 7%, and hypoglycorachia in (46.7%). Anti-tuberculosis treatment was instituted in 90% of cases,17.6% were initially admitted to an intensive care unit, and the median length of hospital stay was 38.5 (1-146). death was identified in 46.6%, with 10% having sequelae. Conclusion: In our study, in addition to viruses, bacteria (especially intracellular) can be responsible for encephalitis and meningoencephalitis, in varying proportions. The most frequent and leading form of bacterial meningoencephalitis in adults is tuberculosis, the prognosis of which depends on early treatment.

Acute Coronary Syndrome (ACS) with ST-Segment Elevation Revealing Cardiac Amyloidosis: A Case Report and Literature Review

Cardiac Amyloidosis (CA) is an infiltrative cardiomyopathy characterized by the accumulation of fibrillar proteins in the myocardium. The deposition of these proteins disrupts the structure and function of the heart, leading to thickened walls, increased myocardial mass, diastolic dysfunction, and altered myocardial contraction, ultimately causing progressive heart failure. We report the case of a 65-year-old patient, S.L., admitted to our service with Acute Coronary Syndrome (ACS) with a posterior extended ST-segment elevation, Killip class I, semi-recent. She is hypertensive and diabetic; she previously underwent surgery for chronic constrictive pericarditis, presumed to be of tuberculous origin, and was treated accordingly. The echocardiogram revealed a hypokinetic left ventricle (LV), predominantly affecting the inferior, inferoseptal, and apical walls. The left and right atria were not dilated, and both ventricles were of normal size. Coronary angiography showed no significant anomalies. Cardiac MRI supported a diagnosis of localized amyloidosis. Through this case, we explore the various clinical forms of CA, referencing existing literature.

Results of Surgical Treatment of Post-Tuberculous Constrictive Pericarditis

Objectives : To evaluate the results of surgical treatment of post-tuberculous constrictive pericarditis. Materials and methods: This was a retrospective study of 08 cases of constrictive pericarditis of tuberculous origin observed between January 2015 and december 2019. These patients presented with right (3 cases) or bilateral (5 cases) adiastolism. All patients underwent subtotal pericardectomy by vertical median sternotomy. Results : There were no early deaths. Non-fatal complications included 3 cases of haemorrhage from a wound in the right atrium. The mean length of stay in intensive care was 2 +/- 0.5 days and the mean length of hospitalisation was 10 +/- 2 days. None of the 08 patients was lost to follow-up. After a mean follow-up of 28 +/- 6 months, 06 are currently at NYHA functional stage I (75%) and 02 at stage II (25%); the mean cardio thoracic ratio had become 0.58 +/- 0.2. Conclusion : Pericardectomy remains the only life-saving procedure for any patient at the stage of constrictive pericarditis.

Tuberculosis of Frontal Bone—A Rare Entity: Case Report and Review of Literature

AbstractTuberculosis of the frontal bone is a rare entity, most commonly occurring in childhood. In situations of painless scalp swelling coupled with or without a discharging sinus that has not responded to antibiotics, a strong index of suspicion must be raised. Generally, conventional radiography and computed tomography are used for establishing the diagnosis along with microbiological confirmation. We present an interesting case of a young boy who presented with a 2-month-old bone lesion in the frontal scalp, accompanied by mediastinal lymph node involvement. Histopathology revealed tuberculous origin and successful antitubercular therapy resulted in significant improvement within 3 months. The calvarial bones can rarely be affected by tuberculosis, which can present with swelling, sinus discharge, pain, or in rare cases as blindness. Prompt diagnosis of this disease is needed as it is potentially curable and has an excellent prognosis. The cornerstone of treatment is antitubercular therapy, while surgical intervention may sometimes be required. Our case highlights the importance of keeping tuberculosis as a differential at the back of the mind when dealing with scalp swellings, particularly in children.

Tuberculous PYO-Pneumothorax: A Rare and Severe form of Tuberculosis

Introduction: Tuberculosis is still a public health problem in Morocco. Tuberculous pyopneumothorax is a rare but serious complication secondary to the rupture of a tuberculous cavern in the pleural cavity. It is a well-known clinical form occurring mainly in extensive forms of tuberculosis and in frail patients. In our context, it poses a management problem. We report the case of a young man, chronic smoker, who presented with dyspnea and productive cough revealing a tuberculous pyopneumothorax. Case Report: The patient was a 28 year old male, chronic smoker with 10 PA always active, without any particular pathological history, who had been presenting for 2 months with a productive cough bringing back yellowish sputum with Sadoul stage III dyspnea, and progressive chest pain, all evolving in a context of altered general condition and feverish feeling. The clinical examination found a conscious patient, polypneic at 26 cpm, febrile at 38C°, hemodynamically stable, with objective pleuro pulmonary examination of a left aerial pleural effusion syndrome. A chest X-ray was requested in first intention, objectifying an opacity occupying the internal 2/3 of the left pulmonary hemichamp, not very dense, heterogeneous, seat of some cartées within it in connection with bronchograms with a clear external and internal limit drowned in the mediastinum, a left pneumothorax of great abundance made of an axilobasal parenchymatous hyperclarity without vascular framework with enlargement of the EICs and refoulement of the elements of the mediastinum towards the counter lateral side, and a filling of the left costo diaphragmatic cul de sac. A complementary thoracic CT scan noted a left hydropneumothorax of great abundance associated with pneumonic foci complicated by abscesses and multiple branching micronodules of the right upper lobe and middle lobe suggestive of a tuberculous origin. A drainage of the pyo-pneumothorax was performed with a bacteriological, cytological and ..........

Single-stage combined urethroplasty for extended strictures of the anterior urethra of tuberculous origin

Background. Urethral strictures are currently one of the most complex pathologies in reconstructive urology. The most promising direction in this area is the development of single-stage surgical interventions that meets modern requirements for the quality of life of patients.The aim of the study. To evaluate the possibility and the effectiveness of surgical treatment of extended recurrent tuberculous urethral strictures in men using a combination of a skin flap and a buccal graft. In the literature, there is no description of the use of this technique in patients with urethral tuberculosis.Materials and methods. We observed 44 patients with urethral tuberculosis. Three men from this group of patients were diagnosed with tuberculous (post-tuberculous) extended recurrent stricture of the anterior urethra and they underwent combined single-stage urethroplasty with a ventral fasciocutaneous flap and a buccal graft using the inlay method in the penile region and with a buccal graft using the ventral onlay method in the bulbous urethra. Ultrasound of the urethra served as a method that determines the possibility of performing this surgery in case of maintaining a sufficient width of the urethral plate with a moderate degree of spongiofibrosis.Results. Patients were under observation for 34, 50 and 54 months and have good long-term functional results – all patients have unassisted urination and no residual urine. Post-micturition dribbling persists in 1 patient. The overall effectiveness of the treatment of these strictures, taking into account the treatment of repeated cases of the disease recurrence, is high.Conclusion. This technique demonstrates the possibility of performing a single-stage reconstruction of the anterior urethra in patients with extended recurrent tuberculous (post-tuberculous) urethral strictures and is also applicable for the surgical treatment of urethral strictures of other origins.

An Interesting Case of a Nonhealing Obstetric Surgical Site Infection of a Concomitant Rare Fungal and Tuberculous Origin

An Interesting Case of a Nonhealing Obstetric Surgical Site Infection of a Concomitant Rare Fungal and Tuberculous Origin

Tenosynovitis of the Fingers Masking Tuberculous Origin Rice Grain Formation: Case Report and Literature Review

Tuberculous tenosynovitis is a rare localization of tuberculosis. The diagnosis is often late due to often poor and chronic clinical manifestations. We report a case of tuberculous tenosynovitis of the 4th finger of the right hand treated surgically at the department of traumatology and orthopedic surgery of the Ibn Sina university hospital in Rabat.

Insights into the diagnostic efficacy and macroscopic appearance of endocranial bony changes indicative of tuberculous meningitis: Three example cases from the Robert J. Terry Anatomical Skeletal Collection

AbstractRecently, the combined macroscopic and statistical evaluation of 427 identified pre‐antibiotic era skeletons from the Terry Collection (Washington, DC, USA) revealed that there is a positive association between tuberculous meningitis (TBM) and four endocranial alteration types, namely, granular impressions (GIs), abnormal blood vessel impressions (ABVIs), periosteal appositions (PAs), and abnormally pronounced digital impressions (APDIs). Although all the four lesion types can be used as diagnostic criteria for TBM in the paleopathological practice, they do not have the same diagnostic value. The first aim of the current paper is to further highlight the diagnostic value of GIs, ABVIs, PAs, and APDIs by calculating and discussing their diagnostic sensitivity and specificity estimate values, as well as their association with each other from the 427 identified pre‐antibiotic era skeletons of the Terry Collection. The second aim is to demonstrate three example cases from the Terry Collection, who exhibit bony changes on the inner skull surface that are representative of the macromorphological appearance and co‐occurrence of GIs, ABVIs, PAs, and APDIs (in different combinations). Based on the generated sensitivity and specificity estimate values, GIs are sufficient enough on their own to make a definitive diagnosis of TBM, whereas ABVIs, PAs, and APDIs are not specific to the disease but can be of tuberculous origin. The χ2 test results regarding the association of ABVIs, PAs, and APDIs revealed that their co‐occurrence with each other (in any possible combination) is significantly more common in individuals who died of TB than in those who died of non‐TB causes—it implies that the chance of them being tuberculous in origin is higher when they simultaneously occur with each other. The three cases demonstrated in detail in the paper provide paleopathologists with a stronger basis for identifying TBM in ancient human remains that reveal endocranial alterations resembling that of the presented cases.

For the treatment of fistulas of the anus located outside the sphincter. Dr. Friedrich Rudofsky (Zentralbl. F. Chir. 1933 r „No. 27)

For the treatment of fistulas of the anus located outside the sphincter. Dr. Friedrich Rudofsky (Zentralbl. F. Chir. 1933 r No. 27) in persistent cases of rectal fistulas, especially ishiorectal, tuberculous origin, suggests applying a temporary anus praeternaturalis to Colon Sigmoideum

Neuromeningeal tuberculosis in HIV-negative patients: a retrospective study in Rabat, Morocco

Neuro-Meningeal Tuberculosis (NMT) is a severe infection of the central nervous system which causes a public health problem in Morocco and in several countries in the world. In order to describe the epidemiological, clinical, paraclinical and outcome among NMT patients without HIV, we carried out a retrospective study at the neurology department of the Military Hospital of Rabat in Morocco, over a period of 17 years (2000-2017). Forty patients were included with a mean age of 44 years (± 18) and a sex ratio of 1.66. A history evoking the possibility of tuberculous origin was found in 8 patients (20%). Febrile confusion was the most common clinical manifestation and was observed in 22 patients (55%) followed by febrile meningeal syndrome in 12 patients (30%). The main abnormalities noted in brain magnetic resonance imaging (MRI) were: hydrocephalus in 13 cases (32.5%), intra-cranial tuberculomas in 10 patients (25%) and leptomeningitis in 9 cases (22.5%). Cerebrospinal fluid study found clear aspect in 29 patients (75%), direct acid fast bacilli smear examination was positive in 4 patients (10%) and positive culture in 4 patients (10%). The Polymerase chain reaction (PCR) study returned positive in 6 patients (35%) of the 17 patients tested. The outcome was good in 18 patients (45%) while 19 patients suffered from neurological sequelae (47.5%) and 3 cases of death recorded (7.5%). Febrile confusion was the most reported manifestation in our patients. Subacute onset of symptoms was the most predominant feature in our patients as reported in the literature. Our results are consistent with the literature and confirm the severity of this infectious disease, even in HIV-negative patients.

La tuberculose de la paroi thoracique : À propos d'un cas au CHU Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

RésuméIntroduction/justificationLa tuberculose est un problème de santé publique. Les présentations extra-pulmonaires sont rares et de diagnostic parfois délicat. Nous rapportons un cas de tuberculose de la paroi thoracique chez un homme de 28 ans afin de discuter le mécanisme, les problèmes diagnostique et thérapeutique posés par cette localisation rare.DescriptionLe patient présentait une tuméfaction pariétale découverte à l'issue d'un effort physique. L'imagerie était en faveur d'un abcès ou d'un hématome infecté. La chirurgie d'exérèse a permis d’établir l'origine tuberculeuse qui a été confirmée par l'histologie. Un traitement antituberculeux institué pendant 9 mois a complété le traitement chirurgical et conduit à la guérison du patient.Discussion/conclusionLa rareté de cette localisation de la tuberculose doit être recherchée. Un traitement étiologique doit être institué et un suivi régulier programmé pour éviter les récidives.

Pre-operative Intraperitoneal Drainage Under Local Anesthesia: A Promising Resuscitation Tool in Peritonitis Secondary to Hollow Viscus Perforation During the Corona Pandemic.

IntroductionTo study the role of intraperitoneal drainage in the resuscitation of patients with perforation peritonitis during the corona pandemic.Materials and methodsThis retrospective study was conducted in the general surgery department of Nishtar Medical University/Hospital Multan from April 2020 to September 2020. Patients of peritonitis who presented with bilateral pulmonary crepitations, SpO2 less than 92%, PaO2 less than 60 mmHg on arterial blood gas (ABG), and chest x-ray (CXR) finding of bilateral infiltrates are included. Due to high suspicion of associated coronavirus infection such patients needed polymerase chain reaction (PCR) for virus detection and special measures were required for resuscitation before any definitive treatment. A delay of six to eight hours is usually encountered while ensuring proper safety measures and dedicated operation theaters. Initial resuscitation started with intravenous fluids and broad-spectrum antibiotics were given to all patients. Twenty-seven patients were resuscitated with preoperative intraperitoneal drainage while waiting for PCR and 13 patients were resuscitated without drainage. Data analysis was carried out using the statistical package for the social sciences (SPSS) version 19 software. The mean was calculated for age while frequency and percentages were calculated for gender, comorbidities, and causes of delay. The mortality was compared using the chi-square test.ResultsThe mean age of patients was 43.73 ± 16.04 years. The common cause of peritonitis were perforations due to duodenal ulcer, typhoid, tuberculous (TB), and biliary origin. The variables that led to suspicion of coronavirus were SpO2 < 92%, PaO2 <60mmHg and bilateral infiltrates on chest x-ray. PCR for coronavirus was positive in nine patients. Mortality was 29.6% in those resuscitated with intraperitoneal drainage before the definitive procedure and 54% in those not resuscitated with intraperitoneal drainage.ConclusionsThe surge of coronavirus infection has put the healthcare staff at great risk. This has led to strict protocols and precautionary measures in the management of patients with perforation peritonitis with suspected corona infection. The local guidelines for the management of patients with acute abdomen should include aggressive measures right from the start during the corona pandemic. Intraperitoneal drainage, early in the management of perforation peritonitis decreases morbidity and mortality in suspected corona infected patients.

PSOAS ABSCESS – THE CHANGING TRENDS

Introduction: Psoas abscess (IPA) is an abscess collection in the retroperitoneal space tracking along the psoas major muscle. The microbial etiology of Psoas abscess is variable and depends on the geographical area. This study attempts to evaluate the microbial etiology, its implication in deciding the management modalities, and outcomes in patients with Psoas abscess from a tertiary care center in South India.&#x0D; Materials and Methods: This was a retrospective study done in a tertiary care center in Southern India. Results: A total of 47 patients were enrolled in the study, with causative organism identified in 40 (85.15%) patients. In 17 patients (36.17%), it was found to be tuberculous origin; and of nontuberculous origin in 23 patients (48.93%). No causative organism could not be isolated in 7 patients (14.89%). While 33 patients were treated with percutaneous drainage (70.12%), open drainage was done in 14 patients (29.78%) and 1 patient died (2.12%).&#x0D; Conclusion: The most common causative organism of psoas abscess is found to be of nontuberculous origin and PCD was found to be better modality of treatment. Empirical administration of anti-tuberculous drugs needs further evaluation.&#x0D; Key words: psoas, retroperitoneal, retrospective, tuberculous, drainage, empirical

A study on adenosine deaminase activity in pleural effusion of tuberculous and non tuberculous origin

Introduction: Accumulation of fluid in the pleural space that exceeds the physiological amount is defined as pleural effusion. Pleural effusion can be either transudative or exudative. The exudative pleural effusion is predominantly observed in tuberculosis. Adenosine deaminase (ADA) level remains high in disorders where cellular immunity is stimulated. Tuberculosis is one such disease. Materials and Methods: The cases were classified as two groups. 30 patients of tubercular pleural effusion were enrolled in Group I and 30 patients of non-tubercular pleural effusion were Group II. In non-tubercular pleural effusion, 6 cases were malignant effusions, 12 cases were parapneumonic effusions and 12 cases were transudative effusions, which include 4 cases of congestive cardiac failure, 4 cases of nephrotic syndrome and 4cases of hepatic cirrhosis. The following biochemical parameters in pleural fluid were estimated. They are Glucose, Protein and Adenosine deaminase. Results: In this study mean pleural fluid glucose level was significantly higher in transudative when compared to exudative pleural effusions. In exudative pleural effusions, mean pleural fluid protein level was increased significantly as compared to transudative pleural effusions. The activity of ADA in tubercular effusion was significantly higher when compared to non tubercular pleural effusions of different etiology such as malignant parapneumonic and transudative. Conclusion: The assessment of ADA act as better marker for identifying tuberculosis than the traditional markers. Keywords: Pleural effusion, Exudative, Transudative, Tuberculosis, Adenosine deaminase.

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis.

Although endocranial abnormal blood vessel impressions (ABVIs) and periosteal appositions (PAs) have been considered as paleopathological diagnostic criteria for tuberculous meningitis (TBM) based on findings of previous studies, they are not pathognomonic for tuberculosis (TB). Therefore, their utilization in the paleopathological practice can be questioned, especially in consideration that most of the previous studies were not performed on identified skeletal collections but on osteoarchaeological material and did not include statistical data analysis. To fill the aforementioned research gap, for the first time, a macroscopic investigation was conducted on identified pre-antibiotic era skeletons from the Terry Collection. A sample set of 234 individuals who died of TB (TB group) and 193 individuals who died of non-tuberculous causes (NTB group) were examined. The frequency of ABVIs and PAs, as well as other probable TB-related lesions was recorded. To determine the significance of difference (if any) in the frequencies of ABVIs and PAs between the two groups, χ2 testing of our data was performed. We found that ABVIs, PAs, and their co-occurrence with each other and with other probable TB-related lesions were more common in the TB group than in the NTB group. In addition, the χ2 comparative frequencies of ABVIs and PAs revealed a statistically significant difference between individuals who died of TB and individuals who died of NTB causes. Our findings strengthen those of previous studies that ABVIs and PAs are not specific to TBM but can be of tuberculous origin. Therefore, they do have a diagnostic value in the identification of TB in human osteoarchaeological material, especially when they simultaneously occur with other probable TB-related lesions. Their prudent utilization provides paleopathologists with a stronger basis for diagnosing TB and consequently, a more sensitive means of assessing TB frequency in past human populations.

ROLE OF TUMOR MARKERS IN THE DIAGNOSIS OF MALIGNANT PLEURAL EFFUSIONS

As an aid in the differential diagnosis of oxidative pleural effusions tumor markers were investigated. We measured carcinoembrionic antigen (CEA) and a glycoprotein CA 15-3 in the pleural fluid of 33 patients with carcinomatous pleural effusions and of ten patients with tuberculous pleurisy and other causes because we have frequently found those diseases to be associated with exudative pleuritis. CEA and CA 15-3 were significantly higher in carcinomatous pleural fluids than in tuberculous fluids (p value of 0.0287), therefore combined assay of CEA and CA 15-3 may be useful in distinguishing pleural effusions due to malignancies from those of tuberculous origin.

Different kinetics of infectious processes in vertebral osteomyelitis of pyogenic or tuberculous origin explain different timing of surgery

Background: Whether surgery modalities vary according to kinetics of pathological processes responsible for vertebral osteomyelitis (VO) is unclear. We therefore compared surgical modalities in patients with haematogenous pyogenic VO (HPVO) or tuberculous VO (TVO).Methods: Patients who had surgery for HPVO or TVO between January 1997 and June 2018 in a university hospital were included. Surgical indications, timing, and procedures and outcomes were evaluated at the end of treatment.Results: Seventy-eight patients (50 men) were included: 39 with HPVO and 39 with TVO; median age was 64 and 41 years, respectively. In patients with HPVO, surgery was performed early: 17 (44%) had surgery within 72 h of admission; main indication for surgery was neurological deficit in 29 patients that persisted in 12 patients (27%). In patients with TVO, surgery was performed later (p<.001), after two weeks in 20 patients (51%), and was indicated by a neurological deficit in 23 patients; among them, only one (4%) had residual deficit.Conclusions: Different kinetic profiles of the infectious processes explain the more rapid indication for surgery in patients with HPVO and the more favourable neurological recovery in patients with TVO.

Bilateral tuberculous psoas abscess

The unilateral psoas abscess is a rare disease that is often caused by common germs, including Staphylococcus aureus . Tuberculous origin and bilateral involvement are even rarer, especially in developed countries. It may be primary or secondary to a neighbourhood focus. We report a case of bilateral tuberculous abscess of psoas in an immunocompetent patient secondary to spondylodiscitis.

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection.

Paleopathological diagnosis of tuberculosis (TB) essentially relies on the identification of macroscopic lesions in the skeleton that can be related to different manifestations of TB. Among these alterations, granular impressions (GIs) on the inner skull surface have been considered as pathognomonic features of tuberculous meningitis (TBM). GIs may be established by pressure atrophy of the tubercles formed on the outermost meningeal layer during later stages of TBM. Although GIs were used as diagnostic criteria for TBM in the paleopathological practice since the late 20th century, their diagnostic value has been questioned. To contribute to strengthening the diagnostic value of GIs, a macroscopic investigation-focusing on the macromorphological characteristics and frequency of GIs-was performed on skeletons of known cause of death from the Terry Collection. The χ2 analysis of our data revealed that GIs were significantly more common in individuals who died of TB than in individuals who died of non-TB causes. Furthermore, GIs were localized on the inner surface of the skull base and of the lower lateral skull vault. The localization pattern and distribution of GIs on the endocranial surface resemble that of the tubercles observed in the affected meninges during the pathogenesis of TBM. Our results strengthen the tuberculous origin of GIs and imply that they can be considered as specific signs of TBM. Therefore, GIs can be used as diagnostic criteria for TBM in the paleopathological practice, and the diagnosis of TBM can be established with a high certainty when GIs are present in ancient human bone remains.