Tuberculous Research Articles

Synovial Chondromatosis in Knee Masquerading as Tuberculosis Arthritis

Synovial Chondromatosis in Knee Masquerading as Tuberculosis Arthritis

Diagnostic role of stool TB-PCR in suspected tuberculous colitis patient at Dr Cipto Mangunkusumo National Central General Hospital: a cross-sectional study.

the signs and symptoms of tuberculous (TB) colitis were similar with other diseases, such as inflammatory bowel disease. Therefore, finding the diagnostic modality to help differentiate TB colitis with other diseases was a challenge. In this study we aimed to find the proportion of positive stool TB-PCR in suspected TB colitis subjects and also the diagnostic value of the stool TB-PCR if compared to colonoscopy, histopathology and clinical evaluation. a cross-sectional study was done on subjects suspected to have TB colitis who undergone colonoscopy and histopathology examination between February-April 2019. Stool samples from those subjects were collected and extracted with the QIAamp® Fast Stool DNA Mini Kit. The TB-PCR was done using artus® M. tuberculosis RG PCR kit, which targeted on 16s rRNA gene. The results of stool TB-PCR then were compared with the combination of colonoscopy, histopathology and clinical evaluation as the gold standard. from sixty subjects who were recruited, there were 26/60 (43.3%) subjects with positive stool TB-PC. It was consisted of 7/8 TB colitis subjects and 19/52 non-TB colitis subjects. The diagnostic value of the stool TB-PCR was: sensitivity 87.5%, specificity 63.5%, positive predictive value 26.9% and negative predictive value 97.1%. stool TB-PCR has good sensitivity but low specificity for diagnosing TB colitis. Therefore, stool TB-PCR could be utilized as a screening test for TB colitis.

The lumbar hernia

Lumbar hernias are rarely encountered as compared to other ventral abdominal wall hernias and are often misdiagnosed and overlooked. They account for less than 1.5% of all abdominal hernias. Fewer than 300 cases have been reported over the past 300 years. A lumbar hernia is defined as a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. It must be distinguished from a lipoma, cold (tuberculous) abscess or a pseudo-hernia due to local muscular paralysis. Presenting a case of 65-year-old female who came to surgery OPD with complaint of a swelling in the right lumbar area since 5 years. On examination, a smooth and non-tender swelling measuring approximately 4 x 3 cm was evident in right lumbar region. We proceeded with a lumbar ultrasound which confirmed the presence of the hernia in posterior abdominal wall. Later, the patient was admitted for surgery under spinal anaesthesia. An open approach was performed and intraoperative findings revealed retroperitoneal fat, intermuscular lipoma and a small hernia sac as contents of swelling. It is very unusual to find lumbar hernias presenting with a lipoma, as in our case, the clinical findings alone can be very confusing and increase the chances of incorrect diagnosis and subsequent treatment. Inability of clinical examination and ultrasonography alone in making an adequate diagnosis of lumbar hernia in preoperative setting mandates a routine CT/MRI for all such patients, to ensure surgeons have a correct diagnosis before proceeding for surgery. Ideal management is just like other hernias, i.e., with mesh hernioplasty either laparoscopically or through an open approach.

Extraganglionary Localization of Tuberculosis in Otorhinolaryngology: Rare Presentations About 29 Cases

The extra nodal tuberculosis is a rare disease in Ear, Nose and Throat. The aim of this work is to study the epidemiological, clinical, therapeutic profiles of rare locations of ENT extra nodal tuberculosis. This is a retrospective study between June 2003 and June 2019, including 29 cases of ENT extra nodal tuberculosis. There were 6 cases of laryngeal tuberculosis, 5 cases of nasopharyngeal tuberculosis, 5 cases of salivary gland tuberculosis, 3 cases of tonsillar tuberculosis, 1 case of tuberculous retropharyngeal abscess, 3 cases of nasal tuberculosis, 3 cases of tuberculosis of the middle ear, 1 case of thyroid tuberculosis, 1 case of tuberculosis of the bony palate, and 1 case of mandibular tuberculosis. All ages were affected with a predominance of young adults. The clinical signs, as well as radiological or endoscopic examinations, were not specific. The diagnosis was based on histology and/or bacteriology. Antibacillary therapy was instaured in all cases. Extra nodal tuberculosis in ENT is rare. It is dominated by the laryngeal location. It must be considered as a differential diagnosis in front of any atypical symptoms, particularly in endemic countries.

Pulmonary tuberculosis and Cryptococcal native knee septic arthritis with osteomyelitis in an immunocompetent patient: Mycobacterial effect on CD4 function and cellular immunity

Clinically significant cryptococcal disease is typically seen in patients with human immunodeficiency virus (HIV). However, Cryptococcosis has also been observed among non-HIV immunocompromised hosts. Cryptococcosis and tuberculosis (TB) infections both occur due to impaired cell mediated immunity but co-infection is rare among immunocompromised patients. Co-infection of these pathogens is even less reported in immunocompetent hosts. We present a case of Cryptococcal left native knee septic arthritis with tibial osteomyelitis in an HIV negative patient with recently active tuberculosis.

Tuberculous tibial osteomyelitis with ankle joint arthritis in an immuno-competent patient: An atypical case presentation

Tuberculosis is called the great masquerader as it can mimic other diseases because of its varied clinical presentations. Evolving alongside the humans over the years mycobacteria developed various defence mechanisms to avoid detection and destruction by the host. Bone and joint TB is an extra pulmonary TB and its incidence varies with age and the socioeconomic status of the people and the country as a whole. In this case report we present a patient who had both TB osteomyelitis and arthritis which is an unusual and atypical presentation.

Robot-assisted intracorporeal combined ileal ureter replacement and augmentation cystoplasty in the treatment of genitourinary tuberculosis: an illustrated techniques video.

Robot-assisted intracorporeal combined ileal ureter replacement and augmentation cystoplasty in the treatment of genitourinary tuberculosis: an illustrated techniques video.

Сравнительная оценка логистической регрессии и дерева решений в прогнозировании рецидива у больных туберкулезом органов дыхания с множественной лекарственной устойчивостью возбудителя

Introduction. The rate of recurrence of respiratory tuberculosis is one of the indicators characterizing the effectiveness of anti-tuberculosis measures. Timely detection of patients with relapses is one of the priority approaches in solving the problem. Currently, with the introduction of big data processing technologies, namely artificial intelligence, various classifiers are used that take into account the totality of signs identified in patients. The decision tree algorithm has proven itself widely in medical analytics. By analyzing these data, it is possible to classify the state of health and identify the first signs of tuberculosis recurrence. Aim. To develop and evaluate models for predicting a recurrence in patients with pulmonary tuberculosis caused by multidrug-resistant pathogen (MDR-TB), using logistic regression and decision tree. Materials and methods. The study included clinical and epidemiological, age, sex, social, medical and biological data of 346 patients with MDR-TB who successfully completed chemotherapy. Two observation groups were formed depending on the onset of recurrence of the disease in patients at least in the five-year follow-up period. The first group consisted of 35 patients with relapse, and the second one had 311 patients with no relapse. Statistical data processing for logistic regression was performed by IBM SPSS Statistics 23.0, the decision tree classifier was designed in the Scikit-learn 0.24.2 library in an interactive cloud environment with the Google Colaboratory code, using K-fold stratified validation. The quantitative interpretation of the prediction results was carried out according to the ROC-curves (receiver operating characteristic) with the assessment of the AUC indicator (the area under the ROC-curve). Results. The sensitivity and specificity of the logistic regression model and the decision tree classifier for predicting tuberculosis recurrence were 98.7%, 88.6% and 74.0%, 97.0%, respectively. Conclusion. The created models can become a tool for predicting the recurrence of MDR-TB in cured patients.

Повышение результативности компьютерной томографии при туберкулезном перитоните

The aim of the research. According to the WHO, the prevalence of respiratory tuberculosis in the world tends to decrease, while the rate of extrapulmonary tuberculosis remains stable: in 2019, approximately 1,050,000 new cases were registered and every sixth of them featured the clinical form of peritonitis. The unsatisfactory results of detection and treatment of tuberculous peritonitis as well as the high frequency of disability and mortality in this disease require a further comprehensive approach to its non-invasive diagnosis including the use of CT. The aim of this study was to evaluate the radiological features of tuberculous peritonitis compared with the data of endoscopic and morphological studies, as well as to develop an optimal integral scale for diagnosis of peritoneal tuberculosis. Material and methods. A retrospective analysis of invasive and CT diagnosis in 25 patients with confirmed tuberculous peritonitis within the period from 2014 to 2020 was performed. The same indicators were used in the comparison group consisting of 28 patients with diseases that often mimic tuberculous peritonitis (by carcinomatosis and sarcoidosis of the peritoneum, non-specific ascites). Results. The main signs of peritoneal lesion in tuberculosis have been revealed. Based on this, an integral scale for assessment of the significance of individual CT symptoms in combination with clinical and anamnestic data has been developed. The statistical data obtained suggest the following pattern: the probability of tuberculous peritonitis upon evaluation of all the described parameters is low with the score of up to 5, and high with 6 or more points. Conclusion. The developed integral scheme for assessment of CT signs allows the clinician to assume the presence of tuberculous peritonitis based on CT scans of the abdominal cavity and chest, anamnesis, as well as the results of laboratory findings, and to choose further tactics in diagnostic search.

The role and place of bronchodilative and anti-inflammatory therapy for chronic obstructive pulmonary disease in patients with newly detected respiratory tuberculosis

Introduction. The relevance of the problem of managing patients with concomitant infectious and non-infectious pathology is beyond doubt, a third of patients suffering from tuberculosis have COPD as a comorbidity, which re-quires adequate therapy to improve the prognosis of the patient’s treatment as a whole. Objective: to evaluate the effectiveness of various options for bronchodilatory and anti-inflammatory therapy in patients with newly diag-nosed pulmonary tuberculosis secondary to COPD. Ma-terials and methods. A simple prospective comparative study included 210 patients divided into 3 groups: 124 pa-tients with TB+COPD; 46 patients with drug-susceptible TB (TB DS)+COPD; 40 patients with multidrug-resistant TB+COPD. The selection of treatment regimens was car-ried out with an assessment of the best efficiency, includ-ing inhaled glucocorticosteroid in combination with a long-acting β2-adrenergic agonist (IGCS/LABA) into the treatment regimens in the intensive phase of the course of TB. Duration of the follow-up is 6–9 months with assess-ment of X-ray pattern, bacterial shedding and smear neg-ativity as criteria for curing TB. Results. In patients with TB+COPD, the best effect of minimizing the severity of broncho-obstructive syndrome (reduction of dyspnea ac-cording to mMRC and CAT test) was obtained during ther-apy with a combination drug (long-acting anticholinergic drug and long-acting β2-agonist (LAAC/LABA) with good tolerance. In patients with TB DS+COPD, positive dynam-ics in the reduction of the severity of cough, dyspnea, CAT test was obtained in the ICS group in comparison with patients taking short-acting anticholinergic drugs (SDA). For patients with MDR+TB COPD, ICS/LABA showed the optimal effect on the severity of COPD symptoms. Against the background of taking IGCS/LABA in both groups, there was an increase in the number of patients achiev-ing smear negativity, cessation of bacterial shedding and closure of decay cavities, in comparison with the CAAC group, without any side effects. Conclusion. Adequate correction of broncho-obstructive syndrome in patients with COPD, including the use of bronchodilators (LABA) and anti-inflammatory drugs (IGCS) in the intensive phase of treatment of newly diagnosed pulmonary TB due to the main and additional effects of drugs, can improve the effectiveness of tuberculosis therapy

After 100 Years of BCG Immunization against Tuberculosis, What Is New and Still Outstanding for This Vaccine?

In 2021, most of the world was reasonably still concerned about the COVID-19 pandemic, how cases were up and down in different countries, how the vaccination campaigns were ongoing, and most people were familiar with the speed with which vaccines against SARS-Co-V2 were developed, analyzed, and started to be applied in an attempt to curb the pandemic. Because of this, it may have somehow passed relatively inadvertently for people outside of the field that the vaccine used to control tuberculosis (TB), Mycobacterium bovis Bacille Calmette-Guérin (BCG), was first applied to humans a century ago. Over these years, BCG has been the vaccine applied to most human beings in the world, despite its known lack of efficacy to fully prevent respiratory TB. Several strategies have been employed in the last 20 years to produce a novel vaccine that would replace, or boost, immunity and protection elicited by BCG. In this work, to avoid potential redundancies with recently published reviews, I only aim to present my current thoughts about some of the latest findings and outstanding questions that I consider worth investigating to help develop a replacement or modified BCG in order to successfully fight TB, based on BCG itself.

Management of tuberculous epididymal-orchitis: a literature review

Extrapulmonary tuberculosis can develop in a large number of sites; the 3 common sites are the skeleton, genitourinary tract, and central nervous system. Involvement of these organs due to hematogenous spread of bacilli. Tuberculous (TB) epididymal-orchitis is the most common male genital tuberculosis, followed by prostate tuberculosis and tuberculosis of seminal vesicles. Infections of TB epididymal-orchitis usually start from globus major due to its rich blood supply. Based on clinical findings, tuberculous infection of the epididymal-orchitis is hardly distinguishable from tumor and infarction. In chronic stage, painless or painful swelling is seen. Several laboratory tests such as Urine Acid Fast Bacilli (AFB) Stains, Culture, and Interferon-? release Assay (IGRA) can be performed to diagnose the disease. Radiology and Histopathology findings with fine-needle aspiration cytology (FNAC) also play an important role. Until now, TB epididymo-orchitis has been difficult to diagnose due to non-specific presentation. Therefore, this paper was created to provide an understanding based on current literature studies on the management of TB epididymal orchitis. This paper will discuss the clinical manifestations of tuberculous epididymo-orchitis, methods for diagnosis, and treatment concepts. This paper is also expected to be a guidance for primary healthcare doctors to be aware with the clinical findings of the TB epididymal-orchitis.

Evaluating cognitive outcomes in adult patients with acute encephalitis syndrome: a prospective study from a tertiary care center in Nepal.

Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures. This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up. Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up. We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked.

Maternal-fetal transmission of delta-9-tetrahydrocannabinol (THC) and its metabolites following inhalation and injection exposure during pregnancy in rats.

Cannabis use during pregnancy has increased over the past few decades, with recent data indicating that, in youth and young adults especially, up to 22% of people report using cannabis during pregnancy. Animal models provide the ability to study prenatal cannabis exposure (PCE) with control over timing and dosage; however, these studies utilize both injection and inhalation approaches. While it is known that Δ9-tetrahydrocannabinol (THC; primary psychoactive component of cannabis) can cross the placenta, examination of the transmission and concentration of THC and its metabolites from maternal blood into the placenta and fetal brain remains relatively unknown, and the influence of route of administration has never been examined. Pregnant female rats were exposed to either vaporized THC-dominant cannabis extract for pulmonary consumption or subcutaneous injection of THC repeatedly during the gestational period. Maternal blood, placenta, and fetal brains were collected following the final administration of THC for analysis of THC and its metabolites, as well as endocannabinoid concentrations, through mass spectrometry. Both routes of administration resulted in the transmission of THC and its metabolites in placenta and fetal brain. Repeated exposure to inhaled THC vapor resulted in fetal brain THC concentrations that were about 30% of those seen in maternal blood, whereas repeated injections resulted in roughly equivalent concentrations of THC in maternal blood and fetal brain. Neither inhalation nor injection of THC during pregnancy altered fetal brain endocannabinoid concentrations. Our data provide the first characterization of maternal-fetal transmission of THC and its metabolites following both vaporized delivery and injection routes of administration. These data are important to establish the maternal-fetal transmission in preclinical injection and inhalation models of PCE and may provide insight into predicting fetal exposure in human studies.

Effect of measles prevalence and vaccination coverage on other disease burden: evidence of measles immune amnesia in 46 African countries

ABSTRACT Background Measles is highly infectious that leads to a high disease burden among the vulnerable population, especially in developing countries, despite the availability of highly effective measles vaccine. Immune amnesia, the resetting of the immune systems of infected patients, has been observed in developed countries. This paper is the first to use various African countries to evaluate the extent of immune amnesia. Methods We used two panel datasets from 46 African countries between 1990 and 2018 among children, one is the disease prevalence from Global Burden of Disease, and another is on the measles vaccination coverage from WHO/UNICEF Joint Reporting Form. We used panel regression to estimate the effect of measles prevalence or measles vaccination coverage on other disease prevalence (diarrhea, lower respiratory infection, malaria, meningitis, and tuberculosis). Results We found the strong evidence that the increase in the measles prevalence led to an increase in other disease prevalence and mortality. We also found that the increase in the measles vaccination coverage decreased the prevalence of and the mortality due to other diseases. Discussion and Conclusion Measles vaccination can have a large impact on children’s health because not only does it reduce the prevalence of measles cases and deaths but also could it potentially reduce the prevalence of and deaths due to other diseases.

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

BackgroundAlthough genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka.MethodsData collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6–96).ResultsThere were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26–75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease.ConclusionsThe combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

Intraventricular tuberculosis abscess in an immunocompromised patient: clinical vignette.

Tuberculosis is caused by Mycobacterium tuberculosis. Tuberculosis of the central nervous system is common and manifestations include meningeal and intraparenchymal diseases. However, intraventricular tuberculous abscess is a rare manifestation of intracranial tuberculous infection. We present a case of an immunocompromised female patient with high-grade fever and signs of meningism. The computed tomography and magnetic resonance imaging (MRI) of the brain showed hydrocephalus with rim-enhancing lesion in the right lateral ventricle. The MRI demonstrated a hypointense signal on T1-weighted imaging, hyperintense signal on T2-weighted imaging, and mild restricted diffusion in diffusion-weighted imaging. She underwent emergency external ventricular drainage and frank pus was drained. Diagnosis of tuberculosis was made via polymerase chain reaction analysis and culture. Understanding the intracranial manifestation of neurotuberculosis is imperative to arrive at the diagnosis correctly and ensure prompt treatment.

Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report

BackgroundThe current case report presents acute hemorrhagic necrotizing encephalopathy (AHNE) as an example of a fatal complication, the etiology of which could be coronavirus disease 2019 (COVID-19) with multiple organ damage along with the existing respiratory tuberculosis.Case presentationA male in his 20s had severe symptoms of central nervous system lesion, which developed against the background of COVID-19 and respiratory tuberculosis, for which he was treated in the intensive care unit. Autopsy confirmed that he died from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated AHNE in adults with severe fatal endothelial dysfunction and respiratory tuberculosis. The main morphological signs of brain damage were desquamative endotheliitis, thrombosis, parenchymal hemorrhagic necrosis, encephalitis, severe necrobiotic neuronal damage.ConclusionThe defeat of endothelial cells with the development of generalized endotheliitis in COVID-19, especially in conjunction with comorbid pathology, in particular tuberculosis, can lead to a fatal complication that affects the nervous system—AHNE. Therefore, it is worth paying close attention to the appearance of neurological symptoms in patients with a similar combination of diseases.

A Clinical Case of Extensive Drug Resistant Pulmonary Tuberculosis Using an Endobronchial Valve. Analysis of Errors in the Choice of Chemotherapy Regimen

The article describes a clinical case of a female patient with respiratory tuberculosis exposed to several cases of extensive drug resistance in their family. Tuberculosis progressed in this patient due to the late initiation of adequate treatment. Therefore, the total duration of chemotherapy made 5 years till cure was achieved and an endobronchial valve was used to heal persisting (for 3 years) lung destruction.

ANALYSIS OF THE COURSE OF INFILTRATIVE PULMONARY TUBERCULOSIS IN WOMEN

The article presents a comparative analysis of the course of infiltrative pulmonary tuberculosis in women and men, based on the analysis of the case histories of 58 patients who were in inpatient treatment in the department of respiratory tuberculosis of the Republic Scientific Centre “Phthisiology” in 2018. All patients showed symptoms of intoxication, different intensity. Upon admission, males complainted of weakness in 24% of cases, women - in 21%. It should be noted that sweating occurred in 14% in women and 3% in men, weight loss was observed in 14% of male patients, women lost weight in 7% of cases. When considering the prevalence of the tuberculosis process, it was revealed that the process in most patients was common, since it was localized in 1 segment - 48% in men and 38% in women, in 2 segments - 45% and 52%, respectively. It should also be noted that lesions of an entire lobe of the lung were observed in 5 men and 7 women, however, despite this, it is noted that clinical-radiological improvement occurred in women faster than in men.