Type Of Extrapulmonary Tuberculosis Research Articles

Extra pulmonary tuberculosis in sputum negative cases

In India, Extra Pulmonary Tuberculosis ( EPTB) forms 10 to 15 percent of all types of TB . Diagnosis is based on one culture-positive specimen from the extrapulmonary site or histological evidence or strong clinical evidence consistent with active EPTB disease. The infection may be far advanced before any observable symptom occurs. Thus up to the present time EPTB continuous to present as a clinical problem. To study epidemiological aspects of EPTB and its frequency and various presentations among the suspected sputum negative cases attending MNR Medical College & Hospital, Sangareddy (AP). A total of 515 sputum negative clinically suspected EPTB Patients attending chest & TB dept for a period of 2 years were included in the study. Out of which 82 EPTB cases were confirmed by using site specific diagnostic criteria’s. Out of 515 sputum negative AFB cases suspected samples processed, 82 (15.91%) cases were positive for different types of EPTB. In age groups, the highest number 28% of cases were among young age group (15- 24), whereas the lowest number 7.3% of EPTB cases was among age group (45-550) and female predominance of 53.66%. Out of 82 cases of EPTB the most common type was TB Lymphadenitis 39 (47.56%) followed by Bone and joint TB 14 (17.07%),TB Pleural effusion 11 (13.41%), Abdominal TB 10 (12.04%), Genital TB (4.87%), TB Meningitis 3 (03.6%) and Cutaneous TB 1 (01.22%) In these 2 cases of TB Lymphadenitis was HIV positive. The importance of Extra-pulmonary Tuberculosis (EPTB) among all forms of Tuberculosis has not yet been ascertained in developing countries due to difficulty in diagnosis and lack of culture facilities.

The burden and treatment outcomes of extra-pulmonary tuberculosis in Bhutan.

All tuberculosis (TB) registration sites in Bhutan. Cross-sectional study involving a retrospective review of TB registers and TB treatment cards. To determine: 1) the number and proportion of all TB cases registered as extra-pulmonary TB (EPTB) from 2001 to 2010, 2) the age and sex of the patients and the categories and types of EPTB registered in 2010, and 3) their treatment outcomes. The proportion of all TB cases registered as EPTB over a period of 10 years varied from 30% to 40%. In 2010, 505 patients were registered with EPTB, of whom 50% were male, 21% were children, and 96% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 67%, followed by abdominal TB and spinal/bone/kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB. Bhutan has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Further work is needed to better understand how EPTB is diagnosed throughout the country.

Is diagnostic protocol a cause of overestimation of extra-pulmonary tuberculosis in Himachal Pradesh? A report from a high-prevalence tuberculosis unit

Aims and Objectives: To study the diagnostic practices for diagnosis of extra-pulmonary tuberculosis (EPTB) in a high-prevalence tuberculosis unit (TU). Material and Methods: It was a cross-sectional study using a pre-designed and pre-tested structured questionnaire. The information was collected from new EPTB cases registered in Rampur TU between 1 July 2007 and 31 March 2008. Diagnostic practices of the medical practitioners for establishing the diagnosis of different types of EPTB were studied. Results: For the diagnosis of pleural TB the main tools used were X-ray chest (37 cases; 100.0%) and aspiration of pleural fluid (pleural tap) for color of pleural fluid (35 cases; 94.6%). For establishing the diagnosis of lymph node TB, eight (66.6%) cases were subjected to fine needle aspiration cytology (FNAC) examination of involved lymph nodes. Excision biopsy of lymph nodes was undertaken in the remaining four (33.3%) cases. The diagnosis of abdominal TB was primarily established on the basis of X-ray (six cases; 85.7%) and ultrasonography (USG) of abdomen for the presence of ascites in five (71.4%) cases. The patients of tubercular meningitis were diagnosed predominantly on clinical grounds whereas in bone and genitourinary TB, all appropriate investigations were performed for confirmation of EPTB of these organs. Conclusions: Except for lymph node TB and the patients in whom the diagnosis had been established in tertiary care institutions of the state, patients were being diagnosed on clinical grounds.

Foot ulcer caused by multidrug-resistant Mycobacterium tuberculosis in a diabetic patient

Osteoarticular tuberculosis is the fourth leading type of extrapulmonary tuberculosis. The disease has a progressive course and the diagnosis is often made in the later stages of bone destruction. We describe a case of a foot ulcer caused by drug-resistant Mycobacterium tuberculosis in a patient with known diabetes where the diagnosis was not suspected initially. Although tuberculous foot ulcers are rare, they should be included in the differential diagnosis of unknown foot ulcers. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

BackgroundThe HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians.MethodsThe case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed.ResultsA total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding.ConclusionsThe moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB.

ENFERMEDAD DE POTT: A PROPÓSITO DE UN CASO

One-third of the world population is infected by Tuberculosis. Approximately, eight to ten million cases are reported each year, and three million dies annually for this cause. This disease most of the time affects the lungs, but in 33% affects others organs. Vertebral tuberculosis occurs in less than 1% of the patients. This type of extrapulmonary tuberculosis is most frequent in children than adults. Bone pain, functional limitation, and muscular contracture are the more common clinical findings. In advanced stages of the disease, patients present kyphosys and neurological alterations. We present a 41 years old female patient with two years of lumbar pain. Image studies (CT scan, MRI) revealed fracture of L3 and posterior displacement of L2 with a collection around the fracture. Microbiologic isolation informed the presence of Acid Alcohol Resistant Bacillus Mycobacterium tuberculosis. Medical and surgical treatments were indicated with an adequate clinical

Extrapulmonary Tuberculosis by Nationality, the Netherlands, 1993–2001

This study describes the epidemiology of extrapulmonary tuberculosis (TB) in the Netherlands from 1993 through 2001. We assessed whether the increasing numbers of inhabitants with a non-Western ethnic background had an effect on the number of extrapulmonary patients. We used data from the Netherlands Tuberculosis Register and included all cases of TB diagnosed in the Netherlands between January 1, 1993, and December 31, 2001. Information on age, sex, nationality, year of diagnosis, culture result, anatomic location of the site of disease, and HIV status was retrieved from the register. Of 13,258 patients with TB, 8216 (62%) had pulmonary TB, and 5042 (38%) had extrapulmonary TB. Non-Dutch nationals were more likely to have most types of extrapulmonary TB. The growth of the number of inhabitants with a non-Western ethnic background in the Netherlands explains the proportional growth of extrapulmonary TB. Physicians need to be aware of the changing clinical picture of TB.

The diagnosis of extrapulmonary tuberculosis in Malawi.

There is little information on a country-wide basis in sub-Saharan Africa about how the diagnosis of extra-pulmonary tuberculosis (EPTB) is made. A country-wide cross-sectional study was carried out in 40 non-private hospitals in Malawi which register and treat (TB) patients in order to assess diagnostic practices in adults registered with EPTB. All patients aged 15 years and above in hospital on treatment for EPTB were reviewed usingTB registers, case note files and clinical assessment. There were 244 patients, 132 men and 112 women whose mean age was 36 years. In 138 (57%) patients, all appropriate procedures and investigations, commensurate with hospital resources, had been carried out. Of 171 EPTB patients with cough for 3 weeks or longer, 138 (81%) submitted sputum specimens for smear microscopy of acid-fast bacilli (AFB). A confirmed diagnosis ofTB was made in 15 (6%) patients based on finding AFB or caseating granulomas in specimens. In 157 (64%) patients, the diagnosis of EPTB was considered to be correct. In 46 (19%) patients the diagnosis was considered to be TB, although different from the type of EPTB with which the patient was registered. In 39 (16%) patients an alternative non-TB diagnosis was made and in two (1%) patients it was not possible to make a decision. Diagnostic practices need to be improved, and ways of doing this are discussed.

The current status and problems of the intestinal tuberculosis through a review of the Annual of the Pathological Autopsy Cases in Japan

From 1997 to 1999 the incidence rate of tuberculosis increased and extrapulmonary tuberculosis has also increased during the same period. Among various types of extrapulmonary tuberculosis, intestinal tuberculosis is one of the diseases difficult to diagnose. Recently doctors could not make appropriate diagnosis of intestinal tuberculosis because they did not pay much attention to tuberculosis. With a background described above, we reviewed the Annual of the Pathological Autopsy Cases in Japan in previous five years 1994-1998, in order to investigate a current status of intestinal tuberculosis. Out of 140,358 autopsied cases, the number of cases with active and old tuberculosis was 5,103 (3.6%), in which the intestinal tuberculosis was accompanied in 80 (0.057%). The 80 cases were consisting of 45 males and 35 females and their mean age was 72.7 years old ranging from 28 to 96. Of the 80 intestinal tuberculosis cases, 71 were seen in pulmonary tuberculosis cases and six cases were considered to be intestinal tuberculosis alone. In terms of the location of intestinal tuberculosis the most commonly affected site was ileocecum which occupied 72.7% of all intestinal tuberculosis. Among the 80 cases, 14 cases were complicated with malignant tumor and only 30 cases (37.5%) were diagnosed clinically as intestinal tuberculosis before their death. Clinical diagnosis of other cases were ileus, simple constipation, severe diarrhea, malignant tumor or its tumor. The delay in diagnosing intestinal tuberculosis may result in fatal outcome in the aged persons, so that in general practice much attention should be paid not only to pulmonary but also extrapulmonary tuberculosis including intestinal tuberculosis.

The scourge of HIV-related tuberculosis: a cohort study in a district general hospital in Malawi.

Malawi is similar to a number of other African countries in having an escalating, HIV-related, tuberculosis (TB) epidemic. A prospective study was carried out to determine the pattern of disease and HIV serostatus in unselected, adult, TB patients consecutively admitted to a large, district general hospital in Zomba (in the Southern region of Malawi). Clinical details were obtained, from the district TB register, for the 714, adult TB patients, aged > or = 15 years, who were registered with the district TB officer between 1 July and 31 December in 1995. Patients were counselled, and offered HIV testing using an ELISA and particle agglutination test. Concordant HIV-test results were available for 686 (96%) of the subjects: 547 (80%) of these were HIV-seropositive and 139 seronegative. The HIV-positive patients were significantly younger than the HIV-negative patients and significantly more HIV-positive patients were males (P < 0.05 for each). The proportions of HIV-positive subjects who were new patients, had been previously treated for TB, had pulmonary TB (PTB), had smear-positive PTB or had different types of extrapulmonary TB were similar to those of the HIV-negative. A high percentage of an unselected cohort of adult TB patients admitted to a district, general hospital in Malawi, particularly of the younger age groups was therefore HIV-positive. The pattern of disease was uninfluenced by the HIV serostatus. The large number of cases registered emphasises the severity of the current epidemic of TB in Malawi and its impact upon young adults.