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Modi N, Shah I, Shah P, Bhatt C, Jain A. Tuberculosis of head and neck region, our experience at a tertiary care center in Gujarat. Indian J Tuberc 2024; 71:27-29. [PMID: 38296386 DOI: 10.1016/j.ijtb.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/15/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Head and neck lesions of tuberculosis, though not uncommon are often difficult to diagnose and require a unique management protocol. These lesions are often misdiagnosed as bacterial infections, malignancies or other granulomatous diseases. Hence in our study we endeavor to gain a better understanding of the diagnostic and management protocols of tuberculosis in otorhinolaryngology. METHODS We have performed an observational study at our institute, the patient's details were obtained from patient record forms and noted in a standard proforma. Results were calculated as percentage and Chi square analysis was performed. RESULTS We found cervical tuberculous lymphadenitis to be the most common manifestation 76.97%, with a significant association with pulmonary tuberculosis. Neck swelling was the most common presenting complaint, 65.35%. 26-50 years of age was the most commonly involved age group. CONCLUSION FNAC, PCR and histopathology are the modalities for bacteriological diagnosis for tuberculosis of Head and Neck. Anti-tuberculous therapy is uniformly found to be useful in all the patients, with surgical intervention used as and when required.
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Affiliation(s)
- Niral Modi
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Ishita Shah
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India.
| | - Priyanshi Shah
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Chandni Bhatt
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Apoorva Jain
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
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All Signs Point to Cancer: A Case of Cryptic Miliary Tuberculosis in the Setting of Concomitant Cancer. Case Rep Infect Dis 2021; 2021:4623086. [PMID: 34188962 PMCID: PMC8195647 DOI: 10.1155/2021/4623086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Dissemination of tuberculosis (TB) is known as miliary tuberculosis. When miliary tuberculosis lacks classic radiographic and clinical features, it can be labeled cryptic miliary tuberculosis and may mimic metastatic cancer. This unusual presentation of an already atypical form of TB often delays diagnosis. We present a case of a 58-year-old female who presented with presumed metastatic carcinoma, who was ultimately diagnosed with both primary breast cancer and disseminated TB. This case emphasizes the need for a high index of suspicion for miliary tuberculosis in patients with presumed or proven malignancy.
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Xu P, Gao QL, Wang YJ, Guo CF, Tang MX, Liu SH, Deng A, Wang YX, Li YB, Zhang HQ. rs6127698 polymorphism in the MC3R gene and susceptibility to multifocal tuberculosis in southern Chinese Han population. INFECTION GENETICS AND EVOLUTION 2020; 82:104292. [PMID: 32240798 DOI: 10.1016/j.meegid.2020.104292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/15/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the relationship between melanocortin-3 receptor (MC3R) gene polymorphism and tuberculosis (TB) susceptibility in Han population in southern China. METHODS A total of 341 patients with TB (173 with pulmonary TB and 168 with multifocal TB) and 359 healthy controls were enrolled. Genotyping was performed by PCR and DNA sequencing, and detection of protein was performed by western blot. RESULTS The distributions of genotype and allele frequencies of rs6127698 differed significantly between the pulmonary and multifocal TB groups, and between the multifocal TB and control groups. The GG genotype was significantly more common among multifocal TB patients than among pulmonary TB patients (P = .009) and those in the control group (P = .001) under the recessive model. GG+GT genotype was more common in multifocal TB than in pulmonary TB (P < .01) and control group (P < .01) under the dominant model. G allele was more common in multifocal TB than in pulmonary TB (P < .0167) and control group (P < .0167). Patients with multifocal TB had an increased expression of MC3R protein than healthy controls (P < .05). CONCLUSIONS In the southern Chinese Han population, the MC3R rs6127698 polymorphism, which accompanying an increased expression of MC3R protein,was associated with susceptibility to multifocal TB. Presence of the G allele increased the risk of developing multifocal TB.
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Affiliation(s)
- Peng Xu
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Qi-le Gao
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Yun-Jia Wang
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.
| | - Chao-Feng Guo
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Ming-Xing Tang
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Shao-Hua Liu
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Ang Deng
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Yu-Xiang Wang
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Yan-Bing Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Hong-Qi Zhang
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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Diagnostic performance in active TB of QFT-Plus assay and co-expression of CD25/CD134 in response to new antigens of Mycobacterium tuberculosis. Med Microbiol Immunol 2019; 208:171-183. [PMID: 30623240 DOI: 10.1007/s00430-018-00576-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/30/2018] [Indexed: 12/22/2022]
Abstract
The new QuantiFERON-TB Gold Plus employs modified peptides optimized to elicit an IFNγ response from CD8+ cytotoxic T lymphocytes in addition to CD4+ T cells. With a view to improve the difficult identification of TB cases, we assessed the combination of two specific immunological markers comprising IFNγ secretion and T cells co-expression of CD25 and CD134 in response to Mycobacterium tuberculosis-specific antigens. A total of 34 subjects with suspected TB and 10 age-matched HD were prospectively enrolled. Assessing the performance of QFT-Plus in terms of the TB1 and TB2 results, we found that in TB patients, the quantitative IFNγ value in TB2 was similar to that in TB1, and we did not find any differences irrespective of the disease (pulmonary or extra-pulmonary). The flow cytometric CD25/CD134 assay, allowed a more accurate differentiation between M. tuberculosis-infected and uninfected patients, with a better combination of sensitivity and specificity, especially by evaluation of CD4+ T-cell subset. All individuals with negative QFT-Plus results displayed a positive CD25/CD134 response. Overall, a positive correlation was found between T cells co-expressing CD25/CD134 and IFNγ levels in response to both QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes. We demonstrated that both TB1 and TB2 induce a higher expression of CD25+CD134+ markers on CD4+ T cells among infected TB subjects, compared to the lower degree of CD8+ T cells, mainly induced to TB2 stimulation. We suggest that a combined use of classic QFT-Plus and specific CD25/CD134 response may be a useful means in the diagnostic workup for active TB.
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Chamberlin K, Orfanos S, Mukherjee A, Moy E, Koganti M, Khan W. A case of disseminated tuberculosis mimicking metastatic cancer. Respir Med Case Rep 2018; 25:239-241. [PMID: 30302306 PMCID: PMC6174834 DOI: 10.1016/j.rmcr.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disseminated tuberculosis (TB) or miliary TB is defined as lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli, which may then affect virtually any organ system. The multiple organ involvement in disseminated TB can mimic metastatic cancer and can make the diagnosis challenging. False negatives are common therefore repeating microbiologic and histologic samples is essential. CASE REPORT We report the case of a young immunocompetent patient presenting with multiple atypical extra-pulmonary TB involvement. The patient presented with pulmonary, pleural, bilateral testicular and multiple bone involvement including calcanerium abscesses. These lesions were initially described as metastasis by the radiologist. Therefore lymphoma and metastatic testicular cancer as well as TB were high on the differential in this young foreign-born male. Pleural, broncho-alveolar lavage, bone marrow and cerebrospinal fluid acid-fast bacilli smear and microbiologic culture were all negative. However the histologic examination of the trans-bronchial biopsy and pleural biopsy showed necrotizing granuloma and helped to narrow down the diagnosis. The patient improved with RIPE therapy. CONCLUSION This case illustrates the diagnostic difficulty of disseminated TB with atypical organ involvement. Culture is the gold standard for diagnosing TB but is a long process and with 23% of culture negative TB in the United-States, the diagnosis sometimes relies on thoroughly ruling-out differential diagnosis and histologic examination.
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Affiliation(s)
- K. Chamberlin
- Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W, Piscataway Township, NJ 08854, USA
| | - S. Orfanos
- Rutgers Robert Wood Johnson Internal Medicine Department, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901, USA
| | - A. Mukherjee
- Rutgers Robert Wood Johnson Internal Medicine Department, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901, USA
| | - E. Moy
- Penn Medicine-Princeton Medical Center Intensive Care Unit Department, 1 Plainsboro Road, Plainsboro, NJ 08536, USA
| | - M. Koganti
- Penn Medicine-Princeton Medical Center Intensive Care Unit Department, 1 Plainsboro Road, Plainsboro, NJ 08536, USA
| | - W. Khan
- Penn Medicine-Princeton Medical Center Intensive Care Unit Department, 1 Plainsboro Road, Plainsboro, NJ 08536, USA
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Kramer L, Geib V, Evison J, Altpeter E, Basedow J, Brügger J. Tuberculous sacroiliitis with secondary psoas abscess in an older patient: a case report. J Med Case Rep 2018; 12:237. [PMID: 30119703 PMCID: PMC6098574 DOI: 10.1186/s13256-018-1754-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/22/2018] [Indexed: 11/11/2022] Open
Abstract
Background Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25–30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3–5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. Case presentation A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. Conclusions Sacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.
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Affiliation(s)
- Luisa Kramer
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Vanessa Geib
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - John Evison
- Department of Infectious Disease, Lindenhof Hospital, Bremgartenstrasse 117, 3001, Bern, Switzerland
| | - Ekkehardt Altpeter
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003, Bern, Switzerland
| | - Jasmin Basedow
- Department of Radiology, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Jan Brügger
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
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Ji L, Lou YL, Wu ZX, Jiang JQ, Fan XL, Wang LF, Liu XX, Du P, Yan J, Sun AH. Usefulness of interferon-γ release assay for the diagnosis of sputum smear-negative pulmonary and extra-pulmonary TB in Zhejiang Province, China. Infect Dis Poverty 2017; 6:121. [PMID: 28859694 PMCID: PMC5579952 DOI: 10.1186/s40249-017-0331-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 07/04/2017] [Indexed: 01/08/2023] Open
Abstract
Background Quick diagnosis of smear-negative pulmonary tuberculosis (TB) and extra-pulmonary TB are urgently needed in clinical diagnosis. Our research aims to investigate the usefulness of the interferon-γ release assay (IGRA) for the diagnosis of smear-negative pulmonary and extra-pulmonary TB. Methods We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients (including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients), 113 extra-pulmonary TB patients, 81 patients with other pulmonary diseases and 100 healthy controls. Blood samples for the TB-Ab test and the TB-IGRA were collected, processed, and interpreted according to the manufacturer’s protocol. Results The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8% (109 of 120) and 89.6% (241 of 269), respectively. There was no statistically significant difference of its performance between these two sample sets (P > 0.05). The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0% (350 of 389) and 87.6% (99 of 113), respectively, which was not significantly different (P > 0.05). Conclusions In this work, the total detection ratio using TB-IGRA was 89.4%, therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0331-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lei Ji
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Yong-Liang Lou
- School of Laboratory Medical Science and Life Science, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, People's Republic of China
| | - Zhong-Xiu Wu
- Zhejiang Blood Center, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Jin-Qin Jiang
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Xing-Li Fan
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Li-Fang Wang
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Xiao-Xiang Liu
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Peng Du
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Jie Yan
- Division of Basic Medical Microbiology, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Department of Medical Microbiology and Parasitology, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, People's Republic of China.
| | - Ai-Hua Sun
- Department of Basic Medicine, Hangzhou Medical College, Hangzhou, 310053, Zhejiang, People's Republic of China. .,School of Laboratory Medical Science and Life Science, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, People's Republic of China.
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Abstract
Tuberculous lymphadenitis is the most common extrapulmonary manifestation of disseminated tuberculosis (TB). It is considered to be the local manifestation of the systemic disease that has disseminated to local lymph nodes, but a high index of suspicion is needed for the diagnosis, because there are several infectious and noninfectious diseases that can mimic the same clinical picture. In recent years, different diagnostic methods have been introduced, including fine-needle aspiration cytology, which has emerged as a simple outpatient diagnostic procedure that replaced the complete excisional node biopsy, and a number of molecular methods which have greatly improved diagnostic accuracy. This chapter covers the most actual knowledge in terms of epidemiology, clinical manifestations, pathogenesis, and treatment and emphasizes current trends in diagnosis of tuberculous lymphadenitis. TB parotid gland involvement is extremely rare, even in countries in which TB is endemic. Because of the clinical similarity, parotid malignancy and other forms of parotid inflammatory disease always take priority over the rarely encountered TB parotitis when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of TB parotitis when facing a patient with a slowly growing parotid lump. This chapter highlights the most important features of this uncommon disease.
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