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Torres T, Chiricozzi A, Puig L, Lé AM, Marzano AV, Dapavo P, Dauden E, Carrascosa JM, Lazaridou E, Duarte G, Carvalho AVE, Romiti R, Rompoti N, Teixeira L, Abreu M, Ippoliti E, Maronese CA, Llamas-Velasco M, Vilarrasa E, Del Alcázar E, Daponte AI, Papoutsaki M, Carugno A, Bellinato F, Gisondi P. Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study. Am J Clin Dermatol 2024; 25:333-342. [PMID: 38265746 PMCID: PMC10867072 DOI: 10.1007/s40257-024-00845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Tuberculosis has a major global impact. Immunocompetent hosts usually control this disease, resulting in an asymptomatic latent tuberculosis infection (LTBI). Because TNF inhibitors increase the risk of tuberculosis reactivation, current guidelines recommend tuberculosis screening before starting any biologic drug, and chemoprophylaxis if LTBI is diagnosed. Available evidence from clinical trials and real-world studies suggests that IL-17 and IL-23 inhibitors do not increase the risk of tuberculosis reactivation. OBJECTIVE To evaluate psoriasis patients with treated or untreated newly diagnosed LTBI who received IL-17 and IL-23 inhibitors and the tolerability/safety of tuberculosis chemoprophylaxis. METHODS This is a retrospective, observational, multinational study from a series of 14 dermatology centres based in Portugal, Spain, Italy, Greece and Brazil, which included adult patients with moderate-to-severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors between January 2015 and March 2022. LTBI was diagnosed in the case of tuberculin skin test and/or interferon gamma release assay positivity, according to local guideline, prior to initiating IL-23 or IL-17 inhibitor. Patients with prior diagnosis of LTBI (treated or untreated) or treated active infection were excluded. RESULTS A total of 405 patients were included; complete/incomplete/no chemoprophylaxis was administered in 62.2, 10.1 and 27.7% of patients, respectively. The main reason for not receiving or interrupting chemoprophylaxis was perceived heightened risk of liver toxicity and hepatotoxicity, respectively. The mean duration of biological treatment was 32.87 ± 20.95 months, and only one case of active tuberculosis infection (ATBI) was observed, after 14 months of treatment with ixekizumab. The proportion of ATBI associated with ixekizumab was 1.64% [95% confidence interval (CI): 0-5.43%] and 0% for all other agents and 0.46% (95% CI 0-1.06%) and 0% for IL-17 and IL-23 inhibitors, respectively (not statistically significant). CONCLUSIONS The risk of tuberculosis reactivation in patients with psoriasis and LTBI does not seem to increase with IL-17 or IL-23 inhibitors. IL-17 or IL-23 inhibitors should be preferred over TNF antagonists when concerns regarding tuberculosis reactivation exists. In patients with LTBI considered at high risk for developing complications related to chemoprophylaxis, this preventive strategy may be waived before initiating treatment with IL-17 inhibitors and especially IL-23 inhibitors.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal.
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Maria Lé
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Jόse-Manuel Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Gleison Duarte
- Instituto Bahiano de Imunoterapias-IBIS, Salvador, Brazil
| | - André V E Carvalho
- Ambulatório de psoríase, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Ricardo Romiti
- Faculty of Medicine, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Natalia Rompoti
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Laetitia Teixeira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Abreu
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Elena Ippoliti
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Del Alcázar
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Marina Papoutsaki
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
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Simpson G, Philip M, Vogel JP, Scoullar MJL, Graham SM, Wilson AN. The clinical presentation and detection of tuberculosis during pregnancy and in the postpartum period in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002222. [PMID: 37611006 PMCID: PMC10446195 DOI: 10.1371/journal.pgph.0002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/25/2023]
Abstract
For women infected with Mycobacterium tuberculosis, pregnancy is associated with an increased risk of developing or worsening TB disease. TB in pregnancy increases the risk of adverse maternal and neonatal outcomes, however the detection of TB in pregnancy is challenging. We aimed to identify and summarise the findings of studies regarding the clinical presentation and diagnosis of TB during pregnancy and the postpartum period (within 6 months of birth) in low-and middle-income countries (LMICs). A systematic review was conducted searching Ovid MEDLINE, Embase, CINAHL and Global Index Medicus databases. We included any primary research study of women diagnosed with TB during pregnancy or the postpartum period in LMICs that described the clinical presentation or method of diagnosis. Meta-analysis was used to determine pooled prevalence of TB clinical features and health outcomes, as well as detection method yield. Eighty-seven studies of 2,965 women from 27 countries were included. 70.4% of women were from South Africa or India and 44.7% were known to be HIV positive. For 1,833 women where TB type was reported, pulmonary TB was most common (79.6%). Most studies did not report the prevalence of presenting clinical features. Where reported, the most common were sputum production (73%) and cough (68%). Having a recent TB contact was found in 45% of women. Only six studies screened for TB using diagnostic testing for asymptomatic antenatal women and included mainly HIV-positive women ‒ 58% of women with bacteriologically confirmed TB did not report symptoms and only two were in HIV-negative women. Chest X-ray had the highest screening yield; 60% abnormal results of 3036 women tested. Screening pregnant women for TB-related symptoms and risk factors is important but detection yields are limited. Chest radiography and bacteriological detection methods can improve this, but procedures for optimal utilisation remain uncertain in this at-risk population. Trial registration: Prospero registration number: CRD42020202493.
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Affiliation(s)
- Grace Simpson
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Moira Philip
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Joshua P. Vogel
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Michelle J. L. Scoullar
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Stephen M. Graham
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- Centre for International Health, University of Melbourne Department of Paediatrics, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
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Abdominopelvic Mass Revealing Tuberculosis in a Young Woman. Case Rep Surg 2021; 2021:7257533. [PMID: 34306792 PMCID: PMC8266439 DOI: 10.1155/2021/7257533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/19/2021] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and remains a health problem, especially in developing countries. Abdominal location represents 5 to 10% of all locations. The clinical symptoms are not very specific, and the discovery of an abdominal mass in a context of deterioration of general state may wrongly lead to the diagnosis of a tumor. Radiological explorations remain sensitive in the detection of abdominal masses but they cannot prejudge their etiology. Surgical exploration is sometimes the only recourse either for diagnostic purposes or complications, and the diagnosis can only be confirmed by bacteriological and histological examinations of the surgical specimen. We report the case of abdominopelvic mass and lymph nodes revealing tuberculosis.
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Razafindrazoto CI, Randriamifidy NH, Rakotomalala JA, Ralaizanaka BM, Rakotomaharo M, Hasina Laingonirina DH, Maherison S, Rasolonjatovo AS, Rakotozafindrabe ALR, Rabenjanahary TH, Razafimahefa SH, Ramanampamonjy RM. Inappropriate prescription of corticosteroid therapy during inflammatory ileo-colitis revealing disseminated tuberculosis with digestive involvement: Two case reports. Clin Case Rep 2021; 9:e04215. [PMID: 34136233 PMCID: PMC8190683 DOI: 10.1002/ccr3.4215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
It is essential to differentiate intestinal tuberculosis from Crohn's disease because of the therapeutic implications of Crohn's disease, which can exacerbate the symptoms of tuberculosis.
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Affiliation(s)
- Chantelli Iamblaudiot Razafindrazoto
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | | | | | - Behoavy Mahafaly Ralaizanaka
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
- Department of Hepato‐GastroenterologyUniversity Hospital AndrainjatoFianarantsoaMadagascar
| | - Mialitiana Rakotomaharo
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Domoina Harivonjy Hasina Laingonirina
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Sonny Maherison
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Anjaramalala Sitraka Rasolonjatovo
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Andry Lalaina Rinà Rakotozafindrabe
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Tovo Harimanana Rabenjanahary
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
| | - Soloniaina Hélio Razafimahefa
- Department of Hepato‐GastroenterologyUniversity Hospital AndrainjatoFianarantsoaMadagascar
- Faculty of MedicineUniversity of FianarantsoaFianarantsoaMadagascar
| | - Rado Manitrala Ramanampamonjy
- Department of GastroenterologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
- Faculty of MedicineUniversity of AntananarivoAntananarivoMadagascar
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Ranaivomanana P, Raberahona M, Rabarioelina S, Borella Y, Machado A, Randria MJDD, Rakotoarivelo RA, Rasolofo V, Rakotosamimanana N. Cytokine Biomarkers Associated with Human Extra-Pulmonary Tuberculosis Clinical Strains and Symptoms. Front Microbiol 2018. [PMID: 29515555 PMCID: PMC5826350 DOI: 10.3389/fmicb.2018.00275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The primary site of infection for Mycobacterium tuberculosis (Mtb) is the alveolar macrophages. However, Mtb can disseminate into other organs and causes extrapulmonary tuberculosis (EPTB). The diagnosis of EPTB is challenging due to relatively inaccessible infectious sites that may be paucibacillary and with clinical symptoms varying by site that are similar to those seen in other diseases. Hence, we sought to identify the expression patterns of a variety of cytokines that may be specific to EPTB from in vitro infections and in the plasma of TB patients. Methods: To define those cytokine secretions associated with EPTB, human THP-1 derived macrophages were first infected with Mtb clinical isolates from pulmonary and EPTB. Infected macrophages supernatants were harvested at different time points and cytokines known to play key roles in TB immune responses including TNF-α, IL-6, IL-10, IFN-γ, and VEGF-A were measured by ELISA. Those cytokines that were in vitro associated to EPTB were also measured in the plasma from patients with PTB, EPTB, non-EPTB-confirmed-like symptoms and healthy controls. Results: While all of the studied cytokine secretions varied after in vitro infection, higher levels of TNF-α and VEGF secretions were observed in vitro in the infected macrophages respectively in the PTB and EPTB infecting clinical isolates. Similar trends were observed from the plasma of patients where patients with PTB showed significantly higher level of TNF-α compared to EPTB and healthy control groups. The patients with EPTB showed higher plasma level of VEGF compared to those patients with the non-EPTB (p < 0.01) and to healthy controls group (p < 0.0001). Using Receiver Operating Curves (ROC), we showed that TNF-α and VEGF concentrations could distinguish EPTB from non-confirmed EPTB with high sensitivity and specificity. Conclusion: Pulmonary and extrapulmonary Mtb clinical isolates showed different cytokine induction pattern in human macrophages that is also found in the plasma level of the EPTB patients. Further investigations are needed to define cytokine secretions that can lead to the definition of bio-signatures to differentiate EPTB from other pathologies with confusing symptoms that hampered the diagnosis of TB.
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Affiliation(s)
- Paulo Ranaivomanana
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar
| | - Sedera Rabarioelina
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ysé Borella
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alice Machado
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mamy J De Dieu Randria
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar
| | - Rivo A Rakotoarivelo
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar.,Faculté de Médecine, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Voahangy Rasolofo
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Abstract
Tuberculosis (TC) is very common and significant cause of morbidity and mortality worldwide. Isolated cystic duct lymph node TC cases without involvement of gallbladder are exceedingly rare. It is difficult to diagnose preoperatively because of lack of characteristic signs and symptoms of TC. We report a man aged 45 years who presented with right upper abdominal pain since 1week. It was associated with nausea and postprandial fullness. There was no evidence of jaundice and lymphadenopathy. Abdominal examination showed moderate right upper quadrant tenderness with positive Murphy's sign and splenomegaly but no signs of peritonism. Abdomen ultrasound revealed sludge in gallbladder, dilated pancreatic duct, coarse exotexture of liver, splenomegaly and no lymphadenopathy. He underwent laparoscopic cholecystectomy; histological report showed chronic caseating granulomatous lymphadenitis with Langhans type of giant cells in lymph node near cystic duct with chronic cholecystitis of gallbladder. Standard antituberculosis therapy was given for 12 months.
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Affiliation(s)
- Aamir Ghazanfar
- Department of General Surgery, KRL Hospital, Islamabad, Pakistan
| | - Afifa Asghar
- Department of General Surgery, KRL Hospital, Islamabad, Pakistan
| | | | - Iram Hassan
- Department of General Surgery, KRL Hospital, Islamabad, Pakistan
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Khanna SR, Kralovic SM, Prakash R. Tuberculous Meningitis in an Immunocompetent Host: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:977-981. [PMID: 28008165 PMCID: PMC5214229 DOI: 10.12659/ajcr.900762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 57 Final Diagnosis: Tuberculous meningitis Symptoms: Altered mental state • headache Medication: — Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases
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Affiliation(s)
- Suchin R Khanna
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Stephen M Kralovic
- Department of Infectious Diseases, University of Cincinnati Medical Center, Medical Epidemiologist, National Infectious Diseases Program, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Rajan Prakash
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Pollett S, Banner P, O’Sullivan MVN, Ralph AP. Epidemiology, Diagnosis and Management of Extra-Pulmonary Tuberculosis in a Low-Prevalence Country: A Four Year Retrospective Study in an Australian Tertiary Infectious Diseases Unit. PLoS One 2016; 11:e0149372. [PMID: 26963244 PMCID: PMC4786131 DOI: 10.1371/journal.pone.0149372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Extra-pulmonary tuberculosis (EPTB) is relatively neglected and increasing in incidence, in comparison to pulmonary tuberculosis (PTB) in low-burden settings. It poses particular diagnostic and management challenges. We aimed to determine the characteristics of EPTB in Western Sydney, Australia, and to conduct a quality assurance investigation of adherence to guidelines among Infectious Diseases (ID) practitioners managing EPTB cases. METHODS All adult EPTB cases managed by a large ID service during 01/01/2008-31/12/2011 were eligible for inclusion in the retrospective review. Data were extracted from patient medical records on demographic, diagnostic, clinical and management details, and on clinician adherence to local and international TB guidelines. RESULTS 129 cases managed by the ID service were identified, with files available for 117. 98 cases were managed by the Respiratory service and were excluded. 98.2%(112/114) had been born in a country other than Australia. HIV status was tested or previously known in 97 people, and positive in 4 (4%). Microbiological confirmation was obtained in 68/117 (58.1%), an additional 24 had histopathological findings considered confirmatory (92/117, 78.6%), with the remainder diagnosed on clinical and/or radiological grounds. Median time to diagnosis post-migration from a high TB-burden country was 5 years (range 0-41). 95 cases were successfully treated, 11 cases defaulted, refused therapy or transferred, 2 cases relapsed and outcomes unknown or pending in 9 cases. No deaths occurred in the sample analysed. Clinician adherence to guidelines was high, but with scope for improvement in offering testing for co-infections, performing eye checks, monitoring blood glucose in patients receiving adjunctive corticosteroids, and considering drug interactions. CONCLUSIONS Despite excellent TB outcomes in this setting, the low proportion of cases with susceptibility data is worrying in this era of increasing drug resistance, and illustrates the diagnostic difficulties faced even in a well-resourced setting. Vigilance for EPTB needs to remain high in those moving from high prevalence countries to Australia, even decades after immigration.
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Affiliation(s)
- Simon Pollett
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | | | - Matthew V. N. O’Sullivan
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Westmead, Sydney, NSW, Australia
| | - Anna P. Ralph
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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9
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Tuberculose intestinale ou maladie de Crohn : un défi diagnostique. Arch Pediatr 2014; 21:1123-6. [DOI: 10.1016/j.arcped.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/15/2014] [Accepted: 07/21/2014] [Indexed: 01/15/2023]
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10
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Head and neck tuberculosis in KwaZulu-Natal, South Africa. The Journal of Laryngology & Otology 2014; 128:86-90. [PMID: 24423085 DOI: 10.1017/s0022215113003435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the clinical features of head and neck tuberculosis in KwaZulu-Natal, South Africa. STUDY DESIGN Retrospective, observational study. METHOD The study included 358 patients who received a histopathologically and/or microbiologically confirmed diagnosis of tuberculosis in the head and neck region between 1 January 2007 and 31 December 2011. RESULTS A total of 358 new cases of head and neck tuberculosis were identified during the study period, involving 196 males (54.7 per cent) and 162 females (45.3 per cent). These patients had a median age of 31 years (range, 3 months to 83 years). Testing for human immunodeficiency virus was positive in 233 (65.1 per cent) and negative in 125 (34.9 per cent). Right-sided cervical lymphadenitis was the commonest form of presentation of head and neck tuberculosis. CONCLUSION In this study, right-sided cervical lymphadenopathy was the commonest presentation of head and neck tuberculosis in both human immunodeficiency virus infected and non-infected individuals. Head and neck tuberculosis should not be excluded solely based on a normal chest X-ray, nor on the absence of constitutional symptoms.
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Sevgi DY, Derin O, Alpay AS, Gündüz A, Konuklar AS, Bayraktar B, Bulut E, Uzun N, Sonmez E. Extrapulmonary tuberculosis: 7 year-experience of a tertiary center in Istanbul. Eur J Intern Med 2013; 24:864-7. [PMID: 24028930 DOI: 10.1016/j.ejim.2013.08.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 06/11/2013] [Accepted: 08/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. MATERIAL AND METHODS In this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. RESULTS The most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40 years old (p<0.01), having miliary TB (p<0.05) and high CRP levels (p<0.05) were found to be associated with mortality. CONCLUSIONS EPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevalence of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older ages.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cohort Studies
- Female
- Humans
- Male
- Middle Aged
- Peritonitis, Tuberculous/epidemiology
- Peritonitis, Tuberculous/mortality
- Peritonitis, Tuberculous/pathology
- Prevalence
- Retrospective Studies
- Tertiary Care Centers
- Tuberculosis/epidemiology
- Tuberculosis/mortality
- Tuberculosis/pathology
- Tuberculosis, Cutaneous/epidemiology
- Tuberculosis, Cutaneous/mortality
- Tuberculosis, Cutaneous/pathology
- Tuberculosis, Gastrointestinal/epidemiology
- Tuberculosis, Gastrointestinal/mortality
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Lymph Node/epidemiology
- Tuberculosis, Lymph Node/mortality
- Tuberculosis, Lymph Node/pathology
- Tuberculosis, Meningeal/epidemiology
- Tuberculosis, Meningeal/mortality
- Tuberculosis, Meningeal/pathology
- Tuberculosis, Miliary/epidemiology
- Tuberculosis, Miliary/mortality
- Tuberculosis, Miliary/pathology
- Tuberculosis, Osteoarticular/epidemiology
- Tuberculosis, Osteoarticular/mortality
- Tuberculosis, Osteoarticular/pathology
- Turkey/epidemiology
- Young Adult
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Affiliation(s)
- Dılek Yıldız Sevgi
- Department of Infectious Diseases and Clinical Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
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12
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Chandrasekhar YBVK, Rajesh A, Purohit AK, Rani YJ. Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report. J Neurosci Rural Pract 2013; 4:122-8. [PMID: 23914083 PMCID: PMC3724285 DOI: 10.4103/0976-3147.112733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: There exists a lot of ambiguity in the preoperative diagnosis of the various vertebral lesions. Mostly in these patients tuberculosis of spine (TB) is suspected due to endemicity of the disease in the Indian subcontinent. However, no definite guidelines are available to diagnose tuberculous (TB) vertebral lesions in the current literature. Study Design: This prospective study was conducted in the Department of Neurosurgery, Nizam's Institute of Medical Sciences, from August 2009 to March 2012. Aim of the Study: To formulate non invasive methods to diagnose tuberculous vertebral lesions confidently so that the dependency on histopathologic diagnosis can be reduced. Material and Methods: Spinal MRI images of 45 patients suspected of having tuberculosis aetiology were included in the study prospectively. Results: A total of 64 patients were analysed and 19 patients were excluded due to lack of regular follow up or histological proof. The patients were divided into two groups; those with TB of the spine and those with some other condition affecting the spine (non TB spine) based on the final diagnosis. Of the 45 patients males were 30 (66.6%) and females were 15 (33.3%). There was no significant difference in the mean age of presentation. For TB patients this was 41 ± 15.56 years and in Non TB was 43 ± 18.27 years. All patients presented with backache in either group. There was epiphyseal involvement (100%), disc height reduction (71.42%) and pedicle destruction (42.82%) in plain X-rays in the TB group. Lumbar spine was the most common affected region in our study (26.31% in non TB and 34.6% in TB group of patients). Significant P value and the Odds Ratio was found for T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement, anterior subligamentous extension, paraspinal extension and no spinous process involvement (eight parameters). The eight parameters were tested among both the groups and it was noted that scores ≥ 6 favored a tuberculous pathology whereas ≤4 were suggestive of non tuberculous etiology. Conclusions: The eight point MRI criteria of the vertebral lesions are likely to enhance the diagnostic ability of tuberculous and non tuberculous pathologies thereby reducing the dependency on histopathologic diagnosis or invasive method for early initiation of therapy.
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Naing C, Mak JW, Maung M, Wong SF, Kassim AIBM. Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis. Lung 2012. [PMID: 23180033 DOI: 10.1007/s00408-012-9440-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Extrapulmonary tuberculosis has been an AIDS-defining condition. Individual studies that highlight the association between HIV and extrapulmonary TB are available. Our objectives were to synthesis evidence on the association between extrapulmonary tuberculosis and HIV and to explore the effective preventive measures of these two diseases. METHODS This is a meta-analysis of observational studies reporting effect estimates on how HIV is associated with extrapulmonary tuberculosis. We searched for the eligible studies in the electronic databases using search terms related to HIV and extrapulmonary tuberculosis. Where possible, we estimated the summary odds ratios using random effects meta-analysis. We stratified analysis by the type of study design. We assessed heterogeneity of effect estimates within each group of studies was assessed using I (2) test. RESULTS Nineteen studies (7 case control studies and 12 cohort studies) were identified for the present study. The pooled analysis shows a significant association between HIV and extrapulmonary tuberculosis (summary odds ratio: 1.3; 95 % confidence interval (CI) 1.05-1.6; I (2): 0 %). In a subgroup analysis with two studies, a significant association was found between CD4+ count less than 100 and the incidence of extrapulmonary tuberculosis (summary OR: 1.31; 95 % CI 1.02-1.68; I (2): 0 %). CONCLUSIONS Findings show evidence on the association between extrapulmonary tuberculosis and HIV, based on case control studies. Further studies to understand the mechanisms of interaction of the two pathogens are recommended.
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Affiliation(s)
- Cho Naing
- School of Postgraduate Studies and Research, International Medical University (IMU), 57000, Kuala Lumpur, Malaysia.
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14
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Mrówka-Kata K, Namysłowski G, Czecior E, Sowa P, Iwańska J. An updated view on tuberculous lymphadenitis in the context of HIV epidemic as well as multidrug and extensively drug-resistant tuberculosis. Otolaryngol Pol 2012; 66:176-80. [DOI: 10.1016/s0030-6657(12)70765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/27/2011] [Indexed: 10/28/2022]
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15
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Ersoy Y, Yetkin F, Bayraktar MR, Ersoy Y, Yologlu S. A new diagnostic scoring for discrimination of tuberculous and bacterial meningitis on the basis of clinical and laboratory findings. Med Princ Pract 2012; 21:259-63. [PMID: 22133866 DOI: 10.1159/000333808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop a new diagnostic index (DI) on the basis of clinical and laboratory findings including serum C-reactive protein (CRP) for tuberculous meningitis (TM) and bacterial meningitis (BM). SUBJECTS AND METHODS During a 7-year period, 96 adult patients with meningitis (30 with TM and 66 with BM) were studied retrospectively. Multivariate logistic regression analysis was performed to investigate the diagnostic value of clinical and laboratory parameters as independent predictors on discrimination of tuberculous from BM patients. RESULTS Six features predictive for diagnosis including age, CSF leukocyte count, PML dominance, length of illness, serum CRP level and blood WBC count were used. The DI model developed from these features had very high sensitivity and specificity rates of 100.0 and 95.4%, respectively. The sensitivity and specificity rates were 97.4 and 100%, respectively, in microbiologically proven cases. CONCLUSION Our results suggested that this new DI which consists of simple clinical and laboratory parameters had the power to discriminate adult patients with documented tuberculous and BM (excluding Brucella meningitis). It should, however, be tested in prospective studies.
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Affiliation(s)
- Yasemin Ersoy
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey.
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16
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Sbrana E, Grise J, Stout C, Aronson J. Co-morbidities associated with tuberculosis in an autopsy case series. Tuberculosis (Edinb) 2011; 91 Suppl 1:S38-42. [DOI: 10.1016/j.tube.2011.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Gunal S, Yang Z, Agarwal M, Koroglu M, Arıcı ZK, Durmaz R. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007. BMC Public Health 2011; 11:154. [PMID: 21385458 PMCID: PMC3060117 DOI: 10.1186/1471-2458-11-154] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 03/08/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Extrapulmonary tuberculosis (EPTB) has an increasing rate in Turkey. The reason remains largely unknown. A better understanding of the demographic and microbial characteristics of EPTB in the Turkish population would extend the knowledgebase of EPTB and allow us to develop better strategies to control tuberculosis (TB). METHODS We retrospectively evaluated clinical and laboratory data of 397 bacteriologically-confirmed TB cases diagnosed during an eight year-period using by chi-square analysis and multivariate logistic regression model. RESULTS Of the 397 study patients, 103 (25.9%) had EPTB and 294 (74.1%) had pulmonary tuberculosis (PTB). The most commonly seen two types of EPTB were genitourinary TB (27.2%) and meningeal TB (19.4%). TB in bone/joints, pleural cavity, lymph nodes, skin, and peritoneal cavity occurred at a frequency ranging from 9.7% to 10.7%. The age distribution was significantly different (P<0.01) between PTB and EPTB, with patients older than 45 years tending to have an increased risk of EPTB. Furthermore, the distribution of different types of EPTB differed significantly among age groups (P=0.03). Meningeal and bone and/or joint TB were more commonly observed among the male patients, while lymphatic, genitourinary, and peritoneal TB cases were more frequently seen among females. Unique strain infection was statistically significantly associated with EPTB (OR: 2.82, 95% CI [1.59, 5.00]) CONCLUSIONS EPTB accounted for a significant proportion of TB cases in Malatya, Turkey between 2001 and 2007. The current study has provided an insight into the dynamics of EPTB in Malatya, Turkey. However, the risk factors for having EPTB in Malatya, Turkey remain to be assessed in future studies using population-based or randomly selected sample.
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Affiliation(s)
- Selami Gunal
- Department of Clinical Microbiology, Medical Faculty, Inonu University, Malatya, Turkey
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González-Martín J, García-García JM, Anibarro L, Vidal R, Esteban J, Blanquer R, Moreno S, Ruiz-Manzano J. [Consensus document on the diagnosis, treatment and prevention of tuberculosis]. Arch Bronconeumol 2010; 46:255-74. [PMID: 20444533 DOI: 10.1016/j.arbres.2010.02.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2-3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest X-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB. At least 3 serial representative samples of the clinical location are used for diagnosis whenever possible. Bacilloscopy and liquid medium cultures are indicated in all cases. Genetic amplification techniques are coadjuvant in moderate or high TB suspicion. Administration of isoniazid, rifampicin, ethambutol and pyrazinamide (HREZ) for 2 months and HR for 4 additional months is recommended in new cases of TB, except in cases of meningitis in which treatment should continue for up to 12 months and up to 9 months in spinal TB with neurological involvement, and in silicosis. Appropriate adjustments with antiretroviral treatment should be made in HIV patients. Combined therapy is recommended to avoid development of resistance. An antibiogram to first line drugs should be performed in all the initial isolations of new patients. Treatment control is one of the most important activities in TB management. The Tuberculin Skin Test (TST) is positive in TB infection when >or=5mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TT. The standard treatment schedule for infection is 6 months with isoniazid. In pulmonary TB, respiratory isolation is applied for 3 weeks or until 3 negative bacilloscopy samples are obtained.
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Affiliation(s)
- Julià González-Martín
- Servei de Microbiologia, Institut Clínic de Diagnòstic Biomèdic (CDB), Hospital Clínic, Institut Clínic de Diagnòstic Biomèdic August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España.
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González-Martín J, García-García JM, Anibarro L, Vidal R, Esteban J, Blanquer R, Moreno S, Ruiz-Manzano J. Consensus Document on the Diagnosis, Treatment and Prevention of Tuberculosis. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(10)70061-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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González-Martín J, García-García JM, Anibarro L, Vidal R, Esteban J, Blanquer R, Moreno S, Ruiz-Manzano J. [Consensus document on the diagnosis, treatment and prevention of tuberculosis]. Enferm Infecc Microbiol Clin 2010; 28:297.e1-20. [PMID: 20435388 DOI: 10.1016/j.eimc.2010.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/10/2010] [Indexed: 11/30/2022]
Abstract
Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2-3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest x-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB. At least 3 serial representative samples of the clinical location are used for diagnosis whenever possible. Bacilloscopy and liquid medium cultures are indicated in all cases. Genetic amplification techniques are coadjuvant in moderate or high TB suspicion. Administration of isoniazid, rifampicin, ethambutol and pyrazinamide (HREZ) for 2 months and HR for 4 additional months is recommended in new cases of TB, except in cases of meningitis in which treatment should continue for up to 12 months and up to 9 months in spinal TB with neurological involvement, and in silicosis. Appropriate adjustments with antiretroviral treatment should be made in HIV patients. Combined therapy is recommended to avoid development of resistance. An antibiogram to first line drugs should be performed in all the initial isolations of new patients. Treatment control is one of the most important activities in TB management. The Tuberculin Skin Test (TST) is positive in TB infection when >or=5mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TT. The standard treatment schedule for infection is 6 months with isoniazid. In pulmonary TB, respiratory isolation is applied for 3 weeks or until 3 negative bacilloscopy samples are obtained.
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Affiliation(s)
- Julià González-Martín
- Servei de Microbiologia-CDB, Hospital Clínic, Institut Clínic de Diagnòstic Biomèdic August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España.
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21
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Hasan Z, Cliff JM, Dockrell HM, Jamil B, Irfan M, Ashraf M, Hussain R. CCL2 responses to Mycobacterium tuberculosis are associated with disease severity in tuberculosis. PLoS One 2009; 4:e8459. [PMID: 20041183 PMCID: PMC2793516 DOI: 10.1371/journal.pone.0008459] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/01/2009] [Indexed: 01/09/2023] Open
Abstract
Background Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity. Methodology We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, n = 16). Secretion of CCL2, IFNγ, IL10 and CCL3, and mRNA expression of CCL2, TNFα, CCL3 and CXCL8 were determined. Results M. tuberculosis- and BCG- induced CCL2 secretion was significantly increased in both PTB and D-ETB (p<0.05, p<0.01) as compared with L-ETB patients. CCL2 secretion in response to M. tuberculosis was significantly greater than to BCG in the PTB and D-ETB groups. M. tuberculosis-induced CCL2 mRNA transcription was greater in PTB than L-ETB (p = 0.023), while CCL2 was reduced in L-ETB as compared with D-ETB (p = 0.005) patients. M. tuberculosis –induced IFNγ was greater in L-ETB than PTB (p = 0.04), while BCG-induced IFNγ was greater in L-ETB as compared with D-ETB patients (p = 0.036). TNFα mRNA expression was raised in PTB as compared with L-ETB group in response to M. tuberculosis (p = 0.02) and BCG (p = 0.03). Mycobacterium-induced CCL3 and CXCL8 was comparable between TB groups. Conclusions The increased CCL2 and TNFα in PTB patients may support effective leucocyte recruitment and M. tuberculosis localization. CCL2 alone is associated with severity of TB, possibly due to increased systemic inflammation found in severe disseminated TB or due to increased monocyte infiltration to lung parenchyma in pulmonary disease.
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Pinto VL, Lima MA, Rolla VC, Rebelo MC, Bóia MN. Atypical cerebrospinal fluid profile in tuberculous meningitis. Trop Doct 2009; 39:76-8. [PMID: 19299285 DOI: 10.1258/td.2008.080242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to describe atypical cerebrospinal fluid (CSF) alterations in tuberculous meningitis (TBM) and to analyse the differences in outcome between patients with typical and atypical profiles. We did a retrospective study during the period of 2000 to 2005 including the cases of TBM assisted in a referral centre for infectious diseases in Rio de Janeiro State, Brazil. Neutrophilic plecytosis at the first spinal tap was found in 32.4% of TBM patients, who had a worse outcome when compared with those patients with typical CSF profiles. One factor that might have a major impact was the delay in starting empirical treatment (27.5 versus 11.6 days). We conclude that, in cases with clinical and epidemiological data compatible with TBM but with an atypical CSF profile, empirical treatment should be considered if CSF culture and direct examination for bacteria are negative.
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Affiliation(s)
- Vitor Laerte Pinto
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av. Brasil 4365, Manguinhos 21040-360, Rio de Janeiro, Brazil.
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Hasan Z, Jamil B, Khan J, Ali R, Khan MA, Nasir N, Yusuf MS, Jamil S, Irfan M, Hussain R. Relationship between circulating levels of IFN-gamma, IL-10, CXCL9 and CCL2 in pulmonary and extrapulmonary tuberculosis is dependent on disease severity. Scand J Immunol 2009; 69:259-67. [PMID: 19281538 DOI: 10.1111/j.1365-3083.2008.02217.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Protection against Mycobacterium tuberculosis infection is dependent on T cell and macrophage activation regulated by cytokines. Cytokines and chemokines produced at disease sites may be released into circulation. Data available on circulating cytokines in tuberculosis (TB) is mostly on pulmonary TB (PTB) with limited information on extrapulmonary disease (EPul-TB). We measured interferon-gamma (IFN-gamma), interkeukin-10 (IL-10), CXCL9 and CCL2 in sera of patients (n = 80) including; PTB (n = 42), EPul-TB (n = 38) and BCG vaccinated healthy endemic controls (EC, n = 42). EPul-TB patients comprised those with less severe (LNTB) or severe (SevTB) disease. Serum IFN-gamma, IL-10 and CXCL9 levels were significantly greater while CCL2 was reduced in TB patients as compared with EC. IFN-gamma was significantly greater in PTB as compared with LNTB (P = 0.002) and SevTB (P = 0.029). CXCL9 was greater in PTB as compared with LNTB (P = 0.009). In contrast, CCL2 levels were reduced in PTB as compared with LNTB (P = 0.021) and SevTB (P = 0.024). A Spearman's rank correlation analysis determined a positive association between IFN-gamma and IL-10 (rho = 0.473, P = 0.002) and IFN-gamma and CXCL9 (rho = 0.403, P = 0.008) in the PTB group. However, in SevTB, only IFN-gamma and CXCL9 were positively associated (rho = 0.529, P = 0.016). Systemic levels of cytokines are reflective of local responses at disease sites. Therefore, our data suggests that in PTB increased IFN-gamma and CXCL9 balanced by IL-10 may result in a more effective cell mediated response in the host. However, elevated inflammatory chemokines CXCL9 and CCL2 in severe EPul-TB without concomitant down modulatory cytokines may exacerbate disease related pathology and hamper restriction of M. tuberculosis infection.
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Affiliation(s)
- Z Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan.
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24
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Hasan Z, Jamil B, Ashraf M, Islam M, Yusuf MS, Khan JA, Hussain R. ESAT6-induced IFNgamma and CXCL9 can differentiate severity of tuberculosis. PLoS One 2009; 4:e5158. [PMID: 19340290 PMCID: PMC2659747 DOI: 10.1371/journal.pone.0005158] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 03/06/2009] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Protective responses against Mycobacterium tuberculosis are dependent on appropriate T cell and macrophage activation. Mycobacterial antigen six kDa early secreted antigenic target (ESAT6) and culture filtrate protein 10 (CFP10) can detect M. tuberculosis specific IFNgamma responses. However, most studies have been performed in non-endemic regions and to study pulmonary tuberculosis (PTB). We have studied ESAT6 and CFP10 induced cytokine and chemokines responses in PTB and extrapulmonary (EPul) TB. METHODOLOGY IFNgamma, IL10, CXCL9 and CCL2 responses were determined using an ex vivo whole blood assay system in PTB (n = 30) and EPulTB patients with limited (LNTB, n = 24) or severe (SevTB, n = 22) disease, and in healthy endemic controls (ECs). Responses to bacterial LPS were also determined. PRINCIPAL FINDINGS ESAT6- and CFP10-induced IFNgamma was comparable between ECs and TB patients. Both ESAT6- and CFP10-induced IFNgamma secretion was greater in LNTB than PTB. ESAT6-induced CXCL9 was greater in EPulTB as compared with PTB, with an increase in SevTB as compared with LNTB. CFP10-induced CCL2 was higher in PTB than LNTB patients. LPS-stimulated CXCL9 was greatest in SevTB and LPS-induced CCL2 was increased in PTB as compared with LNTB patients. A positive correlation between ESAT6-induced IFNgamma and CXCL9 was present in all TB patients, but IFNgamma and CCL2 was only correlated in LNTB. ESAT-induced CCL2 and CXCL9 were significantly associated in LNTB while correlation in response to LPS was only present in SevTB. CONCLUSIONS ESAT6 induced IFNgamma and CXCL9 can differentiate between limited and severe TB infections.
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Affiliation(s)
- Zahra Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan.
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25
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Welsh KJ, Abbott AN, Hwang SA, Indrigo J, Armitige LY, Blackburn MR, Hunter RL, Actor JK. A role for tumour necrosis factor-alpha, complement C5 and interleukin-6 in the initiation and development of the mycobacterial cord factor trehalose 6,6'-dimycolate induced granulomatous response. MICROBIOLOGY-SGM 2008; 154:1813-1824. [PMID: 18524936 DOI: 10.1099/mic.0.2008/016923-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Trehalose 6,6'-dimycolate (TDM) is a glycolipid component of the mycobacterial cell wall that causes immune responses in mice similar to Mycobacterium tuberculosis (MTB) infection, including granuloma formation with production of proinflammatory cytokines. The precise roles of tumour necrosis factor (TNF)-alpha, complement C5 and interleukin (IL)-6 in the molecular events that lead to the initiation and maintenance of the granulomatous response to TDM have not been fully elucidated. Macrophage proinflammatory responses from wild-type and complement-deficient mice after infection with MTB were assessed, and compared to responses from organisms in which surface TDM had been removed. Removal of TDM abolished proinflammatory responses, markedly so in the complement-deficient macrophages. Mice deficient in TNF-alpha, C5a and IL-6, along with wild-type C57BL/6 controls, were intravenously injected with TDM in a water-in-oil emulsion, and analysed for histological response and cytokine production in lungs. Wild-type C57BL/6 mice formed granulomas with increased production of IL-1beta, IL-6, TNF-alpha, macrophage inflammatory protein-1alpha (MIP-1alpha), IL-12p40, interferon-gamma (IFN-gamma), and IL-10 protein and mRNA. TNF-alpha-deficient mice failed to produce a histological response to TDM, with no increases in cytokine production following TDM administration. While C5a-deficient mice exhibited inflammation, they did not form structured granulomas and initially had decreased production of proinflammatory mediators. IL-6-deficient mice initiated granuloma formation, but failed to maintain the granulomas through day 7 and demonstrated decreased early production of proinflammatory mediators in comparison to wild-type mice. These data suggest that TNF-alpha is critical for initiation of the granulomatous response, C5a is necessary for formation of cohesive granulomas, and IL-6 plays a key role in the granuloma maintenance response to mycobacterial TDM.
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Affiliation(s)
- Kerry J Welsh
- Medical School, University of Texas-Houston, Houston, TX 77030, USA
| | - April N Abbott
- Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA
| | - Shen-An Hwang
- Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA
| | - Jessica Indrigo
- Corporate and Foundation Relations, Washington University School of Medicine, St Louis, MO 63105, USA
| | - Lisa Y Armitige
- Department of Internal Medicine-Infectious Diseases, Medical School, University of Texas-Houston, Houston, TX, USA.,Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA.,Medical School, University of Texas-Houston, Houston, TX 77030, USA
| | - Michael R Blackburn
- Department of Biochemistry and Molecular Biology, Medical School, University of Texas-Houston, Houston, TX, USA.,Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA.,Medical School, University of Texas-Houston, Houston, TX 77030, USA
| | - Robert L Hunter
- Department of Pathology, Medical School, University of Texas-Houston, Houston, TX, USA.,Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA.,Medical School, University of Texas-Houston, Houston, TX 77030, USA
| | - Jeffrey K Actor
- Department of Pathology, Medical School, University of Texas-Houston, Houston, TX, USA.,Graduate School of Biomedical Sciences, Program in Molecular Pathology, University of Texas-Houston Health Science Center, Houston, TX, USA.,Medical School, University of Texas-Houston, Houston, TX 77030, USA
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[Gastro-intestinal tract tuberculosis: a little documented form of a too well-known infection]. Med Mal Infect 2008; 38:400-2. [PMID: 18280076 DOI: 10.1016/j.medmal.2007.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 11/29/2007] [Indexed: 11/20/2022]
Abstract
In France, tuberculosis (TB) is still a health issue among underprivileged people and immigrants. We report a case of disseminated tuberculosis with intestinal involvement causing ill absorption and thus, making oral treatment impossible. Intestinal TB is often underrated and yet, malabsorption may lead to treatment failure or to developing antibiotic resistance. This type of tuberculosis must be systematically investigated when assessing the damage caused by tuberculosis and, more particularly, if there is any abdominal pain as well as clinical and biological signs of malabsorption. Parenteral antibiotherapy and nutrition must be systematically discussed.
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Abstract
CONCLUSION Tuberculosis is a rare disease that can mimic a neck malignancy. It should be taken into consideration when evaluating a patient with a neck mass, especially when the patient has come from an area of high endemic incidence. Another risk group comprises older people with dormant tuberculosis. OBJECTIVES We wanted to find out the incidence of head and neck tuberculosis in Finland and to define the factors that should make one suspect it. PATIENTS AND METHODS This was a retrospective analysis of patients who were diagnosed with tuberculosis in the Department of Otolaryngology, Helsinki University Central Hospital (population base c.a. 1,000,000) during 1996-2005. All the patients with culture- or PCR-positive tuberculosis were included. RESULTS During 1996-2005, 63 patients were diagnosed with head and neck tuberculosis, the average incidence being 0.6/100,000 per year. The age of the patients varied between 3 and 94 years (mean 47 years). The mean age of patients who were of Finnish extraction (37 patients) was 62 years and that of immigrants (26 patients) was 27 years. Forty-four (70%) patients were female and 19 (30%) male. The majority of patients presented with a neck mass without symptoms of general infection such as fever or fatigue.
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Affiliation(s)
- Elina Nohrström
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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30
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Hiéronimus S, Bernard JL, Chevallier P, Chevallier A, Chyderiotis G, Fenichel P, Landraud L. Adrenal tuberculosis after a pheochromocytoma: a misleading tumoral presentation. ANNALES D'ENDOCRINOLOGIE 2007; 68:191-5. [PMID: 17559792 DOI: 10.1016/j.ando.2007.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 01/29/2007] [Accepted: 02/13/2007] [Indexed: 10/22/2022]
Abstract
Adrenal gland involvement could account for 6% of active tuberculosis. The diagnosis of this extrapulmonary form of tuberculosis is difficult, especially when presenting as unilateral adrenal tumor. This report describes an unusual case of adrenal tuberculosis presenting as a tumor occurring shortly after surgical removal of an adrenal pheochromocytoma located in the opposite gland, in a 63-year-old woman with a previous history of breast cancer. At initial presentation, the patient suffered from symptomatic paroxysmal hypertension. A pheochromocytoma in the left adrenal was diagnosed and resected. One year later, while physical examination and biological parameters were unremarkable, an enhanced adrenal computed tomography (CT) scan showed a right adrenal mass mimicking the CT features of the resected pheochromocytoma. A peripheral tissular rim delineating a central hypodensity characterized this tumor. Magnetic resonance imaging (MRI) showed the same findings on gadolinium-enhanced T1-weighted slices, while the mass was not seen on T2-weighted images. No tumoral signal loss was observed on out of phase images when using the in phase-out of phase T1-weighted sequence. Because of the tumoral evolution and the uncertainty of the nature of that lesion, the patient underwent a second adrenalectomy. Definitive diagnosis was provided by culture of tissue sample, which resulted in the identification of Mycobacterium tuberculosis. In an era of tuberculosis resurgence, this unusual case underscores the necessity of keeping in mind adrenal tuberculosis as a possible differential diagnosis in adrenal tumors of uncertainty nature. It stresses the importance of culture of biopsy tumor, whenever feasible, to avoid unnecessary operations. In the near future, interferon-gamma assay could be a valuable means to recognize extrapulmonary forms of tuberculosis.
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Affiliation(s)
- S Hiéronimus
- Services d'endocrinologie-médecine de la reproduction, hôpital l'Archet, CHU de Nice, BP 3079, 06202 Nice cedex 03, France.
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31
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Thoracic Pott Disease (Tuberculous Spondylitis) Presenting as Cervical Lymphadenitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2006. [DOI: 10.1097/01.idc.0000206489.97798.f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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