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Wetscherek MTA, Sadler TJ, Lee JYJ, Karia S, Babar JL. Active pulmonary tuberculosis: something old, something new, something borrowed, something blue. Insights Imaging 2022; 13:3. [PMID: 35001143 PMCID: PMC8743064 DOI: 10.1186/s13244-021-01138-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis remains a major global health issue affecting all countries and age groups. Radiology plays a crucial role in the diagnosis and management of pulmonary tuberculosis (PTB). This review aims to improve understanding and diagnostic value of imaging in PTB. We present the old, well-established findings ranging from primary TB to the common appearances of post-primary TB, including dissemination with tree-in-bud nodularity, haematogenous dissemination with miliary nodules and lymphatic dissemination. We discuss new concepts in active PTB with special focus on imaging findings in immunocompromised individuals. We illustrate PTB appearances borrowed from other diseases in which the signs were initially described: the reversed halo sign, the galaxy sign and the cluster sign. There are several radiological signs that have been shown to correlate with positive or negative sputum smears, and radiologists should be aware of these signs as they play an important role in guiding the need for isolation and empirical anti-tuberculous therapy.
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Affiliation(s)
- Maria T A Wetscherek
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK. .,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babeș Street, 400000, Cluj-Napoca, Romania.
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Janice Y J Lee
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Sumit Karia
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Judith L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
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Choe J, Jung KH, Park JH, Kim SH, Kim MY. Clinical and radiologic characteristics of radiologically missed miliary tuberculosis. Medicine (Baltimore) 2021; 100:e23833. [PMID: 33663042 PMCID: PMC7909107 DOI: 10.1097/md.0000000000023833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023] Open
Abstract
While chest CT provides important clue for diagnosis of miliary tuberculosis (TB), patients are occasionally missed on initial CT, which might delay the diagnosis. This study was to evaluate the clinical and radiological characteristics of radiologically missed miliary TB.Total 117 adult patients with microbiologically confirmed miliary TB in an intermediate TB-burden country were included. 'Missed miliary TB' were defined as the case in which miliary TB was not mentioned as a differential diagnosis in the initial CT reading. Clinical characteristics and radiologic findings including the predominant nodule size, demarcation of miliary nodules and disease extent on CT were retrospectively evaluated. Findings were compared between the missed and non-missed miliary TB groups. Multivariable analyses were performed to determine independent risk factors of missed miliary TB.Of 117 patients with miliary TB, 13 (11.1%) were classified as missed miliary TB; these patients were significantly older than those with non-missed miliary TB (median age, 71 vs 57 years, P = .024). There was a significant diagnostic delay in the missed miliary TB group (P < .001). On chest CT, patients with missed miliary TB had a higher prevalence of ill-defined nodules (84.6% vs 14.4%; P < .001), miliary nodule less than 2 mm showing granular appearance (69.2% vs 12.5%; P < .001), and subtle disease extent (less than 25% of whole lung field, 46.2% vs 8.7%; P < .001). Multivariable analysis revealed that only CT findings including ill-defined nodule (Odd ratios [OR], 15.64; P = .002) and miliary nodule less than 2 mm (OR, 10.08; P = .007) were independently associated with missed miliary TB.Approximately 10% of miliary TB could be missed on initial chest CT, resulting in a delayed diagnosis and treatment. Caution is required in patients with less typical CT findings showing ill-defined miliary nodules less than 2 mm showing granular appearance and follow-up CT might have a benefit.
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Affiliation(s)
- Jooae Choe
- Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine
| | - Kyung Hwa Jung
- Department of Infectious Diseases, Nowon Eulji Medical Center, University of Eulji College of Medicine
| | - Joung-Ha Park
- Infectious Diseases Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Infectious Diseases Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Young Kim
- Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine
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Takasaka N, Seki Y, Fujisaki I, Uchiyama S, Matsubayashi S, Sato A, Yamanaka Y, Odashima K, Kazuyori T, Seki A, Takeda H, Ishikawa T, Kuwano K. Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis. BMC Pulm Med 2020; 20:287. [PMID: 33160360 PMCID: PMC7648401 DOI: 10.1186/s12890-020-01325-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.
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Affiliation(s)
- Naoki Takasaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan.
| | - Yoshitaka Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Ikumi Fujisaki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Shota Uchiyama
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Sachi Matsubayashi
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Akihito Sato
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Yumie Yamanaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kyuto Odashima
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Taisuke Kazuyori
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Aya Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Hiroshi Takeda
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Takeo Ishikawa
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kazuyoshi Kuwano
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
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Delayed Isolation of Active Pulmonary Tuberculosis in Hospitalized Patients: A Pivotal Role of Radiologic Evaluation. AJR Am J Roentgenol 2020; 215:359-366. [PMID: 32432910 DOI: 10.2214/ajr.19.22540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine factors related to delayed isolation of patients hospitalized with active pulmonary tuberculosis (TB). MATERIALS AND METHODS. A total of 130 immunocompetent hospitalized patients with active pulmonary TB who had positive sputum culture results from January 2015 to December 2017 were reviewed. Delayed isolation of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of hospitalization. Clinical and microbiologic characteristics of the patients and radiologic features on chest radiography (n = 130) and chest CT (n = 118) were retrospectively reviewed. Findings were compared between patients with early isolation and those with delayed isolation. Univariate and multivariate analyses were performed to determine independent predictors of delayed isolation. RESULTS. Forty-four patients (34%) had delayed isolation after initial hospitalization. On univariate and multivariate analyses, atypical presentation of active pulmonary TB on CT (odds ratio, 7.203; 95% CI, 2.203-23.551; p = 0.001) and concurrent lung parenchymal diseases on CT (odds ratio, 14.605; 95% CI, 3.274-65.155; p < 0.001) were significant predictors of delayed isolation of patients with active pulmonary TB. CONCLUSION. Awareness of the factors related to delayed diagnosis of active pulmonary TB is important to avoid an unexpected in-hospital outbreak of TB and control the disease. Atypical presentation of active pulmonary TB and concurrent lung parenchymal diseases on CT are significant factors related to delayed isolation of hospitalized patients with active pulmonary TB.
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Ji Y, Shao C, Cui Y, Shao G, Zheng J. 18F-FDG Positron-Emission Tomography/Computed Tomography Findings of Radiographic Lesions Suggesting Old Healed Pulmonary Tuberculosis and High-risk Signs of Predicting Recurrence: A Retrospective Study. Sci Rep 2019; 9:12582. [PMID: 31467384 PMCID: PMC6715749 DOI: 10.1038/s41598-019-49057-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022] Open
Abstract
Pulmonary tuberculosis (PTB) is a common worldwide infection with high mortality and morbidity, especially in developing countries. This study analyzed PET/CT findings in tumor patients with radiographic lesions suggesting old healed pulmonary tuberculosis (OHPTB) and imaging follow-up to find and verify PET/CT signs that may predict tuberculosis recurrence. A retrospective analysis of the tumor patients was carried out. These patients underwent 18F-FDG PET/CT in our center from 2010 to 2018. Confirmation of tuberculosis recurrence was obtained by follow-up of morphological changes in old lesions by PET/CT or CT. In total, 238 patients with a complete medical history were included in the final study, and 22 patients experienced OHPTB recurrence. We found that the SUVmax of tuberculosis in PET/CT was significantly increased in the recurrence group compared to the non-recurrence group [5.00 (3.40, 7.30) vs. 1.10 (0.80, 1.30), P < 0.001]. The ROC curve showed good discrimination, with an AUC of 0.980, and a cut-off SUVmax value of 2.15 was identified (the sensitivity was 90.5%, the specificity was 97.2%, the positive predictive value was 76.0%, and the negative predictive value was 99.1%). Both the tumor and the anti-tumor treatment can cause the patient to be immunocompromised and might further cause the recurrence of OHPTB. Positive imaging on 18F-FDG PET can predict the recurrence of OHPPT. Although there might be a false positive, 18F-FDG PET can greatly narrow the monitoring range. A negative result on imaging has high reliability for eliminating the possibility of tuberculosis recurrence. PET/CT has important clinical significance in tuberculosis management in patients with concurrent OHPTB.
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Affiliation(s)
- Yu Ji
- Department of PET/CT, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, 250117, Jinan, Shandong, China.,Department of Radiology, The Second Hospital of Shandong University, 247 Beiyuan Rd, 250033, Jinan, Shandong, China
| | - Chunchun Shao
- Department of Evidence-Based Medicine, The Second Hospital of Shandong University, 247 Beiyuan Rd, 250033, Jinan, Shandong, China
| | - Yong Cui
- Department of Radiology, The Second Hospital of Shandong University, 247 Beiyuan Rd, 250033, Jinan, Shandong, China
| | - Guangrui Shao
- Department of Radiology, The Second Hospital of Shandong University, 247 Beiyuan Rd, 250033, Jinan, Shandong, China
| | - Jingsong Zheng
- Department of PET/CT, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, 250117, Jinan, Shandong, China.
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Serum Exosomal miRNAs Are Associated with Active Pulmonary Tuberculosis. DISEASE MARKERS 2019; 2019:1907426. [PMID: 30886653 PMCID: PMC6388314 DOI: 10.1155/2019/1907426] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 01/28/2023]
Abstract
Introduction Tuberculosis (TB) remains a major threat to human health. Due to the limited accuracy of the current TB diagnostic tests, it is critical to determine novel biomarkers for this disease. Circulating exosomes have been used as diagnostic biomarkers in various diseases. Objective of the Study In this pilot study, we examined the expression of miRNAs as biomarker candidates for the diagnosis of TB infection. Methods Serum-derived exosomes were isolated from TB patients and matched control subjects. The expression of miR-484, miR-425, and miR-96 was examined by RT-PCR methods. Results The expression of miR-484, miR-425, and miR-96 were significantly increased in serum of TB patients which correlated with the TB infection level. A receiver operating characteristic (ROC) curve analysis showed the diagnostic potency of each individual serum exosomal miRNA with an area under the curve (AUC) = 0.72 for miR-484 (p < 0.05), 0.66 for miR-425 (p < 0.05), and 0.62 for miR-96 (p < 0.05). Conclusion These results demonstrate that exosomal miRNAs have diagnostic potential in active tuberculosis. The diagnostic power may be improved when combined with conventional diagnostic markers.
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Park JH, Choe J, Bae M, Choi S, Jung KH, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Jo KW, Shim TS, Kim MY, Kim SH. Clinical Characteristics and Radiologic Features of Immunocompromised Patients With Pauci-Bacillary Pulmonary Tuberculosis Receiving Delayed Diagnosis and Treatment. Open Forum Infect Dis 2019; 6:ofz002. [PMID: 30775402 PMCID: PMC6366656 DOI: 10.1093/ofid/ofz002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/11/2018] [Accepted: 01/12/2019] [Indexed: 02/04/2023] Open
Abstract
Background Pauci-bacillary pulmonary tuberculosis (TB) can be delayed to diagnose and start anti-TB therapy, especially in immunocompromised patients. We therefore evaluated the clinical and radiologic features of these delayed cases. Methods Immunocompromised adult patients with pauci-bacillary pulmonary TB were retrospectively enrolled in a tertiary hospital in an intermediate–TB burden country over a 5-year period. We defined “missed TB” or “not-missed TB” patients as those who started anti-TB therapy after or before positive mycobacterial culture results, respectively. Results Of 258 patients, 134 (52%) were classified in the missed TB group, and 124 (48%) in the not-missed TB group. Positive results of molecular tests including MTB polymerase chain reaction and/or Xpert TB/RIF were only obtained in the not-missed TB group (54/106, 54%). The median diagnostic delay in the missed TB group was longer than in the other group (30 vs 6 days; P < .001). In the missed TB group, the most common working diagnoses were pneumonia (46, 34%) and lung metastasis of malignancy (40, 30%). Typical radiologic findings for TB, such as upper lobe predominance and centrilobular nodules with tree-in-bud appearance, were less common in the missed TB group than in the other group. Old age (odds ratio [OR], 1.03), solid organ transplant (OR, 3.46), solid tumor (OR, 3.83), and hematologic malignancy (OR, 4.04) were independently associated with missed TB. Conclusions Care is needed to differentiate pauci-bacillary TB, especially in immunocompromised patients with the mentioned risk factors, even without the usual radiologic features of TB. Additional rapid diagnostic tests to rule out pauci-bacillary TB are urgently needed.
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Affiliation(s)
- Joung Ha Park
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jooae Choe
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moonsuk Bae
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sungim Choi
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwa Jung
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Wook Jo
- Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Sun Shim
- Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Young Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chesov D, Botnaru V. Imaging for diagnosis and management of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Eddy J, Khan T, Schembri F. Medical management of drug-sensitive active thoracic tuberculosis: the work-up, radiographic findings and treatment. J Thorac Dis 2018; 10:S3378-S3391. [PMID: 30505525 DOI: 10.21037/jtd.2018.08.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Tuberculosis (TB) infection and disease have plagued human civilization across time and led to immeasurable morbidity and mortality. This review article focuses on the most currently available information regarding the diagnostic workup, radiologic presentation and treatment of drug-sensitive active TB. As discussed, if adequate resources and methods are available to diagnose, evaluate, and treat patients, drug sensitive TB is an imminently curable disease.
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Affiliation(s)
- Jared Eddy
- Department of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Taimur Khan
- Department of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Frank Schembri
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
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Gregg RW, Maiello P, Borish HJ, Coleman MT, Reed DS, White AG, Flynn JL, Lin PL. Spatial and temporal evolution of lung granulomas in a cynomolgus macaque model of Mycobacterium tuberculosis infection. RADIOLOGY OF INFECTIOUS DISEASES (BEIJING, CHINA) 2018; 5:110-117. [PMID: 35128020 DOI: 10.1016/j.jrid.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Little is known about granuloma progression of Mycobacterium tuberculosis infection in humans. Using serial positron emission tomography and computed tomography (PET/CT) of an animal model that recapitulates human infection with M. tuberculosis, we are able to track lung granulomas. OBJECTIVE We characterized the spatial and temporal pattern of granuloma formation during primary infection and reactivation. METHODS Serial PET/CT was performed on cynomolgus macaques (n = 28) during primary and reactivation M. tuberculosis infection. Distances between granulomas during the first six weeks post infection ("primary" granulomas) were compared to new granulomas that developed afterwards ("secondary" granulomas) using nearest neighbor analysis during primary infection, reactivation and between different routes of infection. RESULTS Secondary granulomas developed within 2 cm of a primary granuloma within the same lung lobe with 80% probability during the course of primary infection, and this same pattern was observed during reactivation of latent infection after immune suppression. Using a logistic growth function, we were able to predict the maximum number of granulomas that would develop over the course of infection with good correlation (R2 = 0.96). CONCLUSION These data provide important insights into the dynamic patterns of bacterial dissemination during the earliest phases of primary infection and reactivation tuberculosis.
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Affiliation(s)
- Robert W Gregg
- Department of Chemical Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pauline Maiello
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - H Jacob Borish
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M Teresa Coleman
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas S Reed
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander G White
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Schluger NW. AJRCCM: 100-Year Anniversary. Focus on Tuberculosis. Am J Respir Crit Care Med 2017; 195:1112-1114. [PMID: 28459341 DOI: 10.1164/rccm.201703-0446ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Neil W Schluger
- 1 Department of Medicine.,2 Department of Epidemiology and.,3 Department of Environmental Health Science Columbia University New York, New York
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Abstract
CLINICAL ISSUE Tuberculosis (TB) is a granulomatous disease caused by Mycobacterium tuberculosis and transmission is via an airborne route by droplet infection. In the majority of cases patients have thoracic TB, which most frequently presents with hilar lymphadenopathy and pulmonary manifestation. Due to the rise in incidence of TB in central Europe to be expected over the coming years, it is essential to be acquainted with the radiological manifestations of pulmonary TB, particularly to be able to discriminate active from inactive TB. Due to the use of molecular techniques entailing DNA fingerprinting, the traditional classification of TB in primary and postprimary TB is being challenged. These genetic studies have revealed that variations in the clinical and radiographic appearance of TB are mainly affected by the immune status of the patients. Due to the low prevalence of TB in central Europe and the wide variation of radiological presentations, the diagnosis and therapy of TB is often delayed. In this article, the radiographic manifestations of thoracic TB are summarized and discussed. STANDARD RADIOLOGICAL METHODS Together with the medical history and bacteriological tests, chest X‑ray imaging and computed tomography (CT) play a major role not only in the detection of TB but also in the follow-up during and after therapy. PRACTICAL RECOMMENDATIONS Chest X‑radiographs should be the primary diagnostic method in patients with suspected TB in screening as well as for diagnosis and therapy monitoring. The use of CT is more sensitive than chest radiographs and is frequently performed after chest radiographs to obtain detailed information about subtle parenchymal changes or lymph node manifestation. When active TB is suspected CT should be performed. Tree in bud, lobular consolidations, centrilobular nodules, cavities and ground-glass opacification are typical changes in active TB.
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Affiliation(s)
- D Kienzl-Palma
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - H Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Pulmonary Tuberculosis in Patients With Emphysema: Computed Tomography Findings. J Comput Assist Tomogr 2017; 40:912-916. [PMID: 27438229 DOI: 10.1097/rct.0000000000000452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the computed tomography (CT) findings and clinical characteristics of pulmonary tuberculosis (TB) in patients with emphysema, compared with those without emphysema. MATERIALS AND METHODS Thirty-nine patients (M:F = 36:3; mean age, 64.8 years) who were diagnosed with chronic obstructive pulmonary disease and had emphysema in pretreatment chest CT scans were included in this study (emphysema group). Their clinical presentation, laboratory findings, and CT findings were compared with those of 57 pulmonary TB patients without chronic obstructive pulmonary disease and emphysema (M:F = 52:5; mean age, 64.3 years) (nonemphysema group). RESULTS Fever was a more frequent clinical presentation and the C-reactive protein level was higher in the emphysema group. Among CT findings, consolidation and ground-glass opacity were seen more frequently in the emphysema group (82% and 69% vs 42% and 19%, respectively, P < 0.001). Consolidation was more often nonsegmental than lobular or segmental. Tree-in-bud appearance was less frequently noted in the emphysema group (36% vs 79%, P < 0.001). The location of main lesions (upper lung vs middle/lower lung) was not different between the 2 groups. CONCLUSIONS Pulmonary TB in emphysema patients often shows bacterial pneumonia-like features, that is, presence of consolidation and ground-glass opacity and lack of bronchogenic spread on chest CT scans, combined with the presence of fever and a high C-reactive protein level. Sputum smear for acid-fast bacteria should be performed early in emphysema patients with pneumonia in TB-endemic areas.
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Cudahy P, Shenoi SV. Diagnostics for pulmonary tuberculosis. Postgrad Med J 2017; 92:187-93. [PMID: 27005271 DOI: 10.1136/postgradmedj-2015-133278] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/21/2016] [Indexed: 01/30/2023]
Abstract
Tuberculosis (TB) remains a leading cause of human suffering and mortality despite decades of effective treatment being available. Accurate and timely diagnosis remains an unmet goal. The HIV epidemic has also led to new challenges in the diagnosis of TB. Several new developments in TB diagnostics have the potential to positively influence the global campaign against TB. We aim to review the performance of both established as well as new diagnostics for pulmonary TB in adults, and discuss the ongoing challenges.
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Affiliation(s)
- Patrick Cudahy
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheela V Shenoi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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15
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Kim W, Lee KS, Kim HS, Koh WJ, Jeong BH, Chung MJ, Jang HW. CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol 2016; 57:197-204. [PMID: 25759483 DOI: 10.1177/0284185115575196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little attention has been paid to the initial and follow-up computed tomography (CT) features in primary multi-drug resistant tuberculosis (pMDR-TB) setting. PURPOSE To describe serial CT findings and clinical course of pMDR-TB with antibiotic treatment. MATERIAL AND METHODS For the last 10 years, 340 MDR-TB patients were managed in a tertiary referral hospital. Among them, we included 44 (27 men, 17 women; mean age, 40 years; age range, 20-81 years) pMDR-TB patients; 37 treated with chemotherapy only and seven treated with medical therapy plus surgery. CT findings were evaluated regarding tree-in-bud sign, acinar nodule, peribronchial, segmental or lobar consolidation and cavity, and their extent. Sputum negative conversion rates and serial CT scores were assessed. To compare changes in disease extent between initial and follow-up CT studies, paired t-test was performed. RESULTS Two most frequent patterns of lung abnormality were tree-in-bud sign (37 of 44, 84.1%) and acinar nodule (41 of 44, 93.2%). Among 37 patients treated with chemotherapy only, 36 showed negative sputum conversion within 3 months after second-line drug commencement, maintained for >12 months. The other seven undergoing surgery during medical treatment showed excellent outcome with negative conversion achieved within one month after surgery and maintained for >12 months. CT scores showed significant decrease on serial CT studies (P < 0.001) in all. CONCLUSION In pMDR-TB, two most frequent abnormal CT patterns are tree-in-bud sign and acinar nodule. In 98% of patients, negative sputum conversion is achieved, and CT score also shows decrease in extent after TB chemotherapy.
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Affiliation(s)
- Wooil Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Won Jang
- Department of Social and Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Infection. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7120007 DOI: 10.1007/174_2016_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-Acquired Pneumonia (CAP) is the first leading cause of death due to infection worldwide.Many gram-positive, gram-negative bacteria, funguses and viruses can cause the infectious pulmonary disease, and the severity of pneumonia depends on the balance between the microorganism charge, the body immunity defenses and the quality of the underlying pulmonary tissue. The microorganisms may reach the lower respiratory tract from inhaled air or from infected oropharyngeal secretions. The same organism may produce several different patterns that depend on the balance between the microorganism charge and the body immunity defenses.CAP is classified into three main groups: lobar pneumonia, bronchopneumonia and interstitial pneumonia.Lobar pneumonia is characterized by the filling of alveolar spaces by edema full of white and inflammatory cells. Necrotizing pneumonia consists of a fulminant process associated with focal areas of necrosis that results in abscesses. Bronchopneumonia or lobular pneumonia, is characterized by a peribronchiolar inflammation with thickening of peripheral bronchial wall, the diffusion of inflammation to the centrilobular alveolar spaces and development of nodules.The interstitial pneumonia represents with the destruction and esfoliation of the respiratory ciliated and mucous cells. The interstitial septa, the bronchial and bronchiolar walls become thickened for the inflammation process and lymphocytes interstitial infiltrates.Chest radiography represents an important initial examination in all patients suspected of having pulmonary infection and for monitoring response to therapy.Its role is to identify the pulmonary opacities, their internal characteristics and distribution, pleural effusion and presence of other complications as abscesses and pneumothorax.High spatial CT resolution allows accurate assessment of air space inflammation.The CT findings include nodules, interlobular septal thickening, intralobular reticular opacities, ground-glass opacities, tree-in-bud pattern, lobar-segmental consolidation, lobular consolidation, abscesses, pneumatocele, pleural effusion, pericardial effusion, mediastinal and hilar lymphoadenopaties, airway dilatation and emphysema.
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Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
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Flynn JL, Gideon HP, Mattila JT, Lin PL. Immunology studies in non-human primate models of tuberculosis. Immunol Rev 2015; 264:60-73. [PMID: 25703552 DOI: 10.1111/imr.12258] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Non-human primates, primarily macaques, have been used to study tuberculosis for decades. However, in the last 15 years, this model has been refined substantially to allow careful investigations of the immune response and host-pathogen interactions in Mycobacterium tuberculosis infection. Low-dose challenge with fully virulent strains in cynomolgus macaques result in the full clinical spectrum seen in humans, including latent and active infection. Reagents from humans are usually cross-reactive with macaques, further facilitating the use of this model system to study tuberculosis. Finally, macaques develop the spectrum of granuloma types seen in humans, providing a unique opportunity to investigate bacterial and host factors at the local (lung and lymph node) level. Here, we review the past decade of immunology and pathology studies in macaque models of tuberculosis.
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Affiliation(s)
- JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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A Novel Reading Scheme for Assessing the Extent of Radiographic Abnormalities and Its Association with Disease Severity in Sputum Smear-Positive Tuberculosis: An Observational Study in Hyderabad/India. PLoS One 2015; 10:e0138070. [PMID: 26381644 PMCID: PMC4575099 DOI: 10.1371/journal.pone.0138070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Existing reading schemes for chest X-ray (CXR) used to grade the extent of disease severity at diagnosis in patients with pulmonary tuberculosis (PTB) are often based on numerical scores that summate specific radiographic features. However, since PTB is known to exhibit a wide heterogeneity in pathology, certain features might be differentially associated with clinical parameters of disease severity. Objective We aimed to grade disease severity in PTB patients at diagnosis and after completion of DOTS treatment by developing a reading scheme based on five different radiographic manifestations and analyze their association with the clinical parameters of systemic involvement and infectivity. Methods 141 HIV-negative adults with newly diagnosed sputum smear-positive PTB were enrolled in a prospective observational study in Hyderabad, India. The presence and extent on CXRs of five radiographic manifestations, i.e., lung involvement, alveolar infiltration, cavitation, lymphadenopathy and pleural effusion, were classified using the new reading scheme by using a four-quadrant approach. We evaluated the inter-reader reliability of each manifestation, and its association with BMI and sputum smear positivity at diagnosis. The presence and extent of these radiographic manifestations were further compared with CXRs on completion of DOTS treatment. Results At diagnosis, an average lung area of 51.7% +/- 23.3% was affected by radiographic abnormalities. 94% of the patients had alveolar infiltrates, with 89.4% located in the upper quadrants, suggesting post primary PTB and in 34.8% of patients cavities were found. We further showed that the extent of affected lung area was a negative predictor of BMI (β value -0.035, p 0.019). No significant association of BMI with any of the other CXR features was found. The extent of alveolar infiltrates, along with the presence of cavitation, were strongly associated with sputum smear positivity. The microbiological cure rate in our cohort after 6 months of DOTS treatment was 95%. The extent of the affected lung area in these patients decreased from 56.0% +/- 21.5% to 31.0 +/- 20% and a decrease was also observed in the extent of alveolar infiltrates from 98.4% to 25.8% in at least one quadrant, presence of cavities from 34.8% to 1.6%, lymphadenopathy from 46.8% to 16.1%, and pleural effusion from 19.4% to 6.5%. Conclusions We established a new assessment scheme for grading disease severity in PTB by specifically considering five radiographic manifestations which were differently associated with the BMI and sputum smear positivity, changed to a different extent after 6 months of treatment and exhibited an excellent agreement between radiologists. Our results suggest that this reading scheme might contribute to the estimation of disease severity with respect to differences in disease pathology. Further studies are needed to determine a correlation with short and long-term pulmonary function impairment and whether there would be any benefit in lengthening or modulating therapy based on this CXR severity assessment.
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Mayer-Barber KD, Barber DL. Innate and Adaptive Cellular Immune Responses to Mycobacterium tuberculosis Infection. Cold Spring Harb Perspect Med 2015; 5:a018424. [PMID: 26187873 PMCID: PMC4665043 DOI: 10.1101/cshperspect.a018424] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Host resistance to Mycobacterium tuberculosis (Mtb) infection requires the coordinated efforts of innate and adaptive immune cells. Diverse pulmonary myeloid cell populations respond to Mtb with unique contributions to both host-protective and potentially detrimental inflammation. Although multiple cell types of the adaptive immune system respond to Mtb infection, CD4 T cells are the principal antigen-specific cells responsible for containment of Mtb infection, but they can also be major contributors to disease during Mtb infection in several different settings. Here, we will discuss the role of different myeloid populations as well as the dual nature of CD4 T cells in Mtb infection with a primary focus on data generated using in vivo cellular immunological studies in experimental animal models and in humans when available.
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Affiliation(s)
- Katrin D Mayer-Barber
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892
| | - Daniel L Barber
- T Lymphocyte Biology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892
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Abstract
OBJECTIVE The purpose of this article is to review the origins of the classic teaching on pulmonary tuberculosis, its evolution in the modern literature, and the evidence that led to its demise. CONCLUSION Use of molecular epidemiologic techniques that entail DNA finger-printing has led to the discovery that the radiographic appearance of pulmonary tuberculosis does not depend on the time since infection. It has been confirmed that the upper lobe cavitary disease typical in adults is the disease of the immunocompetent host, whereas lower lung zone disease, adenopathy, and effusions, which are uncommon in adults, are the hallmarks of tuberculosis in an immunocompromised host.
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21
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Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberc Respir Dis (Seoul) 2015; 78:64-71. [PMID: 25861338 PMCID: PMC4388902 DOI: 10.4046/trd.2015.78.2.64] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/12/2015] [Accepted: 03/13/2015] [Indexed: 01/31/2023] Open
Abstract
Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.
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Affiliation(s)
- Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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22
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Choo JY, Lee KY, Kim MY, Kang EY, Oh YW, Lee SH, Seo BK, Je BK. Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease. Balkan Med J 2014; 31:208-13. [PMID: 25625018 DOI: 10.5152/balkanmedj.2014.13187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/23/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. AIMS The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. STUDY DESIGN Cross sectional study. METHODS We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (<3 cm in diameter), mass (any masses ≥3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. RESULTS The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. CONCLUSION Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolidation. Therefore, PNTB is useful for the accurate diagnosis of pulmonary TB in the following cases: airspace consolidation or mass associated with underlying usual interstitial pneumonia, emphysema mimicking lung malignancy or cases of bacterial pneumonia.
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Affiliation(s)
- Ji Young Choo
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Mi-Young Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Yu Whan Oh
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Bo Kyung Seo
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Bo Kyung Je
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
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Abstract
Tuberculosis (TB) is still a public health issue; it continues to reign as one of the world's deadliest diseases. One-third of the world's population has been infected with TB. Identified cases of mycobacterium must be notified in an attempt to reduce the public health impact of TB on the population. TB transmission occurs via inhalation of droplet nuclei. The most common site for the development of TB is the lungs. Treatment of TB depends on whether latent TB or active TB is treated.
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Affiliation(s)
- Wanda Cruz-Knight
- Department of Family Medicine and Community Health, University Hospitals Case Medical Center, Cleveland, OH 44118, USA.
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Behr MA, Waters WR. Is tuberculosis a lymphatic disease with a pulmonary portal? THE LANCET. INFECTIOUS DISEASES 2013; 14:250-5. [PMID: 24268591 DOI: 10.1016/s1473-3099(13)70253-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tuberculosis most commonly presents as a pulmonary disease, in which infection, persistence, and induction of transmissible pathology all occur in the lungs. If viewed as a pulmonary disease, enlarged lymph nodes represent reactive adenitis, and extrapulmonary forms of tuberculosis (including lymphatic tuberculosis) are not transmissible, hence representing an evolutionary dead-end for the pathogen. In an alternative theory, Mycobacterium tuberculosis passes asymptomatically through the lungs and rapidly establishes a chronic lymphatic infection. After a period of weeks to decades secondary lung pathology develops, ultimately allowing transmission to occur. Evidence that supports this lymphatic model includes historical descriptions of human tuberculosis from the preantibiotic era, analogy with other mycobacterial infections, observations of tuberculosis in non-human hosts, and experimental models of tuberculosis disease. At a fundamental level, a lymphocentric model proposes that spread of organisms outside the lung parenchyma is essential to induce adaptive immunity, which is crucial for the generation of transmissible pathology. Furthermore, a lymphatic model could explain why the lesion associated with primary infection (Ghon focus) is anatomically separated from the most common site of reactivation disease (the apex). More practically, an alternative perspective that classes tuberculosis as a lymphatic disease might affect strategies for preclinical and clinical assessment of novel diagnostics, drugs, and vaccines.
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Affiliation(s)
- Marcel A Behr
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.
| | - W Ray Waters
- Bovine Tuberculosis Research Project, National Animal Disease Center, Ames, IA, USA
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Brust JCM, Berman AR, Zalta B, Haramati LB, Ning Y, Heo M, van der Merwe TL, Bamber S, Moll AP, Friedland GH, Shah NS, Gandhi NR. Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela Ferry, South Africa. PLoS One 2013; 8:e73975. [PMID: 24040132 PMCID: PMC3765317 DOI: 10.1371/journal.pone.0073975] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/26/2013] [Indexed: 01/16/2023] Open
Abstract
Background The majority of patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa are co-infected with HIV, but the radiographic features of MDR-TB and their relationship with time to sputum culture conversion in the antiretroviral therapy era have not been described. Methods We reviewed baseline chest radiographs for 56 patients with MDR-TB from a rural area of South Africa. We analyzed the association of cavities, consolidation, pleural effusion and hilar lymphadenopathy with time to sputum culture conversion, adjusting for HIV status, baseline sputum smear and CD4 count. Results Of the 56 subjects, 49 (88%) were HIV-positive, with a median CD4 count of 136 cells/mm3 (IQR 65-249). Thirty-two (57%) patients were sputum smear positive. Twenty-two (39%) patients had a cavity and 37 (66%) patients had consolidations. Cavitary disease and consolidations were each associated with longer time to culture conversion on bivariate analysis but not after adjusting for sputum smear status (aORs 1.79 [0.94-3.42] and 1.09 [0.67-1.78], respectively). Positive baseline sputum smear remained independently associated with longer time to conversion (aOR 3.45 [1.39-8.59]). We found no association between pleural effusion or hilar lymphadenopathy and time to conversion. Seventy-nine percent of patients were cured at the end of treatment. Conclusions Despite high rates of HIV co-infection and advanced immunodeficiency, the majority of patients had severe pathology on baseline chest radiograph. Nevertheless, culture conversion rates were high and treatment outcomes were favorable. Cavitation and consolidation do not appear to have an independent association with time to culture conversion beyond that of baseline sputum smear status.
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Affiliation(s)
- James C. M. Brust
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
- * E-mail:
| | - Andrew R. Berman
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
- New Jersey Medical School, Newark, New Jersey, United States of America
| | - Benjamin Zalta
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
| | - Linda B. Haramati
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
| | - Yuming Ning
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
| | - Moonseong Heo
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
| | | | - Sheila Bamber
- Philanjalo and Church of Scotland Hospital, Tugela Ferry, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Anthony P. Moll
- Philanjalo and Church of Scotland Hospital, Tugela Ferry, South Africa
| | - Gerald H. Friedland
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - N. Sarita Shah
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
| | - Neel R. Gandhi
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America
- Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
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Tuberculous Lymphadenitis of the Thorax: Comparisons of Imaging Findings Between Patients With and Those Without HIV Infection. AJR Am J Roentgenol 2012; 199:1234-40. [DOI: 10.2214/ajr.12.8522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Soussan M, Brillet PY, Mekinian A, Khafagy A, Nicolas P, Vessieres A, Brauner M. Patterns of pulmonary tuberculosis on FDG-PET/CT. Eur J Radiol 2012; 81:2872-6. [DOI: 10.1016/j.ejrad.2011.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 12/25/2022]
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Abstract
The granuloma that forms in response to Mycobacterium tuberculosis must be carefully balanced in terms of immune responses to provide sufficient immune cell activation to inhibit the growth of the bacilli, yet modulate the inflammation to prevent pathology. There are likely many scenarios by which this balance can be reached, given the complexity of the immune responses induced by M. tuberculosis. In this review, we focus on the key role of the macrophage in balancing inflammation in the granuloma.
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A spotlight on liquefaction: evidence from clinical settings and experimental models in tuberculosis. Clin Dev Immunol 2011; 2011:868246. [PMID: 21437230 PMCID: PMC3061317 DOI: 10.1155/2011/868246] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/19/2010] [Accepted: 12/30/2010] [Indexed: 12/14/2022]
Abstract
Liquefaction is one of the most intriguing aspects of human tuberculosis. It is a major cause of the transition from the infection to active disease (tuberculosis, TB) as well as the transmission of M. tuberculosis to other persons. This paper reviews the natural history of liquefaction in humans from a pathological and radiological point of view and discusses how the experimental models available can be used to address the topic of liquefaction and cavity formation. Different concepts that have been related to liquefaction, from the influence of immune response to mechanical factors, are reviewed. Synchronic necrosis or apoptosis of infected macrophages in a close area, together with an ineffective fibrosis, appears to be clue in this process, in which macrophages, the immune response, and bacillary load interact usually in a particular scenario: the upper lobes of the lung. The summary would be that even if being a stochastic effect, liquefaction would result if the organization of the intragranulomatous necrosis (by means of fibrosis) would be disturbed.
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30
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Seiscento M, Vargas FS, Bombarda S, Sales RKB, Terra RM, Uezumi K, Teixeira LR, Antonangelo L. Pulmonary involvement in pleural tuberculosis: how often does it mean disease activity? Respir Med 2011; 105:1079-83. [PMID: 21392956 DOI: 10.1016/j.rmed.2011.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/09/2011] [Accepted: 02/12/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate in chest X-rays and high-resolution computed tomographies of patients with pleural tuberculosis, the incidence of parenchymal and mediastinal lung lesions suggestive of active disease. METHODS Prospective study (2008-2009) evaluating the radiographic and tomographic abnormalities of 88 HIV-negative patients with pleural tuberculosis (unilateral effusion). The images were reviewed by 3 independent specialists, and the observed changes were classified according to previously established criteria: presence or absence of signs suggestive of disease activity, and nonspecific findings. RESULTS Abnormal changes were observed in chest X-rays of 22 (25%) patients and in the computed tomography of 55 (63%). Images compatible with active pulmonary tuberculosis were detected by radiography in 9 (10%) patients and by tomography in 38 (43%). Only 4 (4.5%) patients had tomography images suggestive of residual disease. CONCLUSION The present study demonstrates that pulmonary involvement is quite common in pleural tuberculosis. This finding is mainly observed in high-resolution computed tomography and has important epidemiological implications, since patients with pleural tuberculosis are significant sources of infection and disease dissemination.
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Affiliation(s)
- Márcia Seiscento
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Brazil
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Almeida LAD, Barba MF, Moreira FA, Bombarda S, Felice SAD, Calore EE. Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8%) dos casos, derrame pleural em 29 (64,4%), nódulos centrolobulares de distribuição segmentar em 26 (57,7%), consolidação em 24 (53,3%), confluência de micronódulos em 17 (37,7%), nódulos mal definidos com distribuição centrolobular em 16 (35,5%), padrão de "árvore em brotamento" em 13 (28,9%), espessamento de parede brônquica em 12 (26,6%), cavidade de parede espessa em 10 (22,2%), nódulos miliares em 9 (20%) e bronquiectasias cilíndricas em 6 (13,3%). Dos 45 pacientes, 35 (77,8%) apresentaram CD4 < 200 cel/mm³ e 10 (22,2%) apresentaram CD4 > 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 < 200 cel/mm³.
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[An 80-year-old male with pleural effusion and mediastinal lymph nodes]. Med Clin (Barc) 2010; 135:700-6. [PMID: 20846696 DOI: 10.1016/j.medcli.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/03/2010] [Indexed: 11/21/2022]
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Koh WJ, Jeong YJ, Kwon OJ, Kim HJ, Cho EH, Lew WJ, Lee KS. Chest radiographic findings in primary pulmonary tuberculosis: observations from high school outbreaks. Korean J Radiol 2010; 11:612-7. [PMID: 21076586 PMCID: PMC2974222 DOI: 10.3348/kjr.2010.11.6.612] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 07/01/2010] [Indexed: 01/05/2023] Open
Abstract
Objective To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients. Materials and Methods The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. Results Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. Conclusion The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.
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Affiliation(s)
- Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Affiliation(s)
- Christoph Lange
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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35
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Vasconcelos-Santos DV, Zierhut M, Rao NA. Strengths and weaknesses of diagnostic tools for tuberculous uveitis. Ocul Immunol Inflamm 2010; 17:351-5. [PMID: 19831571 DOI: 10.3109/09273940903168688] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diagnostic criteria for tuberculous uveitis encompass exclusion of other known etiologies of uveitis, suggestive clinical history and signs, supportive systemic investigations, positive response to empiric antituberculosis treatment and evidence of Mycobacterium tuberculosis or its DNA in ocular fluids/tissues. Recent advances in diagnostic tools for tuberculous infection, including molecular biology techniques for detection of M. tuberculosis DNA and interferon-gamma release assays, have improved the specificity of the diagnosis and the ability to ascertain exposure to the infectious agent. However even with such advances, establishing the diagnosis of tuberculous uveitis remains a challenging issue because each of these available investigations has its strengths and limitations and tuberculous infection can present with clinical features of any type of extraocular or intraocular inflammation. This article critically analyzes the role of these tests in supporting the diagnosis of tuberculous uveitis and proposes a practical diagnostic approach, based on a judicious combination of these tests.
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36
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37
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Reply. AJR Am J Roentgenol 2009. [DOI: 10.2214/ajr.08.1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Ruiz-Manzano J, Blanquer R, Luis Calpe J, Caminero JA, Caylà J, Domínguez JA, María García J, Vidal R. Diagnóstico y tratamiento de la tuberculosis. Arch Bronconeumol 2008. [DOI: 10.1157/13126836] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE Pulmonary tuberculosis (TB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity, especially in developing countries. The traditional imaging concept of primary and reactivation TB has been recently challenged, and radiologic features depend on the level of host immunity rather than the elapsed time after the infection. We aimed to elaborate the new concept of the diagnosis and treatment of pulmonary TB, to review the characteristic imaging findings of various forms of pulmonary TB, and to assess the role of CT in the diagnosis and management of pulmonary TB. CONCLUSION Fast and more accurate TB testing such as bacterial DNA fingerprinting and whole-blood interferon-gamma assay has been developed. Miliary or disseminated primary pattern or atypical manifestations of pulmonary TB are common in patients with impaired immunity. CT plays an important role in the detection of TB in patients in whom the chest radiograph is normal or inconclusive, in the determination of disease activity, in the detection of complication, and in the management of TB by providing a roadmap for surgical treatment planning. PET scans using 18F-FDG or 11C-choline can sometimes help differentiate tuberculous granuloma from lung malignancy.
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40
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Tuberculosis in the age of biologic therapy. J Am Acad Dermatol 2008; 59:363-80; quiz 382-4. [DOI: 10.1016/j.jaad.2008.05.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 05/07/2008] [Accepted: 05/27/2008] [Indexed: 11/17/2022]
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Garcia GF, Moura AS, Ferreira CS, Rocha MODC. Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression. Rev Soc Bras Med Trop 2008; 40:622-6. [PMID: 18200412 DOI: 10.1590/s0037-86822007000600004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 10/11/2007] [Indexed: 01/27/2023] Open
Abstract
Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76% were male. The median CD4 was 106 cells/mm(3) and 71% had CD4 < 200 cells/mm(3). Sputum bacilloscopy was positive in 45% of the patients. Patients with CD4 < 200 cells/mm(3) showed significantly less post-primary pattern (7% vs. 63%; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37% vs. 64%; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm(3) showed post-primary patterns less frequently and reported weight loss more frequently.
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Affiliation(s)
- Guilherme Freire Garcia
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG.
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42
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Ruiz-Manzano J, Blanquer R, Calpe JL, Caminero JA, Caylà J, Domínguez JA, María García J, Vidal R. Diagnosis and Treatment of Tuberculosis. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1579-2129(08)60102-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, Han SK, Shim YS, Yim JJ. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest 2006; 129:1253-8. [PMID: 16685016 DOI: 10.1378/chest.129.5.1253] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To examine the prevalence and characteristics of parenchymal tuberculous pleuritis in adult patients. DESIGN Prospective cohort study. SETTING Three hospitals affiliated with Seoul National University in South Korea. PATIENTS All patients > 15 years old with a diagnosis of tuberculous pleuritis were enrolled prospectively between January 1, 2004, and October 31, 2004. INTERVENTIONS Diagnostic thoracocentesis and CT of the chest were done for each patient. Acid-fast bacilli (AFB) smears and cultures for Mycobacterium tuberculosis were requested if patients produced any sputum. A board-certified radiologist reviewed the chest radiographs for the presence and characteristics of any lesions. MEASUREMENTS AND RESULTS One hundred six patients with tuberculous pleuritis were enrolled (median age, 53 years; range 16 to 89 years). Among them, 33 patients (31%) had sputum or bronchial washing findings positive for AFB smears or for M tuberculosis by culture. Lung parenchymal lesions were observed in 91 of the patients (86%) using chest CT; 39 patients (37%) with parenchymal lesions had radiographic characteristics of active pulmonary tuberculosis. In total, 62 patients (59%) had bacteriologically or radiographically active pulmonary tuberculosis. In addition, 78 patients (74%) had features of reactivated pulmonary tuberculosis. CONCLUSIONS Lung parenchymal lesions were more common in this series of patients with tuberculous pleuritis than has been reported in previous studies. The patients mostly had radiographic features of reactivated, rather than primary, tuberculosis.
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Affiliation(s)
- Hee Joung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Lung Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea
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Basta PC, Alves LCC, Coimbra Júnior CEA. Padrões radiológicos da tuberculose pulmonar em indígenas Suruí de Rondônia, Amazônia. Rev Soc Bras Med Trop 2006; 39:221-3. [PMID: 16699654 DOI: 10.1590/s0037-86822006000200017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foram analisados padrões radiológicos de 23/33 (69,7%) dos indígenas Suruí tratados em 2003-2004. Observou-se 44,8% de consolidações não homogêneas, 10,3% de cavitações e 39,1% de acometimentos múltiplos do parênquima. Apesar de 36% dos doentes avaliados terem apresentado radiografias normais, o tratamento específico foi iniciado sem que tivessem sido esgotadas as possibilidades de investigação diagnóstica.
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Affiliation(s)
- Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ
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45
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Corbett EL, Marston B, Churchyard GJ, De Cock KM. Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet 2006; 367:926-37. [PMID: 16546541 DOI: 10.1016/s0140-6736(06)68383-9] [Citation(s) in RCA: 272] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rapid scale-up of antiretroviral treatment programmes is happening in Africa, driven by international advocacy and policy directives and supported by unprecedented donor funding and technical assistance. This welcome development offers hope to millions of HIV-infected Africans, among whom tuberculosis is the major cause of serious illness and death. Little in the way of HIV diagnosis or care was previously offered to patients with tuberculosis, by either national tuberculosis or AIDS control programmes, with tuberculosis services focused exclusively on diagnosis and treatment of rising numbers of patients. Tuberculosis control in Africa has yet to adapt to the new climate of antiretroviral availability. Many barriers exist, from drug interactions to historic differences in the way that tuberculosis and HIV are perceived, but failure to successfully integrate HIV and tuberculosis control will threaten the viability of both programmes. Here, we review tuberculosis epidemiology in Africa and policy implications of HIV/AIDS treatment scale-up.
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Abstract
Tuberculosis, caused by Mycobacterium tuberculosis, kills approximately two million people each year. The infection is characterized by an inflammatory response culminating in the formation of a granuloma, a collection of immune cells that controls the infection. However, the granuloma can be the source of immunopathology that encourages transmission. Recent data support the idea that mycobacterial products can positively and negatively regulate the inflammatory response. Our contention is that induction of the immune response and subsequent granuloma formation is beneficial to the host for control of infection, and is also beneficial to the bacillus, as a place to hide and as a means for transmitting the infection to naive hosts.
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Affiliation(s)
- JoAnne L Flynn
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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47
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Abstract
In the past 5 years, there have been significant advances in the understanding of the pathogenesis of TB in people infected with HIV and in the approach to diagnosis, treatment, and prevention in patients with HIV. Nucleic acid amplification tests and restriction fragment length polymorphism can contribute to the clinical management of TB patients. New guidelines are available for the treatment of active and latent TB infection in patients with HIV.
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Affiliation(s)
- Peter F Barnes
- Center for Pulmonary and Infectious Disease Control, Departments of Medicine, Microbiology and Immunology, University of Texas Health Center, Tyler, Texas, USA.
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48
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Weis SE, Burgess G. Tuberculosis control in a border state. Treatment of the foreign-born. Infect Dis Clin North Am 2002; 16:59-71. [PMID: 11917816 DOI: 10.1016/s0891-5520(03)00046-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As the epidemiology of TB in the United States changes, with more foreign-born and fewer native-born residents developing the disease, treatment can be expected to become more complicated and expensive.
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Affiliation(s)
- Stephen E Weis
- Department of Medicine, School of Public Health, University of North Texas Health Science Center at Fort Worth, Tarrant County Health Department, Fort Worth, Texas, USA.
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Laws A, Gu Y, Marshall V. Biosynthesis, characterisation, and design of bacterial exopolysaccharides from lactic acid bacteria. Biotechnol Adv 2001; 19:597-625. [PMID: 14550013 DOI: 10.1016/s0734-9750(01)00084-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lactic acid bacteria (LAB) are characterised by their conversion of a large proportion of their carbon feed, fermentable sugars, to lactic acid. However, in addition to lactic acid production, the LAB are able to divert a small proportion of fermentable sugars towards the biosynthesis of exopolysaccharides (EPSs) that are independent of the cell surface and cell wall material. These microbial EPSs when suspended or dissolved in aqueous solution provide thickening and gelling properties, and, as such, there is great interest in using EPSs from food grade microorganisms (such as the LAB that are traditionally used for food fermentations) for use as thickening agents. The current review includes a brief summary of the recent literature describing features of the biosynthetic pathways leading to EPS production. Many aspects of EPS biosynthesis in LAB are still not fully understood and a number of inferences are made regarding the similarity of the pathway to those involved in the synthesis of other cell polysaccharides, e.g., cell wall components. The main body of the review will cover practical aspects concerned with the isolation and characterisation of EPS structures. In the last couple of years, a substantial number of structures have been published and a summary of the common elements of these structures is included as is a suggestion for a system for representing structures. A brief highlight of the attempts that are being made to design 'tailor'-made polysaccharides using genetic modification and control of metabolic flux is presented.
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Affiliation(s)
- A Laws
- School of Applied Sciences, University of Huddersfield, Queensgate, UK.
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50
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de Albuquerque MDF, Albuquerque SC, Campelo AR, Cruz M, de Souza WV, Ximenes RA, de Souza RA. Radiographic features of pulmonary tuberculosis in patients infected by HIV: is there an objective indicator of co-infection? Rev Soc Bras Med Trop 2001; 34:369-72. [PMID: 11562731 DOI: 10.1590/s0037-86822001000400010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV(+), with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV(+) patients and 19% of the HIV(-) had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.
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