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Cesilia C, Nugraha HG, Siregar S, Nataprawira HM. The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report. BMC Urol 2024; 24:61. [PMID: 38504239 PMCID: PMC10949577 DOI: 10.1186/s12894-024-01442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Genitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male. CASE PRESENTATION A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department. CONCLUSIONS Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.
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Affiliation(s)
- Citra Cesilia
- Division of Respirology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Pasteur Street No. 38, Sukajadi, Bandung, West Java, 40161, Indonesia
| | - Harry Galuh Nugraha
- Department of Radiology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Pasteur Street No. 38, Sukajadi, Bandung, West Java, 40161, Indonesia
| | - Safendra Siregar
- Department of Urology Surgery, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Pasteur Street No. 38, Sukajadi, Bandung, West Java, 40161, Indonesia
| | - Heda Melinda Nataprawira
- Division of Respirology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Pasteur Street No. 38, Sukajadi, Bandung, West Java, 40161, Indonesia.
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Prasanna S, Mithari H, Kharkar V. A cross sectional descriptive study of dermoscopic features of clinical variants of cutaneous tuberculosis. Indian J Tuberc 2023; 70:501-507. [PMID: 37968058 DOI: 10.1016/j.ijtb.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 11/17/2023]
Abstract
Tuberculosis continues to be a major public health concern worldwide with almost 20-40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1-1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.
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Affiliation(s)
- Swati Prasanna
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India.
| | - Hershada Mithari
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India
| | - Vidya Kharkar
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India
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Mondoni M, Saderi L, Puci MV, De Pascalis S, Re B, Centanni S, Sotgiu G. Xpert MTB/RIF in the Diagnosis of Mediastinal Tuberculous Lymphadenitis by Endoscopic Ultrasound-Guided Needle Aspiration Techniques: A Systematic Review and Meta-Analysis. Respiration 2023; 102:237-246. [PMID: 36693335 DOI: 10.1159/000528947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Lymphadenopathy is one of the most prevalent clinical manifestations of extrapulmonary tuberculosis. Endosonography is the recommended technique in the diagnostic work-up of mediastinal lymphadenopathies. Xpert MTB/RIF assay is a self-contained cartridge-based fully automated DNA testing platform which can accurately detect both tuberculosis and mycobacterial resistance to rifampicin. A few studies assessed its accuracy for mediastinal lymph node aspirates collected using endosonography. A systematic review of observational studies was performed to provide a pooled estimate of sensitivity and specificity of Xpert MTB/RIF in the diagnosis of mediastinal tuberculous lymphadenitis using endoscopic ultrasound-guided needle aspiration techniques. METHODS A search of the scientific evidence was carried out using PubMed, Embase, and Scopus. Articles describing observational studies on Xpert MTB/RIF in the diagnosis of mediastinal tuberculous lymphadenitis using endoscopic ultrasound-guided needle aspiration techniques were selected. RESULTS Eight studies met the inclusion criteria. The overall pooled sensitivity was 61% (95% CI = 55-68%; I2 = 66.3%; p = 0.004), overall pooled specificity was 89% (95% CI = 85-91%; I2 = 90.1%; p < 0.0001). Area under the sROC curve was 0.68. Only one study reported data on rifampin resistance detection and showed a sensitivity of 83.3% and a specificity of 16%. CONCLUSIONS Xpert MTB/RIF shows a good accuracy in the diagnosis of mediastinal mycobacterial lymphadenitis by endosonographic needle aspiration techniques. It should be always recommended for suspected mediastinal tuberculosis.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mariangela Valentina Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sabrina De Pascalis
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Beatrice Re
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
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Jain P, Singh U, Kumar V, Ratnam R, Jain A. Agreement between CBNAAT, liquid culture and line probe assay for detection of Mycobacterium tuberculosis and anti-tubercular drug resistance in extrapulmonary samples. Indian J Med Microbiol 2022; 40:365-369. [PMID: 35710480 DOI: 10.1016/j.ijmmb.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Cartridge based nucleic acid amplification test (CBNAAT) has been endorsed by the WHO as the screening test for diagnosing extrapulmonary tuberculosis (EPTB). In the present study we report the agreement between CBNAAT (Xpert MTB/RIF), liquid culture (LC) and line probe assay (LPA) for diagnosis of Mycobacterium tuberculosis and detection of drug resistance among EPTB cases. METHODS The EP samples were subjected to CBNAAT (Xpert MTB/RIF, Cepheid, USA) and wherever possible, to LC (MGIT 960, Becton Dickinson, USA) followed sequentially by first line and second line-LPA (FL-LPA, SL-LPA, Hain Lifescience, Germany) on the isolates. RESULTS Total 566/4080 (13.9%) EP samples were detected positive for M. tuberculosis on CBNAAT. Aspirates from lymph nodes were most often positive (11/30; 36.6%), followed by pus (240/873; 27.5%) and CSF samples (166/104; 15.8%). The detection of M. tuberculosis was more in adults than children except in tissue biopsy samples. Rifampicin resistance was also higher among adults except CSF in which resistance was more in children. Total 185 of 566 (32.7%) CBNAAT positive and 770 of 3510 (21.9%) CBNAAT negative samples could be cultured of which 110/185 (59.4%) and 33/770 (4.3%) respectively turned positive. FL-LPA and SL-LPA of 143 culture isolates showed that 27 isolates had drug resistance, of which 3 (2.1%) were XDR, 11 (7.7%) were Pre-XDR (FQ) and 13 (9.1%) were MDR. Of these 27 resistant isolates, 12 were negative by CBNAAT and two were mislabeled as Rifampicin sensitive or indeterminate based on the unique RpoB gene mutation patterns on LPA. The positive and negative agreements between LC and CBNAAT for detection of M. tuberculosis were 67.1% and 92.7% respectively and between LPA and CBNAAT for rifampicin resistance detection were 98.9% and 92.9% respectively. CONCLUSIONS For EPTB, CBNAAT should be accompanied with LC wherever possible irrespective of the CBNAAT result.
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Affiliation(s)
- Parul Jain
- Department of Microbiology, King George's Medical University, Lucknow 226003, India
| | - Urmila Singh
- Department of Microbiology, King George's Medical University, Lucknow 226003, India
| | - Vijay Kumar
- Department of Microbiology, King George's Medical University, Lucknow 226003, India
| | - Rashmi Ratnam
- Department of Microbiology, King George's Medical University, Lucknow 226003, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow 226003, India.
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Shabariah R, Hatta M, Idris I, Santoso A, Patellongi I, Permatasari TAE, Farsida, Islam AA, Natzir R, Wahyudin B, Warsinggih, Emilda. Comparison TLR2 and TLR4 serum levels in children with pulmonary and extrapulmonary tuberculosis with and without a Bacillus Calmette-Guérin (BCG) scar. J Clin Tuberc Other Mycobact Dis 2021; 25:100272. [PMID: 34504953 DOI: 10.1016/j.jctube.2021.100272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The formation of a scar after Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination influences the effectiveness of protection against Mycobacterium tuberculosis (MTB) infection. The innate immunity plays a critical role both in the pathophysiology of tuberculosis (TB) and BCG vaccination protection mechanism. Parts of innate immunity: macrophages, dendritic cells, and neutrophils, have microbial recognition surface receptors called Toll-like receptors (TLR) 2 and 4. The objective of this study is to compare the serum levels of TLR2 and TLR4 in BCG-vaccinated pediatric patients with pulmonary and extrapulmonary TB. This cross-sectional study included children aged less than 18 years old with contracted TB disease and had received BCG vaccination. The subjects were recruited by convenience sampling from both outpatient and inpatient care at Bhakti Medicare and Jakarta Islamic Hospital, from November 2018 to December 2019. Serum TLR2 and TLR4 levels measured using ELISA of the two groups of subjects: children with pulmonary TB (PTB) and extrapulmonary TB (EPTB), were then compared. The presence of BCG scars was included in the analysis. Independent T-test, ANOVA test, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. Serum TLR2 and TLR4 levels were higher in EPTB group, but the difference was not significant (TLR2 p = 0.758 and TLR4 p = 0.646, respectively). Subjects with BCG scars in both groups have significantly higher serum TLR2 and TLR4 levels than those without BCG scars in the EPTB group (EPTB p = 0.001 and p = 0.004, respectively); (PTB p < 0.001 and p < 0.001, respectively). BCG vaccination and MTB infection stimulate better innate immune response in EPTB than in PTB and serum TLR2 and TLR4 levels in those with BCG scars were higher when compared to those without BCG scars.
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Uddin MKM, Ather MF, Rahman A, Nasrin R, Rahman SMM, Kabir S, Chedid C, Ahmed S, Banu S. Genetic diversity and characterization of M. tuberculosis isolates causing extrapulmonary tuberculosis in Bangladesh. Infect Genet Evol 2021; 95:105052. [PMID: 34454121 DOI: 10.1016/j.meegid.2021.105052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
Tuberculosis (TB) remains one of the leading causes of death and Bangladesh ranks 7th among the highest TB burden countries. Though molecular epidemiological data for pulmonary TB (PTB) have previously been described in Bangladesh, data on the molecular characterization and clinical association with different lineages among extrapulmonary TB (EPTB) is lacking. The aim of the study was to investigate the molecular characterization and lineage distribution of M. tuberculosis isolates obtained from patients with EPTB in Bangladesh. Between November 2015 and March 2017, a total of 1,340 EPTB specimens including lymph node, pus, tissue, ascitic fluid, cerebrospinal fluid, pleural fluid, abscess wall, urine etc. were collected from four tertiary care hospitals in Dhaka city, Bangladesh. Among the specimens, 141 were found positive on solid culture. Molecular characterization of the 141 isolates was done by deletion analysis, spoligotyping and Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats (MIRU-VNTR) analysis. Among the 141 isolates, 80 (56.7%) were found as 'modern' and the remaining 61 (43.3%) were 'ancestral' type. Spoligotyping results revealed 91 distinct patterns of which 74 isolates were unique and the remaining 67 were divided into 17 distinct clusters. East African- Indian (EAI) lineage was the most predominant, comprising 26 (18.4%) isolates, followed by the Beijing lineage (14.2%). 15-loci MIRU-VNTR analysis revealed that 132 isolates (93.5%) had unique patterns, whereas only 9 (6.5%) isolates were grouped into 4 distinct clusters. In conclusion, the study findings provide a first insight into genetic diversity of EPTB isolates in Bangladesh. The present study demonstrated that 'modern' strains were more prevalent among the EPTB cases, while EAI lineages were predominantly circulating in this region.
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Affiliation(s)
| | - Md Fahim Ather
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
| | - Arfatur Rahman
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh; Medicinal Chemistry Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia.
| | - Rumana Nasrin
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
| | - S M Mazidur Rahman
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
| | - Senjuti Kabir
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
| | - Carole Chedid
- Laboratoire des Pathogènes Emergents Centre International de Recherche en Infectiologie, 21 Avenue Tony Garnier, 69365 Lyon Cedex 07, France; Département de Biologie, Ecole Normale Supérieure de Lyon, Lyon, France.
| | - Shahriar Ahmed
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
| | - Sayera Banu
- Infectious Diseases Division, icddr,b 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh.
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Sharma K, Singh S, Sharma M, Batra N, Kaur V, Modi M, Sharma A, Ray P. Multi-targeted loop mediated amplification PCR for diagnosis of extrapulmonary tuberculosis. Indian J Tuberc 2020; 67:479-482. [PMID: 33077047 DOI: 10.1016/j.ijtb.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AIMS The present study was conceived to evaluate multi-targeted loop mediated amplification (MLAMP) for the rapid diagnosis of extrapulmonary tuberculosis (EPTB). METHODS AND RESULTS A total of 700 patients were included who were classified into 2 groups: Group 1 (n = 400) included a 100 culture confirmed EPTB patients and 300 culture negative, suspected EPTB patients. Group 2 (n = 300) included negative controls from non-tubercular patients. All samples were subjected to Ziehl-Neelsen microscopy, solid culture on Lowenstein Jensen media, Polymerase chain reaction (PCR) targeting IS6110 gene and LAMP targeting both IS6110 and MPB64 individually and as MLAMP. The overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the MLAMP assay were 12%, 25%, 72.5%, 80% and 86.6% respectively and the specificity of all the tests was 100%. CONCLUSION MLAMP is a rapid robust tool for the diagnosis of EPTB and utilizing two targets for M. tuberculosis can improve the overall sensitivity and increase the yield of detection from extrapulmonary samples. The rapidity, ease of performance and low cost make MLAMP an excellent alternative in low-income, resource limited settings.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nitya Batra
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varpreet Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Algazaq JN, Daid SS, Zaidi N. Abdominal Mass and Fever in a Young Woman. Gastroenterology 2020; 159:48-49. [PMID: 32205167 DOI: 10.1053/j.gastro.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Jumanah N Algazaq
- Department of Internal Medicine, Roger Williams Medical Center, Rhode Island.
| | | | - Najam Zaidi
- Department of Infectious Disease, Roger Williams Medical Center, Rhode Island
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Abstract
Current guidelines regarding management of spinal TB are mostly extrapolated from trials on pulmonary disease. Since the British Medical Research Council (BMRC) trials in the 1970s, there are not many good quality studies that substantiate best practice guidelines for the management of this entity. Tuberculous infection of the spine behaves much differently from bacterial osteomyelitis and limited data leads to ambiguity in many cases. Although a few studies have been conducted in patients with spinal TB, most were in the era preceding short course chemotherapy and prior to current radiological and surgical advances. While spinal TB is primarily managed medically, surgical intervention may be needed in certain cases. We discuss areas of uncertainty and challenges that exist with regards to medical treatment, diagnosis, therapeutic endpoints, and a few surgical considerations. Substantial delay in diagnosis continues to be common with this disease even in the developed nations, leading to substantial morbidity. In light of limited evidence, there is an emerging recognition of the need to individualize various aspects of its treatment such as duration, frequency and acknowledging the limitations of various diagnostic and radiological modalities. We aim to consolidate potential areas of research in the diagnosis and management of spinal TB and to revisit the latest published evidence on its redressal.
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Affiliation(s)
- Aakriti Pandita
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Nikhil Madhuripan
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Saptak Pandita
- Division of Medicine, Hind Institute of Medical Sciences, India
| | - Rocio M. Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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De Mulder P, Harth C, Ide L, Vallaeys J, Baelde N, De Bo T. An uncommon cause of sciatic pain: tuberculous osteomyelitis of the ischial tuberosity. Acta Clin Belg 2017; 72:357-360. [PMID: 28074705 DOI: 10.1080/17843286.2016.1271499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 66-year-old Caucasian female presented with insidious sciatic pain leading to an uncommon diagnosis of tuberculous osteomyelitis with unknown portal entry. The patient did not report a history of a previous tuberculosis (TB) infection and her chest X-ray was negative for TB. Considering TB in the differential diagnosis of a 'bone abscess', it is of paramount importance to come to a correct diagnosis. Conventional radiographs still remain the first-line imaging modality for evaluation of skeletal symptomatology. However, biopsies or aspirates are often needed to yield the definitive diagnosis. The lack of awareness of the potential extrapulmonary involvement of TB leads to an important delay in diagnosis and treatment. Antituberculous drugs should be started at the time of biopsy and continued during 12-18 months, due to poor drug penetration into osseous and fibrous tissues.
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Affiliation(s)
| | | | - Louis Ide
- Department of Microbiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Jurgen Vallaeys
- Department of Pathology, Jan Palfijn Hospital, Ghent, Belgium
| | - Nick Baelde
- Department of Radiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Thomas De Bo
- Department of Orthopaedic surgery, Jan Palfijn Hospital, Ghent, Belgium
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Jetley S, Jairajpuri ZS, Pujani M, Khan S, Rana S. Tuberculosis 'The Great Imitator': A usual disease with unusual presentations. Indian J Tuberc 2016; 64:54-59. [PMID: 28166920 DOI: 10.1016/j.ijtb.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND A number of infectious diseases have been referred to by the phrase 'The Great Imitator', of which the oldest is syphilis; others include Lyme disease, nocardiosis, etc. Tuberculosis has been described as the second great imitator as it can imitate various other disease processes. An awareness of the atypical clinical manifestations of tuberculosis is important, especially in regions where tuberculosis continues to be a major public health problem, such as India. Extrapulmonary tuberculosis (EPTB) constitutes about 15-20% of all cases of tuberculosis in immunocompetent patients and accounts for more than 50% of the cases in human immunodeficiency virus (HIV)-positive individuals. METHODS We hereby report 4 cases of tuberculosis at unusual sites, which were not suspected clinically and were subsequently diagnosed by pathological examination and by ancillary techniques. OBSERVATIONS AND RESULTS In all the four cases, the involvement was extrapulmonary in nature and at unusual sites. Three cases were diagnosed by a positive Ziehl Neelsen stain while culture for Mycobacterium tuberculosis was positive in three cases. All the four patients tested negative for HIV status on serology. CONCLUSIONS AND IMPLICATIONS Unusual presentations, which mimic many diverse conditions, as seen in this series, highlight the importance of a high index of suspicion in the timely diagnosis of tuberculosis. Evidence of systemic or lung involvement may not always be present and laboratory and radiological findings play an important role.
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Affiliation(s)
- Sujata Jetley
- Professor & Head, Dept. of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Zeeba S Jairajpuri
- Associate Professor, Dept. of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mukta Pujani
- Associate Professor, Dept. of Pathology, ESI Medical College, Faridabad, India.
| | - Sabina Khan
- Associate Professor, Dept. of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Safia Rana
- Lecturer, Dept. of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Gutlapalli R, Sykam A, Tenali SP, Chandran P, Suneetha S, Suneetha LM. Detection of Tuberculosis in HIV Co-infected Individuals: Use of Multiple ELISA Responses to 38kDa, Lipoarabinomannan and ESAT- 6 of M. tuberculosis. J Clin Diagn Res 2016; 10:KC01-4. [PMID: 27042484 DOI: 10.7860/jcdr/2016/16559.7322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/22/2015] [Indexed: 01/06/2023]
Abstract
INTRODUCTION There is a constant search for more sensitive and specific laboratory markers for tuberculosis (TB) infection. The early detection of TB in HIV co infected individuals is a diagnostic challenge. This is further compounded in those harbouring extrapulmonary disease. AIM To evaluate the use of multiple Enzyme Linked Immunosorbent Assays (ELISA) quantifying antibody responses to 38kDa, LAM and ESAT-6 M.tb antigens in detection of TB in patients with TB and HIV-TB co-infection. MATERIALS AND METHODS This is a cross-sectional study carried out in Hyderabad, India. Patient groups included 124 HIV-TB {62 with pulmonary TB (PTB) and 62 with extrapulmonary TB (ETB)}, 39 TB, 56 HIV and 57 healthy subjects (HS). A combination of anti 38kDa and LAM ELISAs measuring IgG, IgM and IgA levels and another ELISA measuring anti ESAT-6 combined antibody levels of IgG, IgM and IgA were evaluated. One-way ANOVA was performed to compare antibody responses among groups. To assess the efficacy of multiple ELISAs in detecting TB, concomitant seropositivity of an individual for all four ELISAs were evaluated for sensitivity and specificity. RESULTS A single ELISA carried out to detect TB in HIV patients showed a sensitivity ranging from 39% to 72%. The sensitivities of concomitant evaluation of multiple ELISAs were 92% for any single, 72% for any two, 44% for any three and 14% for any four. Based on the specificities, a simple algorithm for TB detection can be deduced. When four ELISAs are positive (specificity 100%) in a patient-confirmed TB; when three ELISAs are positive (specificity 98%) - probably TB; when two ELISAs are positive (specificity 95%) - possibly TB; and when one ELISA is positive (specificity 70%) - suspicion of TB. CONCLUSION The present study establishes the value of combining two or more M.tb antigen based ELISAs to enhance the sensitivity and specificity of TB detection in patients with tuberculosis as well as in those co-infected with HIV.
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Affiliation(s)
- Ravi Gutlapalli
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Aparna Sykam
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Sandeep P Tenali
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Priscilla Chandran
- Professor and Head, Department of Biochemistry, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, Telangana, India
| | - Sujai Suneetha
- Director, CODEWEL-Nireekshana-ACET (AIDS Care Education and Training) , Hyderabad, Telangana, India
| | - Lavanya M Suneetha
- Research Director, CODEWEL-Nireekshana-ACET (AIDS Care Education and Training) , Hyderabad, Telangana, India
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Yashveer JK, Kirti YK. Presentations and Challenges in Tuberculosis of Head and Neck Region. Indian J Otolaryngol Head Neck Surg 2016; 68:270-4. [PMID: 27508125 DOI: 10.1007/s12070-015-0923-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022] Open
Abstract
(1) To study the different patterns of presentations of tuberculosis in Head and Neck region. (2) To know the importance and reliability of ESR and Mantoux test as an aid in diagnosis of tuberculosis. This study was conducted at Department of ENT and Head and Neck Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh from January 2014 to June 2015. Patients presenting with lesions in the Head and Neck region suspected of tuberculosis were subjected for cytological and histological investigations. Those cases confirmed to be tuberculosis on the basis of either of these tests were included in the study. Study comprised of 113 proven cases of tuberculosis of Head and Neck region. A female preponderance of 1:1.97 (M:F) ratio was noted. Most commonly involved structure was cervical lymph node (92.92 %) followed by larynx, skin and oral mucosa (1.76 %). It was also noted that Mantoux test was positive in 93.8 % of patients and ESR was >30 mm (first hour) in 95.5 % of patients with tuberculosis. Most common presentation of Tuberculosis in Head and Neck area was cervical lymphadenopathy. In a developing country like India the population is mostly in the lower socioeconomic strata. Access to various modern investigations is limited and diagnosis is challenging. Here ESR and Mantoux test are helpful in purusing the case for further evaluation. Based on these pointers cytologically negative cases can be taken up for biopsy.
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Hasan Z, Irfan M, Khan JA, Jahangir SK, Haris M, Ashraf M, Salahuddin N, Jamil B, Rao NA. BCG vaccination is associated with decreased severity of tuberculosis in Pakistan. Int J Mycobacteriol 2012; 1:201-6. [PMID: 26785624 DOI: 10.1016/j.ijmyco.2012.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022] Open
Abstract
Vaccination with Bacille Calmette-Guérin (BCG) is given at birth to protect against tuberculosis (TB) in Pakistan. The country ranks 6th amongst high-burden countries worldwide and has an incidence of 231/100,000 pyopulation. This was a cross-sectional multi-center hospital-based study. TB patients (n=218) with pulmonary (PTB, n=120) or extrapulmonary (ETB, 98) were recruited, and the presence of a BCG vaccination scar was documented. Cases were further classified into minimal, moderate and advanced PTB or less severe (L-ETB) or severe disseminated (D-ETB) disease. The association of age, gender and severity of TB infections with BCG vaccination of the individual TB cases was investigated. No difference was found of the BCG vaccination status of PTB and ETB cases, or in relation to age or gender. Patients under 29years of age comprised the largest group. There were more females with ETB than PTB. The largest group within ETB comprised those with tuberculous lymphadenitis (LNTB, 39%). A significantly greater number of LNTB cases had received BCG vaccinations than had those with pleural (unilateral) TB (p=0.004), and tuberculous meningitis (p=0.027) groups. Also, there were more immunized patients with pulmonary as compared with pleural disease (p=0.001). LNTB represents localized granulomatous disease and the observation of higher vaccination rates in this group suggests that BCG has protected against more severe forms of TB in this high-burden region.
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Affiliation(s)
| | | | | | | | - Muhammad Haris
- Dow University of Health Sciences Medical School, Karachi, Pakistan
| | | | | | | | - Nisar A Rao
- Dow University of Health Sciences Medical School, Karachi, Pakistan
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Barthwal MS, Rajan KE, Deoskar RB, Sharma SK. Extrapulmonary Tuberculosis in Human Immunodificiency Virus Infection. Med J Armed Forces India 2011; 61:340-1. [PMID: 27407802 DOI: 10.1016/s0377-1237(05)80059-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Accepted: 09/21/2004] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In view of increase in incidence of exptrapulmonary tuberculosis after the epidemic of human immunodeficiency virus infection, the clinical profile of extrapulmonary tuberculosis in patients with HIV infection was studied. METHOD The study population comprised patients of HIV infection with extrapulmonary tuberculosis. Work up included history, clinical examination, sputum for acid fast bacilli, chext X-ray, ultrasonography (USG) abdomen, fine needle aspiration cytology(FNAC), transbronchial needle aspiration (TBNA) and computed tomography of chest. RESULTS There were 50 cases, all males with mean age of 35 years. 24(48%) were without pulmonary tuberculosis and 26(52%) had pulmonary tuberculosis. 41(82%) had disseminated disease and 9(18%) involve one site. Fever and weight loss were the most frequent symptoms (79% and 58% respectively) in cases without pulmonary tuberculosis. The most frequent extrapulmonary site was lymph node in 46(92%), followed by spleen in 13(26%), pleura 9(18%), miliary 7(14%) and hepatic 1(2%). The diagnosis was confirmed by invasive methods in 30 out of 50(60%) cases [FNAC in 23(88%), TBNA in 2(25%) and pleural biopsy in 5(55%)]. CONCLUSION In HIV infected patients, the most common extrapulmonary site is lymph mode followed by spleen.
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Affiliation(s)
| | - K E Rajan
- Senior Advisor(Medicine and Respiratory Medicine), Military Hospital (CTC), Pune-40
| | - R B Deoskar
- Classified Specialist(Medicine) MH Namkum; Classified Specialist (Med) BH Delhi Cantt
| | - S K Sharma
- Commandant, Military Hospital (CTC), Pune-40
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