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Wang Y, Jin F, Mao W, Yu Y, Xu W. Identification of diagnostic biomarkers correlate with immune infiltration in extra-pulmonary tuberculosis by integrating bioinformatics and machine learning. Front Microbiol 2024; 15:1349374. [PMID: 38384272 PMCID: PMC10879613 DOI: 10.3389/fmicb.2024.1349374] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
The diagnosis of tuberculosis depends on detecting Mycobacterium tuberculosis (Mtb). Unfortunately, recognizing patients with extrapulmonary tuberculosis (EPTB) remains challenging due to the insidious clinical presentation and poor performance of diagnostic tests. To identify biomarkers for EPTB, the GSE83456 dataset was screened for differentially expressed genes (DEGs), followed by a gene enrichment analysis. One hundred and ten DEGs were obtained, mainly enriched in inflammation and immune -related pathways. Weighted gene co-expression network analysis (WGCNA) was used to identify 10 co-expression modules. The turquoise module, correlating the most highly with EPTB, contained 96 DEGs. Further screening with the least absolute shrinkage and selection operator (LASSO) and support vector machine recursive feature elimination (SVM-RFE) narrowed down the 96 DEGs to five central genes. All five key genes were validated in the GSE144127 dataset. CARD17 and GBP5 had high diagnostic capacity, with AUC values were 0.763 (95% CI: 0.717-0.805) and 0.833 (95% CI: 0.793-0.869) respectively. Using single sample gene enrichment analysis (ssGSEA), we evaluated the infiltration of 28 immune cells in EPTB and explored their relationships with key genes. The results showed 17 immune cell subtypes with significant infiltrations in EPTB. CARD17, GBP5, HOOK1, LOC730167, and HIST1H4C were significantly associated with 16, 14, 12, 6, and 4 immune cell subtypes, respectively. The RT-qPCR results confirmed that the expression levels of GBP5 and CARD17 were higher in EPTB compared to control. In conclusion, CARD17 and GBP5 have high diagnostic efficiency for EPTB and are closely related to immune cell infiltration.
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Affiliation(s)
| | | | | | | | - Wenfang Xu
- Department of Clinical Laboratory, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China
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Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol 2024; 97:1-12. [PMID: 38263840 PMCID: PMC11027299 DOI: 10.1093/bjr/tqad019] [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: 08/05/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024] Open
Abstract
Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.
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Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mouna Chelli Bouaziz
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis, Tunisia
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore
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da Silva MP, Cassim N, Ndlovu S, Marokane PS, Radebe M, Shapiro A, Scott LE, Stevens WS. More Than a Decade of GeneXpert ®Mycobacterium tuberculosis/Rifampicin (Ultra) Testing in South Africa: Laboratory Insights from Twenty-Three Million Tests. Diagnostics (Basel) 2023; 13:3253. [PMID: 37892074 PMCID: PMC10605857 DOI: 10.3390/diagnostics13203253] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
This study seeks to describe the rollout and current state of South Africa's GeneXpert molecular diagnostic program for tuberculosis (TB). Xpert MTB/RIF was introduced in 2011 with a subsequent expansion to include extra-pulmonary and paediatric testing, followed by Xpert MTB/RIF Ultra in 2017. Through a centralised laboratory information system and the use of a standardised platform for more than a decade, over 23 million tests were analysed, describing the numbers tested, Mycobacterium tuberculosis complex detection, rifampin resistance, and the unsuccessful test rates. The stratification by province, specimen type, age, and sex identified significant heterogeneity across the program and highlighted testing gaps for men, low detection yield for paediatric pulmonary TB, and the effects of inadequate specimen quality on the detection rate. The insights gained from these data can aid in the monitoring of interventions in support of the national TB program beyond laboratory operational aspects.
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Affiliation(s)
- Manuel Pedro da Silva
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
| | - Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
| | - Silence Ndlovu
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
| | - Puleng Shiela Marokane
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
| | - Mbuti Radebe
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
| | - Anne Shapiro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Lesley Erica Scott
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
| | - Wendy Susan Stevens
- National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa; (N.C.); (S.N.); (P.S.M.); (M.R.); (W.S.S.)
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
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Bal HB, Kar S, Otta S, Kumar S, Samal S, Pattnaik A, Rout SS, Turuk J, Das D, Pati S, Giri S. Impact of cartridge-based nucleic acid amplification test (CBNAAT) introduction on the detection of pulmonary and extra-pulmonary tuberculosis in Bhubaneswar, Odisha. INDIAN J PATHOL MICR 2023; 66:764-769. [PMID: 38084529 DOI: 10.4103/ijpm.ijpm_666_22] [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] [Indexed: 11/17/2022] Open
Abstract
Background Compared to conventional microscopy, the cartridge-based nucleic acid amplification test (CBNAAT, Xpert MTB/RIF, Cepheid, USA) has the dual advantage of higher sensitivity to detect Mycobacterium tuberculosis (M. tb), and the ability to detect rifampicin resistance. Aim To evaluate the impact of the CBNAAT on the detection of pulmonary and extra-pulmonary tuberculosis from private and public healthcare facilities in Bhubaneswar, Odisha. Materials and Methods The study included specimens received between June 2015 to February 2017 from public and private health sectors for tuberculosis diagnosis at a national reference laboratory for tuberculosis in Bhubaneswar, where the CBNAAT was initiated in February 2016. We retrospectively collected the patients' socio-demographic characteristics from their test request form, CBNAAT results from the CBNAAT register and PMDT culture and drug susceptibility testing (DST) register and validated the data by comparing the patient details and test results from the CBNAAT software. Results From June 2015 to January 2016, 106 samples were received from Bhubaneswar at the reference laboratory, of which there were zero referrals from the private sector and zero referrals of extra-pulmonary tuberculosis (TB) samples. After initiation of the CBNAAT, from February 2016 to February 2017, 1262 specimens were received, of which 55.2% (696/1262), 17.8% (225/1262), 17.2% (217/1262), and 9.8% (124/1262) were from government hospitals and medical colleges, private hospitals, private practitioners, and district TB centers, respectively. Conclusion The availability of TB diagnostics at public sector facilities to patients from private sectors and the rollout of the CBNAAT increased the referral of patients from private health facilities and the referral of paucibacillary non-sputum samples.
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Affiliation(s)
| | - Sarita Kar
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sujeet Kumar
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Suryakanta Samal
- Department of Health and Family Welfare, Government of Odisha Microbiologist, Rayagada, Odisha, India
| | - Archana Pattnaik
- Biofuels and Bioprocessing Research Center, ITER, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Sunil Swick Rout
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jyotirmayee Turuk
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Dasarathi Das
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sidhartha Giri
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Binsaeedu AS, Sadi NV, Yusuf S, Yusuf S, Youshay H. Non-contiguous Rare Presentation of Spinal Tuberculosis: A Case Report. Cureus 2023; 15:e44881. [PMID: 37814759 PMCID: PMC10560378 DOI: 10.7759/cureus.44881] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Spinal tuberculosis (TB), also known as Pott's disease, is a severe form of extrapulmonary TB that affects the vertebral bodies and intervertebral discs. While the typical presentation involves the contiguous involvement of multiple vertebrae, atypical forms, such as non-contiguous multilevel spinal TB (NMLST), can occur. However, diagnosing spinal TB poses challenges due to its gradual onset, nonspecific symptoms, and varying imaging results. The timely diagnosis and treatment of spinal TB are critical to prevent serious consequences, including vertebral damage, irreversible neurological impairment, or even death. In this report, we present the case of a 58-year-old South Asian female who presented with several months of back pain, fatigue, and weight loss. Despite initially negative TB test results, spinal magnetic resonance imaging (MRI) raised suspicion of NMLST, which was later confirmed by bone biopsy. This case highlights the complexities of diagnosing and managing atypical spinal TB presentations while discussing the case findings and reviewing relevant research.
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Affiliation(s)
| | - Nehal V Sadi
- Internal Medicine, Saint James School of Medicine, Chicago, USA
| | - Sagal Yusuf
- Internal Medicine, Windsor University School of Medicine, Illinois, USA
| | - Salma Yusuf
- Internal Medicine, Windsor University School of Medicine, Illinois, USA
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Al Jazzar RI, Sulaihim Z, Alkhiary A, Alzahrani N. Abdominal tuberculosis mimicking peritoneal metastasis. Pleura Peritoneum 2023; 8:139-140. [PMID: 37662603 PMCID: PMC10469162 DOI: 10.1515/pp-2023-0012] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Ragad I. Al Jazzar
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zeinah Sulaihim
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmad Alkhiary
- Department of Pathology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nayef Alzahrani
- Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Bhunia SK, Dey S, Pal A, Giri B. Evaluation of socio-demographic profile and basic risk factors of tuberculosis patients in South 24 Parganas district of West Bengal, India: a hospital-based study. Afr Health Sci 2023; 23:358-365. [PMID: 38357120 PMCID: PMC10862564 DOI: 10.4314/ahs.v23i3.42] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim To study and analyse the socio-demographic profile and basic risk factors of tuberculosis(TB) patients and their relation with the current epidemiological status of TB registered under the RNTEP program in the study area. Subjects and Methods This prospective study was conducted on 1743 newly registered tuberculosis patients at TB-DOT center of South 24 Parganas, West Bengal, India from 2011-2014. Socio-demographic variables and baseline characteristics of the participants were noted by a semi-structured questionnaire. Results Our study results indicate that more than 95% of the TB patients were from lower socioeconomic class, and had poor literacy status and tuberculosis was observed highest in non-agricultural labour and cultivators. Among the young adult's majority of the affected population were females from the lower/upper-lower socioeconomic class. Our analysis revealed that, in successful tuberculosis therapy, men were more defaulters than women. Conclusion Our study provides a socioeconomic profile and the risk factors of tuberculosis in patients such as the status of therapeutic intervention, involvement of other chronic diseases, age, sex and malnutrition. The findings of this study can be used to plan future studies with specific risk factors of the region and also for implementing the intervention and evaluating its effectiveness.
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Affiliation(s)
| | - Sananda Dey
- Department of Physiology, University of Gour Banga, Malda 732103, India
| | - Amitava Pal
- Department of Physiology, City College, University of Calcutta, Kolkata 700009, India
| | - Biplab Giri
- Department of Physiology, University of Gour Banga, Malda 732103, India
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8
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Bose M, Giri A, Varma-Basil M. Comparative Genetic Association Analysis of Human Genetic Susceptibility to Pulmonary and Lymph Node Tuberculosis. Genes (Basel) 2023; 14:genes14010207. [PMID: 36672948 PMCID: PMC9859508 DOI: 10.3390/genes14010207] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) manifests itself primarily in the lungs as pulmonary disease (PTB) and sometimes disseminates to other organs to cause extra-pulmonary TB, such as lymph node TB (LNTB). This study aimed to investigate the role of host genetic polymorphism in immunity related genes to find a genetic basis for such differences. METHODS Sixty-three, Single nucleotide polymorphisms (SNPs) in twenty-three, TB-immunity related genes including eleven innate immunity (SLCA11, VDR, TLR2, TLR4, TLR8, IRGM, P2RX7, LTA4H, SP110, DCSIGN and NOS2A) and twelve cytokine (TNFA, IFNG, IL2, Il12, IL18, IL1B, IL10, IL6, IL4, rs1794068, IL8 and TNFB) genes were investigated to find genetic associations in both PTB and LNTB as compared to healthy community controls. The serum cytokine levels were correlated for association with the genotypes. RESULTS PTB and LNTB showed differential genetic associations. The genetic variants in the cytokine genes (IFNG, IL12, IL4, TNFB and IL1RA and TLR2, 4 associated with PTB susceptibility and cytokine levels but not LNTB (p < 0.05). Similarly, genetic variants in LTA4H, P2RX7, DCSIGN and SP110 showed susceptibility to LNTB and not PTB. Pathway analysis showed abundance of cytokine related variants for PTB and apoptosis related variants for LNTB. CONCLUSIONS PTB and LNTB outcomes of TB infection have a genetic component and should be considered for any future functional studies or studies on susceptibility to pulmonary and extra-pulmonary TB.
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Affiliation(s)
- Mridula Bose
- Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
- Correspondence: (A.); (M.B.)
| | - Astha Giri
- Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
| | - Mandira Varma-Basil
- Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
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Velásquez Gortaire E, Sívori M, Jajati M, Trullás MF. [Coinfection of COVID-19 and extrapulmonary tuberculosis]. Medicina (B Aires) 2022; 82:167-171. [PMID: 35417378] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The SARS-CoV-2 coronavirus pandemic continues causing significant global morbidity and mortality. COVID-19 is an acute respiratory infection that can affect other organs. Tuberculosis (TB) is also an endemic infection that typically occurs with pulmonary involvement and very infrequently, with extra-pulmonary involvement. There is little information on extrapulmonary TB and COVID-19 coinfection. The objective of this communication was to present information about this association in a public hospital in the city of Buenos Aires. Between March 2020 and April 2021, our Hospital diagnosed 10 809 cases of COVID-19, 106 of TB and 20 of TB-COVID-19 coinfection (incidence 185 cases of TB/100 000 cases of COVID-19), exceeding more than six times the average frequency of TB/100 000 inhabitants of the country (31/100 000). Of these 20 cases diagnosed with COVID-19 and TB, five presented extrapulmonary involvement due to TB (25%). The median age was 30 years (CI25-75, 28-31), three (60%) of them were female. The most frequently associated infection was due to human immunodeficiency virus, (n = 3), underweight (n = 2), COPD (n = 1) and drug addiction (n = 1). Three presented exclusive extrapulmonary involvement of the central nervous system, two pulmonary and pericardial. Four patients (80%) had a favorable evolution.
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Affiliation(s)
- Edgar Velásquez Gortaire
- Unidad de Neumotisiología, Centro Universitario de Neumonología Dr. J. M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Hospital General de Agudos Dr. J.M. Ramos Mejía, Buenos Aires, Argentina. E-mail:
| | - Martín Sívori
- Unidad de Neumotisiología, Centro Universitario de Neumonología Dr. J. M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Hospital General de Agudos Dr. J.M. Ramos Mejía, Buenos Aires, Argentina
| | - Mónica Jajati
- Unidad de Neumotisiología, Centro Universitario de Neumonología Dr. J. M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Hospital General de Agudos Dr. J.M. Ramos Mejía, Buenos Aires, Argentina
| | - María F Trullás
- Unidad de Neumotisiología, Centro Universitario de Neumonología Dr. J. M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Hospital General de Agudos Dr. J.M. Ramos Mejía, Buenos Aires, Argentina
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Alrashed RF, Alkhuwaylidi AA, Aldashash KA, Albati NA, Algarni AA, Almodhaiberi H, Al Hasan I. Peritoneal Tuberculosis in a Young Healthy Male Resembling Intra-Abdominal Malignancy. Cureus 2021; 13:e20677. [PMID: 35106218 PMCID: PMC8784981 DOI: 10.7759/cureus.20677] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/05/2022] Open
Abstract
Intra-peritoneal tuberculosis is a rare disease, accounting for 1-2% of all tuberculosis cases. The absence of characteristic clinical picture of intra-peritoneal tuberculosis makes the diagnosis rarely easy for clinicians as it mimics malignancy. We present a case of a young male patient who presented with peritoneal tuberculosis, aiming to contribute to a better understanding of peritoneal tuberculosis in the literature.
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Affiliation(s)
- Rema F Alrashed
- Department of Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | | | - Khloud A Aldashash
- Department of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Naif A Albati
- Department of Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | | | | | - Ibrahim Al Hasan
- Department of Surgery, Prince Sultan Military Medical City, Riyadh, SAU
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Jha AK, Jalan D, Beniwal RK. Tubercular Osteomyelitis of Pubis with Labial Abscess: A Rare Presentation of a Common Disease. J Orthop Case Rep 2021; 11:22-25. [PMID: 35415143 PMCID: PMC8930370 DOI: 10.13107/jocr.2021.v11.i12.2550] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Skeletal tuberculosis (TB) accounts for 10-15% of all cases of extra-pulmonary TB. The involvement of pubis is extremely rare with only 40 cases of pubic bone TB reported in the medical literature. The presentation of the disease with labial abscess is much rarer with only one case reported till now. Case Report A 23-year-old female presented with symptoms of pain and swelling in the right groin. The patient was evaluated with hematological and radiological investigations and the diagnosis of Tubercular osteomyelitis of pubis with labial abscess was confirmed using AFB staining and culture of the aspirate. The patient was subsequently managed with Anti-tubercular chemotherapy for 18 months and the lesion healed with excellent functional outcome. Conclusion Tubercular Osteomyelitis of the pubis is a rare disease with varied clinical presentation. Timely diagnosis and anti-tubercular chemotherapy usually result in complete recovery.
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Affiliation(s)
- Amit Kumar Jha
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divesh Jalan
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,Address of Correspondence: Dr. Divesh Jalan, Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029. India. E-mail:
| | - R K Beniwal
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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12
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Zhou Q, Zhang M. Disseminated tuberculosis mimicking abdominal metastatic carcinoma: A case report. Medicine (Baltimore) 2021; 100:e27886. [PMID: 34964756 PMCID: PMC8615311 DOI: 10.1097/md.0000000000027886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/23/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Extra-pulmonary tuberculosis (TB) has long been a diagnostic challenge for clinicians, often requiring extensive workup and invasive procedures, with the risk of significant complications. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive and highly accurate diagnostic modality for the evaluation of mediastinal and abdominal lymphadenopathy and masses. Several reports on the utility of EUS-FNA as a favorable method for diagnosing extrapulmonary TB have been published. PATIENT CONCERNS A 54-year-old man complained of intermittent melena. DIAGNOSES 18 fluorine-fluorodeoxyglucose positron emission tomography/computed tomography revealed suspected carcinoma metastasis. EUS-FNA did not reveal any evidence of malignancy. INTERVENTIONS AND OUTCOMES Laparoscopy was performed, and frozen section pathology during surgery showed granulomas with focal necrosis. Mycobacterium tuberculosis polymerase chain reaction was positive, but acid-fast bacilli staining was negative. Anti-TB treatment was initiated, and the patient was advised to visit the local TB dispensary regularly. LESSONS The presence of atypical inflammation of inadequate material or non-representative samples of extra-pulmonary TB was observed on EUS-FNA cytology. Mycobacterium tuberculosis polymerase chain reaction and acid fast bacilli should be performed to diagnose TB because of its higher sensitivity.
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Abstract
The pathogenicity of Mycobacterium tuberculosis (M. tuberculosis) causes it to most commonly manifest within the respiratory system (pulmonary tuberculosis); however, 15% of cases undergo extra-pulmonary spread to various organs. Genitourinary tuberculosis (GUTB) is a rare form of tuberculosis infection which has a propensity to affect the genitourinary tract, primarily affecting the kidneys, epididymis, seminal vesicles and prostate; however, 0.5% of cases result in infection of the testicles. This may present unilaterally or bilaterally with varying atypical presentations, thus misleading physicians in diagnosis. We present a case in a 48-year-old patient admitted to the surgical assessment unit in our hospital presenting with a unilateral painful testicular lesion and scrotal changes. He was admitted nine weeks prior for unexplainable constitutional symptoms however presented again whilst awaiting follow up in an outpatient clinic. Ultrasound guidance and fine-needle aspiration & culture (FNAC) of the lesion resulted in a positive diagnosis for M. tuberculosis. He underwent anti-tuberculous chemotherapy treatment for six months as per clinical guidance with adequate clinical response.
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Affiliation(s)
| | - Umar N Said
- General Medicine, Bradford Royal Infirmary, Bradford, GBR
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Chen Y, Ge P, Zhang K, Xiang J, Zhang L, Robertson ID, Guo A. Use of Rv0222-Rv2657c-Rv1509 Fusion Protein to Improve the Accuracy of an Antibody ELISA for Extra-Pulmonary Tuberculosis in Humans. Pathogens 2021; 10:828. [PMID: 34209358 DOI: 10.3390/pathogens10070828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: Tuberculosis (TB) in humans is a serious chronic epidemic disease caused by Mycobacterium tuberculosis (M. tb). The diagnosis of TB, especially extra-pulmonary TB (EPTB), is difficult. Isolation of M. tb from culture has a low sensitivity in patients with TB and an even lower sensitivity in cases of EPTB. Although Xpert MTB/RIF assays and serological tests are more sensitive than the above tests, they still lack sensitivity for EPTB diagnosis. (2) Methods: To improve the accuracy of TB diagnosis, a Rv0222-Rv2657c-Rv1509 fusion protein based iELISA was constructed, the diagnosis of TB, pulmonary TB (PTB) and EPTB was then evaluated. Sera of 40 TB patients including 14 with PTB, 14 with EPTB and 12 with no information about the form of TB, and five pneumonia patients were investigated. (3) Results: The sensitivity of the ELISA in TB, PTB and EPTB patients was 80% (95% CI: 64.4, 90.9%), 85.7% (95% CI: 57.2, 98.2%) and 92.8% (95% CI: 66.1, 99.8%), respectively, with a specificity of 70% (95% CI: 53.5, 83.4%). Both the sensitivity and specificity with this fusion protein were higher than for CFP10/ESAT6 (used as reference antigen) fusion protein (71.4%; 95% CI: 41.9, 91.6%, and 67.5%; 95% CI: 50.9, 81.4%), respectively, in cases of EPTB. All pneumonia patients’ sera tested negative in both ELISAs. (4) Conclusion: use of these new fusion proteins as antigens in serological assays has the potential to improve the diagnosis of all forms of TB in humans, especially EPTB.
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Abstract
OBJECTIVES To describe characteristics, details of diagnosis and outcomes of urogenital tuberculosis (UGTB) in a low-prevalence country. METHODS We conducted a retrospective observational study of 37 consecutive patients diagnosed with UGTB between 1st January 2014 and 31st October 2019 in an East London hospital. RESULTS 68% (25/37) of patients were male and the median age was 42 years (IQR 34-55). 89% (33/37) of patients were born outside the United Kingdom with 65% (24/37) born in the South Asian region. Renal (32.4%), epididymal (24.3%) and endometrial TB (21.6%) were the most prevalent forms of UGTB. Only 13.5% of UGTB patients had concurrent pulmonary TB. The median length of time from symptom onset to treatment was 163 days, while endometrial TB had an average delay to diagnosis of 564 days. Approximately half of patients with UGTB were culture positive (51.4%). However, 70% of early morning urines (EMUs) sent in urinary TB were culture positive. 11 patients (30.6%) underwent two or more invasive procedures, such as biopsy to obtain specimen samples. The mean treatment length for all UGTB cases was 7.3 months (SD 3.1). Notably, 25% of patients with endometrial TB required surgery despite antituberculous treatment. CONCLUSIONS UGTB is challenging to diagnose as early disease is often asymptomatic. Clinicians faced with non-specific symptoms, or features suggestive of urogenital malignancy amongst patients from TB-endemic areas, should maintain a high suspicion of UGTB.
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Affiliation(s)
- Shruthi Chandran
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Ananna Rahman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
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Hegazy WAH, Al Mamari R, Almazroui K, Al Habsi A, Kamona A, AlHarthi H, Al Lawati AI, AlHusaini AH. Retrospective Study of Bone-TB in Oman: 2002-2019. J Epidemiol Glob Health 2021; 11:238-245. [PMID: 33969946 PMCID: PMC8242117 DOI: 10.2991/jegh.k.210420.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: Little information is available about the etiology, pathophysiology, risk factors, and epidemiologic features of Bone Tuberculosis (Bone-TB). In this work, we present the epidemiological data about the Bone-TB in the Sultanate of Oman. Methods: Retrospectively, we identified and assessed those patients who were diagnosed with Bone-TB between January 2002 and December 2019 at Khoula Hospital. The following data were collected: demographics, clinical presentation, anatomical location, diagnosis, and treatment of the Bone-TB. Results: During the study period, 115 cases of Bone-TB were diagnosed. Males were affected more than females (57.4% and 42.6%, respectively). About 30% of Bone-TB cases were primary diagnosed in other organs particularly the lungs and then after disseminated to the bone. However, the Bone-TB was detected in hip, leg, hand, shoulder, and skull bones, the most detected Bone-TB was in spine (66% of cases). After vaccination the Bacillus Calmette–Guérin (BCG) strains were identified in the bones of eight babies. Tubercle bacilli were detected by Acid-Fast Stain (AFS) in 59% of cases, and the rest of cases were confirmed using polymerase chain reaction (PCR) tests. There are two used treatment regimens, with 12.4% relapse. The gastrointestinal tract (GIT) disturbances were the most related side effects. The resistance has been detected to pyrazinamide in six cases, rifampicin in three cases, and isoniazid, streptomycin and kanamycin were detected in one case. Conclusion: The most predominant Bone-TB cases were spine-TB that were mainly disseminated from the lungs. AFS failed to detect tubercle bacilli in 40% of cases. There is no statistical significance in relapse between the used two regimens. The death was predominant among skull-TB cases.
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Affiliation(s)
- Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt.,Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - R Al Mamari
- Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - K Almazroui
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - A Al Habsi
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - A Kamona
- Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - H AlHarthi
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - Areej I Al Lawati
- Pharmacy and Medical Store Department, Directorate General of Royal Hospital, Muscat, Sultanate of Oman
| | - AlZahra H AlHusaini
- Directorate of Drug Store, Injection Section, Directorate General of Medical Supplies, Muscat, Sultanate of Oman
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17
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Abstract
We report a case of primary adrenal insufficiency (PAI) due to adrenal tuberculosis with no findings of active tuberculosis in the lung of a 51-year-old female patient. The patient was admitted with a 10-year history of skin hyperpigmentation and was diagnosed with PAI. The primary cause was adrenal tuberculosis. An adrenocorticotropic hormone stimulation test, T-Spot test and adrenal computed tomography scan were used to confirm the diagnosis. The patient's status improved, and the hyperpigmentation subsided after 15 months of treatment with anti-tuberculosis drugs and cortisol replacement therapy.
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Affiliation(s)
- Jie Yu
- Department of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Department of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Han
- Department of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Shirzad-Aski H, Hamidi N, Sohrabi A, Abbasi A, Golsha R, Movahedi J. Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health 2020; 25:1131-1139. [PMID: 32501638 DOI: 10.1111/tmi.13452] [Citation(s) in RCA: 4] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. METHODS Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. RESULTS Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). CONCLUSION Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
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Affiliation(s)
| | - Niloofar Hamidi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Abbasi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Golsha
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jamileh Movahedi
- Tuberculosis laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
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19
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Bobbio F, Di Gennaro F, Marotta C, Kok J, Akec G, Norbis L, Monno L, Saracino A, Mazzucco W, Lunardi M. Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open 2019; 9:e027179. [PMID: 30944140 PMCID: PMC6500283 DOI: 10.1136/bmjopen-2018-027179] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature. DESIGN Cross-sectional study. SETTING Voluntary Counselling and Testing Centre (VCT) of Yirol Hospital, South Sudan. PARTICIPANTS From May to November 2017, 252 HIV-positive patients out of 624 newly admitted to VCT Centre were registered for antiretroviral treatment. According to the number of trained doctors available to practise ultrasound (US) scan, a sample of 100 patients were screened using the FASH protocol. INTERVENTIONS Following a full clinical examination, each patient was scanned with a portable US scanner in six different positions for pleural, pericardial, ascitic effusion, abdominal lymphadenopathy and hepatic/splenic microabscesses, according to the FASH protocol. A k39 antigen test for visceral leishmaniasis was also performed on patients with lymphadenopathy and/or splenomegaly. All demographic, clinical and HIV data, as well as FASH results and therapy adjustments, were recorded following the examination. RESULTS The FASH protocol allowed the detection of pathological US findings suggestive of tuberculosis in 27 out of the 100 patients tested. Overall, FASH results supported tuberculosis treatment indication for 16 of 21 patients, with the treatment being based exclusively on FASH findings in half of them (8 patients). The group of FASH-positive patients had a significantly higher proportion of patients with CD4 count below 0.2 x109/L (n=22, 81%) as compared with FASH-negative patients (n=35, 48%) (p=0.003). Moreover, 48% (n=13) of FASH-positive patients had CD4 below 100 cells/mm3. All patients tested had a negative result on k39 antigen test. CONCLUSION FASH was found to be a relevant diagnostic tool to detect signs of tuberculosis. Further research is needed to better define a patient profile suitable for investigation and also considering diagnostic accuracy.
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Affiliation(s)
| | | | - Claudia Marotta
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
| | - John Kok
- Yirol Hospital, Yirol, South Sudan
| | | | - Luca Norbis
- Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Laura Monno
- Infectious Diseases, University of Bari, Bari, Italy
| | | | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
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20
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Ahmed MIM, Ziegler C, Held K, Dubinski I, Ley-Zaporozhan J, Geldmacher C, von Both U. The TAM-TB Assay-A Promising TB Immune-Diagnostic Test With a Potential for Treatment Monitoring. Front Pediatr 2019; 7:27. [PMID: 30805325 PMCID: PMC6378289 DOI: 10.3389/fped.2019.00027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/22/2019] [Indexed: 02/05/2023] Open
Abstract
Tuberculosis (TB) epidemiology is changing in Western and Central Europe due to the rise in immigration and refugees fleeing high-TB-burden areas of war and devastation. The change in local demography and the lack of sensitive and specific TB diagnostic and monitoring tools, especially for cases of childhood TB, leads to either missed cases or over-treatment of this group. Here we present a promising new diagnostic approach, the T cell activation marker (TAM)-TB assay, and its performance in a case of extra-pulmonary TB occurring in a 16 year old refugee from Afghanistan. This assay is based on the characterization of 3 activation markers (CD38, HLA-DR, and Ki67) and one maturation marker (CD27) on M. tuberculosis-specific CD4 T cells. It was performed at time-points T0 (10 days), T1 (1 month), T2 (6 months), and T3 (12 months) post-treatment initiation. All markers were able to detect active tuberculosis (aTB) within this patient at T0 and reverted to a healthy/LTBI phenotype at the end of treatment. Tantalizingly, there was a clear trend toward the healthy/LTBI phenotype for the markers at T1 and T2, indicating a potential role in monitoring anti-TB treatment in the future. This assay may therefore contribute to improved TB diagnostic algorithms and TB treatment monitoring, potentially allowing for individualization of TB treatment duration in the future.
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Affiliation(s)
- Mohamed I M Ahmed
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Tropical Medicine and Infectious Diseases, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,CIHLMU Center for International Health, University of Munich, Munich, Germany
| | - Christian Ziegler
- Division of Orthopaedics, Ludwig-Maximilians-University, Munich, Germany
| | - Kathrin Held
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Tropical Medicine and Infectious Diseases, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ilja Dubinski
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Julia Ley-Zaporozhan
- Department of Radiology, Paediatric Radiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Christof Geldmacher
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Tropical Medicine and Infectious Diseases, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich von Both
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Section of Paediatric Infectious Diseases and Allergy, Department of Medicine, Imperial College London, London, United Kingdom
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21
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Mann TN, Schaaf HS, Dunn RN, Dix-Peek S, du Preez K, Lamberts RP, du Toit J, Davis JH. Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend. Epidemiol Infect 2018; 146:2107-15. [PMID: 30264687 DOI: 10.1017/S0950268818002649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6-4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.
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22
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Ranaivomanana P, Raberahona M, Rabarioelina S, Borella Y, Machado A, Randria MJDD, Rakotoarivelo RA, Rasolofo V, Rakotosamimanana N. Cytokine Biomarkers Associated with Human Extra-Pulmonary Tuberculosis Clinical Strains and Symptoms. Front Microbiol 2018. [PMID: 29515555 PMCID: PMC5826350 DOI: 10.3389/fmicb.2018.00275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The primary site of infection for Mycobacterium tuberculosis (Mtb) is the alveolar macrophages. However, Mtb can disseminate into other organs and causes extrapulmonary tuberculosis (EPTB). The diagnosis of EPTB is challenging due to relatively inaccessible infectious sites that may be paucibacillary and with clinical symptoms varying by site that are similar to those seen in other diseases. Hence, we sought to identify the expression patterns of a variety of cytokines that may be specific to EPTB from in vitro infections and in the plasma of TB patients. Methods: To define those cytokine secretions associated with EPTB, human THP-1 derived macrophages were first infected with Mtb clinical isolates from pulmonary and EPTB. Infected macrophages supernatants were harvested at different time points and cytokines known to play key roles in TB immune responses including TNF-α, IL-6, IL-10, IFN-γ, and VEGF-A were measured by ELISA. Those cytokines that were in vitro associated to EPTB were also measured in the plasma from patients with PTB, EPTB, non-EPTB-confirmed-like symptoms and healthy controls. Results: While all of the studied cytokine secretions varied after in vitro infection, higher levels of TNF-α and VEGF secretions were observed in vitro in the infected macrophages respectively in the PTB and EPTB infecting clinical isolates. Similar trends were observed from the plasma of patients where patients with PTB showed significantly higher level of TNF-α compared to EPTB and healthy control groups. The patients with EPTB showed higher plasma level of VEGF compared to those patients with the non-EPTB (p < 0.01) and to healthy controls group (p < 0.0001). Using Receiver Operating Curves (ROC), we showed that TNF-α and VEGF concentrations could distinguish EPTB from non-confirmed EPTB with high sensitivity and specificity. Conclusion: Pulmonary and extrapulmonary Mtb clinical isolates showed different cytokine induction pattern in human macrophages that is also found in the plasma level of the EPTB patients. Further investigations are needed to define cytokine secretions that can lead to the definition of bio-signatures to differentiate EPTB from other pathologies with confusing symptoms that hampered the diagnosis of TB.
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Affiliation(s)
- Paulo Ranaivomanana
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar
| | - Sedera Rabarioelina
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ysé Borella
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alice Machado
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mamy J De Dieu Randria
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar
| | - Rivo A Rakotoarivelo
- Infectious Diseases, Joseph Raseta Befelatanana University Hospital, Antananarivo, Madagascar.,Faculté de Médecine, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Voahangy Rasolofo
- Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Bélard S, Heller T, Orie V, Heuvelings CC, Bateman L, Workman L, Grobusch MP, Zar HJ. Sonographic Findings of Abdominal Tuberculosis in Children With Pulmonary Tuberculosis. Pediatr Infect Dis J 2017; 36:1224-6. [PMID: 28333710 DOI: 10.1097/INF.0000000000001590] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound reports of 102 children with microbiologically confirmed or clinically diagnosed pulmonary tuberculosis (TB) showed that 23 of 37 (64%) and 23 of 65 (36%) had TB suggestive abdominal lymphadenopathy, and 16 of 37 (44%) and 8 of 65 (13%) had splenic microabscesses, respectively. Splenic microabscesses were associated with HIV infection (P = 0.041). These data suggest that pulmonary TB is often complicated by abdominal TB in children.
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24
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Wei Z, Wenhao S, Yuanyuan M, Yang L, Daming Z, Jiangchun X, Jijun J. A single nucleotide polymorphism in the interferon-γ gene ( IFNG +874 T/A) is associated with susceptibility to tuberculosis. Oncotarget 2017; 8:50415-50429. [PMID: 28881572 PMCID: PMC5584145 DOI: 10.18632/oncotarget.17304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022] Open
Abstract
Interferon-γ (Interferon gamma, IFNG) is an important cytokine involved in providing resistance to mycobacterial diseases. Common variants of IFNG, such as IFNG +874 T/A(rs2430561), may be related to tuberculosis susceptibility, but this association has not been consistently observed. We performed an updated meta-analysis to evaluate the association between the IFNG +874 T/A (rs2430561) polymorphism and tuberculosis susceptibility. PubMed and SinoMed databases were searched up to October 2016, and odds ratios (OR) and 95% confidence intervals (CI) were used to assess the association strength. Based on search criteria for manuscripts reporting tuberculosis susceptibility and its relationship with the IFNG +874 T/A(rs2430561)polymorphism, 42 case-control studies from 39 different articles were retrieved. Significantly positive, decreased, and protective associations were found between the IFNG +874 T/A(rs2430561)polymorphism and tuberculosis risk in five genetic models. Moreover, in the stratified subgroup analysis, a protective relationship was detected in four different ethnicities and sources of the control groups. Furthermore, the IFNG +874 T/A(rs2430561)polymorphism played an important role in protecting individuals from both pulmonary tuberculosis and extra-pulmonary tuberculosis. Our meta-analysis suggests that the IFNG +874 T/A(rs2430561)polymorphism is potentially associated with tuberculosis susceptibility and may be used as a predictive biomarker. Further studies with larger sample sizes and consideration of gene-environment interactions should be conducted to elucidate the role of IFNG +874 T/A(rs2430561) polymorphism in tuberculosis susceptibility.
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Affiliation(s)
- Zhang Wei
- Department of Infectious Disease, Taizhou People's Hospital, Taizhou, China
| | - Shen Wenhao
- Department of Oncology, Taizhou People's Hospital, Taizhou, China
| | - Mi Yuanyuan
- Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, China
| | - Li Yang
- Department of Infectious Disease, Taizhou People's Hospital, Taizhou, China
| | - Zhou Daming
- Department of Infectious Disease, Taizhou People's Hospital, Taizhou, China
| | - Xian Jiangchun
- Department of Infectious Disease, Taizhou People's Hospital, Taizhou, China
| | - Jiang Jijun
- Department of Infectious Disease, Taizhou People's Hospital, Taizhou, China
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25
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Diallo AB, Kollo AI, Camara M, Lo S, Ossoga GW, Mbow M, Karam F, Niang MYF, Thiam A, Diawara AN, Mboup S, Diallo AG. [Performance of GeneXpert MTB / RIF ® in the diagnosis of extrapulmonary tuberculosis in Dakar: 2010-2015]. Pan Afr Med J 2016; 25:129. [PMID: 28292091 PMCID: PMC5325514 DOI: 10.11604/pamj.2016.25.129.10065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/25/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Le défi des pays en voie de développement est la disponibilité de méthodes de diagnostic rapide et précis pour le management de la tuberculose. Des techniques moléculaires offrent cet avantage et nous avons utilisé le test GeneXpert MTB/RIF dans le diagnostic de la tuberculose extra-pulmonaire pour évaluer sa performance par rapport aux méthodes conventionnelles. Méthodes Entre 2010 et 2015, 544 échantillons cliniques extra-pulmonaires ont été recueillis et traitées par la microscopie, la culture et le GeneXpert. L'étude de la sensibilité aux antituberculeux a été effectué avec le MGIT 960. Le Génotype MTBDRplus a été utilisé pour confirmer les cas de résistance à la rifampicine détectés par le système GX. Résultats La population d'étude de 544 patients incluait 55,15% d'hommes et 44,85% de femmes. L'âge des patients variait entre 1 à 92 avec la majorité dans le groupe d'âge 18-45 ans. La sensibilité et la spécificité globale de la microscopie étaient de 43,86% et 98,36%, et pour le GeneXpert® 94,74% et 97,95% respectivement avec 95% IC. Deux résultats de résistance à la rifampicine discordants ont été trouvées entre le test GeneXpert et la méthode phénotypique. Les résultats du test MTBDRplus ont montré une concordance de 100% avec ceux du MGIT 960 pour les cas discordants de résistance à la rifampicine. Conclusion Cette étude a montré que le test GeneXpert a une plus grande sensibilité pour le diagnostic de routine de la tuberculose extra-pulmonaire et devrait être utilisé à la place de la microscopie. Les cas de résistance à la rifampicine détectés par le GeneXpert doivent être confirmés par d'autres tests moléculaires avant d'initier un traitement.
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Affiliation(s)
- Awa Ba Diallo
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal; Département des Sciences Biologiques, Université Cheikh Anta Diop, Dakar, Sénégal
| | | | - Makhtar Camara
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal; Département des Sciences Biologiques, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Seynabou Lo
- UFR Sciences de la Santé, Université Gaston Berger, Saint Louis
| | | | - Moustapha Mbow
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal
| | - Farba Karam
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal
| | | | - Aliou Thiam
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal
| | - Awa Ndiaye Diawara
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal
| | - Souleymane Mboup
- Laboratoire de Bactériologie, Virologie du CHNU Aristide Le Dantec, Sénégal
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Abraham S, Izaguirre Anariba DE, Dua K, Mir M, Ankireddypalli A. A case of testicular tuberculosis mimicking malignancy in a healthy young man. Ther Adv Infect Dis 2016; 3:110-3. [PMID: 27536355 DOI: 10.1177/2049936116655261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
Genitourinary tuberculosis represents a form of extra-pulmonary tuberculosis that occurs in the kidneys, ureters, seminal vesicles, prostate, testis, vas deferens, and epididymis. Isolated testicular involvement is unusual, and differential diagnosis includes testicular tumor, acute infection, infarction, and granulomatous infection. We report a case of a 36-year-old Ecuadorian man residing in New York, New York, who presented with a painful scrotal mass, weight loss, and purulent discharge from ulcerated lesion in scrotal area 10 years following his immigration to the United States. No other systemic symptoms were noted. Positive QuantiFERON-TB Gold and radio imaging results led to the diagnosis. After extensive workup, acid fast bacilli positive cultures obtained by computed tomography guided fine needle aspiration grew Mycobacterium tuberculosis complex. Anti-tuberculosis chemotherapy was initiated after sensitivity tests were confirmed. Significant recovery after 3 months of directly observed therapy was accomplished.
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Affiliation(s)
- Sherly Abraham
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
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Abstract
BACKGROUND Fibrous tuberculous pleural effusion (TPE) represents common disease in tuberculous clinic. Medical thoracoscopy has been used to treat pleural empyema and shown promising outcomes, but data of its use in multiloculated and organized TPE remains limited to know. METHODS The study was performed on 430 cases with TPE. The cases were divided into free-flowing, multiloculated effusion and organized effusion group. Each group was subdivided into two or three types of therapeutic approaches: ultrasound guided pigtail catheter, large-bore tube chest drainage and medical thoracoscopy. Patients with multiloculated or organized effusions received streptokinase, introduced into the pleural cavity via chest tubes. The successful effectiveness of the study was defined as duration of chest drainage, time from treatment to discharge days and no further managements. RESULTS Patients with organized effusion were older than those with free-flowing effusion and incidence of organized effusion combined with pulmonary tuberculosis (PTB) was higher than those of multiloculated effusion and free-flowing effusion respectively. Positive tuberculosis of pleural fluid culture was higher in organized effusion than that in free-flowing effusion. Sputum positive for acid-fast bacillus (AFB) in organized effusion was higher than that in multiloculated effusion and free-flowing effusion. Medical thoracoscopy showed significant efficacy in the group of multiloculated effusion and organized effusion but free-flowing effusion. No chronic morbidity and mortality related to complications was observed. CONCLUSIONS Medical thoracoscopy was a safe and successful method in treating multiloculated and organized TPE.
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Affiliation(s)
- Yu Xiong
- 1 Department of TB clinic, 2 Centre of Thoracoscopic Surgery, Shandong Chest Hospital, Shandong Tuberculosis Control Center, Jinan 250013, China ; 3 Department of Biomedicine, University of Bergen, Bergen, Norway ; 4 ChiNor Research Network, Neurosurgical Department of Qilu Hospital, Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Xusheng Gao
- 1 Department of TB clinic, 2 Centre of Thoracoscopic Surgery, Shandong Chest Hospital, Shandong Tuberculosis Control Center, Jinan 250013, China ; 3 Department of Biomedicine, University of Bergen, Bergen, Norway ; 4 ChiNor Research Network, Neurosurgical Department of Qilu Hospital, Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Huaiyang Zhu
- 1 Department of TB clinic, 2 Centre of Thoracoscopic Surgery, Shandong Chest Hospital, Shandong Tuberculosis Control Center, Jinan 250013, China ; 3 Department of Biomedicine, University of Bergen, Bergen, Norway ; 4 ChiNor Research Network, Neurosurgical Department of Qilu Hospital, Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Caihong Ding
- 1 Department of TB clinic, 2 Centre of Thoracoscopic Surgery, Shandong Chest Hospital, Shandong Tuberculosis Control Center, Jinan 250013, China ; 3 Department of Biomedicine, University of Bergen, Bergen, Norway ; 4 ChiNor Research Network, Neurosurgical Department of Qilu Hospital, Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Jian Wang
- 1 Department of TB clinic, 2 Centre of Thoracoscopic Surgery, Shandong Chest Hospital, Shandong Tuberculosis Control Center, Jinan 250013, China ; 3 Department of Biomedicine, University of Bergen, Bergen, Norway ; 4 ChiNor Research Network, Neurosurgical Department of Qilu Hospital, Brain Science Research Institute, Shandong University, Jinan 250012, China
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Abstract
Background A high rate of infection has been reported in patients receiving treatment with anti-tumor necrosis factor (anti-TNF). This study describes the rate of and risk factors for serious infections in patients receiving anti-TNF agents in Jordan. Methods This retrospective observational study was conducted at a large tertiary referral center in the north of Jordan. Between January 2006 and January 2012, 199 patients who received an anti-TNF agent (infliximab, adalimumab, or etanercept) were included. Patients received the anti-TNF treatment for rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, or other conditions. A serious infection was defined as any bacterial, viral, or fungal infection that required hospitalization, administration of appropriate intravenous antimicrobial therapy, and temporary withholding of anti-TNF treatment. Results The mean duration of anti-TNF treatment was 26.2 months. Steroids were used in 29.1% of patients, while 54.8% were given additional immunosuppressant therapy (methotrexate or azathioprine). Only one anti-TNF agent was given in 70.4% of patients, while 29.6% received different anti-TNF agents for the duration of treatment. Serious infections were documented in 39 patients (19.6%), including respiratory tract infections (41%), urinary tract infections (30.8%), and skin infections (20.5%), and extrapulmonary tuberculosis in three patients (7.7%). Exposure to more than one anti-TNF agent was the only factor associated with a significant increase in the rate of infection (relative risk 1.9, 95% confidence interval 1.06–4.0, P=0.03). Conclusion Serious infections, including tuberculosis, were a common problem in patients receiving anti-TNF agents, and exposure to more than one anti-TNF agent increased the risk of serious infection.
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Affiliation(s)
- Khaldoon M Alawneh
- Department of Medicine, College of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud H Ayesh
- Department of Medicine, College of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Y Khassawneh
- Department of Medicine, College of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Salwa Shihadeh Saadeh
- Department of Medicine, College of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud Smadi
- College of Science, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaldoun Bashaireh
- Department of Special Surgery, College of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
BACKGROUND Tuberculosis is classified as either pulmonary or extra-pulmonary (EPTB). While much focus has been paid to pulmonary tuberculosis, EPTB has received scant attention. Moreover, EPTB is viewed as one wastebasket diagnosis, as "the other" which is not pulmonary. METHODS This is a retrospective cohort study of all patients treated for EPTB in the state of Texas between January 2000 and December 2005, who had no pulmonary disease. Clinical and epidemiological factors were abstracted from electronic records of the Report of Verified Case of Tuberculosis. The long-term outcome, which is death by December 2011, was established using the Social Security Administration Death Master File database. Survival in EPTB patients was compared to those with latent tuberculosis, as well as between different types of EPTB, using Cox proportional hazard models. A hybrid of the machine learning method of classification and regression tree analyses and standard regression models was used to identify high-order interactions and clinical factors predictive of long-term all-cause mortality. RESULTS Four hundred and thirty eight patients met study criteria; the median study follow-up period for the cohort was 7.8 (inter-quartile range 6.0-10.1) years. The overall all-cause mortality rate was 0.025 (95% confidence interval [CI]: 0.021-0.030) per 100 person-year of follow-up. The significant predictors of poor long-term outcome were age (hazard ratio [HR] for each year of age-at-diagnosis was 1.05 [CI: 1.04-1.06], treatment duration, type of EPTB and HIV-infection (HR = 2.16; CI: 1.22, 3.83). Mortality in genitourinary tuberculosis was no different from latent tuberculosis, while meningitis had the poorest long-term outcome of 46.2%. Compared to meningitis the HR for death was 0.50 (CI: 0.27-0.91) for lymphatic disease, 0.42 (CI: 0.21-0.81) for bone/joint disease, and 0.59 (CI: 0.27-1.31) for peritonitis. The relationship between mortality and therapy duration for each type of EPTB was a unique "V" shaped curve, with the lowest mortality observed at different therapy durations for each, beyond which mortality increased. CONCLUSIONS EPTB is comprised of several different diseases with different outcomes and durations of therapy. The "V" shaped relationship between therapy duration and outcome leads to the hypothesis that longer duration of therapy may lead to higher patient mortality.
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Affiliation(s)
- Tobias Pusch
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jotam G Pasipanodya
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
- Office of Global Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-8504, USA
| | - Ronald G Hall
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, 4500 Lancaster, Dallas, Texas 75216, USA
| | - Tawanda Gumbo
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
- Office of Global Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-8504, USA
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Makeshkumar V, Madhavan R, Narayanan S. Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis. Indian J Med Res 2014; 139:161-6. [PMID: 24604051 PMCID: PMC3994732] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Diagnosis of extrapulmonary tuberculosis (EPTB) is difficult using conventional diagnostic methods. This study was conducted to evaluate the use of polymerase chain reaction (PCR) in diagnosis of definitive and probable extrapulmonary tuberculosis patients, and to assess the performance of insertion sequence (IS) 6110 based PCR assay as compared to conventional culture by Lowenstein-Jensen (LJ) method for the diagnosis of EPTB. METHODS A total of 178 non repeated clinical specimens were collected from clinically suspected extrapulmonary tuberculosis patients. The specimens included 59 ascitic fluid, 54 pleural fluid, 25 cerebrospinal fluid (CSF), 12 fine needle aspiration (FNA), 8 urine, 7 pus, 6 synovial fluid, 2 skin tissue, one pericardial fluid, one liver abscess, one pancreatic cyst fluid, one omental biopsy and one semen sample. All these clinical samples were subjected to Ziehl-Neelsen staining (ZN) for acid fast bacilli (AFB) and culture on LJ medium. PCR was performed by targeting 123bp fragment of insertion sequence IS6110 of Mycobacterium tuberculosis (MTB). RESULTS Of the 178 specimens, 10 (5.61%) were ZN smear positive for AFB, six (3.37%) were L-J culture positive from 10 AFB smear positive cases and 48 (26.96%) were PCR IS 6110 positive for M. tuberculosis. INTERPRETATION & CONCLUSIONS PCR using IS6110 primer was able to pick up more EPTB patients compared to conventional L-J culture method for detection of M. tuberculosis. False positive PCR IS6110 in three CSF samples may be due to latent TB infection which was limitation in this study.
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Affiliation(s)
- V. Makeshkumar
- Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Kanchipuram, India
| | - Radha Madhavan
- Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Kanchipuram, India,Reprint requests: Dr Radha Madhavan, Professor & Head, Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Potheri Village, Kattankulathur 603203, Kanchipuram District, Tamil Nadu, India e-mail:
| | - Sujatha Narayanan
- Department of Immunology, National Institute for Research in Tuberculosis (ICMR), Chennai, India
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Das S, Roychowdhury T, Kumar P, Kumar A, Kalra P, Singh J, Singh S, Prasad HK, Bhattacharya A. Genetic heterogeneity revealed by sequence analysis of Mycobacterium tuberculosis isolates from extra-pulmonary tuberculosis patients. BMC Genomics 2013; 14:404. [PMID: 23773324 PMCID: PMC3699378 DOI: 10.1186/1471-2164-14-404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 06/03/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tuberculosis remains a major public health problem. Clinical tuberculosis manifests often as pulmonary and occasionally as extra-pulmonary tuberculosis. The emergence of drug resistant tubercle bacilli and its association with HIV is a formidable challenge to curb the spread of tuberculosis. There have been concerted efforts by whole genome sequencing and bioinformatics analysis to identify genomic patterns and to establish a relationship between the genotype of the organism and clinical manifestation of tuberculosis. Extra-pulmonary TB constitutes 15-20 percent of the total clinical cases of tuberculosis reported among immunocompetent patients, whereas among HIV patients the incidence is more than 50 percent. Genomic analysis of M. tuberculosis isolates from extra pulmonary patients has not been explored. RESULTS The genomic DNA of 5 extra-pulmonary clinical isolates of M. tuberculosis derived from cerebrospinal fluid, lymph node fine needle aspirates (FNAC) / biopsies, were sequenced. Next generation sequencing approach (NGS) was employed to identify Single Nucleotide Variations (SNVs) and computational methods used to predict their consequence on functional genes. Analysis of distribution of SNVs led to the finding that there are mixed genotypes in patient isolates and that many SNVs are likely to influence either gene function or their expression. Phylogenetic relationship between the isolates correlated with the origin of the isolates. In addition, insertion sites of IS elements were identified and their distribution revealed a variation in number and position of the element in the 5 extra-pulmonary isolates compared to the reference M. tuberculosis H37Rv strain. CONCLUSIONS The results suggest that NGS sequencing is able to identify small variations in genomes of M. tuberculosis isolates including changes in IS element insertion sites. Moreover, variations in isolates of M. tuberculosis from non-pulmonary sites were documented. The analysis of our results indicates genomic heterogeneity in the clinical isolates.
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Affiliation(s)
- Sarbashis Das
- School of Computational and Integrative Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Tanmoy Roychowdhury
- School of Computational and Integrative Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Parameet Kumar
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Kumar
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Kalra
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Jitendra Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - HK Prasad
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Bhattacharya
- School of Computational and Integrative Sciences, Jawaharlal Nehru University, New Delhi, India
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
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Abstract
Objectives: The aim of this study is to assess the value of chest radiographs (CXRs) and sputum examinations in detecting pulmonary involvement of tuberculosis (TB) in patients with extra-pulmonary tuberculosis (EPTB). Materials and Methods: A retrospective analysis was performed among 248 EPTB patients with culture-proven diagnosis of tuberculosis seen between January 2001 and December 2007 at a tertiary teaching hospital, Riyadh, Saudi Arabia. Demographics, clinical, laboratory and radiological findings were reviewed and assessed. This study was approved by the hospital ethics and research committee. Results: One hundred twenty five of 233 EPTB patients (53.6%) had abnormal CXR findings. There was a significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings (30/57) and those with normal CXR findings (4/17) (P = 0.04). Of 17 HIV-negative/unknown HIV-status EPTB patients with normal CXR results, 4 patients (23.5%) had positive sputum culture results. Intrathoracic lymphadenopathy (P < 0.001), pleural TB (P < 0. 001) and disseminated TB (P = 0.004) were associated with an increased risk of abnormal CXR findings. Patients with cough (52.9%), weight loss (41.2%) and night sweats (26.5%) are more likely to have positive sputum culture results. Conclusion: CXR findings are predictive of positive sputum culture results. However, the rate of normal CXR among EPTB patients with positive sputum culture results was relatively high. Therefore, respiratory specimen cultures should be obtained in TB suspects with a normal CXR to identify potentially infectious cases of TB.
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Affiliation(s)
- Malak M El-Hazmi
- Department of Microbiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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