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Sample records for active pulmonary tuberculosis

  1. Pulmonary tuberculosis

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    ... ray Pulmonary nodule, solitary - CT scan Miliary tuberculosis Tuberculosis of the lungs Erythema nodosum associated with sarcoidosis Respiratory system Tuberculin skin test References Fitzgerald DW, Sterling TR, Haas DW. ...

  2. Addison's Disease Caused by Tuberculosis with Atypical Hyperpigmentation and Active Pulmonary Tuberculosis.

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    Namikawa, Hiroki; Takemoto, Yasuhiko; Kainuma, Shigeto; Umeda, Sakurako; Makuuchi, Ayako; Fukumoto, Kazuo; Kobayashi, Masanori; Kinuhata, Shigeki; Isaka, Yoshihiro; Toyoda, Hiromitsu; Kamata, Noriko; Tochino, Yoshihiro; Hiura, Yoshikazu; Morimura, Mina; Shuto, Taichi

    2017-01-01

    We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis. In addition, the presence of active tuberculosis needs to be assumed whenever we treat patients with Addison's disease caused by tuberculosis, despite its rarity.

  3. Spontaneous pneumothorax due to recently diagnosed active pulmonary tuberculosis

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    Carrillo, Leonidas; 1 Facultad de Medicina, UNMSM. Lima, Perú. 2 Hospital Nacional Arzobispo Loayza, Ministerio de Salud. Lima, Perú.; Pintado, Silvia; Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.; Cueva, Luis; Facultad de Medicina, UNMSM. Lima, Perú.

    2011-01-01

    We describe the case of a male patient aged 17, Lima student who had no history of known tuberculosis contact, nonreactive HIV ELISA, diagnosed 21 days befote admission with active pulmonary tuberculosis, sputum smear 3 +, who was started with first line antituberculosis drugs. He was admitted to the hospital for pleural chest pain of sudden onset, and moderate dyspnea; on physical examination there was abolition of vocal vibrations, absence of breath sounds and hyperresonance in right hemith...

  4. Determinants of active pulmonary tuberculosis in Ambo Hospital, West Ethiopia

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    Tenna Ephrem

    2015-02-01

    Full Text Available Objectives: The aim of this study was to determine factors associated with active pulmonary tuberculosis seen in cases in Ambo Hospital, Ethiopia.Design: A facility-based prospective case-control study.Setting: Patients attending Ambo Hospital from 01 December 2011 to 29 March 2012.Participants: The sample included 312 adult patients attending Ambo Hospital. The main outcome measure was presence of active pulmonary tuberculosis (TB.Explanatory measures: Age, gender, occupation, educational status, marital status, place of residence, patient history of TB, family history of TB, human immunodeficiency virus (HIV infection, smoking, alcohol intake, khat chewing, body mass index (BMI, employment, diabetes, history of asthma, previous history of worm infestation, history of hospitalisation, number of adults living in the household (HH, person per room, housing condition.Results: A total of 312 study participants, including 104 active pulmonary tuberculosis (PTB cases (cases and 208 non-active PTB cases (controls, were recruited for the present study. Having one or more family member with a history of TB (OR = 4.4; 95% CI: 1.50–12.90, marital status (OR = 7.6; 95% CI: 2.2–12.6, male gender (OR = 3.2; 95% CI: 1.4–7, rural residence (OR = 3.3; P = 0.012, being a current or past smoker (OR = 2.8; 95% CI: 1.1–7.2, BMI < 18.5 (OR = 2.1; 95% CI: 1.03–4.2, HIV infection (OR = 8.8; 95% CI: 2.4–23.8 and a history of worm infestation (OR = 6.4; 95% CI: 2.6–15.4 remained significant independent host-related factors for active PTB.Conclusion: Patients who came from a compound with more than two HHs were more likely to develop active PTB than those who came from a compound with only one HH. Those who lived in houses with no windows were more likely to develop active PTB than those who lived in houses with one or more windows, had a family history of TB, lived in rural areas. Sex of the patient was a predicting factor. Not being the owner of the house

  5. Pulmonary Tuberculosis in Children

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    Keshtkar Jahromi

    2014-09-01

    Full Text Available Tuberculosis (TB is the most common cause of infection-related death worldwide. Children represent 5 to 15% of all TB cases around the world and are more frequently infected and more easily affected by the most severe forms of the disease such as meningitis and disseminated form .Here, we reviewed TB in children with impact on the routes of transmission, clinical manifestations, treatment, control, and prophylaxis. Electronic databases (PubMed, Scopus were searched from June1995 to May 2014 by using key words (pulmonaryTB,epidemiology,transmission,clinical manifestations,treatment,control, and prophylaxis . Pulmonary tuberculosis may manifest in several forms, including endobronchial TB with focal lymphadenopathy, progressive pulmonary disease, pleural involvement, and reactivated pulmonary disease . Symptoms of primary pulmonary disease in the pediatric population are often insignificant. Gastric aspirates are used instead of sputum in children younger than 6 years. BCG vaccination is used in many parts of the world and the major role of vaccination is the prevention of life-threatening illness such as disseminated TB and meningitis in children.Treatment is the same as for adults. Most people infected with M .tuberculosis do not develop active disease. In healthy individuals, the lifetime risk of developing infection to disease is 5-10%. Reactivation of TB often occurs in older children and adolescent and is more common in patients who acquire TB at age 7 years and older.

  6. Loss of Receptor on Tuberculin-Reactive T-Cells Marks Active Pulmonary Tuberculosis

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    2007-01-01

    BACKGROUND: Tuberculin-specific T-cell responses have low diagnostic specificity in BCG vaccinated populations. While subunit-antigen (e.g. ESAT-6, CFP-10) based tests are useful for diagnosing latent tuberculosis infection, there is no reliable immunological test for active pulmonary tuberculosis. Notably, all existing immunological tuberculosis-tests are based on T-cell response size, whereas the diagnostic potential of T-cell response quality has never been explored. This includes surface ...

  7. Tc-99m-MIBI Uptake in Active Pulmonary Tuberculosis: A Case Report

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    Lee, Chang Ho; Park, Chan Hee; Hwang, Hee Sung; Bae, Moon Sun [Ajou University College of Medicine, Suwon (Korea, Republic of)

    1996-06-15

    Technetium-99m MIBI was developed as a myocardiac perfusion imagine agent and has been used effectively in the detection and post-therapeutic evaluation of various neoplasm such as thyroid, lung, bone and breast tumors. As an infrequent findings, Tc-99m MIBI agent has shown in non-neoplastic pulmonary conditions including fibroding alveolitis, pulmonary actinomycosis, active pulmonary sarcoidosis, pulmonary interstitial fibrosis in progressive systemic sclerosis and active osteomyelitis. In a recent report conducted by Cetin Oncel, Tc-99m MIBI imaging is an effective method in the detection and follow-up of pulmonary tuberculosis. We have also experienced Tc-99m-MIBI uptake in active pulmonary tuberculosis incidentally found in a patient with suspected proliferative villonodular synovitis of the left ankle.

  8. Prevalence of pulmonary tuberculosis in rheumatoid arthritis

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    Sudin Koshy

    2016-09-01

    Results: 18 patients had evidence of pulmonary tuberculosis. 5 patients had active disease and 13 patients had evidence of healed pulmonary tuberculosis. The prevalence of pulmonary tuberculosis was 8.3%. This is much higher than the prevalence in the Indian population which is 13-25 per thousand. Of the 5 patients who had active disease 3 patients were on leflunamide for 1 year or more. On analysis it was found that patients on leflunamide were at an increased risk of developing tuberculosis (p <0.001 and the risk estimate showed an odds ratio of 14.2. Conclusions: Prevalence of pulmonary tuberculosis in the study population was found to be 8.3%. In countries with high prevalence of latent and active tuberculosis, rheumatoid arthritis patients should be carefully monitored for pulmonary tuberculosis before and during the treatment with immunosuppressive drugs. [Int J Res Med Sci 2016; 4(9.000: 3729-3732

  9. Densely calcified tuberculous constrictive pericarditis with concurrent active pulmonary tuberculosis infection

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    S Laudari

    2015-07-01

    Full Text Available Though pulmonary tuberculosis is a common chronic infection in the developing countries like Nepal, the incidence of tubercular constrictive pericarditis is very low. Here we report a patient of active pulmonary tuberculosis with sputum positive for acid fast bacilli along with densely calcified constrictive pericarditis which has been reported as a very rare presentation in the literature.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12955 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2; 41-43

  10. 38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation...

  11. Loss of receptor on tuberculin-reactive T-cells marks active pulmonary tuberculosis.

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    Mathias Streitz

    Full Text Available BACKGROUND: Tuberculin-specific T-cell responses have low diagnostic specificity in BCG vaccinated populations. While subunit-antigen (e.g. ESAT-6, CFP-10 based tests are useful for diagnosing latent tuberculosis infection, there is no reliable immunological test for active pulmonary tuberculosis. Notably, all existing immunological tuberculosis-tests are based on T-cell response size, whereas the diagnostic potential of T-cell response quality has never been explored. This includes surface marker expression and functionality of mycobacterial antigen specific T-cells. METHODOLOGY/PRINCIPAL FINDINGS: Flow-cytometry was used to examine over-night antigen-stimulated T-cells from tuberculosis patients and controls. Tuberculin and/or the relatively M. tuberculosis specific ESAT-6 protein were used as stimulants. A set of classic surface markers of T-cell naïve/memory differentiation was selected and IFN-gamma production was used to identify T-cells recognizing these antigens. The percentage of tuberculin-specific T-helper-cells lacking the surface receptor CD27, a state associated with advanced differentiation, varied considerably between individuals (from less than 5% to more than 95%. Healthy BCG vaccinated individuals had significantly fewer CD27-negative tuberculin-reactive CD4 T-cells than patients with smear and/or culture positive pulmonary tuberculosis, discriminating these groups with high sensitivity and specificity, whereas individuals with latent tuberculosis infection exhibited levels in between. CONCLUSIONS/SIGNIFICANCE: Smear and/or culture positive pulmonary tuberculosis can be diagnosed by a rapid and reliable immunological test based on the distribution of CD27 expression on peripheral blood tuberculin specific T-cells. This test works very well even in a BCG vaccinated population. It is simple and will be of great utility in situations where sputum specimens are difficult to obtain or sputum-smear is negative. It will also help

  12. Active pulmonary tuberculosis: Role for amikacin in early treatment.

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    Méchaï, F; Figoni, J; Leblanc, C; Gousseff, M; Vignier, N; Bouchaud, O

    2016-09-01

    To evaluate the efficacy of amikacin on sputum conversion during initial sputum smear positive tuberculosis treatment. Single-center observational cohort study (2012-2013) evaluating time to sputum smear conversion with standard treatment (ST) versus standard treatment+amikacin (IV 15mg/kg/day) for seven days (STamK). Forty-five patients were included. Median time to smear negative samples was 26.5 days (14-56) for the 30 (66.7%) patients included in the ST group and 48 days (19.5-69.5) for the 15 patients (33.3%) included in the STamK group (P=0.76). Time to negative culture was only known for 27 patients (61.4%): 47.5 days (26-58) for 18 patients in the ST group and 40 days (14-77) for nine patients in the STamK group. Despite our small sample size, the addition of amikacin in active tuberculosis treatment did not seem to impact time to smear conversion or period of contagiousness. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. BTLA exhibits immune memory for αβ T cells in patients with active pulmonary tuberculosis.

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    Zeng, Jin-Cheng; Lin, Dong-Zi; Yi, Lai-Long; Liu, Gan-Bin; Zhang, Hui; Wang, Wan-Dang; Zhang, Jun-Ai; Wu, Xian-Jing; Xiang, Wen-Yu; Kong, Bin; Chen, Zheng W; Wang, Cong-Yi; Xu, Jun-Fa

    2014-01-01

    Despite past extensive studies, the role of B and T lymphocyte attenuator (BTLA) in αβ T cells in patients with active pulmonary tuberculosis (ATB) remains poorly understood. Here we demonstrate that BTLA expression on αβ T cells is decreased in patients with M. tuberculosis (Mtb) infection. Particularly, BTLA expression levels are likely critical for αβ T cells to manifest and maintain an active central memory phenotype with high capacity for secretion of IFN-γ and perforin, which are important for immune memory against TB infection. BTLA(high) αβ T cells also exhibited higher capacity in response to Mtb peptide stimulation. In contrast to the role of BTLA played for negative regulation of immune responses, our data in the current studies suggest that BTLA expression on αβ T cells is likely associated with protective immune memory against Mtb infection in the setting of patients with active pulmonary tuberculosis. This previous unappreciated role for BTLA may have implications for prevention and treatment of patients with Mtb infection.

  14. Coincident helminth infection modulates systemic inflammation and immune activation in active pulmonary tuberculosis.

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    Parakkal Jovvian George

    Full Text Available Helminth infections are known to modulate innate and adaptive immune responses in active and latent tuberculosis (TB. However, the role of helminth infections in modulating responses associated with inflammation and immune activation (reflecting disease activity and/or severity in TB is not known.We measured markers of inflammation and immune activation in active pulmonary TB individuals (ATB with co-incidental Strongyloides stercoralis (Ss infection. These included systemic levels of acute phase proteins, matrix metalloproteinases and their endogenous inhibitors and immune activation markers. As a control, we measured the systemic levels of the same molecules in TB-uninfected individuals (NTB with or without Ss infection.Our data confirm that ATB is associated with elevated levels of the various measured molecules when compared to those seen in NTB. Our data also reveal that co-incident Ss infection in ATB individuals is associated with significantly decreased circulating levels of acute phase proteins, matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases as well as the systemic immune activation markers, sCD14 and sCD163. These changes are specific to ATB since they are absent in NTB individuals with Ss infection.Our data therefore reveal a profound effect of Ss infection on the markers associated with TB disease activity and severity and indicate that co-incidental helminth infections might dampen the severity of TB disease.

  15. Comparison of sensitivity of QuantiFERON-TB gold test and tuberculin skin test in active pulmonary tuberculosis.

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    Khalil, Kanwal Fatima; Ambreen, Asma; Butt, Tariq

    2013-09-01

    To compare the sensitivity of tuberculin skin test (TST) and quantiFERON-TB gold test (QFT-G) in active pulmonary tuberculosis. Analytical study. Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi, from July 2011 to January 2012. QuantiFERON-TB gold test (QFT-G) was evaluated and compared it with tuberculin skin test (TST) in 50 cases of active pulmonary tuberculosis, in whom tuberculous infection was suspected on clinical, radiological and microbiological grounds. Sensitivity was determined against postive growth for Mycobacterium tuberculosis. Out of 50 cases, 43 were females and 7 were males. The mean age was 41.84 ± 19.03 years. Sensitivity of QFT-G was 80% while that of TST was 28%. QFT-G has much higher sensitivity than TST for active pulmonary tuberculosis. It is unaffected by prior BCG administration and prior exposure to atypical mycobacteria. A positive QFT-G result can be an adjunct to diagnosis in patients having clinical and radiological data compatible with pulmonary tuberculosis.

  16. Control measures to trace ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis

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    Cláudia Di Lorenzo Oliveira

    2015-10-01

    Full Text Available This was descriptive study carried out in a medium-sized Brazilian city. In ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis, we assessed compliance with the Brazilian national guidelines for tuberculosis control. We interviewed 43 contacts and their legal guardians. Approximately 80% of the contacts were not assessed by the municipal public health care system, and only 21% underwent tuberculin skin testing. The results obtained with the Chi-square Automatic Interaction Detector method suggest that health care teams have a biased attitude toward assessing such contacts and underscore the need for training health professionals regarding tuberculosis control programs.

  17. Prevalence, risk factors and social context of active pulmonary tuberculosis among prison inmates in Tajikistan.

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    Daniel E Winetsky

    Full Text Available SETTING: Tuberculosis (TB is highly prevalent in prisons of the former Soviet Union. OBJECTIVE: To understand the behavioral, demographic and biological factors placing inmates in Tajikistan at risk for active TB. DESIGN: We administered a behavioral and demographic survey to 1317 inmates in two prison facilities in Sughd province, Tajikistan along with radiographic screening for pulmonary TB. Suspected cases were confirmed bacteriologically. Inmates undergoing TB treatment were also surveyed. In-depth interviews were conducted with former prisoners to elicit relevant social and behavioral characteristics. RESULTS: We identified 59 cases of active pulmonary TB (prevalence 4.5%. Factors independently associated with increased prevalence of active TB were: HIV-infection by self-report (PR 7.88; 95%CI 3.40-18.28, history of previous TB (PR 10.21; 95%CI 6.27-16.63 and infrequent supplemental nutrition beyond scheduled meals (PR 3.00; 95%CI 1.67-5.62. Access to supplemental nutrition was associated with frequency of visits from friends and family and ability to rely on other inmates for help. CONCLUSION: In prison facilities of Tajikistan, HIV-infection, injection drug use and low access to supplemental nutrition were associated with prevalent cases of active pulmonary TB. Policies that reduce HIV transmission among injection drug users and improve the nutritional status of socially isolated inmates may alleviate the TB burden in Tajikistan's prisons.

  18. Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis

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    Olanisun Olufemi Adewole

    2013-01-01

    Full Text Available Introduction: Interferon-γ (IFN-γ is essential for defence against Mycobacterium tuberculosis; however, levels in patients with active tuberculosis (TB and changes during treatment have not been documented in our tuberculosis patients in Nigeria, hence this study has been carried out. Objective: To determine variations, treatment kinetics, and predictive value of IFN-γ levels during treatment of active tuberculosis. Design: Patients with pulmonary tuberculosis were recruited and subsequently followed up for 3 months during treatment with anti-TB. Peripheral blood was collected for IFN-γ assays, C-reactive protein and others followed by a Mantoux test. IFN-γ levels produced by stimulation with TB antigens were determined by ELISA and repeated measurement of IFN-γ were done at 1 and 3 months of anti-TB therapy. Chi Associations and correlations between IFN-γ were determined. Regression analysis was done to determine association between serial IFN-γ and treatment outcome. Results: We recruited 47 patients with active tuberculosis with a mean age of 34.8 ± 3.6 years and M:F ratio of 1.12:1. Six (11% were HIV positive. The mean level of IFN-γ induced by TB antigens was 629 ± 114.1 pg/ml, higher for HIV-negative PTB patients compared with HIV-positive PTB patients, 609.78 ± 723.9 pg/ml and 87.88 ± 130.0 pg/ml, respectively, P-value = 0.000. The mean level of IFN-γ induced by TB antigen increased significantly from 629 ± 114.1 pg/ml to 1023.46 + 222.8 pg/ml, P-value = 0.03 and reduced to 272.3 ± 87.7 pg/ml by the third month on anti-TB drugs, P-value = 0.001. Negative correlation was observed between the mean of baseline and chest X-ray involvement, P = 0.03. There was no significant correlation between sputum smear grade with baseline and follow-up IFN-γ levels. Three-month IFN-γ level among cured patients were higher than those with treatment failure, regression analysis showed that it does not predict outcome. Conclusion: IFN

  19. Double-positive Goodpasture′s syndrome with concomitant active pulmonary tuberculosis

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    Waqar Kashif

    2013-01-01

    Full Text Available Anti-glomerular basement membrane (anti-GBM disease usually presents as rapidly progressive glomerulonephritis, and, when accompanied with pulmonary hemorrhage, it is called Goodpasture′s syndrome. Anti-neutrophilic cytoplasmic antibodies (ANCA may co-exist with anti-GBM antibodies. In most of these "double positive" cases, ANCA is specific for myeloperoxidase (p-ANCA. We report a rare case of a critically ill patient c-ANCA-associated double-positive Goodpasture′s syndrome with concomitant tuberculosis that was successfully treated with immunosuppression, plasmapheresis and anti-tuberculous therapy (ATT. A 32-year-old gentleman with a 15 pack-year smoking history presented with massive hemoptysis, respiratory failure and oliguria. Laboratory investigation revealed anemia, elevated creatinine and active urinary sediment. Chest X-ray revealed bilateral pulmonary infiltrates. Broad-spectrum antibiotics and intravenous corticosteroids were started. Bronchoscopy showed alveolar hemorrhage and smears from bronchial lavage from both lungs were positive for acid fast bacillus (AFB. Vasculitis work-up revealed high titers of c-ANCA and anti-GBM antibodies. Kidney biopsy revealed crescents in >50% glomeruli on light microscopy. Immunofluorescence showed linear deposition of IgG and C3. The patient received pulse methylprednisone for three days followed by oral prednisone and ATT. In addition, he also underwent nine sessions of plasmapheresis. Oral Cyclophosphamide was added on Day 10. The patient showed remarkable recovery as his lung fields cleared and his kidney function got stabilized. Cyclophosphamide was continued for three months and then switched to azathioprine. At six months, the creatinine is 1.2 mg/dL, with minimal proteinuria and a normal chest X-ray. To the best of our knowledge, this is the only reported case of double-positive Goodpasture′s syndrome (c-ANCA and anti GBM with active tuberculosis treated successfully.

  20. Radioiodine uptake in inactive pulmonary tuberculosis

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    Bakheet, S.M.; Powe, J.; Al Suhaibani, H. [Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia); Hammami, M.M.; Bazarbashi, M. [Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)

    1999-06-01

    Radioiodine may accumulate at sites of inflammation or infection. We have seen such accumulation in six thyroid cancer patients with a history of previously treated pulmonary tuberculosis. We also review the causes of false-positive radioiodine uptake in lung infection/inflammation. Eight foci of radioiodine uptake were seen on six iodine-123 diagnostic scans. In three foci, the uptake was focal and indistinguishable from thyroid cancer pulmonary metastases from thyroid cancer. In the remaining foci, the uptake appeared nonsegmental, linear or lobar, suggesting a false-positive finding. The uptake was unchanged, variable in appearance or non-persistent on follow-up scans and less extensive than the fibrocystic changes seen on chest radiographs. In the two patients studied, thyroid hormone level did not affect the radioiodine lung uptake and there was congruent gallium-67 uptake. None of the patients had any evidence of thyroid cancer recurrence or of reactivation of tuberculosis and only two patients had chronic intermittent chest symptoms. Severe bronchiectasis, active tuberculosis, acute bronchitis, respiratory bronchiolitis, rheumatoid arthritis-associated lung disease and fungal infection such as Allescheria boydii and aspergillosis can lead to different patterns of radioiodine chest uptake mimicking pulmonary metastases. Pulmonary scarring secondary to tuberculosis may predispose to localized radioiodine accumulation even in the absence of clinically evident active infection. False-positive radioiodine uptake due to pulmonary infection/inflammation should be considered in thyroid cancer patients prior to the diagnosis of pulmonary metastases. (orig.) With 4 figs., 1 tab., 9 refs.

  1. Interleukin 17-Producing γδT Cells Increased in Patients with Active Pulmonary Tuberculosis

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    Meiyu Peng; Zhaohua Wang; Chunyan Yao; Lina Jiang; Qili Jin; Jing Wang; Baiqing Li

    2008-01-01

    Although it has been known that y8 T cells may play an important role in the immune response to infection of Mycobacterium tuberculosis (M. tb), the mechanisms by which the T8 T cells participate in the innate and/or acquired immunity to tuberculosis (TB) have not been full elucidated. In the present study, 27 patients with active pulmonary TB and 16 healthy donors (HD) were performed. We found that proportion of IL-17-producing cells among lymphocyte was similar between TB patients and HD, whereas the proportions of γδ T cells in IL-17- producing cells (59.2%) and IL-17-producing cells in γδ T cells (19.4%) in peripheral blood were markedly increased in TB patients when compared to those in HD (43.9% and 7.7%, respectively). In addition, the proportions of IFN-γ-producing γδ T cells in TB patients were obviously lower than that in HD. Upon re-stimulated with M. tb heat-treated antigen (M. tb-HAg) in vitro, fewer IL-17-producing γδ T cells were generated from HD and TB patients, whereas IFN-γ-producing γδ T cells were increased in TB patients compared to that in HD. Our findings in TB patients and healthy human were consistent with other murine investigation that the IL-17- producing γδ T cells were main source of IL-17 in mouse model of BCG infection, suggesting that γδ T cells might be involved in the formation of tubercular granuloma in pulmonary TB patients, but need further identification. Cellular & Molecular Immunology. 2008;5(3):203-208.

  2. IL23R(Arg381Gln) functional polymorphism is associated with active pulmonary tuberculosis severity.

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    Ben-Selma, Walid; Boukadida, Jalel

    2012-08-01

    The purpose of our study was to investigate the association between a functional single nucleotide polymorphism (SNP) in the interleukin-23 receptor gene (IL23R; rs11209026, 1142 G(wild type) → A(reduced function), Arg381Gln) and disease severity outcome in pulmonary tuberculosis (TB) in the Tunisian population. SNP was investigated in a population of 168 patients with active pulmonary TB (cases were stratified into patients with minimal/moderate lung involvement, i.e., patients with minimal/moderate disease [Pmd], and patients with extensive lung involvement, i.e., patients with active disease [Pad]) and 150 healthy subjects. Genotype analyses were carried out using the PCR-restriction fragment length polymorphism method. We have found that the IL23R reduced-function allele 1142A and genotypes AA and AG were overrepresented, especially in the Pad subgroup compared with the control group (51% versus 18% [P = 10(-8)], 33% versus 5% [P = 10(-8)], and 36% versus 26% [P = 5 × 10(-3)], respectively). Additionally, comparison of the Pad and the Pmd groups showed that the A allele and AA genotype seemed to be associated with 2.79-fold (P = 4 × 10(-5)) and 7.74-fold (P = 10(-5)) increased risks of TB with minimal/moderate lung involvement, respectively. Our results demonstrate that the reduced-function polymorphism 1142G → A encoded by IL23R influences the outcome of disease severity of active pulmonary TB in Tunisian patients.

  3. [Hemophagocytic syndrome secondary to cavitary pulmonary tuberculosis].

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    Rakotoson, J L; Rakotonirainy, O H; Moroyandsa, F; Rakotoharivelo, H; Rakotomizao, J R; Andrianarisoa, A C F

    2012-01-01

    Hemophagocytic syndrome is due to the activation and nonmalignant proliferation of macrophages and T lymphocytes. The purpose of this report is to describe a 25-year-old man who presented with fever, coughing, and weight loss over the past month. Laboratory findings demonstrated pancytopenia, hyperferritinemia, and cytolysis. The myelogram showed a hemophagocytic syndrome, and tuberculosis bacilli were found in the sputum. Chest radiography and thoracic computed tomography depicted a cavitary lesion suggestive of pulmonary tuberculosis. Treatment of tuberculosis alone, without an immunosuppressant agent, was effective and led to improvement. In a country where tuberculosis is highly endemic, hemophagocytic syndrome should be considered in the differential diagnosis of patients with active tuberculosis complicated by pancytopenia.

  4. Chest radiography and thoracic computed tomography findings in children who have family members with active pulmonary tuberculosis

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    Uzum, Kazim; Karahan, Okkes I.; Dogan, Sukru; Coskun, Abdulhakim E-mail: coskuna@erciyes.edu.tr; Topcu, Faik

    2003-12-01

    Objective: The chest radiography and TCT findings in children who had contacted with adult family members with active pulmonary tuberculosis were compared. The contributions of thoracic computed tomography to the diagnosis of tuberculosis were investigated. Methods and material: The children who were 0-16 years old (n=173) and children of families with an adult member which was diagnosed as pulmonary tuberculosis were evaluated. The children were considered in two groups based on the absence (n=125) or presence (n=48) of complaints and/or ambiguous symptoms such as lack of appetite, mild cough, sweating, history of lung infection, low body weight and those with suspicious chest radiography findings (12 cases) were included in this study. Asymptomatic patients (n=125) did not undergo TCT. Patients who had positive PPD skin tests only received isoniazid. If the TCT demonstrated enlarged lymph nodes or parenchymal lesions, minimally active pulmonary tuberculosis was diagnosed and antituberculous treatment was given. Results and discussions: TCT revealed lymph node enlargement or parenchymal lesions in 39 children (81.2%). Of the 12 children whose CXRs revealed suspicious lymph node enlargement and/or infiltration, five had normal findings in TCT whereas the initial findings were confirmed in the remaining seven. These data suggest that there is a correlation between the presence of ambiguous symptoms in exposed children and TCT findings; chest radiography and TCT findings do not yield parallel findings. All the patients who received anti-TB treatment were resolved in the control examinations. Conclusion: In this study there is a correlation between presence of ambiguous symptoms and TCT findings, but the chest radiography and TCT findings do not yield harmony in exposed children with ambiguous symptoms (suspicious tuberculosis cases). These observations should be considered in children with symptoms similar to those of exposed children, but with no definite history of

  5. Pulmonary mycoses among the clinically suspected cases of pulmonary tuberculosis

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    Tshering Ongmu Bhutia; Luna Adhikari

    2015-01-01

    Background: This study was carried with the main objectives: (1) to find out the occurrence of pulmonary mycoses in clinically suspected pulmonary tuberculosis cases at central referral hospital, Tadong, Sikkim. (2) To find out the various fungi causing pulmonary mycoses in clinically suspected pulmonary tuberculosis cases. Methods: 200 clinically suspected pulmonary tuberculosis cases who visited the department of microbiology for the diagnostic microscopic examination of sputum sample f...

  6. Role of digital tomosynthesis and dual energy subtraction digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis

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    Sharma, Madhurima, E-mail: madhurimashrm88@gmail.com [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Sandhu, Manavjit Singh, E-mail: manavjitsandhu@yahoo.com [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Gorsi, Ujjwal, E-mail: ujjwalgorsi@gmail.com [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Gupta, Dheeraj, E-mail: dheeraj1910@gmail.com [Department of Pulmonary Medicine, PGIMER, Chandigarh 160012 (India); Khandelwal, Niranjan, E-mail: khandelwaln@hotmail.com [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India)

    2015-09-15

    Highlights: • Digital tomosynthesis and dual energy subtraction digital radiography are modifications of digital radiography. • These modalities perform better than digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis. • Digital tomosynthesis has a sensitivity of 100% in detection of cavities. • Centrilobular nodules seen on CT in active pulmonary tuberculosis, were also demonstrated on digital tomosynthesis in our study. • Digital tomosynthesis can be used for diagnosis and follow up of patients in pulmonary tuberculosis, thereby reducing the number of CT examinations. - Abstract: Objective: To assess the role of digital tomosynthesis (DTS) and dual energy subtraction digital radiography (DES-DR) in detection of parenchymal lesions in active pulmonary tuberculosis (TB) and to compare them with digital radiography (DR). Materials and methods: This prospective study was approved by our institutional review committee. DTS and DES-DR were performed in 62 patients with active pulmonary TB within one week of multidetector computed tomography (MDCT) study. Findings of active pulmonary TB, that is consolidation, cavitation and nodules were noted on digital radiography (DR), DTS and DES-DR in all patients. Sensitivity, specificity, positive and negative predictive values of all 3 modalities was calculated with MDCT as reference standard. In addition presence of centrilobular nodules was also noted on DTS. Results: Our study comprised of 62 patients (33 males, 29 females with age range 18–82 years). Sensitivity and specificity of DTS for detection of nodules and cavitation was better than DR and DES-DR. Sensitivity and specificity of DTS for detection of consolidation was comparable to DR and DES-DR. DES-DR performed better than DR in detection of nodules and cavitation. DTS was also able to detect centrilobular nodules with sensitivity and specificity of 57.4% and 86.5% respectively. Conclusion: DTS and DES-DR perform better

  7. miRNA Signatures in Sera of Patients with Active Pulmonary Tuberculosis

    Science.gov (United States)

    Valente, Ilaria C.; Norbis, Luca; Sotgiu, Giovanni; Bosu, Roberta; Ambrosi, Alessandro; Codecasa, Luigi R.; Goletti, Delia; Matteelli, Alberto; Ntinginya, Elias N.; Aloi, Francesco; Heinrich, Norbert; Reither, Klaus; Cirillo, Daniela M.

    2013-01-01

    Several studies showed that assessing levels of specific circulating microRNAs (miRNAs) is a non-invasive, rapid, and accurate method for diagnosing diseases or detecting alterations in physiological conditions. We aimed to identify a serum miRNA signature to be used for the diagnosis of tuberculosis (TB). To account for variations due to the genetic makeup, we enrolled adults from two study settings in Europe and Africa. The following categories of subjects were considered: healthy (H), active pulmonary TB (PTB), active pulmonary TB, HIV co-infected (PTB/HIV), latent TB infection (LTBI), other pulmonary infections (OPI), and active extra-pulmonary TB (EPTB). Sera from 10 subjects of the same category were pooled and, after total RNA extraction, screened for miRNA levels by TaqMan low-density arrays. After identification of “relevant miRNAs”, we refined the serum miRNA signature discriminating between H and PTB on individual subjects. Signatures were analyzed for their diagnostic performances using a multivariate logistic model and a Relevance Vector Machine (RVM) model. A leave-one-out-cross-validation (LOOCV) approach was adopted for assessing how both models could perform in practice. The analysis on pooled specimens identified selected miRNAs as discriminatory for the categories analyzed. On individual serum samples, we showed that 15 miRNAs serve as signature for H and PTB categories with a diagnostic accuracy of 82% (CI 70.2–90.0), and 77% (CI 64.2–85.9) in a RVM and a logistic classification model, respectively. Considering the different ethnicity, by selecting the specific signature for the European group (10 miRNAs) the diagnostic accuracy increased up to 83% (CI 68.1–92.1), and 81% (65.0–90.3), respectively. The African-specific signature (12 miRNAs) increased the diagnostic accuracy up to 95% (CI 76.4–99.1), and 100% (83.9–100.0), respectively. Serum miRNA signatures represent an interesting source of biomarkers for TB disease with the

  8. miRNA signatures in sera of patients with active pulmonary tuberculosis.

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    Paolo Miotto

    Full Text Available Several studies showed that assessing levels of specific circulating microRNAs (miRNAs is a non-invasive, rapid, and accurate method for diagnosing diseases or detecting alterations in physiological conditions. We aimed to identify a serum miRNA signature to be used for the diagnosis of tuberculosis (TB. To account for variations due to the genetic makeup, we enrolled adults from two study settings in Europe and Africa. The following categories of subjects were considered: healthy (H, active pulmonary TB (PTB, active pulmonary TB, HIV co-infected (PTB/HIV, latent TB infection (LTBI, other pulmonary infections (OPI, and active extra-pulmonary TB (EPTB. Sera from 10 subjects of the same category were pooled and, after total RNA extraction, screened for miRNA levels by TaqMan low-density arrays. After identification of "relevant miRNAs", we refined the serum miRNA signature discriminating between H and PTB on individual subjects. Signatures were analyzed for their diagnostic performances using a multivariate logistic model and a Relevance Vector Machine (RVM model. A leave-one-out-cross-validation (LOOCV approach was adopted for assessing how both models could perform in practice. The analysis on pooled specimens identified selected miRNAs as discriminatory for the categories analyzed. On individual serum samples, we showed that 15 miRNAs serve as signature for H and PTB categories with a diagnostic accuracy of 82% (CI 70.2-90.0, and 77% (CI 64.2-85.9 in a RVM and a logistic classification model, respectively. Considering the different ethnicity, by selecting the specific signature for the European group (10 miRNAs the diagnostic accuracy increased up to 83% (CI 68.1-92.1, and 81% (65.0-90.3, respectively. The African-specific signature (12 miRNAs increased the diagnostic accuracy up to 95% (CI 76.4-99.1, and 100% (83.9-100.0, respectively. Serum miRNA signatures represent an interesting source of biomarkers for TB disease with the potential to

  9. A cross sectional survey on the prevalence of active pulmonary tuberculosis in three ‘key’ elderly population

    Institute of Scientific and Technical Information of China (English)

    李曙光

    2014-01-01

    Objective To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above.Study subjects would include those with characteristics of TB suspicious symptoms,diabetes and close contacts.Methods Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites,relying on the local basic public health service,for those elderly under 65 years old or above.The

  10. Tomographic Aspects of Advanced Active Pulmonary Tuberculosis and Evaluation of Sequelae following Treatment

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    Rafael Barcelos Capone

    2017-01-01

    Full Text Available Objectives. To evaluate tomographic changes in pulmonary tuberculosis (TB, degree of agreement among three radiologists regarding tomographic diagnoses, and sequelae following treatment. Methods. Cross-sectional and descriptive study of 74 TB patients confirmed by sputum culture and chest computed tomography before (CT1 and 6 months after (CT2 drug therapy. Results were performed by three radiologists blinded to clinical and laboratory results. Results. Main findings in CT1 included nodules indicating the presence of a tree-in-bud pattern in 93% of cases, ill-defined nodules in 84% of cases, consolidation in 77% of cases, architectural distortion in 71% of cases, cavitary lesions in 62% of cases, and ground glass opacities in 37% of cases. Airway involvement, characterized by increased thickness and dilatation of the bronchial walls, occurred in 93% of cases. Pleural involvement occurred in 54%. There was an agreement on active TB among the three radiologists in 85% of cases. The results in CT2 indicated the presence of architectural distortion in 91% of cases and cylindrical bronchiectasis in 86%. Conclusions. The study established a tomographic pattern for diagnosis of active TB characterized by the presence of airway nodules, consolidation, architectural distortion, and cavitary lesions, and an almost complete degree of agreement (Kappa was observed among the radiologists (0.85. CT after treatment assists in defining the cure.

  11. Tc-99m Ciprofloxacin SPECT of Pulmonary Tuberculosis

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    Lee, Min Kyung; Hwang, Kyung Hoon [Gachon University Gil Hospital, Incheon (Korea, Republic of); Yoon, Min Ki [Good Samaritan Hospital, Pohang (Korea, Republic of); Choe, Won Sick [Kangbuk Samsung Hospital, Seoul (Korea, Republic of)

    2010-06-15

    Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis. Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555 MBq (15 mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients' clinical and radiological classifications. The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.0%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%. Conclusions Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.

  12. [Update on the radiological study of pulmonary tuberculosis].

    Science.gov (United States)

    Navarro Ballester, A; Marco Domenech, S F

    2015-01-01

    Tuberculosis has made a comeback in recent years. This upsurge has been attributed to factors such as increased immigration and the human immunodeficiency virus epidemic. Primary pulmonary tuberculosis manifests radiologically with parenchymal involvement, lymph node involvement, pleural effusion, and/or miliary disease. In post-primary tuberculosis, the earliest radiological sign is small nodules and branching centrilobular lesions that increase in size and coalesce to form ill-defined patchy consolidations; cavitations are very characteristic of active disease. The aim of this article is to describe the radiologic findings for pulmonary tuberculosis and its complications.

  13. Detección de la expresión génica in vivo de Mycobacterium tuberculosis durante la tuberculosis pulmonar activa Mycobacterium tuberculosis in vivo-expressed genes detection during active pulmonary tuberculosis

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    Alejandra Otazo M

    2012-12-01

    Full Text Available El estudio de la expresión génica de Mycobacterium tuberculosis ha involucrado la experimentación "in vitro ", "ex vivo " e "in vivo " (modelos animales, pero aún sin el éxito esperado. Proponemos que revelar los factores clave de la tuberculosis humana requiere investigar la expresión génica de M. tuberculosis dentro del ser humano ("in vivo ". Para ello, aislamos el mRNA total de M. tuberculosis, desde muestras clínicas respiratorias de pacientes con diagnóstico de tuberculosis pulmonar; posteriormente, sintetizamos el dscDNA y lo analizamos mediante RT-PCR cualitativo. Detectamos la expresión de la secuencia de inserción IS6110 y de los genes "housekeeping " 16SrRNA y sigA en M. tuberculosis creciendo in vivo (tuberculosis pulmonar así como cultivado in vitro. La expresión de los genes mprA y mprB, que codifican el sistema de transducción de señales MprAB, sólo se detectó en M. tuberculosis crecido in vitro. Con nuestros resultados damos el primer paso hacia la implementación de un método no invasivo para el estudio del transcriptoma de M. tuberculosis, dentro de su único hospedero natural, con el fin de analizar la regulación "in vivo" de los determinantes genéticos requeridos para su virulencia y patogénesis.Mycobacterium tuberculosis gene expression studies have involved "in vitro", "ex vivo" and "in vivo" experiments (animal models, but without the expected success. We propose that key features of human tuberculosis could be discovered by studying the M. tuberculosis gene expression within the human host. Therefore, we isolated totalM. tuberculosis mRNA from human clinical respiratory specimens of patients diagnosed with pulmonary tuberculosis; after this, we synthesized the dscDNA and tested it by qualitative RT-PCR assays. We detected the expression of IS6110 insertion sequence and of the "housekeeping" genes 16SrRNA andsigA in M. tuberculosis grown in vivo (pulmonary tuberculosis as well as grown in vitro M

  14. Rheumatoid arthritis increases the risk of nontuberculosis mycobacterial disease and active pulmonary tuberculosis.

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    Jun-Jun Yeh

    Full Text Available BACKGROUND: Few studies have examined the association of rheumatoid arthritis (RA with nontuberculosis mycobacterium (NTM disease and pulmonary tuberculosis (PTB. METHODS: We identified 29 131 patients with RA from the catastrophic illness registry who were diagnosed from 1998-2008; 116 524 patients without RA from inpatient data files were randomly frequency matched according to sex, age, and index year and used as a comparison group. Both groups were followed-up until the end of 2010 to measure the incidence of NTM disease and active PTB. We analyzed the risk of NTM disease and active PTB using the Cox proportional hazards regression models, controlling for sex, age, and Charlson comorbidity index (CCI. RESULTS: The incidence of NTM disease was 4.22 times greater in the RA group than in the non-RA group (1.91 vs 0.45 per 10,000 person-years. The incidence of PTB was 2.99 times greater in the RA group than in the non-RA group (25.3 vs 8.46 per 10,000 person-years. After adjusting for age, sex, and CCI, the adjusted hazard ratios (HRs of NTM disease and active PTB for the RA group were 4.17 (95% CI = 2.61-6.65 and 2.87 (95% CI = 2.55-3.23, respectively, compared with the non-RA group. In the first 2 years of follow-up, the RA group yielded corresponding adjusted HRs of 4.98 and 3.39 compared with the non-RA group. The follow-up time-specific RA group to the non-RA group HR of both the NTM disease and active PTB varied. CONCLUSION: This study can serve as a reference for clinical physicians to increase awareness regarding the detection of NTM disease and active PTB in RA patients among the any stage of the clinical course even without CCI.

  15. MCP-1 -2518 A/G functional polymorphism is associated with increased susceptibility to active pulmonary tuberculosis in Tunisian patients.

    Science.gov (United States)

    Ben-Selma, Walid; Harizi, Hedi; Boukadida, Jalel

    2011-11-01

    Monocyte chemoattractant protein-1 (MCP-1) plays crucial role in protective immunity against Mycobacterium tuberculosis (MT). In this study, we examined whether single nucleotide polymorphism (SNP) -2518 A/G (rs 1024611) of MCP-1 affect the susceptibility to active tuberculosis (TB) in Tunisian populations. Genomic DNA from patients with active TB (168 cases of pulmonary TB and 55 cases of extrapulmonary TB) and ethnically controls (150 cases) was genotyped for the MCP-1 -2518 A/G SNP by polymerase chain reaction fragment length polymorphism (PCR-RFLP). We observed that -2518 G allele and GG genotype (high MCP-1 producer) frequencies were significantly more elevated in active pulmonary TB group in comparison to control group [34 vs. 22%; P = 0.0007; 15 vs. 5%, P corrected for the number of genotypes (Pc) = 0.015; respectively]. Additionally, they were associated with increased risk development of this clinical form of TB [odds ratio (OR) = 1.83, 95% confidence intervals (CI) = 1.26-2.66; OR = 3.1, 95% CI = 1.28-7.76; respectively]. However, wild type allele -2518 A and AA genotype were over-represented in control group (78 and 62%) and seem to be protective factors against TB. Moreover, -2518 AA genotype was more frequent in control group and was associated with resistance against development of active pulmonary TB (OR = 0.56, 95% CI = 0.35-0.89, Pc = 0.03). Our findings confirm the key role of -2518 A/G SNP of MCP-1 and support its association with resistance/susceptibility to the development of active pulmonary TB in the Tunisian population.

  16. Crescentic Glomerulonephritis Associated with Pulmonary Tuberculosis.

    Science.gov (United States)

    Kanodia, K V; Vanikar, A V; Patel, R D; Suthar, K S; Trivedi, H L

    2016-01-01

    Tuberculosis of kidney and urinary tract is caused by members of the Mycobacterium tuberculosis complex. Kidney is usually infected by haematogenous spread of bacilli from focus of infection in the lungs. Glomerular involvement in tuberculosis presenting as a rapidly progressive glomerulonephritis is a rare entity. We report a rare case of crescentic glomerulonephritis associated with pulmonary tuberculosis in a 26-year-old man. Patient was treated with corticosteroids, haemodialysis, intravenous immunoglobulin and four cycles of plasmapheresis. He did not respond to 4-drug anti-tuberculosis treatment for renal pathology and was switched over to maintenance haemodialysis. However, he responded to pulmonary TB.

  17. Interferon gamma +874T/A polymorphism is associated with susceptibility to active pulmonary tuberculosis development in Tunisian patients.

    Science.gov (United States)

    Ben Selma, Walid; Harizi, Hedi; Bougmiza, Iheb; Hannachi, Naila; Ben Kahla, Imen; Zaieni, Radhia; Boukadida, Jalel

    2011-06-01

    Interferon gamma (IFN-γ) is a key cytokine involved mainly in the defense against intracellular pathogens such as Mycobacterium tuberculosis. Given its key role in the control of tuberculosis (TB), in the present article we have investigated a possible association between IFN-γ gene single-nucleotide polymorphism linked to high and low producer phenotypes (IFN-γ [+874T(high) → A(low)]) (rs2430561) and risk development of active TB in Tunisian patients. Genomic DNA samples were obtained from 223 patients with active TB (168 pulmonary and 55 extrapulmonary cases) and 150 healthy blood donors. Genotypes were analyzed using polymerase chain reaction-restriction fragment length polymorphism method. The +874 AA genotype (low IFN-γ producer) was significantly associated with increased risk of developing of active pulmonary TB (odds ratio [OR] = 2.18; 95% confidence intervals [CI], 1.33-3.57; P corrected for the number of genotypes [Pc] = 0.003). By contrast, the AT genotype was found to be significantly associated with resistance to pulmonary TB (OR = 0.46; 95% CI, 0.28-0.74; Pc = 0.0018) and extrapulmonary TB development (OR = 0.46; 95% CI, 0.23-0.91; Pc = 0.045). Collectively, our data showed that the IFN-γ +874T/A polymorphism is a determinant in the resistance or susceptibility to the development of active TB in the studied population.

  18. Thyroid function in pulmonary tuberculosis.

    Science.gov (United States)

    Sajid, Khan Mohammad; Parveen, Riffat; Sabih, Durr-e-; Mahmood, Rubaida

    2006-10-01

    To evaluate the thyroid hormone economy in pulmonary tuberculosis (PTB). Cohort comparative study. Multan Institute of Radiotherapy and Nuclear Medicine (MINAR) from January 2003 to June 2005. The study included 266 confirmed cases of pulmonary tuberculosis (PTB), aged between 11 and 65 years, who had completed short course of chemotherapy. Two samples were collected from each patient, first after final diagnosis and second after completion of the treatment. Initial analysis of samples showed that 31 samples had both T3 (triiodothyronine) and T4 (thyroxine) in lower than normal range. One more sample in the middle of treatment was collected for these patients. Radioimmunoassays and immunoradiometeric assays were applied to estimate mean TT3, TT4 and TSH (thyroid stimulating hormone) levels. Students t-test was used to compare patient and normal values derived from 713 volunteers. The age had no effect on levels of T3, T4 and TSH in normal persons. Mean T3 and T4 values (0.74 nmol/l and 91.9 nmol/l) in PTB patients were significantly decreased (p deiodination of T4). The levels improved after chemotherapy.

  19. Increased levels of BAFF and APRIL related to human active pulmonary tuberculosis.

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    Kai Liu

    Full Text Available BACKGROUND: Despite great efforts to improve diagnosis and treatment, tuberculosis (TB remains a major health problem worldwide, especially in developing countries. Lack of concrete immune markers is still the obstacle to properly evaluate active TB. Therefore, identification of more validated biomarkers and phenotypic signatures is imperative. In particular, T cell-related biomarkers are more significant. METHODOLOGY: To understand the nature of CD4(+ T cell-derived signatures involved in infection and disease development, we examined and analyzed whole genome expression profiles of purified CD4(+ T cells from healthy individuals (HD, two distinct populations with latent infection (with low or high IFN-γ levels, LTB(L/LTB(H and untreated TB patients. Following, we validated the expression profiles of genes in the peripheral CD4(+ T cells from each group and examined secretion levels of distinct cytokines in serum and pleural effusion. PRINCIPAL FINDINGS: Our bio-informatic analyses indicate that the two latent populations and clinical TB patients possess distinct CD4(+ T cell gene expression profiles. Furthermore, The mRNA and protein expression levels of B cell activating factor (BAFF, which belongs to the TNF family, and a proliferation-inducing ligand (APRIL were markedly up-regulated at the disease stage. In particular, the dramatic enhancement of BAFF and APRIL in the pleural effusion of patients with tuberculosis pleurisy suggests that these proteins may present disease status. In addition, we found that the BAFF/APRIL system was closely related to the Th1 immune response. Our study delineates previously unreported roles of BAFF and APRIL in the development of tuberculosis, and these findings have implications for the diagnosis of the disease. Our study also identifies a number of transcriptional signatures in CD4(+ T cells that have the potential to be utilized as diagnostic and prognostic tools to combat the tuberculosis epidemic.

  20. [Anorexia nervosa complicated with pulmonary tuberculosis].

    Science.gov (United States)

    Ishii, Y; Yoneda, T; Tsukaguchi, K; Fu, A; Takeuchi, S; Tomoda, K; Tokuyama, T; Narita, N

    1994-02-01

    A study was made on a patient with anorexia nervosa complicated with pulmonary tuberculosis treated with intravenous hyperalimentation (IVH). A 24-year-old female was admitted to our hospital because of progressive loss of body weight during medication for pulmonary tuberculosis at another hospital. She was diagnosed as having anorexia nervosa. After the nutritional assessment IVH was performed. As a result of IVH, her body weight increased and her nutritional deprivation, (i.e., low visceral proteins, low branched amino acids, etc.) recovered. Nutritional support was effective upon treating pulmonary tuberculosis.

  1. Pulmonary mycoses among the clinically suspected cases of pulmonary tuberculosis

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    Tshering Ongmu Bhutia

    2015-01-01

    Full Text Available Background: This study was carried with the main objectives: (1 to find out the occurrence of pulmonary mycoses in clinically suspected pulmonary tuberculosis cases at central referral hospital, Tadong, Sikkim. (2 To find out the various fungi causing pulmonary mycoses in clinically suspected pulmonary tuberculosis cases. Methods: 200 clinically suspected pulmonary tuberculosis cases who visited the department of microbiology for the diagnostic microscopic examination of sputum sample for acid fast bacilli were included in this cross sectional study, carried out under the department of microbiology, Sikkim Manipal institute of medical sciences, over one year. Smears of sputum samples were examined microscopically for acid fast bacilli and fungal elements. Sputum samples were also plated onto different fungal culture media. Results: Out of 200 patients, various types of pathogens were detected in 54 (27% patients. Fourteen (7% patients were positive only for AFB, while fungus as a primary etiological agent was detected in 16(8% patients. Fungus as a secondary etiological agent was detected in 4 (2% patients [AFB with fungus in 2 (1%, AFB with fungus and bacteria in 1 (0.5% and bacteria with fungus in 1 (0.5% patient]. Conclusion: Pulmonary mycosis can be a primary infection in non- tuberculosis cases or co-infection in pulmonary tuberculosis cases. Investigation for fungal cause in clinically suspected cases of pulmonary tuberculosis will prevent misdiagnosis and mistreatment of cases. [Int J Res Med Sci 2015; 3(1.000: 260-268

  2. PECULIARITIES OF THE FUNCTIONAL ACTIVITY OF BLOOD EOSINOPHIL GRANULOCYTES IN PULMONARY TUBERCULOSIS

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    Yu. V. Kolobovnikova

    2014-01-01

    Full Text Available Eosinophils are polyfunctional leukocytes detected in excess in blood and in the focus of granulomatous inflammation in pulmonary TB.The research objective was to evaluate the adhesive properties as well as cytokine-secretory and antibacterial activity of blood eosinophils in pulmonary TB.The research has been conducted on eosinophils isolated from peripheral blood of 43 patients with freshly identified progressive destructive TB with and without eosinophilia. Using flow cytometry and ELISA, expression of CD9 and CD18 adhesion molecules on blood eosinophils has been studied along with the phagocyte and cytokine-secretory functions and activity of eosinophil granulocyte peroxidase.As a result of the research it has been established that in TB patients with eosinophilia the number of CD18-expressing eosinophils rises, whereas the amount of CD9+ remains within norm. Activation of the phagocyte function of blood eosinophil granulocytes is associated with the decrease in eosinophil peroxidase activity, while the increase in IL-5 and TNFα secretory reactivity is connected with oppositely directed changes in  IL-2 basal secretion by eosinophils in vitro (a fall in infiltrative TB and a rise in disseminated TB.

  3. DIFFERENCES BETWEEN PEDIATRIC PULMONARY AND EXTRA-PULMONARY TUBERCULOSIS: A WARNING SIGN FOR THE FUTURE

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    Ilker Devrim

    2014-08-01

    Full Text Available Introduction: Tuberculosis (TB remains a major global health problem affecting millions of people annually. Tuberculosis in children has unique features different from adults which makes the diagnosis to be more difficult. The spectrum of the symptoms of TB in children could vary from non-specific symptoms to severe clinical presentations.  In this study, we reviewed our experience at pediatric patients with active TB admitted in a tertiary hospital  and aimed to compare the epide­miological, clinical and microbiological features of  children with  the extra-pulmonary tuberculosis(EPTB and pulmonary tuberculosis(PTB. Material and methods: Patients under 14 years of age diagnosed with active TB in our unit between December 2008 and September 2013 were included in the study. Data including demographic characteristics, clinical history, microbiology, imaging studies, medications and outcomes of the patients were collected from medical records. Results: A total of 129 cases of active TB were identified.  Ninety-two (78.6% of the cases had Pulmonary Tuberculosis and 25 (21.4% of the cases had Extra-pulmonary tuberculosis. The most common signs and symptoms on admission were fever in 40 cases (34.2% and cough in 81 cases (69.2%. The number of patients without symptoms including fever, cough, malaise and weight loss were significantly higher in EXPTB (72.0% group when compared with patients in PTB group (13.0% (p 0.05. The detection rate of source in PTB group (42.4% was significantly higher than the rate in  EPTB group (20.0%( p=0.04. In the drug-resistant group, no source of infection could be established in 5 of 9 patients (55.5%. Conclusions: Extra-pulmonary tuberculosis diagnosis is more difficult than Pulmonary tuberculosis in children due to the various problems such as absence of associated pulmonary involvement,  lack of constitutional symptoms and negative tuberculosis exposure history compared to Pulmonary Tuberculosis. New

  4. The prevalence of pulmonary tuberculosis in Jeonbug Province

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    Rhee, S. J.; Moon, M. C.; Song, H. Y.; Choi, K. C. [Jeonbug Natinal University College of Medicine, Jeonju (Korea, Republic of)

    1981-12-15

    A photofluorographic mass survey of P-A chest had been done to the 13136 residents (male 6264, female 6872) in Jeonbug province, Korea for about 2 years from May 5, to Dec.19, 1978 and from Mar. 5, to Dec. 22, 1979. The results are as follows: 1. The prevalence rate of all active pulmonary tuberculosis is 5.3%. 2. The prevalence rate of male(8.8%) is 4.2 times higher than that of female (2.1%). 3. The prevalence rates of all old age groups above fifty years are higher than that of remainder under fifty years of age. Of these, 61-70 years old age group is highest in prevalence rate. 4. According to extent of active pulmonary tuberculosis, 77.5% is minimal, 15.4% is moderately advanced, and 7.1% is far advanced. Inactive pulmonary tuberculosis are 39 cases (0.3% to objective population). 5. In the incidence of the involved side, right side is about 2 times higher than the left, and involvement of both sides is increased in moderately and far advance pulmonary tuberculosis. In all pulmonary tuberculosis, one or both upper lung fields are most commonly involved. The incidences of cavity in moderately and far advanced pulmonary tuberculosis show no significant difference. 6. The incidences of other intrathoracic lesions are as follows: suspected hypertensive heart disease 2.4%, dextrocardia with situs inversus 0.04%, pleural calcification 0.4%, pleural thickening 0.2%, pleural effusion 0.1%, pneumonia 0.02%, bronchiectasis 0.1%, lung abscess 0.02%, C.O.P.D. 0.2%, suspected lung tumor 0.06%, pneumothorax 0.0076%, and suspected mediastinal tumor 0.02%.

  5. Pulmonary Immune-Compartment-Specific Interferon Gamma Responses in HIV-Infected Individuals with Active Tuberculosis (TB in an Area of High TB Prevalence

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    S. Buldeo

    2012-01-01

    Full Text Available There is a paucity of data on the pulmonary immune-compartment interferon gamma (IFNγ response to M. tuberculosis, particularly in settings of high tuberculosis (TB prevalence and in HIV-coinfected individuals. This data is necessary to understand the diagnostic potential of commercially available interferon gamma release assays (IGRAs in both the pulmonary immune-compartment and peripheral blood. We used intracellular cytokine staining by flow cytometry to assess the IFNγ response to purified protein derivative (PPD and early secretory antigen 6 (ESAT6 in induced sputa (ISp and blood samples from HIV-infected, smear-negative, TB suspects. We found that individuals with active TB disease produced significantly less IFNγ in response to PPD in their induced sputa samples than individuals with non-active TB (control group. This difference was not reflected in the peripheral blood, even within the CD27− CD4+ memory T lymphocyte population. These findings suggest that progression to active TB disease may be associated with the loss of IFNγ secretion at the site of primary infection. Our findings highlight the importance of studying pulmonary immune-compartment M. tuberculosis specific responses to elucidate IFNγ secretion across the spectrum of TB disease.

  6. STUDY OF PULMONARY FUNCTION IMPAIRMENT BY SPIROMETRY IN POST PULMONARY TUBERCULOSIS

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    Sailaja

    2015-05-01

    Full Text Available Often pulmonary Tuberculosis patients declared cured will have residual respiratory disability due to impaired pulmonary function that will have impact on their daily activities . OBJECT IVES : To study pulmonary function impairment in treated pulmonary tuberculosis patients . D ESIGN : P rospective observational study - conducted from Jan 2014 to D ec 2014. METHODOLOG Y : Adult patients treated for pulmonary Tuberculosis under DOTS or Daily regimen and declared cured and presenting with dyspnea are studied . History regarding smoking , bronchial asthma , Interstial lung disease , occupational exposure are taken and if present are excluded from the study . History and clinical features suggestive of reactivation of Tuberculosis if present also excluded from the study . Simple spirometry done to all selected patients . Pre and post bronchodilator FEV 1 , FVC , FEV 1 /FVC recorded . RESULTS : 56 patients satisisfying the criteria are included in the study . In 62 . 5% Obstructive , 16 . 07% Restrictive and 21 . 42% Mixed abnormality detected . CONCLUSIONS : Obstructive , Restrictive and mixed type pattern are seen in treated pulmonary Tuberculosis patients but Obstructive patternof various degree is more common .

  7. Imagem em tuberculose pulmonar Pulmonary tuberculosis imaging

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    SIDNEY BOMBARDA

    2001-11-01

    with the active disease, such as centrilobular nodules segmentarily distributed, thick-walled cavities, thickened bronchial or bronchiolar walls, bronchiectasis and lymphadenopathy can be observed by computerized tomography. Thin-walled cavities, traction bronchiectasis, parenchymal bands, emphysema and mosaic pattern are signs suggestive of inactive disease. Gallium-67 citrate scyntigraphy is a complementary method useful in the detection of infectious diseases, including tuberculosis, especially in immunocompromised patients. Inhalation / perfusion analyses are used in the pre-operative assessment of patients carrying tuberculosis sequelaes and multiresistant tuberculosis. Positron emission tomography with fluorine-18 labeled deoxyglucose allows the detection of the inflammatory process that takes place during the active stage of tuberculosis and may persist, not so intense, after specific treatment is over. Imaging methods are valuable tools to be used in the diagnosis and follow up of pulmonary tuberculosis.

  8. [Tuberculous cheilitis revealing pulmonary tuberculosis].

    Science.gov (United States)

    Bricha, Myriem; Slimani, Hajar; Hammi, Sanae; Bourkadi, Jamal Eddine

    2016-01-01

    Tuberculosis of the oral cavity is rare. It is associated with clinical polymorphism and poses above all a diagnostic problem. We report the case of a 42-year-old male patient with tubercular cheilitis. This study aims to focus attention on tuberculosis that can be detected exceptionally in specific locations, such as the oral lip.

  9. Cavitary pulmonary tuberculosis HIV-related

    Energy Technology Data Exchange (ETDEWEB)

    Busi Rizzi, Elisa E-mail: radiologia@inmi.it; Schinina, Vincenzo; Palmieri, Fabrizio; Girardi, Enrico; Bibbolino, Corrado

    2004-11-01

    Introduction: It was usually assumed that pulmonary tuberculosis (TB) in HIV-seropositive patients represents reactivation TB, despite the radiographic appearance frequently consistent rather with a recent disease. Hence, these radiographic features were considered 'atypical'. We have hypothesised that the so called 'atypical' radiographic features could be due to a greater proportion of primary TB among these patients, representing the typical appearance of primary radiological pattern. Material and methods: We reviewed chest imaging of 219 HIV+ patients with microbiological proven pulmonary tuberculosis, who were assessed for the presence, number, distribution of cavitations and for associated pulmonary parenchymal abnormalities, adenopathies and pleural effusion, and were classified as a primary or post-primary pattern. Results: The patients with post-primary pattern were 50%, and the rate of cavitation was 63%, not wandering off the general population. Cavities still occurred with similar proportion in groups with CD4 <200 or >200 cells/mm{sup 3}. Conclusion: We suggest that HIV-related pulmonary tuberculosis is typical in its radiological appearances, consistent with those of the general population, and this could be confirmed by the most recent molecular epidemiological techniques that allow to definitely classify the tuberculosis episodes as either primary or post-primary disease.

  10. SPECIFIC GYRB SEQUENCE OF MYCOBACTERIUM TUBERCULOSIS CLINICAL ISOLATED FROM SPUTUM OF PULMONARY TUBERCULOSIS PATIENTS IN INDONESIA

    Directory of Open Access Journals (Sweden)

    N. M. Mertaniasih

    2014-12-01

    Full Text Available Background: Indonesia have many different geographic areas which could be various on the variant strains of Mycobacterium tuberculosis. The gyrB gene codes GyrB protein as sub unit compound of Gyrase enzyme that functioning in multiplication of bacteria. Detection of gyrB gene could be a marker of active multiplication of viable bacteria in the specimen from patients; and some of the DNA sequence regions were conserved and specific in the strain of Mycobacterium tuberculosis that would be a marker for identification. This research aims to analyze the sequence of gyrB gene of Mycobacterium tuberculosis clinical isolates from sputum of pulmonary TB patients in Indonesia, and determine the specific region. Method: Mycobacterium tuberculosis clinical isolates have been collected from sputum of the patients with pulmonary TB that live in some area in Indonesia. Isolation and identification of Mycobacterium tuberculosis clinical isolates using standard culture method; sequence analysis using PCR-direct sequencing of the part bases region of gyrB. Results: this study revealed that nucleotide sequence on a fragment 764 bases of gyrB gene Mycobacterium tuberculosis strains among clinical isolates almost identically to a wild type strain Mycobacterium tuberculosis H37Rv and subspecies member of Mycobacterium tuberculosis complex (MTBC, with a little difference of SNPs; there are many difference nucleotide sequence with MOTT and Gram positive or negative bacteria, except Corynebacterium diphtheriae identically with MTBC. Conclusion: the gyrB sequence in Mycobacterium tuberculosis strains among these clinical isolates from sputum of pulmonary TB patients in Indonesia have the conserved specific DNA region that almost identically with wild type strain H37Rv and MTBC.

  11. A CLINICAL STUDY OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS

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    Mojjada Dhanunjaya

    2015-09-01

    Full Text Available Of all the non - tuberculosis complications associated with disease, Diabetes Mellitus exerts, the most adverse influence on the course of pulmonary tuberculosis. The combined diagnosis was invariably fatal before Specific anti tuberculous and anti - diabetic drugs were available. As per new diabetes guidelines, every diabetic patient should be under gone screening for Pulmonary Tuberculosis. We conducted a clinical study of 60 Patients with Diabetes and Pulmonary Tuberculosis. For establishment of Diagnosis Ch est X – ray and Sputum for AFB were done for pulmonary tuberculosis and both blood & Urine Sugar were done for Diabetes Mellitus.

  12. Pulmonary tuberculosis specificities in smokers

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    Rhanim Aziza

    2015-10-01

    Conclusion: Our study raised the harmful impact of smoking on the clinical and radiological presentation of tuberculosis, and late bacteriological negativity, therefore we need to integrate smoking control into the national TB control program.

  13. Cost of Care Among Patients With Pulmonary Tuberculosis in Lagos ...

    African Journals Online (AJOL)

    Cost of Care Among Patients With Pulmonary Tuberculosis in Lagos, Nigeria. ... Open Access DOWNLOAD FULL TEXT Subscription or Fee Access ... and Cost- Effectiveness Analysis of Tuberculosis Control, converting at US$1=N120. Result

  14. Intrathoracic goitre associated with pulmonary tuberculosis.

    Science.gov (United States)

    Garg, Tinu; Gera, Kamal; Modi, Nikhil; Shah, Ashok

    2015-04-01

    Intrathoracic goitre is an uncommon condition which usually occurs in females in the fifth decade. It can cause compression of several mediastinal structures. A 42-year-old female with goitre since childhood was evaluated for dry cough, occasional wheezing and low grade fever. Imaging showed patchy airspace opacities with cavitation in left lung. Imaging of the neck revealed retrosternal extension of the goitre. Stains and cultures of bronchial aspirate were positive for Mycobacterium tuberculosis. A diagnosis of pulmonary tuberculosis with intrathoracic goitre was established, an unusual association.

  15. [Heterogeneity of pulmonary fibroblasts in tuberculosis].

    Science.gov (United States)

    Kogan, E A; Sekamova, S M; Bogadel'nikova, I V; Vitukhnovskaia, L A; Fipps, R; Perel'man, M I; Serov, V V

    1997-01-01

    Chronic inflammation and pneumofibrosis are the central events in tuberculosis morphogenesis. It was suggested that a certain type of fibroblasts may play a role in chronization of the inflammation and development of sclerosis in tuberculosis. Fibrous tissue from the foci of secondary tuberculosis (fibrous-cavernous tuberculosis and tuberculomas) of 35 patients were studied light- and electron-microscopically and immunohistochemically. (THY 1-)fibroblasts non-containing lipids and producing insulin-like growth factor 2 (ILGF 2), binding proteins 2 and 4 and epidermal growth factor receptors were found in the foci of secondary tuberculosis close to the granulomatous inflammation and in the new and scarrous fibrous connective tissue of the tuberculoma capsule and caverna walls. These fibroblasts are able for auto- and paracrine regulation of the proliferation of fibroblasts, epithelium and other cells in the inflammatory foci. (THY 1+) fibroblasts containing lipids were observed in the foci of old sclerotic changes among the rough collagen fibres. Thus, (THY 1-) fibroblasts probably play a key role in chronization of inflammation, proliferation and pretumorous dysplasia of pulmonary epithelium in secondary tuberculosis. (THY 1+) fibroblasts containing lipids may show more pronounced collagenesis and may persist under hypoxia condition in the collagenous scars for a long time.

  16. Cystic changes associated with pulmonary tuberculosis: a case report

    Institute of Scientific and Technical Information of China (English)

    CAI Hou-rong; CAO Min; MENG Fan-qing; LI Wei-chun

    2006-01-01

    @@ There are a wide range of computed tomography (CT) findings in patients with pulmonary tuberculosis, including diffuse or localized nodules,reticular opacities, ground glass attenuation, air trapping, consolidation, cavitation, fibrosis, lymph nodes enlargement, and septal thickening.1-3However, CT findings of pulmonary tuberculosis that appeared as multiple cystic lesions were very rare.3,4Herein, the CT findings appeared as multiple cystic lesions in a patient with pulmonary tuberculosis are reported.

  17. Intestinal permeability and malabsorption of rifampin and isoniazid in active pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Valéria G. F. Pinheiro

    Full Text Available Low antimycobacterial drug concentrations have been observed in tuberculosis (TB patients under treatment. The lactulose/mannitol urinary excretion test (L/M, normally used to measure intestinal permeability, may be useful to assess drug absorption. The objective of this research was to study intestinal absorptive function and bioavailability of rifampin and isoniazid in TB patients. A cross sectional study was done with 41 patients and 28 healthy controls, using the L/M test. The bioavailabilities of rifampin (R and isoniazid (H were evaluated in 18 patients receiving full doses. Urinary excretion of mannitol and lactulose, measured by HPLC, was significantly lower in TB patients. The serum concentrations of the drugs were below the expected range for R (8-24 mcg/mL or H (3-6 mcg/mL in 16/18 patients. Analyzing the drugs individually, 12/18 patients had low serum concentrations of R, 13/18 for H and 8/18 for both drugs. We suggest that there is a decrease in the functional absorptive area of the intestine in TB patients, which would explain the reduced serum concentrations of antituberculosis drugs. There is a need for new approaches to improve drug bioavailability in TB patients.

  18. Reactivation of Pulmonary Tuberculosis following Treatment of Myelofibrosis with Ruxolitinib

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    Maheen Z. Abidi

    2016-01-01

    Full Text Available Ruxolitinib is widely in use for treatment of myeloproliferative disorders. It causes inhibition of the Janus kinase (JAK signal transducer and activation of transcription (STAT pathway, which plays a key role in the underlying pathophysiology of myeloproliferative diseases. We describe a case of reactivation pulmonary tuberculosis in a retired physician while on treatment with ruxolitinib. We also review the literature on opportunistic infections following use of ruxolitinib. Our case highlights the importance of screening for latent tuberculosis in patients from highly endemic areas prior to start of therapy with ruxolitinib.

  19. Mycobactericidal activity of sutezolid (PNU-100480 in sputum (EBA and blood (WBA of patients with pulmonary tuberculosis.

    Directory of Open Access Journals (Sweden)

    Robert S Wallis

    Full Text Available RATIONALE: Sutezolid (PNU-100480 is a linezolid analog with superior bactericidal activity against Mycobacterium tuberculosis in the hollow fiber, whole blood and mouse models. Like linezolid, it is unaffected by mutations conferring resistance to standard TB drugs. This study of sutezolid is its first in tuberculosis patients. METHODS: Sputum smear positive tuberculosis patients were randomly assigned to sutezolid 600 mg BID (N = 25 or 1200 mg QD (N = 25, or standard 4-drug therapy (N = 9 for the first 14 days of treatment. Effects on mycobacterial burden in sputum (early bactericidal activity or EBA were monitored as colony counts on agar and time to positivity in automated liquid culture. Bactericidal activity was also measured in ex vivo whole blood cultures (whole blood bactericidal activity or WBA inoculated with M. tuberculosis H37Rv. RESULTS: All patients completed assigned treatments and began subsequent standard TB treatment according to protocol. The 90% confidence intervals (CI for bactericidal activity in sputum over the 14 day interval excluded zero for all treatments and both monitoring methods, as did those for cumulative WBA. There were no treatment-related serious adverse events, premature discontinuations, or dose reductions due to laboratory abnormalities. There was no effect on the QT interval. Seven sutezolid-treated patients (14% had transient, asymptomatic ALT elevations to 173±34 U/L on day 14 that subsequently normalized promptly; none met Hy's criteria for serious liver injury. CONCLUSIONS: The mycobactericidal activity of sutezolid 600 mg BID or 1200 mg QD was readily detected in sputum and blood. Both schedules were generally safe and well tolerated. Further studies of sutezolid in tuberculosis treatment are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT01225640.

  20. A survey on undiagnosed active pulmonary tuberculosis among pregnant mothers in mekelle and surrounding Districts in Tigray, Ethiopia.

    Science.gov (United States)

    Gebreegziabiher, Dawit; Adane, Kelemework; Abebe, Markos

    2017-01-01

    To determine the prevalence of undiagnosed active pulmonary tuberculosis (PTB) cases and sensitivity, specificity, and positive and negative predictive values of symptom combinations for undiagnosed TB infection in human immunodeficiency virus (HIV)-positive and HIV-negative pregnant mothers attending antenatal care (ANC) clinics. Mycobacterium TB and HIV are the leading causes of death among women of reproductive age worldwide. Symptom screening is the first step in the World Health Organization (WHO)-recommended TB intensified case finding algorithm for people living with HIV. However, the symptom-based PTB screening method for pregnant mothers is suboptimal and needs further optimization as some of the symptoms are obscured by the physiological changes during pregnancy. This was a cross-sectional study, which was conducted from June 2014 to May 2015 at 16 public health institutions in Mekelle and its surrounding areas. All pregnant mothers who visited the maternity clinics for routine ANC follow-up examinations were screened for PTB symptoms. Those who had at least 2 weeks of cough, in addition to other symptoms, were enrolled in the study. Sociodemographic and clinical data and sputum samples were collected by midwives and nurses. The sputum samples were shipped to the Tigray Regional Laboratory and stored at -80°C until TB culture was performed. Between June 2014 and May 2015, 9600 pregnant mothers were screened for PTB symptoms. We collected 174 sputum samples from pregnant mothers who had ≥2 weeks of productive cough. The participant's median age was 27.5 years (interquartile range, 24-31 years). During enrollment, 604 (6.28%) participants were HIV seropositive. Among the HIV-positive mothers, 17 (38.1%) were informed about their HIV status when they visited the health institutions for ANC follow-up, whereas the remaining 27 (61.9%) were already on antiretroviral therapy. All sputum samples (n = 174) were cultured using Löwenstein-Jensen medium at the

  1. Rapid isolation and identification of Mycobacterium tuberculosis from pulmonary tuberculosis patients

    Institute of Scientific and Technical Information of China (English)

    Al-Sulami AA; Ali ZM; Al-Maleky DA

    2009-01-01

    Objective:The Study aimed to develop a rapid inexpensive and simple method for preliminary isolation and detection of M.tuberculosis from clinical specimens.Also to probe the impact of deteriorating health measures on the pulmonary tuberculosis control program in Basra city.Methods:A simple monophasic-diphasic setup (MDCS)was used for the isolation and preliminary identification of M.tuberculosis.This setup consists of a slanted Lowenstein-Jensen medium,the bottom of it is covered with 1 mL of tuberculosis broth thus establishing a diphasic solid liquid environment at the bottom of the screw capped test tube and above them a monophasic one.Results:During 7 months period from the beginning of December 2003 to the end of June 2004,1 295 cases were managed in Tuberculosis and Chest Diseases Clinic in Basra city.Only 348 cases were diagnosed as active pulmonary tuberculosis.They consist of 232 new cases and 116 previously registered ones.The MDCS method showed higher recovery of isolation rate of M.tuberculosis (92.3%)than Lowenstein-Jensen,and pyruvate methods with 78.1% and 51.9% respectively.Also this method revealed more rapid appearance of results of 12 days than Lowenstein-Jensen,and pyruvate media with 22 days and 23 days respectively by the traditional culturing methods.Concurrently the study revealed that drug resistance against one or more anti tu-berculosis drugs was 23.1% for new cases and 70.8% for the old ones.Multi drug resistance accounts for 20% of total isolates from old cases.This was based on using the critical concentration and 1% proportional procedures.Tuberculosis was more common among males than females with 69.4% and 30.6% respectively. A significant correlation (P <0.05)was found between the productive age group (25-54)and incidence of tu-berculosis.Tuberculosis was higher among married (83.8%)than unmarried peoples (22%).Children,hus-bands and wives showed higher infection rates than others indicating kinship influence.Failure of treatment

  2. The history of surgery for pulmonary tuberculosis.

    Science.gov (United States)

    Odell, John A

    2012-08-01

    Thoracic surgical procedures evolved from surgical management of tuberculosis; lung resections, muscle flaps, and thoracoscopy all began with efforts to control the disease. The discovery of antituberculosis drugs in 1944 to 1946 made sanatorium therapy and collapse therapy in all its forms obsolete and changed thoracic surgery dramatically. Currently, management of tuberculosis is primarily medical, and surgery has a minimal role. Today surgery is usually only performed in patients with tuberculosis when the diagnosis is necessary, who have complications or sequelae of the disease, or who have active disease resistant to therapy.

  3. Active Case Finding of Pulmonary Tuberculosis through Screening of Respiratory Symptomatics Using Sputum Microscopy: Is It Time to Change the Paradigm?

    Directory of Open Access Journals (Sweden)

    Eva Carolina del Portillo-Mustieles

    2013-01-01

    Full Text Available Background. One of the main strategies for the early detection of pulmonary tuberculosis (PTB is through the screening of individuals with symptoms compatible with PTB. Although this is programmatic strategy for active case finding, its yield is not well known. Objective. To determine the yield of pulmonary tuberculosis active case finding through the screening of respiratory symptomatic (RS patients at a general hospital. Methods. RS patients were defined as subjects complaining of cough and/or sputum for a period of 2 or more weeks. Outpatients and their companions were approached while they waited in the outpatient care areas of the hospital to detect RS. Two samples from different days or 2 samples taken 2 hours apart on the same day were collected. Results. 122 RS patients were identified. Fifty-seven patients (46.7% had at least one sputum sample analyzed. Three patients presented a positive smear and 2 were culture positive; neither had upper airway symptoms. None of the patients with productive cough and upper airway symptoms had a positive smear (. Only 19 (33.3% returned to the laboratory to retrieve their results. Conclusion. Current strategy to screen RS patients based only on clinical data has a low compliance. Specific strategies to increase compliance (removal of barriers, incentives, etc. should be implemented.

  4. CT findings of pulmonary tuberculosis in diabetic and immunocompromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Noriyuki; Ikezoe, Junpei; Johkoh, Tsuyoshi (Osaka Univ. (Japan). Faculty of Medicine) (and others)

    1992-01-01

    To evaluate the CT features of pulmonary tuberculosis in diabetic or immunocompromised patients, we reviewed CT of the chest in 42 adult patients with active pulmonary tuberculosis. Forty-two had some underlying diseases or immunocompromised conditions (31 diabetes mellitus, 6 malignancies, 2 long-term steroid therapy, 2 pneumoconiosis, and one anorexia nervosa). In diabetic or immunocompromised patients, a high incidence of non-segmental distribution (27%) and multiple small cavities in a cavitary lesion (45%) was observed. Unusual localization of the lesions such as lower lung field disease was observed in 18% of cases (the incidence of unusual localization in patients with no underlying disease was equal to diabetic or immunocompromised patients). (author).

  5. CT imaging of coexisting pulmonary tuberculosis and lung cancer

    Institute of Scientific and Technical Information of China (English)

    吕岩

    2013-01-01

    Objective To study the CT characteristics of coexisting pulmonary tuberculosis and lung cancer. Methods One hundred and four patients of coexisting pulmonary tuberculosis and lung cancer proved by histology,cytology or clinical underwent CT examination. All patients were divided into two groups,group

  6. Antigen induced production of υ-interferon ex vivo, in the peripheral blood of patients with active pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Z. M. Zagdyn

    2013-01-01

    Full Text Available Tuberculosis (TB is one of the most significant problems in the Russian Health Care. Russia remains on the list of the 22 countries with a high TB incidence and on the third place in the world with a high prevalence of Drug Resistant TB [1]. It is urgently needed to develop new TB diagnostic methods as well as effective measures of the specific TB prevention, including a development of the novel vaccines, so we have to know better about the most immunogenic antigens of Mycobacterium Tuberculosis. We studied the Interferon-Q production in the whole blood after stimulating immune response with different proteins of Mycobacterium Tuberculosis in patients with active TB. The study results permitted us to evaluate the immunogenicity of the previously known proteins (Ag85a и ESAT-6 in comparison to the recently identified ones (Rv2957, Rv2958c и Rv0447, analyzing simultaneously their relation to tuberculin, as well as to antigens of the different viruses (Human Immunodeficiency Virus, Cytomegalovirus, Epstein-Barr Virus, Influenza Virus. Protein Rv2958c, unlike protein ESAT-6, showed the high immunogenicity in comparison to tuberculin. The expressed immunogenicity of protein Rv2958c might be indicated a possible greatest specificity of immune response to this antigen in TB patients. Meanwhile, bacillary tuberculosis was strongly associated with low immune response to this protein. Also we were found statistical differences in immune responses of patients to the different Mycobacterium Tuberculosis antigens depending on the drug sensitivity. In addition it was interesting to know about a significantly low immune response of patients with Drug Resistant TB to protein pp65 CMV.

  7. Rifampicin-induced disseminated intravascular coagulation in pulmonary tuberculosis treatment

    Science.gov (United States)

    Chen, Guo; He, Jian-Qing

    2017-01-01

    Abstract Rationale: Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin. Patient concerns: We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. Diagnoses: Laboratory data and symptoms on admission indicated DIC. Interventions: The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed. Outcomes: The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment. Lessons: As a rare adverse effect, DIC induced by

  8. Symptom screening rules to identify active pulmonary tuberculosis: Findings from the Zambian South African Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) trial prevalence surveys

    Science.gov (United States)

    Claassens, M. M.; Floyd, S.; Ayles, H.; Beyers, N.

    2017-01-01

    Background High tuberculosis (TB) burden countries should consider systematic screening among adults in the general population. We identified symptom screening rules to be used in addition to cough ≥2 weeks, in a context where X-ray screening is not feasible, aiming to increase the sensitivity of screening while achieving a specificity of ≥85%. Methods We used 2010 Zambia South Africa Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) survey data: a South African (SA) training dataset, a SA testing dataset for internal validation and a Zambian dataset for external validation. Regression analyses investigated relationships between symptoms or combinations of symptoms and active disease. Sensitivity and specificity were calculated for candidate rules. Results Among all participants, the sensitivity of using only cough ≥2 weeks as a screening rule was less than 25% in both SA and Zambia. The addition of any three of six TB symptoms (cough <2 weeks, night sweats, weight loss, fever, chest pain, shortness of breath), or 2 or more of cough <2 weeks, night sweats, and weight loss, increased the sensitivity to ~38%, while reducing specificity from ~95% to ~85% in SA and ~97% to ~92% in Zambia. Among HIV-negative adults, findings were similar in SA, whereas in Zambia the increase in sensitivity was relatively small (15% to 22%). Conclusion High TB burden countries should investigate cost-effective strategies for systematic screening: one such strategy could be to use our rule in addition to cough ≥2 weeks. PMID:28257424

  9. Radiological analysis of image on geriatric pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective: To evaluate the radiological features in the cases with geriatric pulmonary tuberculosis(GPTB). Methods: One hundred and two elderly patients with tuberculosis were studied in this paper. All patients had an examination on chest X-ray, and 63 of them had a chest scan of CT. Results: The pulmonary tuberculosis infiltration, caseous pneumonia and cavitary lesions were found in 85, 11 and 19 cases with GPTB respectively. Acute miliary tuberculosis was diagnosed in 2 cases. Pleural effusion was in 26 cases. In addition, Hilar and mediastinal lymphadenopathy was presented in the other 13 cases. Conclusion: Radiological findings of GPTB were atypical in general.

  10. Factors of Suppression of Immune Response in Patients with Pulmonary Tuberculosis and Eosinophilia.

    Science.gov (United States)

    Urazova, O I; Novitskii, V V; Kolobovnikova, Yu V; Churina, E G

    2015-07-01

    We studied possible mechanisms of immunosuppression mediated by regulatory T cells that promotes suppression of antigen-specific immune response to Mycobacterium tuberculosis in patients with pulmonary tuberculosis and eosinophilia. It was shown that the number of CD4(+)CD25(+)Foxp3(+) regulatory T cells with immunosuppressive activity (Treg) increased in the peripheral blood of patients with disseminated destructive forms of pulmonary tuberculosis with multiple resistance of the causative agent to antituberculosis substances and eosinophilia. These changes were accompanied by imbalance in secretion of Treg-associated cytokines (in vitro) manifested in hyperproduction of TGFβ and IL-10 and decreased production of IL-2.

  11. Keratinocyte growth factor administration attenuates murine pulmonary mycobacterium tuberculosis infection through granulocyte-macrophage colony-stimulating factor (GM-CSF)-dependent macrophage activation and phagolysosome fusion.

    Science.gov (United States)

    Pasula, Rajamouli; Azad, Abul K; Gardner, Jason C; Schlesinger, Larry S; McCormack, Francis X

    2015-03-13

    Augmentation of innate immune defenses is an appealing adjunctive strategy for treatment of pulmonary Mycobacterium tuberculosis infections, especially those caused by drug-resistant strains. The effect of intranasal administration of keratinocyte growth factor (KGF), an epithelial mitogen and differentiation factor, on M. tuberculosis infection in mice was tested in prophylaxis, treatment, and rescue scenarios. Infection of C57BL6 mice with M. tuberculosis resulted in inoculum size-dependent weight loss and mortality. A single dose of KGF given 1 day prior to infection with 10(5) M. tuberculosis bacilli prevented weight loss and enhanced pulmonary mycobacterial clearance (compared with saline-pretreated mice) for up to 28 days. Similar effects were seen when KGF was delivered intranasally every third day for 15 days, but weight loss and bacillary growth resumed when KGF was withdrawn. For mice with a well established M. tuberculosis infection, KGF given every 3 days beginning on day 15 postinoculation was associated with reversal of weight loss and an increase in M. tuberculosis clearance. In in vitro co-culture experiments, M. tuberculosis-infected macrophages exposed to conditioned medium from KGF-treated alveolar type II cell (MLE-15) monolayers exhibited enhanced GM-CSF-dependent killing through mechanisms that included promotion of phagolysosome fusion and induction of nitric oxide. Alveolar macrophages from KGF-treated mice also exhibited enhanced GM-CSF-dependent phagolysosomal fusion. These results provide evidence that administration of KGF promotes M. tuberculosis clearance through GM-CSF-dependent mechanisms and enhances host defense against M. tuberculosis infection.

  12. Effect of T cell subset and inflammatory cytokine levels on prognosis in patients with pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Cheng-Zhou Wu; Yan-Qiao Wu

    2016-01-01

    Objective:To explore the effect of T cell subset and inflammatory cytokine levels on the prognosis in patients with pulmonary tuberculosis.Methods:A total of 72 patients confirmed with pulmonary tuberculosis who were admitted in our hospital from February, 2013 to February, 2015 were included in the study and served as the experiment group, among which 58 cases had active tuberculosis, and 14 cases had static tuberculosis; while 50 healthy individuals who came for physical examinations were served as the control group. The sputum bacteria before treatment and 6 months after treatment in the two groups were detected. The sputum negative conversion rate was recorded. The absorption of pulmonary lesions and the closure of tuberculosis cavity were examined. The immune cell function of T cell subset was detected again.Results: The peripheral blood CD3, CD4, CD8, and CD4/CD8 levels in the experiment group were significantly lower than those in the control group, especially for the active tuberculosis patients (P<0.01). The peripheral blood CD4/CD8 levels in the static tuberculosis patients was lower than that in the control group, but was significantly higher than that in active tuberculosis patients (P<0.01). The serum IL-1, IL-6, and TNF-α levels in the experiment group were significantly higher than those in the control group, especially for the active tuberculosis patients (P<0.01).Conclusions:The cell subsets and inflammatory cytokines play an important role in patients with pulmonary tuberculosis, whose dynamic change can effectively display the immune function and severity degree, which is of great value in estimating the condition and assessing the prognosis; therefore, it deserves to be further explored in the clinic.

  13. III 型活动性肺结核病人气道高反应性与肺功能康复关系研究%Study on relationship between broncho-hyperreactivity and pulmonary rehabilitation in patients with active pulmonary tuberculosis III

    Institute of Scientific and Technical Information of China (English)

    王永兴; 应延风

    2002-01-01

    Objective To investigate relationship between broncho-hyperreactivity (BHR) and pulmonary rehabilitation in patients with active pulmonary tuberculosis. Method Pulmonary function and histamine provocation tests were conducted to compare results in 103 cases. Results Positive rate for histamine provocation test was 13.59% . Compared with negative group, more patients in positive group developed cough and hemoptysis(P< 0.01).Incidence of BHR in patients with positive result for sputum examination for tubercle bacillus was higher than patients with negative results(P<0.01).Percentage of midexpiratory rate of flow(PMMF)in group with positive provocation test was strikingly lower than that in negative group. Conclusion BHR is closely related to stenosis of little airway in patients with pulmonary tuberculosis. Increased BHR affects pulmonary rehabilitation.

  14. Rapid Diagnosis of Active Tuberculosis by Lipoarabinomanna test

    Directory of Open Access Journals (Sweden)

    Urmila A.Sharma

    2000-04-01

    Full Text Available Presence of antimicrobial antibodies were repidly detected in 47 out of 50 cases of active pulmonaryand extra-pulmonary tuberculosis. The lipoarabinomanan (LAM antigen binds with the opllmumconcentration of anti LAM antibodies from the serum. Our findll1gs showed that the LAM test ISsimple, low cost, rapi~ and reliable test for detecting active tuberculosis.

  15. Spontaneous bronchoesophageal fistula in an adult – A possible delayed sequela of pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Surendra Patel

    2015-01-01

    Full Text Available Spontaneous bronchoesophageal fistula in the adult is a rare clinical entity. Most bronchoesophageal fistulae are due to malignancy, prolonged endotracheal intubation or trauma. Granulomatous infections like tuberculosis, HIV and mediastinitis are rare causes of acquired bronchoesophageal fistula. We report a case of a 50 year old man, treated for pulmonary tuberculosis 15 years ago, who developed a spontaneous bronchoesophageal fistula between the mid-esophagus and right main stem bronchus, having no history of malignancy or trauma. Surgical closure of the fistula was done and post operative recovery was uneventful. In this case, the bronchoesophageal fistula probably developed as a delayed sequela of pulmonary tuberculosis as the patient had no active signs of pulmonary tuberculosis clinically or histopathologically.

  16. Monoarticular Poncet Disease after Pulmonary Tuberculosis: A Rare Case Report and Review of Literature

    Science.gov (United States)

    Garg, Paritosh; Gupta, Nikhil; Arora, Mohit

    2016-01-01

    Introduction: Tuberculosis is a major health problem worldwide, more so in Asian countries and especially India. Being a communicable disease, it can affect the lives of many people. Tuberculosis has varied manifestations and can affect almost every part of the human body. Pulmonary tuberculosis is the most common form. Poncet disease (tuberculous rheumatism) is a polyarticular arthritis that occurs during acute tuberculosis infection in which no mycobacterial involvement can be found or no other known cause of polyarthritis is detected. Case presentation: We describe an atypical presentation of active pulmonary tuberculosis with monoarticular Poncet disease of the right knee in a 24-year-old woman. Discussion: The diagnosis of Poncet disease is mainly clinical with exclusion of other causes. It generally presents as an acute or subacute form; however, chronic forms have been described in the literature. PMID:27455057

  17. Helminth infections coincident with active pulmonary tuberculosis inhibit mono- and multifunctional CD4+ and CD8+ T cell responses in a process dependent on IL-10.

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    Parakkal Jovvian George

    2014-09-01

    Full Text Available Tissue invasive helminth infections and tuberculosis (TB are co-endemic in many parts of the world and can trigger immune responses that might antagonize each other. We have previously shown that helminth infections modulate the Th1 and Th17 responses to mycobacterial-antigens in latent TB. To determine whether helminth infections modulate antigen-specific and non-specific immune responses in active pulmonary TB, we examined CD4(+ and CD8(+ T cell responses as well as the systemic (plasma cytokine levels in individuals with pulmonary TB with or without two distinct helminth infections-Wuchereria bancrofti and Strongyloides stercoralis infection. By analyzing the frequencies of Th1 and Th17 CD4(+ and CD8(+ T cells and their component subsets (including multifunctional cells, we report a significant diminution in the mycobacterial-specific frequencies of mono- and multi-functional CD4(+ Th1 and (to a lesser extent Th17 cells when concomitant filarial or Strongyloides infection occurs. The impairment in CD4(+ and CD8(+ T cell cytokine responses was antigen-specific as polyclonal activated T cell frequencies were equivalent irrespective of helminth infection status. This diminution in T cell responses was also reflected in diminished circulating levels of Th1 (IFN-γ, TNF-α and IL-2- and Th17 (IL-17A and IL-17F-associated cytokines. Finally, we demonstrate that for the filarial co-infections at least, this diminished frequency of multifunctional CD4(+ T cell responses was partially dependent on IL-10 as IL-10 blockade significantly increased the frequencies of CD4(+ Th1 cells. Thus, co-existent helminth infection is associated with an IL-10 mediated (for filarial infection profound inhibition of antigen-specific CD4(+ T cell responses as well as protective systemic cytokine responses in active pulmonary TB.

  18. Lupus pleuritis: a relevant risk factor for pulmonary tuberculosis.

    Science.gov (United States)

    Pasoto, S G; Borba, E F; Bonfa, E; Shinjo, S K

    2010-12-01

    The objective of the study was to evaluate risk factors for pulmonary tuberculosis in systemic lupus erythematosus (SLE). Clinical/laboratorial features of 1283 SLE patients (ACR criteria) followed at the Lupus Clinic were obtained from the electronic register database from 2001 to 2009. Pulmonary tuberculosis was diagnosed in 20 patients (1.6%) (TB+ group). As control group (TB-), 40 patients without tuberculosis matched for age, gender, ethnicity, age at SLE diagnosis, and disease duration were arbitrarily selected. All 20 patients of the TB+ group presented confirmed pulmonary tuberculosis from 1 to 23 years after SLE diagnosis (7.6 ± 8.1 years). Frequencies of previous SLE involvements (cutaneous, articular, hematological, renal, pericarditis, pneumonitis, and central nervous system) were alike in TB+ and TB- groups (p > 0.05). In contrast, prior pleuritis was more frequent in the TB+ group (40% vs. 5%, p = 0.001). In fact, pulmonary tuberculosis was diagnosed in 8/10 patients with previous pleuritis. Immunosuppressive and corticosteroid therapies at the moment of tuberculosis diagnosis were also similar in both groups (p > 0.05). We have identified pleuritis as a relevant risk factor for pulmonary tuberculosis, suggesting that previous pleural injury is a critical part of the complex interplay between altered immune system, socio-economic conditions, and increased susceptibility to this mycobacterial infection.

  19. IMMUNOTHERAPY IN TREATMENT OF PULMONARY TUBERCULOSIS IN ADOLESCENTS

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    I. I. Lvova

    2014-01-01

    Full Text Available Comprehensive examination of 62 adolescents, hospitalized for pulmonary tuberculosis, established high spread of clinical and laboratory markers of secondary immune deficiency: chronic diseases of ear, throat and nose (59,6%, recurrent infection caused by the herpes simplex viruses (SPGV (55,8% ; serological SPGV activation (90,4% and cytomegalovirus infection (CMV (94,2%; absolute lymphopenia (53,8%, low level and lack of interferon-alpha (28,9% and interferongamma (76,9%. Validity, effectiveness and safety of modern technology immunization with interferon -α-2b (VIFERON® 3 million IU and 1 million IU suppositories in 1 month course in the complex treatment of pulmonary tuberculosis was proved with a random research by a «case-control» method. Significant positive clinical and laboratory dynamics was registered: increase in body weight in 84,6 % of adolescents; reduction in the frequency of arrhythmias; increase absolute lymphocyte count (46,1%, decrease in serological SPGV activation (30,8% and CMV infection (61,5% increase in the amount of interferon-alpha (61,5%, and interferon-gamma (61,5% and absence of intolerance and 3 times less undesirable effects of chemotherapy.

  20. Two cases of pulmonary tuberculosis caused by Mycobacterium tuberculosis subsp canetti.

    Science.gov (United States)

    Miltgen, Jean; Morillon, Marc; Koeck, Jean-Louis; Varnerot, Anne; Briant, Jean-François; Nguyen, Gilbert; Verrot, Denis; Bonnet, Daniel; Vincent, Véronique

    2002-11-01

    We identified an unusual strain of mycobacteria from two patients with pulmonary tuberculosis by its smooth, glossy morphotype and, primarily, its genotypic characteristics. Spoligotyping and restriction fragment length polymorphism typing were carried out with the insertion sequence IS6110 patterns. All known cases of tuberculosis caused by Mycobacterium canetti have been contracted in the Horn of Africa.

  1. Chromoblastomycosis due to Fonsecaea monophora misdiagnosed as sporotrichosis and cutaneous tuberculosis in a pulmonary tuberculosis patient

    NARCIS (Netherlands)

    Shi, Dongmei; Zhang, Wei; Lu, Guixia; de Hoog, G Sybren; Liang, Guanzhao; Mei, Huan; Zheng, Hailin; Shen, Yongnian; Liu, Weida

    2016-01-01

    Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. We report a case of chromoblastomycosis in a pulmonary tuberculosis patient without known history of trauma. The lesions were initially diagnosed as sporotrichosis and skin tuberculosis.

  2. Rate of tuberculosis infection in children and adolescents with household contact with adults with active pulmonary tuberculosis as assessed by tuberculin skin test and interferon-gamma release assays.

    Science.gov (United States)

    Ferrarini, M A G; Spina, F G; Weckx, L Y; Lederman, H M; De Moraes-Pinto, M I

    2016-03-01

    Tuberculosis (TB) infection was evaluated in Brazilian immunocompetent children and adolescents exposed and unexposed (control group) to adults with active pulmonary TB. Both groups were analysed by clinical and radiological assessment, TST, QFT-IT and T-SPOT.TB. The three tests were repeated after 8 weeks in the TB-exposed group if results were initially negative. Individuals with latent tuberculosis infection (LTBI) were treated and tests were repeated after treatment. Fifty-nine TB-exposed and 42 controls were evaluated. Rate of infection was 69·5% and 9·5% for the exposed and control groups, respectively. The exposed group infection rate was 61% assessed by TST, 57·6% by T-SPOT.TB, and 59·3%, by QFT-IT. No active TB was diagnosed. Agreement between the three tests was 83·1% and 92·8% in the exposed and control groups, respectively. In the exposed group, T-SPOT.TB added four TB diagnoses [16%, 95% confidence interval (CI) 1·6-30·4] and QFT-IT added three TB diagnoses (12%, 95% CI 0-24·7) in 25 individuals with negative tuberculin skin test (TST). Risk factors associated to TB infection were contact with an adult with active TB [0-60 days: odds ratio (OR) 6·9; >60 days: OR 27·0] and sleeping in the same room as an adult with active TB (OR 5·2). In Brazilian immunocompetent children and adolescents, TST had a similar performance to interferon-gamma release assays and detected a high rate of LTBI.

  3. Pulmonary disease due to Mycobacterium tuberculosis in a horse: zoonotic concerns and limitations of antemortem testing

    Science.gov (United States)

    A case of pulmonary tuberculosis caused by Mycobacterium tuberculosis was diagnosed in a horse. Clinical evaluation performed prior to euthanasia did not suggest tuberculosis, but postmortem examination provided pathological and bacteriological evidence of disease. In the lungs, multiple tuberculoid...

  4. γ-干扰素释放试验对活动性肺结核的诊断价值%Diagnostic value of interferon gamma release assay to active pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    吴静; 徐建; 张映铭; 王彩英

    2011-01-01

    Objective To evaluate the diagnostic value of interferon gamma release assay to active pulmonary tuberculosis. Methods The interferon gamma release assay based on enzyme linked immunospot assay was performed in 75 patients with suspected active pulmonary tuberculosis. And the result was compared with tuberculosis culture. Results The sensitivity, specificity and accuracy of interferon gamma release assay were 81.1%, 90.9% and 84. 0%, respectively. The sensitivity of interferon gamma release assay was higher than that of tuberculosis culture (P<0. 01). Among 23 cases af negative culture results, 16 cases were detected positive by interferon gamma release assay. Conclusion Interferon gamma release assay is highly sensitive, specific and helpful to the early and rapid detection of active pulmonary tuberculosis.%目的 评价γ-干扰素释放试验(interferon gamma release assay,IGRA)对活动性肺结核的诊断价值.方法 采用IGRA检测75例肺结核疑似病例,与结核菌培养结果进行比较.结果 IGRA诊断肺结核灵敏度为81.1%,特异度为90.9%,准确性为84.0%;IGRA灵敏度明显高于结核菌培养(P<0.01);在23例培养阴性的肺结核确诊病例中,16例IGRA阳性.结论 IGRA灵敏度高,特异度强,有助于活动性肺结核的早期、快速诊断.

  5. 38 CFR 3.374 - Effect of diagnosis of active tuberculosis.

    Science.gov (United States)

    2010-07-01

    ... active tuberculosis. 3.374 Section 3.374 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... Considerations Relative to Specific Diseases § 3.374 Effect of diagnosis of active tuberculosis. (a) Service diagnosis. Service department diagnosis of active pulmonary tuberculosis will be accepted unless a board of...

  6. EFFICIENCY OF NEW IMMOBILIZED PROBIOTIC AS A PART OF TREATMENT OF PULMONARY TUBERCULOSIS PATIENTS

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    I. V. Belovа

    2017-01-01

    Full Text Available The study was conducted in order to evaluate the efficiency of adding immobilized probiotic biologically active food supplement of LB-Complex L to integral treatment of pulmonary tuberculosis. Changes of colon microorganism community in pulmonary tuberculosis patients including those with multiple drug resistance were studied in two groups of patients: receiving only basic treatment and basic treatment with the immobolized probiotic of LB-Complex L as a food supplement. The algorithm of probiotic intake has been offered with the consideration of pharmacodynamics of anti-tuberculosis drugs. The offered algorithm proved to be effective for prevention of disorders in microorganism community, enhancement of adherence to treatment, reduction of frequency, severity and duration of side effects to anti-tuberculosis drugs. 

  7. A 35-year-old immuno-competent male with open pulmonary tuberculosis associated with extra-ordinary extensive extra-pulmonary tuberculosis

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    Liaqat Ali Chaudhry

    2013-01-01

    Full Text Available Multifocal tuberculosis is characterized by the presence of large multifocal tuberculosis areas in the same or different adjacent or distant organs. Primary lesions are usually in the lungs in the majority of patients. Difficulty in confirming multifocal tuberculosis and consideration of other diseases may lead to a delay in diagnosis and thus in initiating treatment. Bone and joint involvement in tuberculosis is uncommon. While osteoarticular tuberculosis most commonly occurs in the vertebral column, less frequently affected sites are hip, knee, and sacroiliac joints. The following is a fascinating case of open pulmonary tuberculosis associated with extensive extra-pulmonary multifocal tuberculosis.

  8. Is tuberculosis a lymphatic disease with a pulmonary portal?

    Science.gov (United States)

    Behr, Marcel A; Waters, W Ray

    2014-03-01

    Tuberculosis most commonly presents as a pulmonary disease, in which infection, persistence, and induction of transmissible pathology all occur in the lungs. If viewed as a pulmonary disease, enlarged lymph nodes represent reactive adenitis, and extrapulmonary forms of tuberculosis (including lymphatic tuberculosis) are not transmissible, hence representing an evolutionary dead-end for the pathogen. In an alternative theory, Mycobacterium tuberculosis passes asymptomatically through the lungs and rapidly establishes a chronic lymphatic infection. After a period of weeks to decades secondary lung pathology develops, ultimately allowing transmission to occur. Evidence that supports this lymphatic model includes historical descriptions of human tuberculosis from the preantibiotic era, analogy with other mycobacterial infections, observations of tuberculosis in non-human hosts, and experimental models of tuberculosis disease. At a fundamental level, a lymphocentric model proposes that spread of organisms outside the lung parenchyma is essential to induce adaptive immunity, which is crucial for the generation of transmissible pathology. Furthermore, a lymphatic model could explain why the lesion associated with primary infection (Ghon focus) is anatomically separated from the most common site of reactivation disease (the apex). More practically, an alternative perspective that classes tuberculosis as a lymphatic disease might affect strategies for preclinical and clinical assessment of novel diagnostics, drugs, and vaccines.

  9. Sweet's syndrome: a very rare association with pulmonary tuberculosis.

    Science.gov (United States)

    Karmakar, Partha Sarathi; Sherpa, Pasang Lahmu; Ray, Achintya Narayan; Saha, Bikram Kr; Santra, Tuhin; Saha, Sanchita; Chakrabarti, Indranil

    2013-05-13

    Mycobacterium tuberculosis infection is a common infection in developing countries, including India. It can induce several cutaneous reactions such as erythema nodosum, and erythema induratum; however, association of tuberculosis with Sweet's syndrome (also known as acute febrile neutrophilic dermatosis) is extremely rare. Here we present an interesting case of sputum-positive pulmonary tuberculosis with Sweet's syndrome. A 55-year-old female who was receiving a regimen of four antitubercular drugs (isoniazid, rifampicin, pyrazinamide, ethambutol- HRZE) for six weeks for sputum-positive pulmonary tuberculosis developed new onset high-grade fever for 15 days along with multiple reddish brown plaques and nodules involving the face as well as all four limbs of the body. Histopathology of the skin lesion was suggestive of Sweet's syndrome. The patient responded well to immunosuppressive steroid therapy.

  10. A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, Jun-Jun [Ditmanson Medical Foundation Chia-Yi Christian Hospital, Section of Thoracic Imaging, Department of Chest Medicine and Family Medicine, Chiayi City (China); Chia Nan University of Pharmacy and Science, Tainan (China); Meiho University, Pingtung (China); Pingtung Christian Hospital, Pingtung (China); Chen, Solomon Chih-Cheng; Chen, Cheng-Ren [Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Medical Research, Chiayi City (China); Yeh, Ting-Chun; Lin, Hsin-Kai; Hong, Jia-Bin; Wu, Bing-Tsang [Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Family Medicine, Chiayi City (China); Wu, Ming-Ting [Department of Radiology, Kaohsiung Veterans General Hospital, Section of Thoracic and Circulation Imaging, Kaohsiung (China); School of Medicine, National Yang Ming University, Faculty of Medicine, Taipei (China)

    2014-10-15

    The objective of this study was to use high-resolution computed tomography (HRCT) imaging to predict the presence of smear-positive active pulmonary tuberculosis (PTB) in elderly (at least 65 years of age) and non-elderly patients (18-65 years of age). Patients with active pulmonary infections seen from November 2010 through December 2011 received HRCT chest imaging, sputum smears for acid-fast bacilli and sputum cultures for Mycobacterium tuberculosis. Smear-positive PTB was defined as at least one positive sputum smear and a positive culture for M. tuberculosis. Multivariate logistic regression analyses were performed to determine the HRCT predictors of smear-positive active PTB, and a prediction score was developed on the basis of receiver operating characteristic curve analysis. Of 1,255 patients included, 139 were diagnosed with smear-positive active PTB. According to ROC curve analysis, the sensitivity, specificity, positive predictive value, negative predictive value, false positive rates and false negative rates were 98.6 %, 95.8 %, 78.5 %, 99.8 %, 4.2 % and 1.4 %, respectively, for diagnosing smear-positive active PTB in elderly patients, and 100.0 %, 96.9 %, 76.5 %, 100.0 %, 3.1 % and 0.0 %, respectively, for non-elderly patients. HRCT can assist in the early diagnosis of the most infectious active PTB, thereby preventing transmission and minimizing unnecessary immediate respiratory isolation. (orig.)

  11. Personal Determinants of Formation Disease Adaptation in Patients with Active Pulmonary Tuberculosis: a Comparative Analysis from the Standpoint of Gender Approach

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    Sevostyanova M.S.,

    2014-08-01

    Full Text Available We present the design and results of empirical research, facing the actual problem of integration of theoretical and methodological knowledge of different areas of psychology to solve actual applied problems of modern physical medicine. For the first time, we described the use of gender-based approach to the study of psychological structures of disease internal picture in men aged 25 to 49, suffering from various forms of active pulmonary tuberculosis no more than 3 years. The hypothesis that individual gender characteristics are personality determinants of formation specific adaptation to the disease is confirmed by the results of empirical research. The main conclusions of the work: 1 individual gender appearance is an important psychological factor in the development of a healthy personality; 2 internalization of certain personal characteristics in individual gender space affects the features of the formation of certain types of patients relationship to the disease. The study conclusions highlight the need to complement the complex biopsychosocial rehabilitation programs of somatic patients by methods of psychological intervention from the standpoint of gender mainstreaming, thereby having significant practice oriented focus.

  12. Rapid laboratory diagnosis of pulmonary tuberculosis

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    Prasanna Bhirud

    2017-01-01

    Full Text Available Background: Tuberculosis (TB ranks as the second leading cause of death from an infectious disease worldwide. Early diagnosis of Mycobacterium tuberculosis in clinical samples becomes important in the control of TB both for the treatment of patients and for curbing of disease transmission to the others in the community. The study objective was to perform Ziehl–Neelsen (ZN staining, fluorochrome staining, line probe assay (LPA, and loop-mediated isothermal amplification (LAMP assay for rapid detection of pulmonary TB (PTB and to compare the results of LPA and LAMP in terms of sensitivity, specificity, and turnaround time. Methods: A total of 891 sputum samples from clinically diagnosed/suspected cases of TB were subjected to ZN and fluorochrome staining. Smear positive samples were subjected to LPA, and smear negative were cultured on Lowenstein–Jensen media. A total of 177 samples were subjected to liquid culture and LAMP. Conventional culture was considered as “gold standard” for calculation of parameters. Results: Light-emitting diode fluorescence microscopy had the same sensitivity as ZN with similar high specificity. LPA was performed on 548 sputum samples which includes 520 smear positive and 28 smear negative culture positive samples and multidrug-resistant TB was detected in 32.64%. The sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of TB-LAMP on direct sputum samples was found to be 98.96%, 95%, 96%, and 98.70%, respectively, when compared with ZN smear microscopy. By considering culture as “gold standard,” LAMP showed a sensitivity, specificity, PPV, and NPV of 98.94%, 96.34%, 96.90%, and 98.75%, respectively. The sensitivity and PPV of TB-LAMP were 98.97% and 96%, respectively, when compared with LPA. Conclusions: A successful rapid laboratory diagnosis of PTB is possible when one combines the available methodology of microscopy, culture as well as molecular techniques. The LAMP

  13. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

  14. Multiple oral ulcers leading to diagnosis of pulmonary tuberculosis

    Science.gov (United States)

    Nagaraj, Vezhavendhan; Sashykumar, Shanthi; Viswanathan, Stalin; Kumar, Sathish

    2013-01-01

    We report a 47 year old man who presented with painful non-healing tongue ulcers of 3 months duration. Examination revealed an additional buccal ulcer that he was unaware of. Histopathology of the ulcers showed caseation necrosis. Following this report, chest radiography and sputum microscopy performed revealed pulmonary tuberculosis. From this case-study, one should be aware of coexisting pulmonary tuberculosis in patients with chronic non-healing oral ulcers, both for diagnosis as well as prevention of transmission through respiratory droplets. PMID:24883035

  15. Frequency of otorhinolaryngologies' manifestations in patients with pulmonary tuberculosis

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    Sousa, Renato Telles de

    2010-06-01

    Full Text Available Introduction: The tuberculosis continues being a world problem and in the last years had an increase in his incidence mainly by the growing number of patients with HIV. The tuberculosis has like an etiologic agent the Mycobacterium tuberculosis that possesses a period of latency generally prolonged between the initial infection and the illness. That illness can affect diverse organs and systems. M Method: This study is descriptive, transversal and prospective. Within, patients diagnosed with pulmonary tuberculosis by the service of pneumologia of the outpatient clinic Araújo Lima of the Federal University of the Amazon (UFAM, in Manaus, between the period of July of 2005 and May of 2006 were submitted to otorhinolaryngological exam in search of manifestations of the illness. Objectives: The main objective of the study was estimate the predominance of otorhinolaryngological manifestations in patients with tuberculosis and to describe the frequencies of the different manifestations. Results: They were analyzed 15 cases of pulmonary tuberculosis confirmed by the baciloscopia, being 7 of the female sex and 8 of the male sex. The majority of the patients were young adults between the third and fourth decade of life (46,7%. Only one of the patients had co-infection with the HIV virus. Conclusion: The otorhinolaryngological affection by the tuberculosis was observed in 2 patients corresponding to 13.33% of the sample, being a patient with tubercular medium otitis and a patient with linfoadenopatia cervical.

  16. T Cell Functional Disturbances in Patients with Pulmonary Tuberculosis.

    Science.gov (United States)

    Ostanin, Alexander A.; Khonina, Nataliya A.; Norkin, Maxim N.; Leplina, Olga Yu.; Nikonov, Sergey D.; Ogirenko, Anatoly P.; Chernykh, Helen R.

    2000-04-01

    The investigations of 38 patients with pulmonary tuberculosis (PT) revealed combined T cell and monocyte functional disturbances. Indeed, the percentages of CD4(+) and CD8(+) T lymphocytes, proliferative response and IL-2 production, as well as the percentages of HLA DR(+) monocytes and IL-1beta production were significantly decreased in PT patients as compared with normal individuals. Herewith the absolute T lymphocyte number did not undergo the pronounced changes. The decrease of T cell proliferative response was not mediated through immunosuppressive action of monocytes or T lymphocytes since removing of "adherent" cells from patient's peripheral blood mononuclear cells (PBMC) or pretreatment of PBMC with indomethacin and cyclophosphan failed to recover mitogenic reactivity in vitro. The patient's sera also did not significantly influence on PBMC proliferation. The decrease of IL-2 production and the stimulation of T cell proliferative response via TcR-CD3 complex, i.e. through the classic pathway of activation, indicated the anergy of T lymphocyte in tuberculosis patients. Furthermore, T lymphocytes were characterized by enhanced apoptosis. It should be noted, that patient's sera (especially in the patients with an initially high apoptosis) promoted significant anti-apoptotic activity. It is likely that this mechanism may be an explanation, why absolute T lymphopenia is absent during tuberculosis infection. Our findings suggest, that T lymphocyte dysfunctions in patients with PT are caused by impairments of T cell activation process, which lead to predominance of "negative" response (induction anergy, apoptosis) and to a lesser degree connected with direct suppressive mechanisms mediated by monocytes, T lymphocytes or serum factors.

  17. Screening and intervention of diabetes mellitus in patients with pulmonary tuberculosis in poverty zones in China

    DEFF Research Database (Denmark)

    Wang, Qiuzhen; Han, Xiuxia; Ma, Aiguo;

    2012-01-01

    The merging epidemics of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) have been raised concerns by many experts but no large scale screening and intervention have been launched yet, especially in low-income areas. The current study aims to understand the prevalence of DM in active PTB...... patients and evaluate the outcomes of diet and living habit intervention in poverty zones in China....

  18. Clinical application of whole blood interferon-γ release assay on diagnosis of active pulmonary tuberculosis%全血γ干扰素释放试验在活动性肺结核诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    周祖模; 金嘉琳; 王森; 黄河清; 石勇明; 陈林; 张文宏; 翁心华

    2012-01-01

    Objective To evaluate the application of whole blood interferon-γ release assay QuantiFERON-TB gold in tube (QFT-GIT) on the diagnosis of active pulmonary tuberculosis in China. Methods With the commercial whole blood interferon-γ QFT-GIT kit, interferon-γ released by specific T cells stimulated under early secreted antigenic target 6 kD protein ( ESAT-6) , culture filtrate protein 10 (CFP-10) and TB7. 7 were measured among 48 cases with active pulmonary tuberculosis and 55 BCG (bacillus calmette-guerin ) -vaccinated healthy controls, who had no tuberculosis contact history by questionnaire. Results The QFT-GIT was positive in 93. 8% patients with active pulmonary tuberculosis and 11.1% healthy controls, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of QFT-GIT were 93. 8% , 88. 9% , 88. 2% and 94. 1% , respectively. The antigen-specific IFN-γ release was significantly higher in patients with active pulmonary tuberculosis in comparison with that in the controls (P < 0.0001). Furthermore, after anti-tuberculosis treatment, the antigen-specific IFN-γ decreased significantly (P < 0.05). Conclusions QFT-GIT is a sensitive and specific assay for detecting tuberculosis, which could discriminate the active tuberculosis patients from BCG vaccinated healthy controls and could be a convenient and useful diagnostic tool for the diagnosis of tuberculosis.%目的 评价全血γ干扰素释放试验在活动性肺结核诊断中的应用价值.方法 应用一种全血γ干扰素释放检测试剂盒QuantiFERON-TB gold in tube(QFT-GIT)对48例活动性肺结核患者(活动性结核组)进行检测,同时选取55例健康者作为对照(对照组),均通过调查问卷排除结核病接触史.结果 本研究活动性结核组患者和对照组QFT-GIT阳性率分别为93.8%和11.1%,QFT-GIT诊断活动性肺结核的总体敏感性和特异性分别为93.8%和88.9%,阳性和阴性预测值分别为88.2%和94.1%.活动性

  19. Influence of Huangqi injection on the fibrosis indexes and cytokines of patients with pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Jian-Dong Xi

    2016-01-01

    Objective:To observe the efficacy of huangqi injection for patients with pulmonary tuberculosis, and its influence on the fibrosis indexes and inflammation cytokines.Methods: A total of 120 cases of patients with pulmonary tuberculosis were randomly divided into control group and observation group, with 60 cases in each group. Patients in control group were adopted basic treatment, while those in observation group were treated with huangqi injection. Then the score of tuberculosis' activity, and the sputum negative conversion rate, absorption of pathological condition and void closure of two groups were compared. And the levels of Hyaluronic acid (HA), typeⅢ procollagen (PC-Ⅲ), matrix metalloproteinase 9 (MMP-9) and inflammatory cytokines interleukin-6 (IL-6), interleukin-8 (IL-8) both in bronchoalveolar lavage fluid and serum of the two groups were detected and compared respectively before and after treatment.Results:Two and six months after treatment, the score of tuberculosis' activity of observation group was significantly lower than that of control group, while the sputum negative conversion rate, absorption of pathological condition and the void closure were higher than those of control group; and the levels of HA, PC-Ⅲ, IL-8 and IL-6 of observation group in bronchoalveolar lavage fluid and serum were all significantly lower than those of control group, while the level of MMP-9 was higher than that of control group.Conclusion:Huangqi injection plays adjuvant efficacy for patients with pulmonary tuberculosis by regulating the expression of the fibrosis indexes and inflammatory cytokines.

  20. Spoligotype patterns of Mycobacterium tuberculosis isolated from extra pulmonary tuberculosis patients in Puducherry, India

    Directory of Open Access Journals (Sweden)

    G Kandhakumari

    2015-01-01

    Full Text Available Purpose: Genotyping studies like spoligotyping are valuable tools in understanding the genetic diversity and epidemiology of Mycobacterium tuberculosis. Though there are reports of spoligotyping of M. tuberculosis isolates from pulmonary specimens from different parts of India, spoligotyping of extra pulmonary tuberculosis isolates are very few. Puducherry has not yet recorded spoligopatterns of M. tuberculosis from either pulmonary or extra pulmonary (EPTB specimens. The aim of this study is to analyze the spoligotype patterns of EPTB strains circulating in Puducherry and neighboring districts of Tamil Nadu. Materials and Methods: During June 2011 to December 2013, 570 EPTB specimens were processed by culturing on to Lowenstein Jensen (LJ medium and automated Mycobacterium Growth Indicator Tube system (MGIT960. Identification of M. tuberculosis was carried out as per standard procedures, and MPT 64 antigen positivity in a commercial immunochromatography kit. Spoligotyping was carried out at National Institute of Research in Tuberculosis (ICMR, Chennai. Results: M. tuberculosis was isolated from 67 single EPTB specimens (11.8% like pus/cold abscess (34, TB spine (10, pleural fluid (10, urine (5, tissue bit (2, lymph nodes (2, ascitic fluid (2, synovial fluid (1 and endometrial curetting (1. Among 67 isolates with 41 spoligopatterns, EAI lineage with 28 isolates (41.8% predominated followed by 18 orphans (26.9%, 10 Beijing (14.9% and 8 U (11.9%. BOVIS1_BCG (ST482, T1-T2 (ST78 and H3 (ST50 were represented by one strain each (1.5%. C onclusions: Spoligotyping plays a significant role in the epidemiology of tuberculosis. Three spoligotypes, T1-T2 (ST78, EAI6 (ST292 and U (ST1429 are reported for the first time in India.

  1. Biosecurity in pulmonary tuberculosis and nursing practice in a university hospital, RJ, BRAZIL.

    OpenAIRE

    Ramos, Ingrid; Residente de enfermagem pela Universidade federal do estado do rio de janeiro ( UNIRIO); Souza, Fabiana Barbosa Assumpção de; Professora adjunto da Universidade Federal do Estado do Rio de Janeiro ( UNIRIO); Oliveira, Alexandre Baroli; Doutorando em enfermagem pela UFRJ e enfermeiro do Instituto Nacional de Traumatologia e Ortopedia. ( M.S)

    2010-01-01

    The study aimed to use bio in nursing practice with clients in precautionary air for pulmonary tuberculosis (TB) in a University Hospital in Rio de Janeiro (RJ). OBJECTIVES: To describe the use of biosafety in nursing practice with clients holder of pulmonary tuberculosis; characterize the circumstances of use of biosecurity in nursing practice to patients in respiratory precautions for pulmonary tuberculosis. The theoretical addressed: etiology, transmission and pathogenesis of pulmonary tub...

  2. Subcutaneous emphysema in cavitary pulmonary tuberculosis without pneumothorax or pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-01-01

    Full Text Available Extra-alveolar air in the form of subcutaneous tissue emphysema is observed in a variety of clinical settings. Spontaneous subcutaneous emphysema in the absence of pneumothorax or pneumomediastinum is very rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax or pneumomediastinum.

  3. Opportunistic microorganisms in patients undergoing antibiotic therapy for pulmonary tuberculosis

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    Silvia Maria Rodrigues Querido

    2011-12-01

    Full Text Available Antimicrobial therapy may cause changes in the resident oral microbiota, with the increase of opportunistic pathogens. The aim of this study was to compare the prevalence of Candida, Staphylococcus, Pseudomonas and Enterobacteriaceae in the oral cavity of fifty patients undergoing antibiotic therapy for pulmonary tuberculosis and systemically healthy controls. Oral rinsing and subgingival samples were obtained, plated in Sabouraud dextrose agar with chloramphenicol, mannitol agar and MacConkey agar, and incubated for 48 h at 37ºC. Candida spp. and coagulase-positive staphylococci were identified by phenotypic tests, C. dubliniensis, by multiplex PCR, and coagulase-negative staphylococci, Enterobacteriaceae and Pseudomonas spp., by the API systems. The number of Candida spp. was significantly higher in tuberculosis patients, and C. albicans was the most prevalent specie. No significant differences in the prevalence of other microorganisms were observed. In conclusion, the antimicrobial therapy for pulmonary tuberculosis induced significant increase only in the amounts of Candida spp.

  4. Prevalence of nutritional deficiency in patients with pulmonary tuberculosis

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    Silvana Gomes Nunes Piva

    2013-06-01

    Full Text Available OBJECTIVE: To determine the prevalence of nutritional deficiency among patients with pulmonary tuberculosis. METHODS: This was a cross-sectional study using data obtained from the Brazilian Case Registry Database and from the medical records of patients diagnosed with pulmonary tuberculosis (15-59 years of age residing in one of the municipalities that make up the 16th Regional Health District of the state of Bahia. We calculated the incidence, lethality, and mortality rates, as well as the prevalence of nutritional deficiency, as evaluated by body mass index. Demographic, social, clinical, and epidemiological data were collected. RESULTS: Of the 72 confirmed cases of tuberculosis, 59 (81.9% were in males, and 21 (29.2% of the patients were in the 40-49 year age bracket. The majority (85.3% described themselves as Mulatto or Black; 55.2% reported using alcohol; and approximately 90% were treated as outpatients. In the district and age bracket studied, the incidence of pulmonary tuberculosis was 30.6/100,000 population. Among the 72 patients, data regarding nutritional status was available for 34. Of those, 50% and 25%, respectively, presented nutritional deficiency at the beginning and at the end of treatment. No statistically significant differences were found between normal-weight and malnourished patients regarding the characteristics studied. CONCLUSIONS: The prevalence of nutritional deficiency was high among our sample of patients with pulmonary tuberculosis. This underscores the importance of nutritional follow-up for the assessment of tuberculosis treatment in the decision-making process regarding therapeutic interventions.

  5. Conformance contrast testing between rates of pulmonary tuberculosis in Ecuadorian border areas

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    Claudia Ortiz-Rico

    2015-11-01

    Full Text Available Objective. To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. Materials and methods. Cross-sectional survey in the southeastern (SEBA, and the Andean southern Ecuadorian border areas (ASBA, which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals, were compared with local and national official figures using maximum likelihood contrasts. Results. The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole (p<0.001. Conclusion. It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.

  6. Experience with pulmonary resection for extensively drug-resistant tuberculosis.

    Science.gov (United States)

    Shiraishi, Yuji; Katsuragi, Naoya; Kita, Hidefumi; Toishi, Masayuki; Onda, Takahito

    2008-12-01

    Extensively drug-resistant tuberculosis is becoming a global threat. It is a relatively new phenomenon, and its optimal management remains undetermined. We report our experience in using pulmonary resection for treating patients with this disease. Records were reviewed of 54 consecutive patients undergoing a pulmonary resection for multidrug-resistant tuberculosis at Fukujuji Hospital between 2000 and 2006. These patients were identified using the definition approved by the World Health Organization Global Task Force on extensively drug-resistant tuberculosis in October 2006. Five (9%) patients (3 men and 2 women) aged 31-60 years met the definition. None of the patients was HIV-positive. Although the best available multidrug regimens were initiated, no patient could achieve sputum conversion. Adjuvant resectional surgery was considered because the patients had localized disease. Procedures performed included pneumonectomy (2) and upper lobectomy (3). There was no operative mortality or morbidity. All patients attained sputum-negative status after the operation, and they were maintained on multidrug regimens for 12-25 months postoperatively. All patients remained free from disease at the time of follow-up. Pulmonary resection under cover of state-of-the-art chemotherapy is safe and effective for patients with localized extensively drug-resistant tuberculosis.

  7. Pulmonary tuberculosis and lung cancer: simultaneous and sequential occurrence

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    Denise Rossato Silva

    2013-06-01

    Full Text Available OBJECTIVE: Lung cancer (LC is the leading cause of cancer-related death and represents a major public health problem worldwide. Another major cause of morbidity and mortality, especially in developing countries, is tuberculosis. The simultaneous or sequential occurrence of pulmonary tuberculosis and LC in the same patient has been reported in various case series and case-control studies. The objective of this study was to describe the characteristics of patients developing tuberculosis and LC, either simultaneously or sequentially. METHODS: This was a cross-sectional study based on the review of medical charts. RESULTS: The study involved 24 patients diagnosed with tuberculosis and LC between 2009 and 2012. The diagnoses of tuberculosis and LC occurred simultaneously in 10 patients, whereas tuberculosis was diagnosed prior to LC in 14. The median time between the two diagnoses was 5 years (interquartile range: 1-30 years. Fourteen patients (58.3% were male, 20 (83.3% were White, and 22 (91.7% were smokers or former smokers. The most common histological type was adenocarcinoma, identified in 14 cases (58.3%, followed by epidermoid carcinoma, identified in 6 (25.0%. Seven patients (29.2% presented with distant metastases at diagnosis; of those 7 patients, 5 (71% were diagnosed with LC and tuberculosis simultaneously. CONCLUSIONS: In the present study, most of the patients with tuberculosis and LC were smokers or former smokers, and tuberculosis was diagnosed either before or simultaneously with LC. Non-small cell lung cancer, especially adenocarcinoma, was the most common histological type.

  8. Concomittant pulmonary tuberculosis and borderline leprosy with type-II lepra reaction in single patient.

    Science.gov (United States)

    Prasad, Rajendra; Verma, Sanjay Kumar; Singh, Rajni; Hosmane, Giridhar

    2010-01-01

    The concommitant occurrence of both tuberculosis and leprosy in a single individual are not an uncommon clinical condition but is being reported infrequently in literature. We report a case of leprosy, diagnosed previously and also diagnosed as pulmonary tuberculosis.

  9. [Alcohol sales and pulmonary tuberculosis mortality in the Republic of Belarus in 1981 to 2001].

    Science.gov (United States)

    Razvodovskiĭ, Iu E

    2006-01-01

    The fact that there is an association of alcohol abuse with pulmonary tuberculosis is well documented. The effect of alcohol sales per capita on tuberculosis mortality rates is considerably less known. The aim of the study was to evaluate the beverage-specific effect of alcohol on pulmonary tuberculosis mortality rates. Trends in pulmonary tuberculosis mortality rates in Belarus from 1981 to 2001 were analyzed in relation to those in the level of sales of various alcoholic beverages per capita, by applying the time series analysis. The analysis demonstrated a positive and statistically significant effect of changes in per capita alcohol sale levels on pulmonary tuberculosis mortality rates. It suggests that a 1% increase in alcohol sales per capita might cause 0.49 and 0.36% increases in pulmonary tuberculosis mortality rates in males and females, respectively. This study also indicates that tuberculosis prevention programs should place more emphasis on alcohol problems.

  10. Research on the significance of TSPOT.TB test in diagnosing the atypical pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Jin Li; Qi-Huang Chen; Yan-Yu Pan; Wei-Zheng Chen; Wen-Feng Lin; Sai-Li Zeng

    2015-01-01

    Objective:To investigate the sensitivity and specificity of the TSPOT.TB test in diagnosing the atypical pulmonary tuberculosis.Methods:A total of 100 patients with suspected pulmonary tuberculosis were diagnosed by TSPOT.TB test and TST, and the difference between the two detection methods was compared.Results:The positive detection rate in the atypical pulmonary tuberculosis was significantly higher than that in the pulmonary tuberculosis group. The sensitivity (94.21), specificity (94.50), PPV (74.20), NPV (94.17), and LR+ (6.14) in the atypical pulmonary tuberculosis group by TSPOT.TB test were significantly higher than those by TST, while LR-(0.13) was significantly lower than that by TST.Conclusions:When compared with TST, TSPOT. TB test has a higher clinical application value, possesses advantages of rapidness and sensitivity, and plays a vital role in diagnosing atypical pulmonary tuberculosis.

  11. Extra-Pulmonary Tuberculosis and Its Surgical Treatment.

    Science.gov (United States)

    Fry, Donald E

    2016-08-01

    Tuberculous infection has declined in the United States but remains a major infectious disease with morbidity and death for millions of people. Although the primary therapy is drugs, complications of the disease require surgical interventions. The published literature on tuberculosis was reviewed to provide a current understanding of the medical treatment of the disease and to define those areas where surgical intervention continues to be necessary. Multi-drug therapy for tuberculosis has become the standard and has reduced the complications of the disease necessitating surgical intervention. However, multi-drug resistance and extensively drug-resistant tuberculosis continue to be major problems and require effective initial therapy with surveillance to define resistant infections. The roles of surgery in tuberculosis are in establishing the diagnosis in extra-pulmonary infection and in the management of complications of disseminated disease. Tuberculosis remains an occupational risk for surgeons and surgical personnel. Tuberculosis is still a global problem, mandating recognition and treatment. Surgeons should have an understanding of the diverse presentation and complications of the disease.

  12. Spatial analysis of pulmonary tuberculosis in Antananarivo Madagascar: tuberculosis-related knowledge, attitude and practice.

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    Sitraka Rakotosamimanana

    Full Text Available Tuberculosis infection may remain latent, but the disease is nevertheless a serious public health issue. Various epidemiological studies on pulmonary tuberculosis have considered the spatial component and taken it into account, revealing the tendency of this disease to cluster in particular locations. The aim was to assess the contribution of Knowledge Attitude and Practice (KAP to the distribution of tuberculosis and to provide information for the improvement of the National Tuberculosis Program.We investigated the role of KAP to distribution patterns of pulmonary tuberculosis in Antananarivo. First, we performed spatial scanning of tuberculosis aggregation among permanent cases resident in Antananarivo Urban Township using the Kulldorff method, and then we carried out a quantitative study on KAP, involving TB patients. The KAP study in the population was based on qualitative methods with focus groups.The disease still clusters in the same districts identified in the previous study. The principal cluster covered 22 neighborhoods. Most of them are part of the first district. A secondary cluster was found, involving 18 neighborhoods in the sixth district and two neighborhoods in the fifth. The relative risk was respectively 1.7 (p<10-6 in the principal cluster and 1.6 (p<10-3 in the secondary cluster. Our study showed that more was known about TB symptoms than about the duration of the disease or free treatment. Knowledge about TB was limited to that acquired at school or from relatives with TB. The attitude and practices of patients and the population in general indicated that there is still a stigma attached to tuberculosis.This type of survey can be conducted in remote zones where the tuberculosis-related KAP of the TB patients and the general population is less known or not documented; the findings could be used to adapt control measures to the local particularities.

  13. [X-ray features of disseminated pulmonary tuberculosis at late stages of HIV infection].

    Science.gov (United States)

    Babaeva, I Iu; Frolova, O P; Demikhova, O V

    2006-01-01

    The paper analyzes the results of a study of X-ray features of disseminated pulmonary tuberculosis in HIV infection on the basis of a retrospective analysis of the case histories of 65 HIV-infected patients with disseminated pulmonary tuberculosis and 60 patients with disseminated tuberculosis without HIV infection, who have been followed up in the Krasnodar Territory. X-ray changes characteristic for patients with disseminated tuberculosis in HIV infection and their difference from those with disseminated tuberculosis without HIV infection have been ascertained, which assists in timely establishing the diagnosis of tuberculosis in HIV infection.

  14. Co-existence of Pulmonary, Tonsillar and Laryngeal Tuberculosis

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    Erkan Ceylan

    2013-10-01

    Full Text Available    A 56-year old man applied to otorhinolaryngology clinic with sore throat, dysphagia. During direct examination, left palatine tonsil and tonsil plicas ulcerovegetative lesions were found. In the indirect laryngoscopy, in some regions of the larynx and epiglottis, ulcerovegetative lesions were observed too. Because of suspicion of laryngeal carcinoma and metastasis, punch biopsy of the left palatine tonsil was performed. Chest x-ray and computerized tomography of the thorax revealed two adjacent cavitations in the apicoposterior segment of the left upper lobe. In the histopathologic examination of biopsies, granulomatous structures that proved tuberculosis were observed. In the fiberoptic bronchoscopic analysis, endobronchial lesion was not detected. Acid-fast bacilli were determined in sputum and bronchial lavage in microscopy and culture. The case of this middle aged male patient with co-existence of tonsillar, laryngeal and pulmonary tuberculosis presents the clinical significance of upper airway tuberculosis in terms of its infectiousness and rare occurrence.

  15. Pleuropulmonary Paragonimiasis mimicking Pulmonary Tuberculosis - A Report of Three Cases

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    Singh T

    2005-01-01

    Full Text Available Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfishes. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster human transmission. Three patients with clinical and radiological features compatible with pulmonary tuberculosis had been treated for tuberculosis without remedy despite an inability to demonstrate acid fast bacilli in sputum smears. All patients had history of ingestion of raw crabs and crayfishes. The confirmed diagnosis of pleuropulmonary paragonimiasis was made based on the demonstration of Paragonimus eggs in the sputum, and high absolute eosinophilia in their peripheral blood and pleural fluid. All the patients had been treated with praziquantel successfully.

  16. Pulmonary impairment after tuberculosis and its contribution to TB burden

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    Munguia Guadalupe

    2010-05-01

    Full Text Available Abstract Background The health impacts of pulmonary impairment after tuberculosis (TB treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs. Methods TB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis. Results There were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic. Conclusions Our findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.

  17. Pulmonary mucormycosis mimicking as pulmonary tuberculosis : A case report

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    Garg Rajiv

    2008-01-01

    Full Text Available Pulmonary Mucormycosis is an uncommon disease caused by fungi of class Zygomycetes. It occurs predminantly in an immunodeficient host most common risk factor being diabetes mellitus. The lesions are localized in the lungs or the mediastinum. We are reporting a case of 70 years old male, having cough, haemoptysis, fever and chest pain. He was on antituberculosis treatment (RHEZ for last 10 days and was later found to have Pulmonary Mucormycosis on further evaluation.

  18. Pulmonary mucormycosis mimicking as pulmonary tuberculosis: a case report.

    Science.gov (United States)

    Garg, Rajiv; Marak, Rungmei Sk; Verma, Sanjay Kumar; Singh, Jagdeep; Sanjay; Prasad, Rajendra

    2008-07-01

    Pulmonary Mucormycosis is an uncommon disease caused by fungi of class Zygomycetes. It occurs predminantly in an immunodeficient host most common risk factor being diabetes mellitus. The lesions are localized in the lungs or the mediastinum. We are reporting a case of 70 years old male, having cough, haemoptysis, fever and chest pain. He was on antituberculosis treatment (RHEZ) for last 10 days and was later found to have Pulmonary Mucormycosis on further evaluation.

  19. Clinical value of peripheral platelet count in assessing active pulmonary tuberculosis%血小板计数对判断肺结核病情的价值探讨

    Institute of Scientific and Technical Information of China (English)

    尹洪云; 冯永红; 邹丹凤; 肖和平

    2014-01-01

    目的:了解外周血小板计数增高对结核病患者病情的诊治价值。方法选择2012年1-6月住院初治肺结核进展期80例(进展期组)、治疗后好转期43例(好转期组)及同期健康体检者89名(对照组)。采用血常规细胞计数仪检测外周血白细胞、血小板计数,中性粒细胞比值;同日送检血红细胞沉降率(ESR)及 C反应蛋白(CRP)。SPSS13.0统计软件处理数据。结果进展期组 ESR及CRP分别明显高于好转期组(P=0.0065,P=0.0073);进展期组血小板计数高于正常参考值上限者占41.94%,均值亦明显高于好转组及对照者(分别为P=0.0014,P=0.0000);且血小板计数分别与 ESR及 CRP呈正相关。而白细胞计数及中性粒细胞比值与对照组比较差异无统计学意义(P>0.05)。结论结核病患者外周血血小板计数升高,对判断病情的活动性及治疗效果具有一定参考价值。%Objective To understand the role of increasing peripheral blood platelet count in the diagnosis and prognosis of patients with active pulmonary tuberculosis.Methods This analysis included 80 inpatients with active pulmonary tuberculosis evidenced by positive sputum smear,43 patients in recovery and 89 healthy controls during the period from January to June in 2012.Peripheral white blood cell,platelet count,and neutrophil percentage were assayed.Erythrocyte sedimentation rate (ESR)and serum C-reactive protein (CRP)were measured and compared.The data were analyzed by using SPSS 13.0 software.Results ESR and CRP values were significantly higher in the patients with active pulmonary tuberculosis than in the patients in recovery (P=0.006 5 and P=0.007 3,respectively).The peripheral blood platelet count exceeded normal range in 41.94% of the patients with active pulmonary tuberculosis,which was significantly higher than that in the patients in recovery (P=0.001 4)and controls (P=0.000 0).Platelet

  20. [Severe pulmonary tuberculosis in the ICU, diagnosis and treatment].

    Science.gov (United States)

    Phelippeau, M; Petureau, F

    2015-10-01

    Pulmonary tuberculosis can rarely lead to acute respiratory distress syndrome and anti-tuberculous therapy initiation depends on this difficult diagnosis in ICU. A 50-year-old man presented a septic shock and acute respiratory distress syndrome with bilateral infiltrates mainly in the upper lobes on chest radiography. Diagnosis of pulmonary tuberculosis was made 10days after admission on examination of cavitary and diffuse infiltrates on a second CT scan, in addition to presence of acid-fast bacilli on smear examination of bronchial aspirates. Amikacin, with four first-line anti-tuberculous drugs, was started in the case of a resistant strain and seriousness of the illness. After 14weeks, he left on rifampicin and isoniazid treatment. There are no specific recommendations concerning pulmonary tuberculosis in ICU but a delay in initiation of anti-tuberculous therapy is a factor of poor prognosis. Using a second-line anti-tuberculous drug, like amikacin or/and fluoroquinolones, within initial treatment may accelerate improvement of sepsis and immediately treat resistant strains, when genomic methods for detection of resistance are not available in routine. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Pulmonary tuberculosis in patients with chronic renal failure at Zagazig University Hospitals

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    Abdelreheem I. Yousef

    2014-01-01

    Conclusion: Patients with chronic renal failure are at increased risk for pulmonary and extra pulmonary tuberculosis and should be screened routinely and carefully for early detection of TB infection.

  2. Chromoblastomycosis due to Fonsecaea monophora misdiagnosed as sporotrichosis and cutaneous tuberculosis in a pulmonary tuberculosis patient

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    Dongmei Shi

    2016-03-01

    Full Text Available Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. We report a case of chromoblastomycosis in a pulmonary tuberculosis patient without known history of trauma. The lesions were initially diagnosed as sporotrichosis and skin tuberculosis. Histopathology of scales and skin biopsy specimen revealed sclerotic bodies, the hallmark of chromoblastomycosis. The causative organism was identified as Fonsecaea monophora by rDNA ITS sequencing. The lesions recovered markedly after two month treatment with oral terbinafine 250 mg daily according to drug sensitive test in vitro in combination with local thermotherapy

  3. 探讨C-反应蛋白对活动性肺结核的诊断价值分析%The Diagnostic Value of C-Reactive Protein in Active Pulmonary Tuberculosis

    Institute of Scientific and Technical Information of China (English)

    林宏

    2013-01-01

    目的:探讨C-反应蛋白(CRP)判定肺结核病情活动的价值。方法:2011年-2012年本院住院收治的156例肺结核患者,将其分为活动组90例(菌阳者46例、菌阴者44例)和非活动组66例,分别检测其CRP,同时设正常对照组108例,为医院体检中心无结核病史的健康查体者。结果:156例患者CRP升高者142例,阳性率91.02%。活动组CRP明显高于非活动组和正常对照组,非活动组明显高于正常对照组;活动组中菌阳者CRP明显高于菌阴者,差异均有统计学意义(P<0.01)。结论:CRP在评论活动性肺结核中有重要的临床价值。%Objective:To evaluate the diagnostic value of CRP in the diagnosis of pulmonary tuberculosis.Method:One hundred and fifty-six patients with pulmonary tuberculosis in the years 2011-2012 in our hospital were divided into 90 cases of active group(46 cases of bacteria Yang, 44 cases of bacteria Yin)and 66 cases of non active group.The CRP was detected and 108 Healthy people as normal control group without a history of tuberculosis from hospital medical center were selected.Result:One hundred and fifty-six patients with CRP elevated in 142 cases,the positive rate was 91.02%.Activity of CRP was significantly higher than that in non active group and normal control group,non active group was significantly higher than that in normal control group;Bacteria Yang in CRP active group was obviously higher than that of bacteria Yin,the differences were statistically significant (P<0.01).Conclusion:CRP in comment active tuberculosis has important clinical value.

  4. 积极早期胰岛素治疗肺结核合并糖尿病临床效果研究%Clinical Effect of Active Early Insulin Treatment for Pulmonary Tuberculosis Complicated With Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    温乐梅

    2015-01-01

    Objective To explore positive ways of early insulin treatment for pulmonary tuberculosis clinical results. Methods 100 cases of pulmonary tuberculosis complicated with diabetes were selected from May 2012 to May 2014 in our hospital. 50 cases were treated with hypoglycemic drugs and insulin respectively.ResultsTB observation group were signiifcantly better than the control group, and the level of glycemic control was signiifcantly better than the control group (P<0.05).Conclusion For the implementation of active tuberculosis in patients with diabetes early insulin treatment can achieve more signiifcant therapeutic effect,worthy of clinical application.%目的:探讨应用积极早期胰岛素方式对肺结核合并糖尿病进行治疗的临床效果。方法选择2012年5月~2014年5月在我院接受治疗的100例肺结核合并糖尿病患者随机平分为观察组、对照组各50例,分别给予降糖药物、胰岛素进行治疗。结果观察组抗结核疗效优于对照组,且血糖控制水平也优于对照组(P<0.05)。结论对肺结核合并糖尿病患者实施积极早期胰岛素治疗可取得更加显著的治疗效果。

  5. CT findings of pulmonary tuberculosis and tuberculous pleurisy in diabetes mellitus patients

    Science.gov (United States)

    Kim, Jihyun; Lee, In Jae; Kim, Joo-Hee

    2017-01-01

    PURPOSE We aimed to assess computed tomography (CT) findings of pulmonary tuberculosis (TB) and TB pleurisy in diabetes mellitus (DM) patients and to evaluate the effect of duration of DM on radiologic findings of pulmonary TB and TB pleurisy. METHODS Ninety-three consecutive patients diagnosed as active pulmonary TB with underlying DM were enrolled in our study. As a control group, 100 pulmonary TB patients without DM were randomly selected. TB patients with DM were subdivided into two subgroups depending on diabetes duration of ≥10 years or <10 years. Medical records and CT scans of the patients were retrospectively reviewed and compared. RESULTS Bilateral pulmonary involvement (odds ratio [OR]=2.39, P = 0.003), involvement of all lobes (OR=2.79, P = 0.013), and lymph node enlargement (OR=1.98, P = 0.022) were significantly more frequent CT findings among TB patients with DM compared with the controls. There were no statistically significant differences in CT findings of pulmonary TB depending on the duration of DM. CONCLUSION Bilateral pulmonary involvement, involvement of all lobes, and lymph node enlargement are significantly more common CT findings in TB patients with underlying DM than in patients without DM. Familiarity with the CT findings may be helpful to suggest prompt diagnosis of pulmonary TB in DM patients. PMID:28185999

  6. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000–2012

    OpenAIRE

    Guadalupe Delgado-Sánchez; Lourdes García-García; Martín Castellanos-Joya; Pablo Cruz-Hervert; Leticia Ferreyra-Reyes; Elizabeth Ferreira-Guerrero; Andrés Hernández; Victor Manuel Ortega-Baeza; Rogelio Montero-Campos; José Antonio Sulca; Ma de Lourdes Martínez-Olivares; Norma Mongua-Rodríguez; Renata Baez-Saldaña; Jesús Felipe González-Roldán; Hugo López-Gatell

    2015-01-01

    Background Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. Objective To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. Materials and Methods We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individu...

  7. Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal

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    Gobinda Thapa

    2016-08-01

    Full Text Available Abstract Background Multidrug resistant tuberculosis (MDR-TB is a serious public health problem in Nepal. It is a major obstacle for the control of the tuberculosis. The main objectives of this study were to determine the prevalence of the multidrug resistant pulmonary tuberculosis and to evaluate the drug susceptibility patterns of Mycobacterium tuberculosis isolated from previously treated and newly diagnosed cases of pulmonary tuberculosis. Methods A cross-sectional study was conducted from March 2013 to August 2013 at German-Nepal tuberculosis project (GENETUP laboratory, Kathmandu, Nepal. For this the sputum samples from total of 153 (49 new and 104 previously treated suspected pulmonary tuberculosis patients were used. The diagnosis of the tuberculosis was performed by using fluorescent microscopy and culture, while the drug susceptibility testing of Mycobacterium tuberculosis was performed by proportion method. Lowenstein-Jensen (L-J medium was used for the culture of Mycobacterium tuberculosis and the colonies grown were identified on the basis of the colony morphology, pigment production and biochemical characteristics. Results The prevalence of MDR-TB among all the cases of culture positive pulmonary tuberculosis was 15.6 %. The rate of MDR-TB among previously treated culture positive tuberculosis patients was 19.4 % and that among newly diagnosed culture positive pulmonary tuberculosis cases was 7.1 %. The highest rate of resistance of Mycobacterium tuberculosis, was toward streptomycin (24.4 % followed by isoniazid (23 %, rifampicin (17.8 % and ethambutol (15.6 %. Among the total of MDR-TB cases among previously treated patients, highest percentage of the cases were relapse (61.1 % followed by chronic (16.7 %. Conclusions The high prevalence of DR/MDR-TB in our study reflects poor implementation of tuberculosis control program. On the basis of the drug susceptibility patterns of M. tuberculosis we found in our study, we

  8. Consultations of health service providers amongst patients of pulmonary tuberculosis from an urban area

    OpenAIRE

    Pardeshi, Geeta S

    2008-01-01

    Aims: To describe the number, types and reasons of consultations amongst patients of pulmonary tuberculosis from an urban area. Settings and Design Cross sectional study was conducted amongst new patients of pulmonary tuberculosis initiated on DOTS at District Tuberculosis Centre (DTC), Yavatmal from January to June 2006. Material and Methods: The data regarding consultations were collected along a time line. The reasons for consultations were studied by in-depth interviews. Statistical analy...

  9. γ-干扰素释放试验对活动性肺结核的诊断价值%Clinical value of interferon-gamma release assay in the diagnosis of active pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    任斐; 岳英; 苗风济; 孙晓方; 严文; 苟超伦

    2015-01-01

    目的:评价γ-干扰素释放试验( interferon-gamma release assay,IGRA, T-SPOT. TB)对活动性肺结核的诊断价值。方法选取活动性肺结核组(观察组)120例和非结核病组(对照组)84例共计204例,两组患者均行结核菌素试验( tuberculin skin test,TST),血清结核抗体检测( TB-Ab),T-SPOT. TB检测,比较三种方法对活动性肺结核诊断的敏感度、特异度、阳性预测值、阴性预测值。结果外周血 T-SPOT. TB 诊断活动性肺结核的敏感度为90.0%,明显高于 TST (50.0%)和 TB-Ab (55.8%)(P0.05);T-SPOT. TB诊断活动性肺结核的阳性预测值明显高于TST(81.2% vs 67.4%,P0.05);T-SPOT. TB诊断活动性肺结核的阴性预测值为83.0%,明显高于TST(47.8%)和TB-Ab(51.4%)(P0. 05). The positive prediction value of T-SPOT. TB in the diagnosis of active pulmonary tuberculosis was higher than that of TST (81. 2% vs 67. 4%,P 0. 05). The negative prediction value of T-SPOT. TB for non-active pulmonary tuberculosis was 83. 0%, significantly higher than that of TST(47. 8%)and TB-Ab(51. 4%)(P<0. 05). Conclusion Peripheral blood T-SPOT. TB is very sensitive and specific, and the negative prediction value is significantly better than TST and TB-Ab. T-SPOT. TB has a good application value in diagnosis and differenti-al diagnosis of active pulmonary tuberculosis.

  10. Pulmonary impairment after tuberculosis in a South African population

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    Gibwa Cole

    2016-02-01

    Full Text Available Background: In South Africa, pulmonary tuberculosis (PTB remains a problem of epidemic proportions. Despite evidence demonstrating persistent lung impairment after PTB cure, few population-based South African studies have investigated this finding. Pulmonary rehabilitation post-cure is not routinely received.Objectives: To determine the effects of PTB on lung function in adults with current or past PTB. To determine any association between PTB and chronic obstructive pulmonary disease (COPD. Methods: This study was observational and cross-sectional in design. Participants (n = 55 were included if they were HIV positive on treatment, had current PTB and were on treatment, and/or had previous PTB and completed treatment or if they were healthy adult subjects with no history of PTB. A sample of convenience was used with participants coming from a similar socio-economic background and undergoing spirometry testing. Multiple regression analyses were conducted on each lung function variable.Results: Compared to normal percentage-predicted values, forced expiratory volume in 1 second (FEV1 , forced vital capacity (FVC and FEV1 :FVC were significantly reduced in those with current PTB by 23.39%, 15.99% and 6.4%, respectively. Both FEV1 and FVC were significantly reduced in those with past PTB by 11.76% and 10.79%, respectively. There was no association between PTB and COPD – those with previous PTB having a reduced FEV1 :FVC (4.88% less than the norm, which was just short of significance (p = 0.059.Conclusions: Lung function is reduced both during and after treatment for PTB and these deficits may persist. This has implications regarding the need for pulmonary rehabilitation even after medical cure.Keywords: Lung function, pulmonary, tuberculosis

  11. Chronic pneumonia due to Klebsiella oxytoca mimicking pulmonary tuberculosis.

    Science.gov (United States)

    Gera, Kamal; Roshan, Rahul; Varma-Basil, Mandira; Shah, Ashok

    2015-01-01

    Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca is a singularly uncommon cause of CAP. The chronic form of the disease caused by K. oxytoca has been documented only once before. A 50-year-old immunocompetent male smoker presented with haemoptysis for 12 months. Imaging demonstrated a cavitary lesion in the right upper lobe with emphysematous changes. Sputum stains and cultures for Mycobacterium tuberculosis were negative. However, three sputum samples for aerobic culture as well as bronchial aspirate cultured pure growth of K. oxytoca. A diagnosis of chronic pneumonia due to K. oxytoca was established and with appropriate therapy, the patient was largely asymptomatic. The remarkable clinical and radiological similarity to pulmonary tuberculosis can result in patients with chronic Klebsiella pneumonia erroneously receiving anti-tuberculous therapy.

  12. Factors influencing response to treatment of pulmonary tuberculosis.

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    Hiyama J

    2000-08-01

    Full Text Available We analyzed 150 patients with pulmonary tuberculosis from 1990 to 1996 (i to evaluate the frequency of drug resistance, (ii to elucidate factors influencing the response to chemotherapy, and (iii to attempt to improve the therapeutic approach. Multidrug-resistant tuberculosis strains were not found. By univariate analysis, there were 8 factors associated with an increased sputum conversion time: male gender, prior treatment, complications, progressive chest radiographic findings, a high Ziehl-Neelsen stain score, lymphocytopenia, a high erythrocyte sedimentation rate (ESR, and hypoproteinemia. Complications, prior treatment, a high Ziehl-Neelsen stain score, and a high ESR were independent predictive factors in a Cox proportional hazard model. Recursive partitioning and amalgamation (RPA defined 3 subgroups that responded to treatment. In order to reduce the time to sputum conversion, poor responders according to the RPA should be treated with a 4-drug regimen containing pyrazinamide.

  13. [Pulmonary actinomycosis and tuberculosis. A comorbidity pediatric case].

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    Bisero, Elsa D; Luque, Graciela F; Rizzo, Cristina N; Zapata, Alejandra E; Cuello, María S

    2016-08-01

    Actinomycosis is a chronic suppurative infection, produced by anaerobic Gram-positive bacteria or microaerobic Actinomyces species. It is rare in children and adolescents and it is more common in immunocompromised. Mycobacterium tuberculosis collaborates on the development of the disease. Pulmonary involvement appears as a picture of chronic condensation that does not improve with conventional antibiotic treatment. Classic complications affecting the thoracic wall with drainage in «sulfur granule» and fistulization are described less frequently nowadays. The diagnosis is a real challenge and it is set by using the isolation of species of Actinomyces. The treatment of choice for all clinical forms of the disease is the prolonged use of antibiotics. to present a pediatric case of comorbidity between tuberculosis and actinomycosis and to highlight the importance of diagnostic suspicion of actinomycosis in the presence of all chronic suppurative processes. Sociedad Argentina de Pediatría.

  14. [The chest CT findings and pathologic findings of pulmonary tuberculosis].

    Science.gov (United States)

    Ogata, Hideo

    2009-08-01

    The past research of the radiologic manifestations of pulmonary tuberculosis in Japan was based on morphological pathology of the untreated patient autopsy. I would like to show the chest CT scan of tuberculosis diseases with caseous granuloma at its exudative reaction, proliferative reaction, productive reaction, cirrhotic reaction until self cure. This progress reflects the normal cell mediated immunological responses. Also I would like to show the cavitation of granuloma, which results from liquefaction of caseous materials during the course and results in the formation of the source of infection. And finally I would like to show the morphological differences of acinous lesion, acino-nodular lesion and caseous lobular pneumonia. These differences reflect the amount of bacilli disseminated in the peripheral parts under the lobules. In this study, I do not show old age cases and HIV positive cases, who do not form typical granuloma due to the decreased cell mediated immnunity and whose X ray findings are atypical.

  15. CT在肺结核疗效判断与随访观察中的应用评价%Evaluation of values of CT in judging clinical changes and follow-up in active pulmonary tuberculosis SONG

    Institute of Scientific and Technical Information of China (English)

    宋其生; 路希伟; 王镇山; 张国庆

    2008-01-01

    目的 探讨活动性肺结核治愈后肺部病变CT表现的演变规律,评价CT在肺结核临床转归判断中的价值.方法 观察60例获得细菌学治愈的涂阳肺结核患者治疗前、治疗后和随访6个月时的CT征象变化;使用呼气末CT扫描,观察小气道阻塞与空气潴留征象,并探讨空气潴留体积与肺功能参数的相关性.结果 在治疗前、治疗疗程结束和6个月随访3个阶段,肺结核活动性CT征象的检出率分别为95.0%、31.7%和3.3%.在停药随访期内仍有39例(65.0%)肺内残留病变进一步缩小和吸收.小气道病变在治疗结束后仍持续存在,气体潴留体积与肺功能指标MMEF、FEF25%、FEF50%相关(P<0.05).结论 肺结核病变的CT影像转归滞后于细菌学转归;单凭CT征象对疗程结束时肺结核活动性进行判定存在限度;CT对肺结核细菌学治愈后的继发小气道改变有较高的诊断价值.%Objective To observe evolving rules of pulmonary pathological changes manifested by CT of active tuberculosis patients after they have been cured.To evaluate values of CT in judging clinical changes.Methods Sixty smear-positive tuberculosis patients,who had been bacteriologically cured,were collected.CT sign-changes of pre-,post-treatment and 6-month follow-up period of patients were observed.Small airways obstruction and air-trapping sign were observed by post-expiratory CT scans.Correlation between volume of air-trapping and pulmonary function tests was studied.Results During stages of pre-,post-treatment and 6-month follow-up period,checking rates of CT images of active pulmonary tuberculosis were 95.0%,31.7% and 3.3%,respectively.During follow-up period without medicine,there were still 39 patients(65.0%),whose residual lesions had been reduced and absorbed.Small airway diseases still existed after treatment.FEF25%,FEF50% and MMEF were significantly correlated in volume of air-trapping and pulmonary function indexes(P<0.05).Conclusions CT

  16. Increasing pathomorphism of pulmonary tuberculosis: an observational study of slow clinical, microbiological and imaging response of lung tuberculosis to specific treatment. Which role for linezolid?

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    Roberto Manfredi

    Full Text Available During recent years, a progressive emerging of tuberculosis occurred, related to the overall increased age of general population, primary and secondary (iatrogenic immunodeficiencies, the availability of invasive procedures, surgical interventions and intensive care supports, bone marrow and solid organ transplantation, and especially the recent immigration flows of people often coming from areas endemic for tuberculosis, and living with evident social-economical disadvantages, and with a reduced access to health care facilities. Since January 2006, at our reference centre we followed 81 consecutive cases of pulmonary tuberculosis, with 65 of them which remained evaluable for the absence of extrapulmonary complications, and a continuative and effective clinical and therapeutic follow-up. The majority of episodes of evaluable pulmonary tuberculosis (49 cases out of 65: 75,4% occurred in patients who immigrated from developing countries. In two patients multiresistant (MDR Mycobacterium tuberculosis strains were found, while two more subjects (both immigrated from Eastern Europe suffered from a disease due to extremely resistant (XDR M. tuberculosis strains. Although enforcing all possible measures to increase patients' adherence to treatment (empowerment, delivery of oral drugs under direct control, use of i.v. formulation whenever possible, over 72% of evaluable patients had a very slow clinical, microbiological, and imaging ameliorement (1-6 months, with persistance of sputum and/or bronchoalveolar lavage (BAL fluid positive for M.tuberculosis microscopy and/or culture for over 1-4 months (mean 9.2±3.2 weeks, during an apparently adequate treatment. When excluding patients suffering from XDR and MDR tuberculosis, in four subjects we observed that off-label linezolid adjunct together with at least three drugs with residual activity against tuberculosis, led to a significantly more rapid clinical-radiological improvement and negative

  17. INFILTRATE PULMONARY TUBERCULOSIS, GASTRIC ULCER AND HIV INFECTION (COMORBIDITY AND MULTIMORBIDITY

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    E. S. Skvortsova

    2016-01-01

    Full Text Available Peptic ulcer is registered in 20,5% of those suffering from infiltrate pulmonary tuberculosis and in 19,5% of HIV patients at C2 stage, ill with infiltrate pulmonary tuberculosis and presenting complaints about dyspeptic disorders. The following is typical of multimorbidity of pulmonary tuberculosis, HIV infection and peptic ulcer: oligosymptomatic start of tuberculosis, asthenic syndrome dominating among clinical symptoms, manifestations of gastric and intestinal indigestion, weight loss (2-4 times more often compared to HIV negative patients, less expressed lung tissue destruction (2 time less compared to HIV negative patients. H. pylori is a causative agent of the peptic ulcer in 62,5% of patients with infiltrate pulmonary tuberculosis and in 58,7% of HIV infected patients at C2 stage, suffering from pulmonary tuberculosis. Comorbidity of H. pilori negative peptic ulcer and infiltrate pulmonary tuberculosis differs from comorbidity of H. pilori positive peptic ulcer and infiltrate pulmonary tuberculosis since the first has confidently true unfavorable forecast of the outcome.

  18. Psychiatric morbidity in patients of pulmonary tuberculosis-an observational study

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    Lalit Singh

    2015-01-01

    Full Text Available Background: A lot of stigma and misconceptions about pulmonary tuberculosis still persist, in spite of the advances in treatment. Thus, a mere diagnosis of pulmonary tuberculosis can be a psychological trauma to an individual. The situation has aggravated with the association of tuberculosis with HIV infection. Aim: To study the psychiatric morbidity due to the various psychological stresses faced by a patient of pulmonary tuberculosis. Materials and Methods: The study group consisted of 100 inpatients admitted to pulmonary ward with diagnosis of pulmonary tuberculosis. The control group consisted of 100 inpatients admitted to pulmonary ward with nontuberculous pulmonary diseases. Psychiatric history and mental status were recorded on a specially designed proforma and diagnosis of any psychiatric illness, if present, arrived at as per International Classification of Diseases (ICD-10. The psychiatric tests applied were beck's depression inventory (BDI and Taylor's Manifest Anxiety Scale (TMAS. Results: Of the patients of pulmonary tuberculosis, 24% could be given a diagnostic category, as per ICD-10, as compared to only 8% of the controls (P < 0.005. On BDI, 44% of patients of pulmonary tuberculosis showed depression as compared to 27% of the controls (P < 0.02. On TMAS, 38% of patients of pulmonary tuberculosis showed anxiety as compared to 24% of controls (P < 0.05. A greater incidence of depression (on BDI and anxiety (on TMAS was seen in those with longer duration of illness (P < 0.02 and in those with greater severity of illness (P < 0.02. Conclusion: In view of the high psychiatric morbidity associated with pulmonary tuberculosis, there is enough scope for psychiatric services to be made available to these patients. In addition, personnel involved in the treatment of these patients should be trained for early detection of psychiatric symptoms.

  19. Population Structure among Mycobacterium tuberculosis Isolates from Pulmonary Tuberculosis Patients in Colombia

    Science.gov (United States)

    Realpe, Teresa; Correa, Nidia; Rozo, Juan Carlos; Ferro, Beatriz Elena; Gomez, Verónica; Zapata, Elsa; Ribon, Wellman; Puerto, Gloria; Castro, Claudia; Nieto, Luisa María; Diaz, Maria Lilia; Rivera, Oriana; Couvin, David; Rastogi, Nalin; Arbelaez, Maria Patricia; Robledo, Jaime

    2014-01-01

    Background Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. Principal Findings A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). Conclusions This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this

  20. Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia.

    Directory of Open Access Journals (Sweden)

    Teresa Realpe

    Full Text Available BACKGROUND: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. PRINCIPAL FINDINGS: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP, spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs. SIT42 (LAM9 and SIT62 (H1 represented 53.3% of isolates, followed by 8.21% SIT50 (H3, 5.07% SIT53 (T1, and 3.14% SIT727 (H1. Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1. The proportion of Haarlem sublineage (44.3% was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1, as well as HIV-positive serology with SIT727 (H1 and SIT53 (T1. CONCLUSIONS: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali. Dominant spoligotypes were LAM9 (SIT 42 and Haarlem (SIT62. The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of

  1. Keloidal plaque in a patient with pulmonary tuberculosis: A rare morphological variant of tuberculosis verrucosa cutis

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    Sundeep Chowdhry

    2014-01-01

    Full Text Available Tuberculosis verrucosa cutis (TVC, also known as warty tuberculosis, anatomist's wart or prosector's wart is characterized by the presence of verrucous plaque-like lesions, resulting from direct inoculation of the causative organism into the skin of a previously infected patient. A 59-year-old man presented with a hyperpigmented plaque on the chest wall which closely mimicked a keloid. He was a case of sputum-positive pulmonary tuberculosis and had repeatedly been applying early morning saliva on the lesion as a part of the indigenous practices for quick healing. There was further progression of the lesion with discharge from several sites. A smear for acid fast bacilli was positive from the discharge and growth on Lowenstein Jensen medium revealed growth of Mycobacterium tuberculosis. Biopsy was compatible with TVC and the patient was started on 6 months anti-tubercular therapy. However, the plaque continued to persist with continuing discharge from multiple openings which necessitated surgical intervention, finally leading to near complete resolution of the plaque of TVC.

  2. Case-finding for pulmonary tuberculosis in Penang.

    Science.gov (United States)

    Hooi, L N

    1994-09-01

    The process of case-finding was studied in 100 consecutive patients with pulmonary tuberculosis treated by the Chest Clinic, Penang Hospital. The median time from the onset of the illness until the initial medical consultation was two weeks (patient's delay). This delay was longer in males, patients with lower than secondary education and drug abusers. Only 47% of patients were put on treatment with a correct diagnosis within one month of the first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and the mean number of consultations before diagnosis was three. Patients who first visited government medical facilities had shorter doctor's delay than those who first saw private practitioners, and patients who first consulted a private practitioner were the least likely to be appropriately investigated by sputum examination and chest radiography. The median total delay was three months and at the time of diagnosis, 95% of patients had moderate or far advanced disease radiologically. In order to shorten doctor's delay, all medical practitioners, especially those in the private sector, should be made aware of the importance of early diagnosis and the proper management of tuberculosis. Health education campaigns for the public should also be undertaken to shorten patient's delay.

  3. The analysis of lower respiratory tract infection pathogens in active pulmonary tuberculosis group%活动性肺结核合并下呼吸道感染的致病菌群分析

    Institute of Scientific and Technical Information of China (English)

    苗小艳; 刘薇

    2012-01-01

    目的 通过对活动性肺结核合并呼吸道感染的住院患者痰样检测观察,探讨肺结核住院患者下呼吸道致病菌种的分布及药物敏感情况.方法 选取大连市结核病医院1999年1月至2002年1月间住院的活动性肺结核同时合并下呼吸道感染患者164例,对患者晨起漱口后咯出气管深部痰液,置于无菌器皿内及时送检.接种于血平板和伊红美兰平板内24 h后观察,然后按细菌学特征鉴定,及进行抗菌药物体外药敏试验并列表分析.结果 本组肺结核住院患者以Gˉ菌引起的下呼吸道感染为主,占71.8%,真菌感染占28.7%,厌氧菌感染占4.6%,G+球菌占3.8%.单纯感染者59例,占36.0%;伴两种(或两种以上)细菌生长属混合感染105例,占64.0%.结论 肺结核住院患者下呼吸道致病菌种以Gˉ菌为主,真菌感染次之,感染者多为老年复治患者.分析反复发病原因,既往应用多种抗痨药物及抗生素,造成菌群失调导致二重感染.绝大多数肺结核患者营养状况差,住院时间长,极易造成院内感染.菌株检出率相对偏高,且混合感染多.%Objective To investigate the distribution and drug sensitivity of the pathogens in inpatients with active pulmonary tuberculosis combined with lower respiratory tract infection. Methods 164 cases of hospitalized active pulmonary tuberculosis patients with lower respiratory tract infection from January 1999 to January 2002 were collected. Patients' morning sputa in deep trachea were sampled, inoculated on blood agar and eosin methylene blue tablet, and observed after 24 hours. Bacteria identification and drug susceptibility test were performed. Results The main pathogens that caused lower respiratory tract infection of inpatients with tuberculosis were G- bacteria, accounting for 71. 8%; The other pathogens were fungi (28. 7%), anaerobic bacteria (4. 6%), and G+ cocci (3. 8%). There were 59 cases of simple infection (36. 0%) and 105 cases

  4. Clinical Value of Mycobacterium Tuberculosis in Sputum of Patients With Pulmonary Tuberculosis%肺结核患者痰中结核分枝杆菌检验的临床价值

    Institute of Scientific and Technical Information of China (English)

    郭春梅; 李玉梅; 刘佃香

    2016-01-01

    ObjectiveThis study was to investigate the clinical value of mycobacterium tuberculosis in sputum of patients with pulmonary tuberculosis.Methods In our hospital,125 cases of active pulmonary tuberculosis and 25 cases of non active pulmonary tuberculosis patients as the research object.Results Active pulmonary tuberculosis culture positive rate(63.12%)was higher than non active pulmonary tuberculosis(χ2=4.208 5,P<0.001). Conclusion The culture of mycobacterium tuberculosis can improve the positive detection rate of Mycobacterium tuberculosis,and it is of great significance in the early detection and treatment of tuberculosis.%目的:本研究探讨肺结核患者痰中结核分歧杆菌检验的临床价值。方法以我院的125例活动性肺结核和25例非活动性肺结核患者为研究对象。结果活动性肺结核培养的阳性率(63.12%)高于非活动性肺结核(χ2=4.2085,P<0.001)。结论结核分歧杆菌培养有利于提高结核分歧杆菌的阳性检出率,在结核病变早期检出、治疗有着重要的意义。

  5. Delay in DOTS for new pulmonary tuberculosis patient from rural area of Wardha District, India

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    Shilpa Bawankule

    2010-07-01

    Full Text Available Vast majority of active tuberculosis patients seeks treatment, do so promptly, still many patients spend a great deal of time and money “shopping for health” and too often they do not receive either accurate diagnosis or effective treatment, despite spending considerable resources. Objective: To find out the time taken to, for diagnosis of tuberculosis and to put patient on DOTS from the onset of symptoms and pattern of health seeking behavior of new pulmonary tuberculosis patients. A cross-sectional rapid assessment using qualitative (FGD and quantitative (Interview methods conducted at DOTS center of tertiary care hospital from rural Wardha. Participants: 53 pulmonary tuberculosis patients already on DOTS, in intensive phase. Main outcome measure: Delay in initiation of DOTS & health seeking behavior Results: Median total delay for starting DOTS was 111 days, (range: 10 to 321 days. Patient delay was more than provider delay. Patients delay was more in patients above 60 years, illiterate, per-capita income below 650 Rupees and HIV TB co-infection. Pattern of health seeking behavior was complex. Family physician was the preferred health care provider. Patient visited on an average four providers and spent around 1450 rupees (only direct cost before DOTS begin. Time taken from the onset of symptoms and start of DOT is a cause of concern for the tuberculosis control program. Early case detection is important rather than mere achieving target of 70% new case detection. Program manager needs to implement locally relevant & focused strategies for early case detection to improve the treatment success, especially in rural area of India.

  6. Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

    Institute of Scientific and Technical Information of China (English)

    Taj; Eldin; Mohammedein; Abdallah; Fatah; Elrahman; Mohmmed; Toum; Osman; Habeeb; Bashir; Tajedin; Ibrahim; mansoor; Mona; Mamoun; Yuosif; Mustafa; Awad-Elseed; Elkhawad; Idris; Osman; Okud; Abbashar; Osman; Mohammed; Abdel; Aziem; Abdalla; Ali

    2015-01-01

    Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P < 0.001), female(OR = 8.7, CI = 4.9-15.1, P < 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P < 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P < 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.

  7. Evaluation of the Mean Cost and Activity Based Cost in the Diagnosis of Pulmonary Tuberculosis in the Laboratory Routine of a High-Complexity Hospital in Brazil.

    Science.gov (United States)

    de Almeida, Isabela N; de Assis Figueredo, Lida J; Soares, Valéria M; Vater, Maria C; Alves, Suely; da Silva Carvalho, Wânia; Kritski, Afrânio L; de Miranda, Silvana S

    2017-01-01

    At a global level, with the increase in healthcare costs, there is a need to assess the economic impact of the incorporation of new technologies in different health disorders in different countries. There is scarce information regarding costs incurred with the use of current or new diagnostic tests for tuberculosis or from the vantage point of their incorporation within the healthcare systems of high-burden countries. The present study aimed to assess the mean cost and the activity based cost of the laboratory diagnosis for tuberculosis by means of conventional techniques and from the Detect TB(®)LabTest molecular test kit in a general high-complexity hospital of the public health system in Brazil. Cost analysis was performed by means of primary data, collected in the Mycobacteria and Molecular Biology Laboratory in 2013. The mean cost and activity based cost were, respectively, U$10.06/U$5.61 for centrifuged bacilloscopy by Ziehl Neelsen (ZN) and Auramine (AU); U$7.42/U$4.15 for direct bacilloscopy by ZN; U$27.38/U$16.50 for culture in a Loweinstein-Jensen solid medium; and U$115.74/U$73.46 for the Detect TB(®)LabTest Kit. The calculation of the ABC should be used in making decisions by administrators to be the best method of assessing the costs of conventional techniques and molecular method for providing the real value of the tests. So it is need to calculate the ABC, and not of the mean cost, in various scenarios before incorporating new technologies in health institutions.

  8. Evaluation of the Mean Cost and Activity Based Cost in the Diagnosis of Pulmonary Tuberculosis in the Laboratory Routine of a High-Complexity Hospital in Brazil

    Science.gov (United States)

    de Almeida, Isabela N.; de Assis Figueredo, Lida J.; Soares, Valéria M.; Vater, Maria C.; Alves, Suely; da Silva Carvalho, Wânia; Kritski, Afrânio L.; de Miranda, Silvana S.

    2017-01-01

    At a global level, with the increase in healthcare costs, there is a need to assess the economic impact of the incorporation of new technologies in different health disorders in different countries. There is scarce information regarding costs incurred with the use of current or new diagnostic tests for tuberculosis or from the vantage point of their incorporation within the healthcare systems of high-burden countries. The present study aimed to assess the mean cost and the activity based cost of the laboratory diagnosis for tuberculosis by means of conventional techniques and from the Detect TB®LabTest molecular test kit in a general high-complexity hospital of the public health system in Brazil. Cost analysis was performed by means of primary data, collected in the Mycobacteria and Molecular Biology Laboratory in 2013. The mean cost and activity based cost were, respectively, U$10.06/U$5.61 for centrifuged bacilloscopy by Ziehl Neelsen (ZN) and Auramine (AU); U$7.42/U$4.15 for direct bacilloscopy by ZN; U$27.38/U$16.50 for culture in a Loweinstein-Jensen solid medium; and U$115.74/U$73.46 for the Detect TB®LabTest Kit. The calculation of the ABC should be used in making decisions by administrators to be the best method of assessing the costs of conventional techniques and molecular method for providing the real value of the tests. So it is need to calculate the ABC, and not of the mean cost, in various scenarios before incorporating new technologies in health institutions. PMID:28261194

  9. Pattern recognition in pulmonary tuberculosis defined by high content peptide microarray chip analysis representing 61 proteins from M. tuberculosis.

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    Simani Gaseitsiwe

    Full Text Available BACKGROUND: Serum antibody-based target identification has been used to identify tumor-associated antigens (TAAs for development of anti-cancer vaccines. A similar approach can be helpful to identify biologically relevant and clinically meaningful targets in M. tuberculosis (MTB infection for diagnosis or TB vaccine development in clinically well defined populations. METHOD: We constructed a high-content peptide microarray with 61 M. tuberculosis proteins as linear 15 aa peptide stretches with 12 aa overlaps resulting in 7446 individual peptide epitopes. Antibody profiling was carried with serum from 34 individuals with active pulmonary TB and 35 healthy individuals in order to obtain an unbiased view of the MTB epitope pattern recognition pattern. Quality data extraction was performed, data sets were analyzed for significant differences and patterns predictive of TB+/-. FINDINGS: Three distinct patterns of IgG reactivity were identified: 89/7446 peptides were differentially recognized (in 34/34 TB+ patients and in 35/35 healthy individuals and are highly predictive of the division into TB+ and TB-, other targets were exclusively recognized in all patients with TB (e.g. sigmaF but not in any of the healthy individuals, and a third peptide set was recognized exclusively in healthy individuals (35/35 but no in TB+ patients. The segregation between TB+ and TB- does not cluster into specific recognition of distinct MTB proteins, but into specific peptide epitope 'hotspots' at different locations within the same protein. Antigen recognition pattern profiles in serum from TB+ patients from Armenia vs. patients recruited in Sweden showed that IgG-defined MTB epitopes are very similar in individuals with different genetic background. CONCLUSIONS: A uniform target MTB IgG-epitope recognition pattern exists in pulmonary tuberculosis. Unbiased, high-content peptide microarray chip-based testing of clinically well-defined populations allows to visualize

  10. Microscopic examination and smear negative pulmonary tuberculosis in Ethiopia.

    Science.gov (United States)

    Keflie, Tibebe Seyoum; Ameni, Gobena

    2014-01-01

    Tuberculosis causes illness among millions of people each year and ranks as the second leading cause of death from infectious disease worldwide. The aim of this study was to investigate the detection rate of microscopic examination and estimate risk of transmission of TB by smear negative pulmonary TB patients. A cross-sectional study and retrospective data analysis on TB were undertaken in Northwest Shewa, Ethiopia. Microscopic examination, bacterial culture and PCR were performed. The statistical analysis was made by using STATA software version 10. A total of 92 suspected TB cases was included in the study. Of these, 27.17% (25/92) were positive for microscopic examination and 51% (47/92) for culture. The sensitivity and specificity of microscopic examination with 95% CI were 48.94% (34.08% to 63.93%) and 95.56% (84.82 to 99.33%), respectively. The positive and negative predictive values were 92% (73.93% to 98.78%) and 64.18% (51.53% to 75.53%), respectively. Of 8150 pulmonary TB cases in the retrospective study, 58.9% was smear negative. The proportion of TB-HIV co-infection was 28.66% (96/335). The sensitivity of microscopic examination was 48.94% which was very low. The poor sensitivity of this test together with the advent of HIV/AIDS elevated the prevalence of smear negative pulmonary TB. This in turn increased the risk of TB transmission.

  11. Type 2 diabetes mellitus coincident with pulmonary or latent tuberculosis results in modulation of adipocytokines.

    Science.gov (United States)

    Pavan Kumar, Nathella; Nair, Dina; Banurekha, V V; Dolla, Chandrakumar; Kumaran, Paul; Sridhar, Rathinam; Babu, Subash

    2016-03-01

    Type 2 diabetes mellitus (T2DM) is recognized as major risk factor for the progress of active pulmonary tuberculosis (PTB), although the mechanistic link between diabetes and tuberculosis remains poorly characterized. Moreover, the influence of poorly controlled diabetes on the baseline levels of adipocytokines in the context of tuberculosis has not been explored in detail. To characterize the influence of coexistent DM on adipocytokine levels in pulmonary or latent TB (LTB), we examined circulating levels of adipocytokines in the plasma of individuals with PTB-DM or LTB-DM and compared them with those without DM (PTB or LTB). PTB-DM or LTB-DM is characterized by diminished circulating levels of adiponectin and adipsin and/or heightened circulating levels of leptin, visfatin and PAI-1. In addition, adiponectin and adipsin exhibit a significant negative correlation, whereas leptin, visfatin and PAI-1 display a significant positive correlation with HbA1C levels and random blood glucose levels. Therefore, our data reveal that PTB-DM or LTB-DM is characterized by alterations in the systemic levels of adipocytokines, indicating that altered adipose tissue inflammation underlying Type 2 diabetes potentially contributes to pathogenesis of TB disease.

  12. Cushing Syndrome Secondary to Thymic Carcinoid Synchronous With Tuberculous Lymphadenitis and Pulmonary Tuberculosis: A Case

    OpenAIRE

    F Esfahanian; Sadeghi, A.

    2007-01-01

    Thymic carcinoid is an uncommon neoplasm that can present with Cushing syndrome.We report a 39-year old woman with symptoms of Cushing syndrome secondary to thymic carcinoid and synchronous with tuberculous lymphadenitis and pulmonary tuberculosis

  13. [Lupus vulgaris as a complication of pulmonary tuberculosis--case report].

    Science.gov (United States)

    Owczarek, Witold; Targowski, Tomasz; Kozera-Zywczyk, Anna; Paluchowska, Elwira; Patera, Janusz

    2009-10-01

    Tuberculosis is a contagious disease induced by Mycobacterium species, acid-fast bacilli. These are mostly human type--Mycobacterium tuberculosis, less often cattle type--mycobacterium bovis or other: mycobacterium avium, kansasii, marinom, scrofulaceum, heamophilium, gordonae. The infection can affect all organs, but pulmonary tuberculosis is the most common form. The importance of tuberculosis is definitely rising in the context of massive population migrations in regions affected by its higher incidence, increased HIV infections and AIDS development. Cutaneous tuberculosis is a particular tuberculosis form with differentiated clinical picture. Non-typicalness of skin changes and oligobacilleous course of extrapulmonary tuberculosis forms are repeatedly causing difficulties in adequate diagnosis and early treatment. In differential diagnostics of cutaneous tuberculosis one must take leishmaniasis, actinomycosis, leprosy, syphilis and deep mycosis (among others) into consideration. The study is presenting a case of lupus vulgaris as a complication of past pulmonary tuberculosis. In bacteriological diagnostics of skin changes bioptates, no tuberculosis mycobacteria were found. The disease was diagnosed based on specific granulation presence in histopathology test, tuberculin hypersensivity, bacilli DNA presence in polymerase chain reaction (PCR) test and skin changes regression after anti-mycobacterium treatment. According to authors of the study, the described case confirms the usefulness of PCR nucleonic acids amplification test in cutaneous tuberculosis diagnosis.

  14. Wegener′s granulomatosis disease mimicking pulmonary tuberculosis

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    Naveen Pandhi

    2015-01-01

    Full Text Available Wegener′s granulomatosis (WG is an uncommon autoimmune disease with multi-system involvement that manifests as vasculitis, granulomatosis, and necrosis. While its standard form involves the upper and lower respiratory tracts and kidneys, it may essentially involve any organ. We present a case in a young female patient presenting with symptoms of cough with expectoration, fever, dyspnea and chest discomfort, having cavitating lesion in right upper lobe and nodule in left upper lobe with bilateral paranasal sinus involvement on computed tomography. Allergic rhino-sinusitis with pulmonary tuberculosis was suspected, and patient was investigated further. Upon further investigation, renal involvement was detected, and serology revealed cytoplasmic antineutrophil cytoplasmic antibody. WG was suspected and was proven by histopathology of nasal tissue which revealed necrotizing granulomas.

  15. OPPORTUNITIES TO DIAGNOSE ACTIVE TUBERCULOSIS IN THE PATIENTS WITH CLINICALLY CURED RESPIRATORY TUBERCULOSIS

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    G. S. Balasanyants

    2017-01-01

    Full Text Available Goal of the study: to evaluate the test with tuberculous recombinant allergen (TRA in the patients with effective treatment course due to tuberculosis, to investigate the impact of clinical, epidemiological and social factors on persistence of active tuberculosis.Materials and methods. Patients were divided into 2 groups basing on time period after completion of the main treatment course. Group I – 32 patients (up to 6 months, group II – 63 patients (more than 6 months.Results of the study. Results of TRA tests in Group I remained positive in 34.4% of patients and in Group II - 23.8%. The average size of the induration in Group I made 10 mm(95% CI 6.5-13.3, in Group II – 13 mm (95% CI 8.4-19.7 Patients from Group I had positive results of TRA test more often in case of initial infiltrate form of pulmonary tuberculosis and bacillary excretion. In patients from Group II the positive TRA results correlated with presence of concurrent conditions and exposure to a tuberculosis case in the past. Positive results were confidently more often observed in lonely patients in both groups. TRA test can be a valuable tool to evaluate the risk of tuberculosis relapse after completion of the main treatment course. 

  16. Treatment Outcome of Pulmonary Tuberculosis in Eastern Taiwan—Experience at a Medical Center

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    Jen-Jyh Lee

    2007-01-01

    Conclusion: The unsatisfactory outcome of pulmonary tuberculosis treatment in this medical center in eastern Taiwan highlights the importance of implementing directly observed treatment short course strategy. Improvement in the quality of data reported by the National Tuberculosis Program is urgently needed. [J Formos Med Assoc 2007;106(1:25-30

  17. Relationship between Toll-Like Receptor 8 Gene Polymorphisms and Pediatric Pulmonary Tuberculosis

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    Nazan Dalgic

    2011-01-01

    Full Text Available Objectives: Genetic variants in Toll-like receptors (TLRs are considered a potential indicator for host susceptibility to and outcome of several infectious diseases including tuberculosis. The aim of this study was to determine whether −129 C/G and Met1Val polymorphisms of TLR8 were associated with pediatric pulmonary tuberculosis in Turkish population.

  18. Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis

    DEFF Research Database (Denmark)

    Christensen, Anne-Sophie Halkjær; Roed, Casper; Andersen, Peter H

    2014-01-01

    BACKGROUND: Long-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population...

  19. Evaluation of Smear Negative and Pozitive Pulmonary Tuberculosis Cases

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    Fulsen Bozkus

    2014-04-01

    Full Text Available Aim: To determine the relation between radiographic involvement and tuberculin skin test (TST and Bacillus Calmette Guerin (BCG results in patients with pulmonary tuberculosis (PTB. Material and Method: In 210 patients (%42,7 female, %57,6 male, mean age:40,5 ± 16,1 with smear positive and negative PTB we retrospectively analyzed the relation between radiographic findings, TST and BCG. We separated the patients into three groups as mild, moderate and severe according to their radiologic involvement and compared the radiologic extension with tuberculin skin test results. We also compared the degree of sputum smear positivity with tuberculin skin test results. Results: According to the evaluation of radiological findings of the patients, high risk is detected in 58(67,4% patients in smear-positive group and 28(32,6% patients in smear-negative group and statistically valuable relation between smear positivity and radiological findings of the patients is seen (p:0,001. According to the results of TST of the patients, high risk is detected radiologically in 53(61,6% cases of TST-negative group, 33(38,4% cases of TST-positive group and statistically valuable relation between TST results and radiological findings of the patients is seen (p:0,001. A valuable difference between BCG results and radiological findings is not seen. Discussion: It is concluded that radiology is beneficial for diagnosis especially in cases which are without bacilli and suspicious for tuberculosis and TST is shown that it can be beneficial for determining the immunity against to mycobacterium tuberculosis.

  20. Trends, seasonality and forecasts of pulmonary tuberculosis in Portugal.

    Science.gov (United States)

    Bras, A L; Gomes, D; Filipe, P A; de Sousa, B; Nunes, C

    2014-10-01

    Tuberculosis (TB) is a global public health concern. Surveillance programmes present invaluable epidemiological information regarding its temporal evolution, particularly for pulmonary tuberculosis (PTB), the most common form of TB and the one that presents the greatest challenge in public health. To characterise, model and predict monthly incidence rates for PTB in Portugal disaggregated by high/low-incidence areas, sex and age groups. PTB monthly incidence rates were estimated based on PTB cases diagnosed in 2000-2010, disaggregated by population and geographic characteristics. Seasonal-trend LOESS (STL) decomposition was employed to model trend and seasonality. Seasonal autoregressive integrated moving average (SARIMA) models were fit to characterise series behaviour and forecast PTB monthly incidence rates. Overall, the time series showed a downward trend in and seasonality of PTB diagnosis, with a peak in March and a trough in December. The mean seasonal amplitude was consistently higher in high-incidence areas, in males and in adults aged 25-54 years. SARIMA models were found to adequately fit and forecast the time series, thus predicting trend and seasonal persistence. STL and SARIMA findings concurred and were accurate. Endemic PTB seems to be slowly declining and case diagnosis is likely seasonal, which can be expected to persist if past conditions continue.

  1. Natural History of Tuberculosis: Duration and Fatality of Untreated Pulmonary Tuberculosis in HIV Negative Patients: A Systematic Review

    Science.gov (United States)

    Tiemersma, Edine W.; van der Werf, Marieke J.; Borgdorff, Martien W.; Williams, Brian G.; Nagelkerke, Nico J. D.

    2011-01-01

    Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epidemiological data. Methodology and Principal Findings To estimate the duration and case fatality of untreated pulmonary tuberculosis in HIV negative patients we reviewed studies from the pre-chemotherapy era. Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%. Ten-year case fatality of culture-positive smear-negative tuberculosis was nowhere reported directly but can be indirectly estimated to be approximately 20%. The duration of tuberculosis from onset to cure or death is approximately 3 years and appears to be similar for smear-positive and smear-negative tuberculosis. Conclusions Current models of untreated tuberculosis that assume a total duration of 2 years until self-cure or death underestimate the duration of disease by about one year, but their case fatality estimates of 70% for smear-positive and 20% for culture-positive smear-negative tuberculosis appear to be satisfactory. PMID:21483732

  2. Lung abscess due to Streptococcus pneumoniae simulating pulmonary tuberculosis: presentation of two cases

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    Alessandro Perazzo

    2014-03-01

    Full Text Available In the past, anaerobes were the most common cause of community-acquired lung abscess; Streptococcus species were the second most common cause. In recent years, this has changed. Klebsiella pneumoniae is now most common cause of community- acquired lung abscess, although Streptococcus species remain pathogen of major importance. We present two cases of pulmonary cavitation due to Streptococcus pneumoniae which resembled pulmonary tuberculosis with regards to their history and radiological findings. These are examples of a common diagnosis presenting in an uncommon way. Our cases had some peculiarities: they had a clinical picture strongly suggestive of pulmonary tuberculosis or lung cancer rather than necrotizing infectious pneumonia in patients with no comorbidities or underlying diseases (including oral or dental pathologies. Radiological findings did not help the clinicians: pulmonary tuberculosis was the first diagnostic hypothesis in both cases. An underlying lung cancer was excluded in the first case only after invasive pulmonary procedures.

  3. Seasonality in pulmonary tuberculosis among migrant workers entering Kuwait

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    Mohammad Hameed GHH

    2008-01-01

    Full Text Available Abstract Background There is paucity of data on seasonal variation in pulmonary tuberculosis (TB in developing countries contrary to recognized seasonality in the TB notification in western societies. This study examined the seasonal pattern in TB diagnosis among migrant workers from developing countries entering Kuwait. Methods Monthly aggregates of TB diagnosis results for consecutive migrants tested between January I, 1997 and December 31, 2006 were analyzed. We assessed the amplitude (α of the sinusoidal oscillation and the time at which maximum (θ° TB cases were detected using Edwards' test. The adequacy of the hypothesized sinusoidal curve was assessed by χ2 goodness-of-fit test. Results During the 10 year study period, the proportion (per 100,000 of pulmonary TB cases among the migrants was 198 (4608/2328582, (95% confidence interval: 192 – 204. The adjusted mean monthly number of pulmonary TB cases was 384. Based on the observed seasonal pattern in the data, the maximum number of TB cases was expected during the last week of April (θ° = 112°; P α = 0.204 ± 0.04 of simple harmonic curve showed 20.4% difference from the mean to maximum TB cases. The peak to low ratio of adjusted number of TB cases was 1.51 (95% CI: 1.39 – 1.65. The χ2 goodness-of-test revealed that there was no significant (P > 0.1 departure of observed frequencies from the fitted simple harmonic curve. Seasonal component explained 55% of the total variation in the proportions of TB cases (100,000 among the migrants. Conclusion This regularity of peak seasonality in TB case detection may prove useful to institute measures that warrant a better attendance of migrants. Public health authorities may consider re-allocation of resources in the period of peak seasonality to minimize the risk of Mycobacterium tuberculosis infection to close contacts in this and comparable settings in the region having similar influx of immigrants from high TB burden countries

  4. Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis: thinking beyond a normal chest x-ray

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    Herath S

    2014-03-01

    Full Text Available INTRODUCTION: Recognition of pulmonary involvement in extra-pulmonary tuberculosis (TB may be an important public health issue, as smear-negative pulmonary TB is responsible for about 17% of new infections. Pulmonary TB can be present despite a normal chest x-ray (CXR, even in human immunodeficiency virus (HIV–negative patients. In this retrospective clinical audit, we reviewed a case series of HIV-negative patients with extra-pulmonary tuberculosis to identify the proportion with concurrent pulmonary TB despite an unremarkable CXR. METHODS: Clinical notes, microbiology results and CXR reports were reviewed from consecutive patients treated at Auckland City Hospital for extra-pulmonary TB from January 2007 to July 2010. RESULTS: Of the sample of 103 patients with extra-pulmonary TB, the majority of patients were born in an Asian country (n=70; 68%. The commonest presentation of extra-pulmonary TB was lymphadenopathy (n=51; 50%, followed by pleural (n=24; 23% and bone (n=6; 6% disease. Extra-pulmonary TB was diagnosed by biopsy or excision of the extra-pulmonary site in the majority (n=74; 72%, and by sputum testing alone in 26 (25%. The majority had CXR abnormalities (n=76; 74%. In the group with a normal CXR (n=27, 55% (n=15 had sputum cultures performed. In total, 18% (n=5 of patients with extra-pulmonary TB and a normal CXR had pulmonary TB, of whom two were smear positive. DISCUSSION: In patients with extra-pulmonary TB, sputum testing should be considered to detect concurrent pulmonary TB even if a CXR is normal, especially in immunosuppressed or symptomatic patients. This may aid diagnosis and determine infectivity and consequent public health action.

  5. Association of the FCN2 Gene Single Nucleotide Polymorphisms with Susceptibility to Pulmonary Tuberculosis.

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    Dan-Dan Xu

    Full Text Available Ficolin-2 (FCN2 is an innate immune pattern recognition molecule that can activate the complement pathway, opsonophagocytosis, and elimination of the pathogens. The present study aimed to investigate the association of the FCN2 gene single nucleotide polymorphisms (SNPs with susceptibility to pulmonary tuberculosis (TB. A total of seven SNPs in exon 8 (+6359 C>T and +6424 G>T and in the promoter region (-986 G>A, -602 G>A, -557 A>G, -64 A>C and -4 A>G of the FCN2 gene were genotyped using the PCR amplification and DNA sequencing methods in the healthy controls group (n = 254 and the pulmonary TB group (n = 282. The correlation between SNPs and pulmonary TB was analyzed using the logistic regression method. The results showed that there were no significant differences in the distribution of allelic frequencies of seven SNPs between the pulmonary TB group and the healthy controls group. However, the frequency of the variant homozygous genotype (P = 0.037, -557 A>G; P = 0.038, -64 A>C; P = 0.024, +6424 G>T in the TB group was significantly lower than the control group. After adjustment for age and gender, these variant homozygous genotypes were found to be recessive models in association with pulmonary TB. In addition, -64 A>C (P = 0.047 and +6424 G>T (P = 0.03 were found to be codominant models in association with pulmonary TB. There was strong linkage disequilibrium (r2 > 0.80, P A site. Therefore, -557 A>G, -64 A>C and +6424 G>T SNPs of the FCN2 gene were correlated with pulmonary TB, and may be protective factors for TB. This study provides a novel idea for the prevention and control of TB transmission from a genetics perspective.

  6. Channa striatus capsules induces cytokine conversion in pulmonary tuberculosis patients

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    Novita Paliliewu

    2013-06-01

    Full Text Available Objective: This study aimed to investigate whether Channa striatus capsule induces sputum and cytokine conversion in pulmonary tuberculosis (TB patients. Methods: Randomized, placebo-controlled, double-blind pilot study was conducted to pulmonary TB patients who admitted to Department of Internal Medicine, Faculty of Medicine, University of Sam Ratulangi, Manado, North Sulawesi, Indonesia. A total of 36 pulmonary TB patients were randomly divided into two equal groups (n = 18 including one group received standart antituberculosis drugs plus Channa striatus capsule and another group received standart antituberculosis drugs plus placebo. Channa striatus capsule was given at a dose of 2 g each time, 3 times per day, for 12 weeks. The levels of tumor necrosis factor (TNF-α, interferon (IFN-γ, and interleukin (IL-10 were analyses using enzyme linked immunosorbent assay (ELISA method. Results: The rate of positive sputum smear decline was more pronounced in the Channa striatus group but did not reach statistically different value between groups. The levels of TNF-α, IFN-γ, and IL-10 were not significantly different in Channa striatus group compared to placebo group at baseline (week 0. But at week 12, the supplementation of Channa striatus capsule significantly decreased TNF-α, IFN-γ, and IL-10 levels compared to baseline. In placebo groups, there were no significant differences for IL-10 levels at week 12, but the levels of TNF-α and IFN-γ significantly decreased. Conclusion: Adjunctive supplementation of Channa striatus capsules accelerated the beneficial therapeutic effect of TB chemotherapy by improving cytokine response. [J Exp Integr Med 2013; 3(3.000: 237-242

  7. Patterns of pulmonary tuberculosis on FDG-PET/CT

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    Soussan, Michael, E-mail: michael.soussan@avc.aphp.fr [Université Paris 13, Faculté de médecine SMBH, Department of Nuclear Medicine, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France); Brillet, Pierre-Yves [Université Paris 13, Faculté de médecine SMBH, Department of Radiology, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France); Mekinian, Arsène [Université Paris 13, Faculté de médecine SMBH, Department of Internal Medicine, Hôpital Jean Verdier, Bondy (France); Khafagy, Abrahim [Université Paris 13, Faculté de médecine SMBH, Department of Radiology, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France); Nicolas, Patrick [Université Paris 13, Faculté de médecine SMBH, Department of Pharmacology, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France); Vessieres, Annie [Université Paris 13, Faculté de médecine SMBH, Department of Bacteriology, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France); Brauner, Michel [Université Paris 13, Faculté de médecine SMBH, Department of Radiology, CHU Avicenne, 125 rue de Stalingrad, 93000 Bobigny (France)

    2012-10-15

    Objective: This study aims to describe patterns of pulmonary tuberculosis (TB) on FDG-PET/CT. Methods: All patients with a diagnosis of TB and who underwent FDG-PET/CT between January 2009 and June 2010 were included. Clinical, biological and imaging data were reviewed. TB was proven either on bacteriological or histopathological studies (n = 13) or on a clinical and imaging basis (n = 3). Results: Sixteen patients (11 men; median age 56, range 22–84 years) were included. Two distinct patterns were identified. In the lung pattern (9/16), patients had predominantly pulmonary symptoms (6/9 patients, 67%) with a parenchymal involvement: uptakes on lung consolidation ± cavitation surrounded by micronodules. Mediastino-hilar lymph nodes were slightly enlarged (15 mm, 10–27) with moderate uptake (3.9, 2.5–13.4). In the lymphatic pattern (7/16), patients had predominantly systemic symptoms (5/7 cases, 71%) and all had extra-thoracic involvement. Mediastino-hilar lymph nodes were more enlarged (30 mm, 18–35, p = 0.03) and with higher uptake (6.8, 5.7–16.8, p = 0.034) than in the lung pattern. Conclusion: We identified two distinct patterns of pulmonary TB on FDG-PET/CT. The lung pattern related to a restricted and slight hypermetabolic infection and the lymphatic pattern related to a systemic and intense infection. Combined interpretation of PET and CT findings improves the specificity of images, especially for the lung pattern.

  8. Central Nervous System Tuberculosis

    OpenAIRE

    Bano, Shahina; Chaudhary, Vikas; Yadav, Sachchidanand

    2012-01-01

    Central nervous system tuberculosis is a rare presentation of active tuberculosis and accounts for about 1% of cases (1). The three clinical categories include meningitis, intracranial tuberculomas, and spinal tuberculous arachnoiditis. We report a case of a young man who presented with active pulmonary tuberculosis in addition to tuberculous meningitis and the presence of numerous intracranial tuberculomas.

  9. THE VALIDITY OF MYCOBACTERIUM TUBERCULOSIS ANTIGENS COCKTAIL: ESAT-6, CFP-10 AND MPT64 IN SPUTUM AND CEREBROSPINAL FLUID FOR PULMONARY TUBERCULOSIS AND TUBERCULOUS MENINGITIS DIAGNOSIS

    OpenAIRE

    Dewi Kartika Turbawaty; Nenny Gustiani; Livia Noviani; Ida Parwati

    2015-01-01

    Objective: To determine the validity of tuberculosis (TB) antigen cocktail (ESAT-6, CFP-10 and MPT64) for pulmonary tuberculosis and TB meningitis diagnosis. Methods: This is a descriptive observational study design. The study was conducted at the Clinical Pathology Laboratory of Dr. Hasan Sadikin General Hospital during September 2012 until March 2013 for the pulmonary tuberculosis study and from January 2014 to May 2014 for the TB meningitis study. The TB antigen cocktail rapid imm...

  10. Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens

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    Adriana Antônia da Cruz Furini

    2013-12-01

    Full Text Available OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens.METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results.RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard, we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively.CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.

  11. Incremental yield of bronchial washing for diagnosing smear-negative pulmonary tuberculosis

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    Alonso Soto

    2013-08-01

    Full Text Available OBJECTIVE To assess the increased diagnostic yield for pulmonary tuberculosis using bronchial washing cultures compared with sputum cultures. METHODS Study conducted with 61 adults in Lima, Peru, from January 2006 to December 2007. The yield of sputum cultures was compared with the yield of acid-fast bacilli smears and cultures of bronchial washing for diagnosing pulmonary tuberculosis in suspected cases of clinical tuberculosis with negative acid fast bacilli sputum smears. RESULTS Twenty seven (95%CI 32;58 of the cases were eventually diagnosed with smear-negative pulmonary tuberculosis. Bronchial washing samples detected 23 (95%CI 72;99 of the smear-negative pulmonary tuberculosis cases compared with 15 (95%CI 37;74 for sputum cultures (p = 0.02. The incremental diagnostic yield of acid fast bacilli smear and culture of bronchial washing specimens over sputum culture was 44% (95%CI 25;65. CONCLUSIONS In function of the epidemiological context and the resources available, bronchoscopy should be deployed as part of a comprehensive work up that optimizes smear-negative pulmonary tuberculosis diagnosis and minimizes risk and costs.

  12. Co-infection of visceral leishmaniasis and pulmonary tuberculosis: a case study

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    Shweta

    2014-02-01

    Full Text Available Co-infection of visceral leishmaniasis and pulmonary tuberculosis are increasing public health problem in eastern region of country. A large number of clinical cases of leishmaniasis and tuberculosis have been reported in Sudan. Such type of co-infections lead to decreased host ’s immune system. This is a case report of 48 years old male with visceral leishmaniasis and pulmonary tuberculosis. He arrived at hospital with complaints of fever with rigor, abdominal pain, weakness, loss of appetite, yellowish discoloration of urine and sclerosis at lower back. Bone marrow aspiration cytology revealed the presence of Leishmania donovani bodies (2+. His treatment was initiated with amphotericin B deoxycholate (inj. Fungizone 15 infusions on alternate days with 5% dextrose. He had 20 years past history of pulmonary tuberculosis. His chest X-ray showed increased bronchovascular marking encysted pleural effusion on lower segment of right lung. Ultrasonography guided fine needle aspiration cytology of pleural fluid for protein, sugar, lactate dehydrogenase, adenosine deaminase, cell type and cell count. Cytological reports confirmed pulmonary tuberculosis. Antitubercular therapy (four drug regimen: rifampicin, isoniazid, ethambutal, and pyrazinamide was started. Co-infection of visceral leishmaniasis and pulmonary tuberculosis is a real threat in developing countries. There is a need of cost effective diagnostic and therapeutic facilities for these co-infections.

  13. Reactivation of pulmonary tuberculosis following local radiation therapy of prostate cancer.

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    Thomas, Persis; Foley, Raymond; Kosowicz, Lynn

    2014-02-01

    In this report, we describe the case of an 81-year-old male with reactivation tuberculosis following local radiation therapy for prostate cancer. The patient was asymptomatic except for an unintentional 20-pound weight loss and was incidentally found to have a pulmonary infiltrate in the right upper lobe on imaging for shoulder pain. The medical history was not able for recently treated prostate cancer. After further investigation, the patient was determined to have Mycobacterium tuberculosis infection. It is important to have a high level of suspicion for reactivation tuberculosis in patients with a pulmonary infiltrate following radiation therapy due to the impact of radiation on the host's immune system. We will review the literature on reactivation tuberculosis following radiation therapy and explore the mechanism of immunosuppression in this process. To our knowledge, this is the first reported case of tuberculosis reactivation following local radiation therapy for prostate cancer.

  14. Patho-TB test for the rapid diagnosis of pulmonary tuberculosis

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    Roya Alavi-Naini

    2009-09-01

    Full Text Available

    • BACKGROUND: Despite recent technologic improvements in identifying mycobacterium tuberculosis, we are still facing problems in rapid diagnosis of tuberculosis. The objective of this study is to determine the diagnostic value of a new rapid screening test (Patho-TB™ for diagnosis of pulmonary tuberculosis.
    • METHODS: Between September 2006 to August 2007, 178 patients were enrolled in the study who were finally classified into two groups; a group of documented pulmonary tuberculosis (n = 67 and a group of non-tuberculous pulmonary infection (n = 111. Patho-TB™ test, Ziehl-Neelsen staining and culture were done on all specimens.
    • RESULTS: Of all, 43 patients with pulmonary tuberculosis were sputum smear positive for acid fast bacilli and the rest were smear negative. Mean age of the patients was 59.8 ± 16.1 years and 44% of them were men. The results of Patho- TB™ test were positive in 40 of smear positive and 20 of smear negative tuberculous patients and 33 cases of nontuberculous control group. The sensitivity, specificity, positive and negative predictive values and accuracy of Patho- TB™ test were estimated 89.5%, 70.2%, 64.5%, 91.7% and 77.5%, respectively.
    • CONCLUSIONS: According to the present study it would be suggested that Patho-TB™ test could be a rapid and inexpensive method for diagnosis of pulmonary tuberculosis, given by its high sensitivity and negative predictive value. Concerning the high number of false positive results, using a confirmatory diagnostic procedure is mandatory.
    • KEYWORDS: Pulmonary Tuberculosis, Rapid Diagnosis, Mycobacterium Tuberculosis Antigens, Iran

  15. A Rare Case of Intracavitary Fungus Ball (Aspergilloma in the Old Pulmonary Tuberculosis

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    Majzoobi MM

    2017-06-01

    Full Text Available Introduction: Pulmonary fungus ball is a rare complication in pre-existing pulmonary cavitary lesions, due to some chronic pulmonary diseases including tuberculosis, lung abscess and sarcoidosis. Fungus ball is mostly caused by aspergillus. In many patients, fungus ball is asymptomatic, but in a significant number of them it can develop cough and hemoptysis, which may be massive and fatal. The cornerstone of assessment is chest imaging, along with sputum culture or aspergillus antibody in patient's serum. The purpose of this report is increment in attention to this complication in patients with previous pulmonary tuberculosis (TB. Case Presentation: The patient was a 23-year-old woman with chief complaint of fever, cough and hemoptysis, who was hospitalized in the Infectious Diseases Ward of Farshchian Sina hospital in March 2016. She had a history of anti-TB therapy from two years before. Sputum and bronchoalveolar lavage (BAL were negative for cytology and Mycobacterium tuberculosis, but cultures of both samples were positive for Aspergillus niger. Her lung contrast-enhanced computerized tomography (CECT scan revealed the presence of a fungus ball inside the upper lobe cavity of right lung. After lobectomy, fungal mass was confirmed by histopathology. Conclusions: In patients with pulmonary complaints (especially hemoptysis and history of cavitary pulmonary tuberculosis, the differential diagnosis of community-acquired pneumonia, lung abscess, reactivation of tuberculosis and lung cancer as well as fungal infections should be considered.

  16. Altered serum microRNAs as biomarkers for the early diagnosis of pulmonary tuberculosis infection

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    Qi Yuhua

    2012-12-01

    Full Text Available Abstract Background Pulmonary tuberculosis (TB is a highly lethal infectious disease and early diagnosis of TB is critical for the control of disease progression. The objective of this study was to profile a panel of serum microRNAs (miRNAs as potential biomarkers for the early diagnosis of pulmonary TB infection. Methods Using TaqMan Low-Density Array (TLDA analysis followed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR validation, expression levels of miRNAs in serum samples from 30 patients with active tuberculosis and 60 patients with Bordetella pertussis (BP, varicella-zoster virus (VZV and enterovirus (EV were analyzed. Results The Low-Density Array data showed that 97 miRNAs were differentially expressed in pulmonary TB patient sera compared with healthy controls (90 up-regulated and 7 down-regulated. Following qRT-PCR confirmation and receiver operational curve (ROC analysis, three miRNAs (miR-361-5p, miR-889 and miR-576-3p were shown to distinguish TB infected patients from healthy controls and other microbial infections with moderate sensitivity and specificity (area under curve (AUC value range, 0.711-0.848. Multiple logistic regression analysis of a combination of these three miRNAs showed an enhanced ability to discriminate between these two groups with an AUC value of 0.863. Conclusions Our study suggests that altered levels of serum miRNAs have great potential to serve as non-invasive biomarkers for early detection of pulmonary TB infection.

  17. Strain Diversity of Mycobacterium tuberculosis Isolates from Pulmonary Tuberculosis Patients in Afar Pastoral Region of Ethiopia

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    Mulugeta Belay

    2014-01-01

    Full Text Available Data on genotypic diversity of Mycobacterium tuberculosis complex (MTBC is important to understand its epidemiology, human adaptation, clinical phenotypes, and drug resistance. This study aimed to characterize MTBC clinical isolates circulating in a predominantly pastoralist area in Ethiopia, a country where tuberculosis is the second leading cause of mortality. Culture of sputum samples collected from a total of 325 pulmonary TB suspects was done to isolate MTBC. Spoligotyping was used to characterize 105 isolates from culture positive slopes and the result was compared with an international database. Forty-four spoligotype patterns were observed to correspond to 35 shared-types (SITs containing 96 isolates and 9 orphan patterns; 27 SITs containing 83 isolates matched a preexisting shared-type in the database, whereas 8 SITs (n=13 isolates were newly created. A total of 19 SITs containing 80 isolates were clustered within this study (overall clustering of 76.19%. Three dominant lineages (T, CAS, and Manu accounted for 76.19% of the isolates. SIT149/T3-ETH was one of the two most dominant sublineages. Unlike previous reports, we show that Manu lineage strains not only constitute a dominant lineage, but are also associated with HIV infection in Afar region of Ethiopia. The high level of clustering suggests the presence of recent transmission that should be further studied using additional genotyping markers.

  18. Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role?

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    Bachh Arshad

    2010-01-01

    Full Text Available Background : Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Fibreoptic bronchoscopy may provide a confirmative and early diagnosis in such patients. Aims: To assess the role of fibreoptic bronchoscopy in the diagnosis of sputum /smear-negative pulmonary tuberculosis. Materials and Methods: The study was conducted on 75 suspected sputum / smear-negative pulmonary tuberculosis cases attending Pulmonary Medicine Department of Mamata Medical College and Hospital, Khammam, AP. Fibreoptic bronchoscopy was performed; culture of sputum and bronchial washings for Mycobacterium tuberculosis was done by BACTEC method. Results: A final diagnosis of sputum /smear-negative pulmonary tuberculosis was made in 60 patients. Bronchial washings smear for acid-fast bacilli (AFB was positive in 21 patients while culture of bronchial washings was positive in 39 patients. In 29 patients, smear or culture of bronchial washing alone contributed to the final diagnosis. Total yield of bronchoscopy in diagnosis of sputum smear negative pulmonary tuberculosis was 83.33% (50/60; bronchoscopy was the only diagnostic method in 66% cases (40/60 with bronchial washings being the only diagnostic method in 48.33%. Bronchial washings smear for AFB and histopathological evidence of caseating granuloma made immediate diagnosis possible in 48.33% (29/60 patients. Conclusion: Our study suggests that fibreoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria.

  19. Recurrent Tuberculosis Risk Among HIV-Infected Adults in Tanzania With Prior Active Tuberculosis

    Science.gov (United States)

    Lahey, Timothy; MacKenzie, Todd; Arbeit, Robert D.; Bakari, Muhammad; Mtei, Lillian; Matee, Mecky; Maro, Isaac; Horsburgh, C. Robert; Pallangyo, Kisali; von Reyn, C. Fordham

    2013-01-01

    Background. Active tuberculosis is common among human immunodeficiency virus (HIV)–infected persons living in tuberculosis-endemic areas, but the hazard of subsequent tuberculosis disease has not been quantified in a single prospective cohort. Methods. Among HIV-infected, BCG-immunized adults with CD4 counts ≥200 cells/μL who received placebo in the DarDar tuberculosis vaccine trial in Tanzania, we compared the prospective risk of active tuberculosis between subjects who did and who did not report prior active tuberculosis. All subjects with a positive tuberculin skin test without prior active tuberculosis were offered isoniazid preventive treatment. Definite or probable tuberculosis was diagnosed during active follow-up using rigorous published criteria. Results. We diagnosed 52 cases of definite and 92 cases of definite/probable tuberculosis among 979 subjects during a median follow-up of 3.2 years. Among the 80 subjects who reported prior active tuberculosis, 11 (13.8%) subsequently developed definite tuberculosis and 17 (21.3%) developed definite/probable tuberculosis, compared with 41 (4.6%) and 75 (8.3%), respectively, of 899 subjects without prior active tuberculosis (definite tuberculosis risk ratio [RR], 3.01; 95% confidence interval [CI], 1.61–5.63, P tuberculosis RR, 2.55; 95% CI, 1.59–4.09, P tuberculosis had substantially greater hazard of subsequent definite tuberculosis (hazard radio [HR], 3.69; 95% CI, 1.79–7.63, P tuberculosis (HR, 2.78; 95% CI, 1.58–4.87, P tuberculosis, the hazard of active tuberculosis is increased 3-fold among HIV-infected adults with prior active tuberculosis. Clinical Trials Registration. NCT0052195. PMID:22972862

  20. Daily rifapentine for treatment of pulmonary tuberculosis. A randomized, dose-ranging trial.

    Science.gov (United States)

    Dorman, Susan E; Savic, Radojka M; Goldberg, Stefan; Stout, Jason E; Schluger, Neil; Muzanyi, Grace; Johnson, John L; Nahid, Payam; Hecker, Emily J; Heilig, Charles M; Bozeman, Lorna; Feng, Pei-Jean I; Moro, Ruth N; MacKenzie, William; Dooley, Kelly E; Nuermberger, Eric L; Vernon, Andrew; Weiner, Marc

    2015-02-01

    Rifapentine has potent activity in mouse models of tuberculosis chemotherapy but its optimal dose and exposure in humans are unknown. We conducted a randomized, partially blinded dose-ranging study to determine tolerability, safety, and antimicrobial activity of daily rifapentine for pulmonary tuberculosis treatment. Adults with sputum smear-positive pulmonary tuberculosis were assigned rifapentine 10, 15, or 20 mg/kg or rifampin 10 mg/kg daily for 8 weeks (intensive phase), with isoniazid, pyrazinamide, and ethambutol. The primary tolerability end point was treatment discontinuation. The primary efficacy end point was negative sputum cultures at completion of intensive phase. A total of 334 participants were enrolled. At completion of intensive phase, cultures on solid media were negative in 81.3% of participants in the rifampin group versus 92.5% (P = 0.097), 89.4% (P = 0.29), and 94.7% (P = 0.049) in the rifapentine 10, 15, and 20 mg/kg groups. Liquid cultures were negative in 56.3% (rifampin group) versus 74.6% (P = 0.042), 69.7% (P = 0.16), and 82.5% (P = 0.004), respectively. Compared with the rifampin group, the proportion negative at the end of intensive phase was higher among rifapentine recipients who had high rifapentine areas under the concentration-time curve. Percentages of participants discontinuing assigned treatment for reasons other than microbiologic ineligibility were similar across groups (rifampin, 8.2%; rifapentine 10, 15, or 20 mg/kg, 3.4, 2.5, and 7.4%, respectively). Daily rifapentine was well-tolerated and safe. High rifapentine exposures were associated with high levels of sputum sterilization at completion of intensive phase. Further studies are warranted to determine if regimens that deliver high rifapentine exposures can shorten treatment duration to less than 6 months. Clinical trial registered with www.clinicaltrials.gov (NCT 00694629).

  1. Evaluation of blood PCR in the diagnosis of pulmonary tuberculosis

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    Aliakbar Heydari

    2012-05-01

    Full Text Available Background and Aim: Culture and specific staining (including Zeil-Nelson and fluorescent methods are standard measures for the diagnosis of tuberculosis (TB.Because these methods are time-consuming and, sometimes, due to their low accuracy faster and more accurate methods are necessitated. Methods, which can substitute invasive procedures, when obtaining smear samples and culture is not possible and in addition to being simple and fast, they have an acceptable diagnostic accuracy. The aim of the present study was to verify the diagnostic value of blood PCR in pulmonary TB. Materials and Methods: This case-control study included 64 proven pulmonary TB cases (according to The National TB Protocol and 28 subjects who were completely healthy. 4.5ml of blood was derived from each participant and then mixed with 0.5ml EDTA. Finally, DNA extraction and PCR testing using SI 6110 primers was performed for all blood samples. Results: Mean age of the cases and controls was 49.8±18.6 and 48.2±18.5, respectively. 49.2% of the cases and 25% of controls were male. Blood PCR in 23 patients with TB was positive, but none of the controls had a positive PCR (thus, sensitivity of 35.7% and specificity of 100%. Conclusion: With regard to specificity of 100% in PCR method (despite its low sensitivity, in conditions where there is no access to an appropriate specimen, a positive blood PCR can obviate invasive procedures and rapid and definitive diagnosis of the disorder and timely treatment of the patient, his life is saved.

  2. [Therapy and Rehabilitation of Patients with Pulmonary Tuberculosis and Different Treatment Adherence].

    Science.gov (United States)

    Rubleva, N V; Kolomiets, V M; Kochetkova, E Ya

    2016-01-01

    The pulmonary tuberculosis process as dependent on the disease form and the therapy efficacy with the use of Cycloferon in the treatment scheme were investigated. The study had two stages. At the first stage the data concerning 358 patients with primary pulmonary tuberculosis and infiltration (93 patients) or degradation (89 patients) and 176 patients with pulmonary fibrocavernous tuberculosis were analysed. At the second stage the efficacy of the treatment schemes applied to the patients with pulmonary fibrocavernous tuberculosis was compared. The etiotropic therapy intensive phase was applied to all the patients. Moreover, 56 patients (group 1) under the therapy and rehabilitatinon were treated with Cycloferon in a dose of 0.25 administered intramuscularly twice a week (not less than 16 injections for the course), 60 patients (group 2) were treated with Omega 3, 30 patients (group 3) were given the standard complex (vitamins and tonics), 30 patients (group 4) were under the etiotropic therapy alone. The following additional factors promoting progression and aggravation of the tuberculosis process were confirmed: degradation at the time of the disease diagnosis, high resistance of the pathogen to antituberculosis drugs, low adherence to the treatment, social desadaptation and especially psychofunctional state of the patients. The use of Cycloferon in the schemes of the intensive phase treatment of the primary fibrocavernous tuberculosis resulted in reduction of the intoxication signs, bacteria isolation, positive dynamics of the cavity healing, lower lung infiltration and consequently high frequency of the treatment positive outcomes (94.1 ± 3.33%).

  3. Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

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    Marcela Muñoz-Torrico

    Full Text Available ABSTRACT The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination, arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT, and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements". The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation; and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns, and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.

  4. 初治活动性继发性肺结核的HRCT影像研究%The high-resolution CT imaging of active secondary pulmonary tuberculosis in the primary therapy

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    吕岩; 李成海; 谢汝明; 王岳; 周震; 宁锋钢; 周新华; 贺伟

    2015-01-01

    Objective To study the high-resolution CT imaging feature of active secondary pulmonary tuberculosis in the primary therapy.Methods High-resolution CT imaging of 323 cases with active secondary pulmonary tuberculosis in the primary therapy in Beijing Chest Hospital, Capital Medical University were collected, and the lesion distribution and morphological characteristics were observed, respectively. The imaging of high-resolution CT in pulmonary tuberculosis of negative and positive sputum for tuberculous bacterium were compared, the difference of count data in two groups were analyzed by Chi-square test and Logistic regression.Results Among the 323 cases, the lesions of 86 (26.6%) case located in single lung lobe, the lesions of 237 (73.4%) case located in more lung lobe and more segment, mostly in S1, S2 and S6. High-resolution CT manifestation: centrilobular nodles, there were alveolar nodules in 282 case and "tree-in-bud" sign in 193 case, 45 cases with "reversed halo sign" among them, reversed halos with nodular walls and nodules inside the halos were observed. There were 293 (90.7%) lobular and subsegmental consolidation, 115 (35.6%) segmental comsolidation, 22 (6.8%) lobe consolidation , of which, the CT ifndings showed small patchy low-density areas in the lesions, and with bronchiectasis and cavity in part lesions. There were 37 spherical or mass lesions, > 3 cm, the contrast-enhanced CT scanning showed that ring enhancement and uneven enhancement appeared small patchy low-density areas and boundaries were vague. There were 123 interstitial abnormalities, intralobular, include intralobular reticular reticulation with 105 (85.4%) cases, thickened interlobular septum with 35 (28.5%) cases, thickened peribroncho-vascular interstitium with 86 (69.9%) cases, thickening of the airway wall in telecentric end with 78 (90.7%) cases. Lung parenchyma and interstitial lesions: 131 (40.6%) cases with ground-glass opacity. Along with the sign: 112 (34.7%) cases with

  5. The experience of college students with pulmonary tuberculosis in Shaanxi, China: a qualitative study

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    Zhang Tian-Hua

    2010-06-01

    Full Text Available Abstract Background The prevalence of pulmonary tuberculosis among college students in Shaanxi is high. Although tuberculosis leaves much psychological and social impact on patients, little is known about its impact on college students. The objective of this study is to explore the experiences and psychological process of college students with pulmonary tuberculosis in Shaanxi, China. Methods 17 college students with pulmonary tuberculosis were recruited purposively from 9 colleges in Shaanxi. In-depth interviews were conducted to collect data and a thematic framework analysis was used. Results The participants reported that pulmonary tuberculosis deeply influenced their mental health. They were fearful to the nature of pulmonary tuberculosis at the stage of diagnosis, anxious about the illness before the period of diagnosis and the early week of the treatment, excessive worry immediately before the first recheck. They expected an early full recovery, bored on tedious treatment life and worried about future heath and prospects during the whole treatment phase. Their daily life was also influenced, namely discontinued studies, isolation and increased financial burden. They also reported that they could get strong supports from family members, while little supports from healthcare workers and their friends. Conclusions The participants' psychological pressure was significant during the treatment. In addition, there was serious conflict between treatment and study; social support provided for them was insufficient. Healthcare workers should provide psychological support for college students with pulmonary tuberculosis according to the psychological characteristics and offer social support through strengthening communication with them. Colleges should follow governmental policies on TB exactly and provide opportunities for the patients to continue their studies.

  6. The experience of college students with pulmonary tuberculosis in Shaanxi, China: a qualitative study.

    Science.gov (United States)

    Zhang, Shao-Ru; Yan, Hong; Zhang, Jin-Jing; Zhang, Tian-Hua; Li, Xiao-Hong; Zhang, Yin-Ping

    2010-06-16

    The prevalence of pulmonary tuberculosis among college students in Shaanxi is high. Although tuberculosis leaves much psychological and social impact on patients, little is known about its impact on college students. The objective of this study is to explore the experiences and psychological process of college students with pulmonary tuberculosis in Shaanxi, China. 17 college students with pulmonary tuberculosis were recruited purposively from 9 colleges in Shaanxi. In-depth interviews were conducted to collect data and a thematic framework analysis was used. The participants reported that pulmonary tuberculosis deeply influenced their mental health. They were fearful to the nature of pulmonary tuberculosis at the stage of diagnosis, anxious about the illness before the period of diagnosis and the early week of the treatment, excessive worry immediately before the first recheck. They expected an early full recovery, bored on tedious treatment life and worried about future heath and prospects during the whole treatment phase. Their daily life was also influenced, namely discontinued studies, isolation and increased financial burden. They also reported that they could get strong supports from family members, while little supports from healthcare workers and their friends. The participants' psychological pressure was significant during the treatment. In addition, there was serious conflict between treatment and study; social support provided for them was insufficient. Healthcare workers should provide psychological support for college students with pulmonary tuberculosis according to the psychological characteristics and offer social support through strengthening communication with them. Colleges should follow governmental policies on TB exactly and provide opportunities for the patients to continue their studies.

  7. Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico.

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    Salinas, J; Calvillo, S; Caylà, J; Nedel, F B; Martín, M; Navarro, A

    2012-09-01

    To determine diagnostic delay in pulmonary tuberculosis (PTB) cases and analyse associated factors. New PTB cases were studied in Coahuila, Northern Mexico, between 2008 and 2009. We obtained census data and data on residential address, symptoms and diagnosis from the national patient database; sociodemographic variables were obtained during home visits. Bivariate analyses used the Kaplan-Meier method; multivariate analysis consisted of modelling survival. We studied 458 subjects (median age 48 years), who were predominantly males (56.1%); the median years of schooling was 6.0 years, 83.4% were urban residents, 50.3% were unemployed, and 87.7% suffered from food poverty. The median delay between the onset of symptoms and the first medical consultation was 53.5 days. Lack of formal education (P = 0.050) and living ≥5 km from a health unit (P = 0.034) were associated with longer delays and consequently with severe symptoms (cough ≥2 weeks, P = 0.001; chest pain, P = 0.032; malnutrition, P = 0.003). Mean health system delay (between first consultation and smear test result) was 18.5 days, and was significantly longer when the first consultation was with a private physician (P < 0.001) and when patient age was ≥46 years (P = 0.001). In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.

  8. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

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    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  9. Mycobacterium tuberculosis Zinc Metalloprotease-1 Elicits Tuberculosis-specific Humoral Immune Response Independent of Mycobacterial Load in Pulmonary and Extra-Pulmonary Tuberculosis Patients

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    Mani Harika eVemula

    2016-03-01

    Full Text Available Conventionally, facultative intracellular pathogen, Mycobacterium tuberculosis (M.tb, the tuberculosis (TB causing bacilli in human is cleared by cell-mediated immunity (CMI with CD4+ T cells playing instrumental role in protective immunity, while antibody-mediated immunity (AMI is considered non-protective. This longstanding convention has been challenged with recent evidences of increased susceptibility of hosts with compromised AMI and monoclonal antibodies conferring passive protection against TB and other intracellular pathogens. Therefore, novel approaches towards vaccine development include strategies aiming at induction of humoral response along with CMI. This necessitates the identification of mycobacterial proteins with properties of immunomodulation and strong immunogenicity. In this study, we determined the immunogenic potential of M.tb Zinc metalloprotease-1 (Zmp1, a secretory protein essential for intracellular survival and pathogenesis of M.tb. We observed that Zmp1 was secreted by in vitro grown M.tb under granuloma-like stress conditions (acidic, oxidative, iron deficiency and nutrient deprivation and generated Th2 cytokine microenvironment upon exogenous treatment of Peripheral Blood Mononulear Cells (PBMCs with recombinant Zmp1 (rZmp1. This was supported by recording specific and robust humoral response in TB patients in a cohort of 295. The anti-Zmp1 titers were significantly higher in TB patients (n=121 as against healthy control (n=62, household contacts (n=89 and non-specific infection controls (n=23. A significant observation of the study is the presence of equally high titers of anti-Zmp1 antibodies in a range of patients with high bacilli load (sputum bacilli load of 300+ per mL to paucibacillary smear-negative pulmonary tuberculosis (PTB cases. This clearly indicated the potential of Zmp1 to evoke an effective humoral response independent of mycobacterial load. Such mycobacterial proteins can be explored as antigen

  10. Assessment of Cardiovascular Fitness of Patients with Pulmonary Tuberculosis Using Six Minute Walk Test

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    Taofeek Oluwole Awotidebe

    2010-04-01

    Full Text Available AIM: Patients with pulmonary tuberculosis (TB tends to have limited exercise tolerance and a significant disability affecting their activities of daily living. The importance of exercise in the management of these patients has not been well investigated. This study was designed to assess the cardiovascular fitness of patients with pulmonary TB using the six-minute walk test (6-MWT. METHOD: Sixty five consented patients with Pulmonary TB were consecutively recruited into the study. The patients performed 6-MWT over a 30 meter course on a level walkway at a speed as fast as they could. Data were obtained on participants’ physical characteristics, pre and post exercise blood pressure and heart rate, and maximum oxygen consumption. Data were analyzed using descriptive statistics of mean and standard deviation and paired t-test. RESULTS: The post walk test cardiovascular parameters were significantly higher than the resting cardiovascular parameters. The mean VO2 max and MET of the participants were 11.7±0.97 (ml O2kg -1min-1 and 3.35±0.28 (mL/Kg respectively. The means 6-MWT distance for male and female participants were 502.0±43.0m 481.7±68.3m respectively. CONCLUSION: The result implies that the 6-MWT is capable of evoking a significant cardiovascular change among patients with pulmonary TB. The 6-MWT may be useful in the assessment of functional capacity of patients with pulmonary TB. [TAF Prev Med Bull 2010; 9(2.000: 99-106

  11. Application of a geographical information system for information management on pulmonary tuberculosis

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    José Danilo Pacheco González

    2010-12-01

    Full Text Available Background: tuberculosis program is a priority for the National Health System in Cuba. The difficulties encountered in dealing with the disease are associated, directly or indirectly, to a restricted knowledge management by the health system. Objective: to implement a geographical information system to manage information on pulmonary tuberculosis. Methods: retrospective, descriptive and correlational study conducted between January 1, 1996 and December 31, 2007. It included the 155 new cases of pulmonary tuberculosis in 15 years old patients and on in the province of Cienfuegos. MapInfo 8.5 software was used to design the geographical information system. Theoretical, empirical and statistical methods were combined. Results: the elimination of the geographical aspect as an obstacle for carrying out preventive actions established in the program and for the stratification of pulmonary tuberculosis according to its incidence in districts and neighbourhoods of the city. Conclusions: the designed geographical information system is an auxiliary technological tool that improves information management on pulmonary tuberculosis in Cienfuegos as the basis for a variety of analysis and the generation of new knowledge.

  12. Pulmonary tuberculosis and lepromatous leprosy co-infection in a single individual: A Case report

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    Satyadeo Choubey

    2014-01-01

    Full Text Available The concomitant occurrence of the two oldest mycobacterial diseases that is tuberculosis and leprosy in a single individual is not rare but has been infrequently reported. Herein, we report a case of 34-year-old laborer who concomitantly presented with both sputum positive pulmonary tuberculosis and lepromatous leprosy. The diagnosis of the two diseases was made simultaneously, which is again infrequent in literature. The treatment of leprosy warrants screening of individual for tuberculosis because multi-drug therapy for leprosy may lead to acquired drug resistance for rifampicin, which is a mainstem of anti-tubercular therapy.

  13. Comparison of bronchial brushing and sputum in detection of pediatric pulmonary tuberculosis.

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    Chen, Qiao-Pei; Ren, Shi-Feng; Wang, Xin-Feng; Wang, Mao-Shui

    2016-01-27

    The retrospective study aimed to evaluate the diagnostic value of bronchial brushing and sputum using acid fast bacilli smear, mycobacterial culture and real-time PCR in detection of pediatric pulmonary tuberculosis, sensitivity and specificity of bronchial brushing and sputum examined by the three methods were calculated and compared to each other. Data showed there were no significant difference in sensitivity between bronchial brushing and matched sputum using each method. But the specificity of real-time PCR on bronchial brushing was lower than on sputum. Compared with bronchial brushing, sputum was better specimen in detection of pediatric pulmonary tuberculosis.

  14. Association of Pulmonary Tuberculosis and HIV in the Mexican Institute of Social Security, 2006-2014

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    Padilla-Velázquez, Rosario; Valle-Alvarado, Gabriel; Arriaga-Nieto, Lumumba; Rojas-Mendoza, Teresita; Rosado-Quiab, Ulises; Grajales-Muñiz, Concepción

    2016-01-01

    Background Tuberculosis and HIV remain a public health problem in developed countries. The objective of this study was to analyze the incidence trends of pulmonary TB and HIV comorbidity and treatment outcomes according to HIV during the period 2006 to 2014 in the Mexican Institute of Social Security. Methods Analyzed data from this registry including pulmonary tuberculosis patients aged 15 years and older who had been diagnosed during the years 2006 to 2014 in the Mexican Institute of Social Security. The outcomes that we use were incidents rate, failure to treatment and death. Regression models were used to quantify associations between pulmonary tuberculosis and HIV mortality. Results During the study period, 31,352 patients were registered with pulmonary tuberculosis. The incidence rate observed during 2014 was 11.6 case of PTB per 100,000. The incidence rate for PTB and HIV was 0.345 per 100,000. The PTB incidence rate decreased by 0.07%, differences found in the PTB incidence rate by sex since in women decreased by 5.52% and in man increase by 3.62%. The pulmonary TB with HIV incidence rate decreased by 16.3% during the study period (In women increase 4.81% and in man decrease 21.6%). Analysis of PTB associated with HIV by age groups revealed that the highest incidence rates were observed for the 30 to 44 years old group. Meanwhile, the highest incidence rates of PTB without HIV occurred among the 60 and more years old individuals. We did not find statistically significant differences between treatment failure and PTB patients with HIV and without HIV. The treatment failure was associated with sex and the region of the patient. We found a strong association between HIV and the probability of dying during treatment. Our data suggested that patients suffering from both conditions (PTB and HIV) have no difference in the probability of failure of treatment contrary to other reports. Hypotheses to this is adherence to tuberculosis treatment with people living with

  15. A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

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    Mamta Gupta

    2016-01-01

    Full Text Available Background. Tuberculosis (TB is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%. Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%. Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations.

  16. The evaluation of the clinical and laboratory characteristics of children with pulmonary tuberculosis

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    Velat Şen

    2014-09-01

    Full Text Available Objective: Pulmonary tuberculosis is an important health problem in pediatric patients. The aim of this study is to evaluate the epidemiological and clinical signs and treatment results of the children with pulmonary tuberculosis. Methods:Hospital records of 85 children with pulmonary tuberculosis which were diagnosis in Dicle University Medical Faculty, Pediatric Pulmonology Department, between the period of January 2008 and December 2013,were retrospectively reviewed. Results: Of 85 patients, 51.7% were girls with a mean age of 9.84±4.66 years (6 months-18 years.Ratio of patients that aged less than 5 years was 22.3%. The most prominent complaints were cough (81.2%, fever (55.2%, inappetence (47.1%, night sweats (38.8%, and weight lost (32.9 %. Sixty five of the patients (76.4 % had a history of contact with adult patients with tuberculosis. BCG vaccine scarring was present in 70.6% of patients. Tuberculin skin test reactivity was present in 75.3%. Hilar lympadenomegaly (58.8%, primary focuscalsification (37.6%, and parenchymal infiltration (32.9% were the most common radiographic findings. Conclusion: Pulmonary tuberculous is not a rare entity and remains an important infectious disease in children in our country. Early diagnosis and treatment of children with pulmonary uberculosis is important to protect late symptoms and to prevent contamination of healthy people.

  17. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000-2012.

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    Guadalupe Delgado-Sánchez

    Full Text Available Tuberculosis (TB remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM has increased rapidly in recent years.To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM.We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution.In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p<0.001 in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p<0.001. Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11-1.61 p<0.002 compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes.Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.

  18. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000–2012

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    Delgado-Sánchez, Guadalupe; García-García, Lourdes; Castellanos-Joya, Martín; Cruz-Hervert, Pablo; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Hernández, Andrés; Ortega-Baeza, Victor Manuel; Montero-Campos, Rogelio; Sulca, José Antonio; Martínez-Olivares, Ma. de Lourdes; Mongua-Rodríguez, Norma; Baez-Saldaña, Renata; González-Roldán, Jesús Felipe; López-Gatell, Hugo; Ponce-de-León, Alfredo; Sifuentes-Osornio, José; Jiménez-Corona, María Eugenia

    2015-01-01

    Background Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. Objective To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. Materials and Methods We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution. Results In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p <0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p <0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11–1.61) p <0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes. Conclusion Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure. PMID:26075393

  19. Trace elements status of pulmonary tuberculosis patients compared with healthy voluntaries

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    Moraes, Milena L. de; Ramalho, Daniela M.P.; Delogo, Karina N.; Miranda, Pryscila F.C.; Mesquita, Eliene D.D.; Kritski, Afranio L.; Oliveira, Martha M. [Centro de Pesquisa em Tuberculose, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ (Brazil); Canellas, Catarine G.L.; Lopes, Ricardo T., E-mail: ricardo@lin.ufrj.br [Laboratorio de Instrumentacao Nuclear, Programa de Engenharia Nuclear/COPPE UFRJ, RJ (Brazil); Anjos, Marcelino J., E-mail: marcelin@uerj.br [Departamento de Fisica Aplicada e Termodinamica - Instituto de Fisica Armando Dias Tavares. Universidade do Estado do Rio de Janeiro, RJ (Brazil)

    2011-07-01

    Trace elements have important contribution to immune function. The objective of this study was to compare the Iron, Copper and Zinc levels of patients with active Pulmonary Tuberculosis (TB) and healthy subjects using X-ray Total Reflection Fluorescence Spectrometry. The study group was formed by men with active TB hospitalized on the Ary Parreiras State Institute of diseases of the chest and on the Santa Maria State Hospital, Rio de Janeiro, Brazil. The control group was formed by healthy men of Military Academy Fire Dom Pedro II, Rio de Janeiro, Brazil. The measurements of trace elements were performed at XRF beam line at Brazilian Synchrotron Light, Campinas, Sao Paulo. The results show that serum iron concentration was higher in control group than in study group. Besides that, serum copper concentration was higher in control group than in study group. According to the literature higher levels of copper are observed in infectious diseases like tuberculosis. In the case of the serum zinc concentration no statistical difference was observed between the two groups studied. (author)

  20. Mouse model of pulmonary cavitary tuberculosis and expression of matrix metalloproteinase-9

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    Alvaro A. Ordonez

    2016-07-01

    Full Text Available Cavitation is a key pathological feature of human tuberculosis (TB, and is a well-recognized risk factor for transmission of infection, relapse after treatment and the emergence of drug resistance. Despite intense interest in the mechanisms underlying cavitation and its negative impact on treatment outcomes, there has been limited study of this phenomenon, owing in large part to the limitations of existing animal models. Although cavitation does not occur in conventional mouse strains after infection with Mycobacterium tuberculosis, cavitary lung lesions have occasionally been observed in C3HeB/FeJ mice. However, to date, there has been no demonstration that cavitation can be produced consistently enough to support C3HeB/FeJ mice as a new and useful model of cavitary TB. We utilized serial computed tomography (CT imaging to detect pulmonary cavitation in C3HeB/FeJ mice after aerosol infection with M. tuberculosis. Post-mortem analyses were performed to characterize lung lesions and to localize matrix metalloproteinases (MMPs previously implicated in cavitary TB in situ. A total of 47-61% of infected mice developed cavities during primary disease or relapse after non-curative treatments. Key pathological features of human TB, including simultaneous presence of multiple pathologies, were noted in lung tissues. Optical imaging demonstrated increased MMP activity in TB lesions and MMP-9 was significantly expressed in cavitary lesions. Tissue MMP-9 activity could be abrogated by specific inhibitors. In situ, three-dimensional analyses of cavitary lesions demonstrated that 22.06% of CD11b+ signal colocalized with MMP-9. C3HeB/FeJ mice represent a reliable, economical and tractable model of cavitary TB, with key similarities to human TB. This model should provide an excellent tool to better understand the pathogenesis of cavitation and its effects on TB treatments.

  1. Mouse model of pulmonary cavitary tuberculosis and expression of matrix metalloproteinase-9.

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    Ordonez, Alvaro A; Tasneen, Rokeya; Pokkali, Supriya; Xu, Ziyue; Converse, Paul J; Klunk, Mariah H; Mollura, Daniel J; Nuermberger, Eric L; Jain, Sanjay K

    2016-07-01

    Cavitation is a key pathological feature of human tuberculosis (TB), and is a well-recognized risk factor for transmission of infection, relapse after treatment and the emergence of drug resistance. Despite intense interest in the mechanisms underlying cavitation and its negative impact on treatment outcomes, there has been limited study of this phenomenon, owing in large part to the limitations of existing animal models. Although cavitation does not occur in conventional mouse strains after infection with Mycobacterium tuberculosis, cavitary lung lesions have occasionally been observed in C3HeB/FeJ mice. However, to date, there has been no demonstration that cavitation can be produced consistently enough to support C3HeB/FeJ mice as a new and useful model of cavitary TB. We utilized serial computed tomography (CT) imaging to detect pulmonary cavitation in C3HeB/FeJ mice after aerosol infection with M. tuberculosis Post-mortem analyses were performed to characterize lung lesions and to localize matrix metalloproteinases (MMPs) previously implicated in cavitary TB in situ A total of 47-61% of infected mice developed cavities during primary disease or relapse after non-curative treatments. Key pathological features of human TB, including simultaneous presence of multiple pathologies, were noted in lung tissues. Optical imaging demonstrated increased MMP activity in TB lesions and MMP-9 was significantly expressed in cavitary lesions. Tissue MMP-9 activity could be abrogated by specific inhibitors. In situ, three-dimensional analyses of cavitary lesions demonstrated that 22.06% of CD11b+ signal colocalized with MMP-9. C3HeB/FeJ mice represent a reliable, economical and tractable model of cavitary TB, with key similarities to human TB. This model should provide an excellent tool to better understand the pathogenesis of cavitation and its effects on TB treatments.

  2. Concomitant pulmonary tuberculosis in hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: a multi-center retrospective study.

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    Jia-Yih Feng

    Full Text Available BACKGROUND: In tuberculosis (TB endemic areas, Mycobacterium tuberculosis is an important but easily misdiagnosed pathogen in community-acquired pneumonia (CAP. However, the occurrence of concomitant pulmonary tuberculosis (PTB in hospitalized healthcare-associated pneumonia (HCAP has never been investigated. METHODS AND FINDINGS: Seven hundred and one hospitalized HCAP and 934 hospitalized CAP patients from six medical centers in Taiwan were included in this nationwide retrospective study. Concomitant PTB was defined as active PTB diagnosed within 60 days of admission due to HCAP or CAP. The predictors for concomitant PTB and the impact of PTB on the outcomes of pneumonia were investigated. Among the enrolled subjects, 21/701 (3% of the HCAP patients and 25/934 (2.7% of the CAP patients were documented to have concomitant PTB. In multivariate analysis, a history of previous anti-TB treatment (OR = 5.84, 95% CI: 2.29-20.37 in HCAP; OR = 3.33, 95% CI: 1.09-10.22 in CAP and escalated pneumonia severity index (PSI scores (OR = 1.014, 95% CI: 1.002-1.026, in HCAP; OR = 1.013, 95% CI: 1.001-1.026, in CAP were independent predictors for concomitant PTB in both CAP and HCAP patients. Regarding treatment outcomes, HCAP patients with concomitant PTB were associated with more acute respiratory failure within 48 hours of admission (47.6% vs. 22.6%, p = 0.008, higher intensive care unit admission rate (61.9% vs. 35.7%, p = 0.014, longer hospitalization (39.6±34.1 vs. 23.7±27 days, p = 0.009, and higher in-hospital mortality (47.6% vs. 26.3%, p = 0.03 than those without concomitant PTB. Exposure to certain groups of antibiotics for the treatment of pneumonia was not associated with the occurrence of concomitant PTB. CONCLUSIONS: In HCAP patients, the occurrence of concomitant PTB is comparable with that in CAP patients and associated with higher PSI scores, more acute respiratory failure, and higher in-hospital mortality.

  3. Pulmonary tuberculosis incidence in Turkish prisons: importance of screening and case finding strategies.

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    Öngen, Gül; Börekçi, Şermin; İçmeli, Özlem Saniye; Birgen, Nur; Karagül, Gülsüm; Akgün, Salih; Kılıçaslan, Zeki; Umut, Sema

    2013-01-01

    The purpose of this study was to evaluate the burden of pulmonary tuberculosis in 10 prisons mostly located in the Marmara Region of Turkey, and to compare them with the country incidence. All the inmates in ten prisons mostly located in the four cities in the Marmara Region of Turkey were enrolled in this study. Tuberculosis screening was done between January 2006-January 2007. Radiological screening for tuberculosis was performed by the mobile X-ray system and it was followed by bacteriological analysis of sputum for tuberculosis suspects. Four physicians evaluated the X-rays independently. Four thousand six hundred and fifteen prisoners were detected by radiological screening. Three hundred and one (7%) of them were female and 4314 (93%) were male, age range was between 14-72 years. Age ranges of female and male prisoners were 16-59 and 14-72 respectively. 398/4615 (8.6%) were young adults inmates with an age range of 14-18. Radiological abnormalities consistent with tuberculosis were found in 130 chest X-rays and followed by sputum bacteriology. Smear and culture positive pulmonary tuberculosis diagnosed in five out of 130, were all male with mean age 33 ± 10 years. Tuberculosis prevalence in the prisons was found to be 108/100.000 which was four times higher than the overall incidence of tuberculosis in Turkey in the year which the present study was conducted. Prisoners are one of the most important risk groups with high burden of tuberculosis in Turkey. This result highlights the need for adequate case- finding strategies in prisons.

  4. Plasma melatonin and urinary 6-hydroxymelatonin levels in patients with pulmonary tuberculosis.

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    Ozkan, Esin; Yaman, Halil; Cakir, Erdinc; Deniz, Omer; Oztosun, Muzaffer; Gumus, Seyfettin; Akgul, Emin Ozgur; Agilli, Mehmet; Cayci, Tuncer; Kurt, Yasemin Gulcan; Aydin, Ibrahim; Arslan, Yakup; Ilhan, Nevin; Ilhan, Necip; Erbil, Mehmet Kemal

    2012-08-01

    Tuberculosis (TB) is the second most frequent cause of death in the world, after AIDS. Delay in diagnosing TB is an important worldwide problem. It seriously threatens public health. Cell-mediated immune responses play an important role in the pathogenesis of TB infection. The course of Mycobacterium tuberculosis (MTb) infection is regulated by two distinct T cell cytokine patterns. Melatonin is a biomolecule (mainly secreted by the pineal gland) with free radical scavenging, antioxidant and immunoregulatory properties. Melatonin has both its direct and indirect immunomodulatory effects on the immune system. In this study, we measured plasma melatonin and urine 6-hydroxy melatonin sulphate (6-HMS) concentrations in patients with newly diagnosed TB for the purpose of investigating whether there was a relationship between their levels and MTb infection. Thirty-one newly diagnosed patients presenting with active TB and 31 healthy subjects as the control group were included in this study. Blood and 24-h urine samples were collected from all individuals. Plasma melatonin levels and urine 6-HMS were measured. Our results show that in patients with TB, mean melatonin and 6-HMS concentrations were significantly lower than in the control subjects (p = 0.037, p treatment of TB patients with melatonin might result in a wide range of health benefits including improved quality of life and reduced severity of infection in these patients. Supplementation with melatonin may be considered as an adjunctive therapy to classic treatment of pulmonary TB, especially during the acute phase of infection.

  5. IMPACT OF CIGARETTE SMOKING ON RATES AND CLINICAL PROGNOSIS OF PULMONARY TUBERCULOSIS IN SOUTHERN MEXICO

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    Bonacci, Robert A.; Cruz-Hervert, Luis Pablo; García-García, Lourdes; Reynales-Shigematsu, Luz Myriam; Ferreyra-Reyes, Leticia; Bobadilla-del-Valle, Miriam; Canizales-Quintero, Sergio; Ferreira-Guerrero, Elizabeth; Báez-Saldaña, Renata; Téllez-Vázquez, Norma; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Delgado-Sánchez, Guadalupe; Martínez-Gamboa, Rosa Areli; Cano-Arellano, Bulmaro; Sifuentes-Osornio, José; de León, Alfredo Ponce

    2012-01-01

    Objectives To examine the relationship between cigarette smoking and incidence and mortality rates of pulmonary tuberculosis (TB) and treatment outcomes. Materials From 1995-2010, we analyzed data from 1062 patients with TB and from 2001-2004, 2951 contacts in Southern Mexico. Patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and mycobacteriological evaluation and received treatment by the local DOTS program. Results Consumers of 1-10 (LS) or 11 or more (HS) cigarettes per day incidence (1.75 and 11.79) and mortality (HS,17.74) smoker-nonsmoker rate ratios were significantly higher for smokers. Smoker population was more likely to experience unfavorable treatment outcomes (HS, adjusted OR 2.36) and retreatment (LS and HS, adjusted hazard ratio (HR) 2.14 and 2.37). Contacts that smoked had a higher probability of developing active TB (HR 2.38) during follow up. Conclusions Results indicate the need of incorporating smoking prevention and cessation, especially among men, into international TB control strategies. PMID:22982014

  6. Experience with surgical salvage in pulmonary tuberculosis: application to general thoracic surgery.

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    Delarue, N C; Pearson, F G; Henderson, R D; Cooper, J D; Nelems, J M; Gale, G

    1975-11-01

    The diminishing incidence of pulmonary tuberculosis and the increasing effectiveness of drug therapy have resulted in an almost complete disappearance of surgical problems in the management of patients with this disease. However, the lessons learned from the management of such problems should not be forgotten, for they are equally applicable to the management of disabling and life-endangering problems in general thoracic surgical practice. "Salvage" situations develop when therapeutic requirements for control of disease are combined with factors affecting a patient's health so as to increase the surgical risk beyond the range usually considered acceptable. Attempts to salvage patients are indicated when treatment has failed to arrest disease, when life expectancy is threatened, or when return to normal activity is imperiled. Risk may be increased because of age, inadequate cardiopulmonary reserve, or chronic toxemia; in tuberculosis, risk may be increased because of positive sputum culture or resistance of organisms. Experience with 146 tuberculous patients has provided a basis for evaluation of the indications for resection, prophylactic and therapeutic thoracoplasty, and closure of bronchopleural fistulas in general thoracic surgical salvage. Both infection in residual spaces and bronchopleural fistulas are serious complications that can be controlled by thoracoplasty and pedicled muscle grafts. Prophylactic use of osteoplastic thoracoplasty and intercostal muscle grafts warrant more serious consideration. In established complications a "tailored" thoracoplasty can also be combined with an intercostal muscle graft.

  7. Pulmonary tuberculosis and associated factors in areas of high levels of poverty in Chiapas, Mexico.

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    Sánchez-Pérez, H; Flores-Hernández, J; Jansá, J; Caylá, J; Martín-Mateo, M

    2001-04-01

    To estimate the prevalence of pulmonary tuberculosis (PTB) and factors associated with PTB in areas of high levels of poverty in Chiapas, Mexico. In 1998 active case-finding was carried out among those aged over 14 years who had a cough of > or =15 days duration, in a convenience sample of 1894 households in 32 communities selected at random based on the level of poverty and on the level of access to health services, measured by travelling time ( or =1 hour) from the community to the nearest health care unit. Of the 277 identified with a productive cough, we obtained sputum samples from 228 for the purposes of detecting PTB through acid-fast smears and cultures. Mycobacteria characterization was carried out using the BACTEC method. The identification of factors associated with PTB was performed using bivariate analysis and via logistic regression models. A PTB rate of 276.9 per 100 000 persons aged > or =15 years was found (95% CI : 161-443). Blood in sputum was the only factor associated with PTB (none of the demographic or socioeconomic characteristics were). Of 16 positive cultures, 14 became contaminated. The two cultures characterized were Mycobacterium tuberculosis (one being multiresistant). The high prevalence of PTB detected indicates the need, both in the area studied and in others with similar conditions, to develop PTB control programmes which give priority to early diagnosis and to the provision of adequate treatment.

  8. Determination of Urinary Neopterin/Creatinine Ratio to Distinguish Active Tuberculosis from Latent Mycobacterium tuberculosis Infection

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    Michael Eisenhut

    2016-01-01

    Full Text Available Background. Biomarkers to distinguish latent from active Mycobacterium (M. tuberculosis infection in clinical practice are lacking. The urinary neopterin/creatinine ratio can quantify the systemic interferon-gamma effect in patients with M. tuberculosis infection. Methods. In a prospective observational study, urinary neopterin levels were measured by enzyme linked immunosorbent assay in patients with active tuberculosis, in people with latent M. tuberculosis infection, and in healthy controls and the urinary neopterin/creatinine ratio was calculated. Results. We included a total of 44 patients with M. tuberculosis infection and nine controls. 12 patients had active tuberculosis (8 of them culture-confirmed. The median age was 15 years (range 4.5 to 49. Median urinary neopterin/creatinine ratio in patients with active tuberculosis was 374.1 micromol/mol (129.0 to 1072.3, in patients with latent M. tuberculosis infection it was 142.1 (28.0 to 384.1, and in controls it was 146.0 (40.3 to 200.0, with significantly higher levels in patients with active tuberculosis (p<0.01. The receiver operating characteristics curve had an area under the curve of 0.84 (95% CI 0.70 to 0.97 (p<0.01. Conclusions. Urinary neopterin/creatinine ratios are significantly higher in patients with active tuberculosis compared to patients with latent infection and may be a significant predictor of active tuberculosis in patients with M. tuberculosis infection.

  9. Pulmonary tuberculosis: virulence of Mycobacterium africanum and relevance in HIV co-infection.

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    Meyer, Christian G; Scarisbrick, Genevieve; Niemann, Stefan; Browne, Edmund N L; Chinbuah, Margaret Amanua; Gyapong, John; Osei, Ivy; Owusu-Dabo, Ellis; Kubica, Tanja; Rüsch-Gerdes, Sabine; Thye, Thorsten; Horstmann, Rolf D

    2008-09-01

    Although Mycobacterium africanum is being isolated in a significant proportion of cases of pulmonary tuberculosis in West Africa, its pathogenic potential remains a matter of discussion. Recent reports leave the question of whether M. africanum causes more severe pathology than M. tuberculosis or resembles opportunistic pathogens and might gain importance in the course of the HIV pandemic. Patients with pulmonary tuberculosis associated with M. africanum (n=556) and M. tuberculosis (n=1350) were studied in Ghana, West Africa, and compared regarding self-reported signs and symptoms, chest radiography, HIV status, mycobacterial drug resistance and mycobacterial clustering as determined by spoligotyping and IS6110 fingerprints. The rate of M. africanum infections was similar in HIV-positive (27%) and HIV-negative (30%) patients. M. africanum clustered less than M. tuberculosis (21% vs 79%; OR, 0.38; 95% CI, 0.3-0.5; pHIV-negative patients only. No difference in virulence, as assessed by the severity of radiological presentation, was found when the two M. africanum subtypes West African 1 and West African 2 were compared. In the population studied, M. africanum closely resembled M. tuberculosis in pathology and cannot be considered an opportunistic pathogen.

  10. Prevalence of smear positive pulmonary tuberculosis in Gondar prisoners, North West Ethiopia

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    Zelalem Addis; Emebet Adem; Abebe Alemu; Wubet Birhan; Biniam Mathewos; Belaynesh Tachebele; Yegnasew Takele

    2015-01-01

    Objective:To assess the prevalence and risk factors of smear positive pulmonary tuberculosis amongGondar town prisoners,NorthWestEthiopia.Methods:A cross sectional study was conducted fromFebruary toJuly,2008 inGondarPrison.Prisoners with cough duration of more than two weeks were involved in the study by giving three sputum samples and filling the questionnaires prepared for risk factor assessment.Acid fast staining technique was employed to detect the presence of theMycobacterium tuberculosis bacilli in the sputum samples.Data was analyzed usingSPSS version13 computer software and presented in table.Chi-square test was used to assess associations and aP-value less than0.05 was taken as significant.Results:A total of384 prisoners,349 male and35 females, with a mean age of33.3 years were involved in the study.The prevalence of smear positive pulmonary tuberculosis among those prisoners with cough duration of more than two weeks was8.59%.Only the length of imprisonment had a significant association(χ²=18.82,P-value<0.0001) with the prevalence of tuberculosis. Conclusions:This study indicated that tuberculosis among prisoners with cough duration of more than two weeks inGondar prison is very high.ThereforePeriodic screening of the prisoners and screening of newly introduced prisoners should be practiced so as to minimize the burden of tuberculosis in prisoners.

  11. Correction: Rule out pulmonary tuberculosis: clinical and radiographic clues for the internist.

    Science.gov (United States)

    Curley, Catherine Anne

    2015-02-01

    In the article "Rule out pulmonary tuberculosis: Clinical and radiographic clues for the internist" (Curley CA. Cleve Clin J Med 2015; 82:32-38), on page 33, "Bacillus Calmette-Guérin vaccine" has been corrected to "BCG vaccine."

  12. Pulmonary tuberculosis and mucormycosis co-infection in a diabetic patient.

    Science.gov (United States)

    Aggarwal, Deepak; Chander, Jagdish; Janmeja, Ashok K; Katyal, Rahul

    2015-01-01

    Uncontrolled diabetes mellitus is associated with a variety of infections which pose management difficulties. Herein, we report a case of diabetic patient who developed combined pulmonary tuberculosis and mucormycosis. The case illustrates management of this rare co-infection which despite being potentially fatal was treated successfully.

  13. Pulmonary tuberculosis and mucormycosis co-infection in a diabetic patient

    Directory of Open Access Journals (Sweden)

    Deepak Aggarwal

    2015-01-01

    Full Text Available Uncontrolled diabetes mellitus is associated with a variety of infections which pose management difficulties. Herein, we report a case of diabetic patient who developed combined pulmonary tuberculosis and mucormycosis. The case illustrates management of this rare co-infection which despite being potentially fatal was treated successfully.

  14. Cushing Syndrome Secondary to Thymic Carcinoid Synchronous With Tuberculous Lymphadenitis and Pulmonary Tuberculosis: A Case

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    F Esfahanian

    2007-05-01

    Full Text Available Thymic carcinoid is an uncommon neoplasm that can present with Cushing syndrome.We report a 39-year old woman with symptoms of Cushing syndrome secondary to thymic carcinoid and synchronous with tuberculous lymphadenitis and pulmonary tuberculosis

  15. Capreomycin-induced optic neuritis in a case of multidrug resistant pulmonary tuberculosis

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    Magazine Rahul

    2010-01-01

    Full Text Available A patient of multidrug-resistant pulmonary tuberculosis was prescribed an anti-tubercular regimen containing capreomycin. Patient developed optic neuritis 3 months after starting treatment. Investigations did not reveal any specific cause for this ocular condition and on discontinuing capreomycin his vision recovered. We conclude that capreomycin is the cause of reversible optic neuritis in our case.

  16. Induced Sputum for the Diagnosis of Pulmonary Tuberculosis: Is It Useful in Clinical Practice?

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    S-R Olsen

    2010-01-01

    Full Text Available BACKGROUND: Diagnosing pulmonary tuberculosis (PTB is challenging in patients who are unable to spontaneously expectorate. Published evidence suggests that induced sputum (IS is the least invasive and most cost-effective method of diagnosis, and should be used before fibre-optic bronchoscopy (FOB.

  17. COLD AGGLUTININ INDUCED HEMOLYTIC ANEMIA IN A PATIENT WITH PULMONARY TUBERCULOSIS

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    Lohmror Anurag, Choudhary Richa

    2015-11-01

    Full Text Available Autoimmune hemolytic anemias (AIHA are an uncommon group of disorders characterized by red cell destruction due to autoantibodies. Though usually idiopathic, AIHA is commonly associated with lymphoproliferative disorders, infections, autoimmune disease, and some drugs. This report describes a case of 25 year old female presenting history of fever associated with cough and fatigue. There was a past history of receiving blood transfusion on four occasions. The HRCT thorax demonstrated fine nodular densities in right upper lobe, suggestive of tuberculosis. Abdominal ultrasonography revealed mild splenomegaly. A bone marrow biopsy performed on the patient revealed erythroid hyperplasia. There was no evidence of any malignancy. Diagnosis of cold autoantibody hemolytic anemia complicated by pulmonary tuberculosis was made. The patient was managed with blood transfusions and treated with anti-tubercular agents. The occurrence of AIHA in pulmonary tuberculosis is rare.

  18. [A CLINICAL EXPERIENCE OF RIFAMPICIN SUPPOSITORY FOR THE TREATMENT OF PULMONARY TUBERCULOSIS].

    Science.gov (United States)

    Tsubota, Noriyuki; Tanimukai, Shigeatsu

    2015-06-01

    The usefulness of a rifampicin (RFP) suppository for treatment of pulmonary tuberculosis was examined in patients who had difficulty with oral consumption of medication. Among inpatients receiving first-time treatment for pulmonary tuberculosis susceptible to both isoniazid (INH) and RFP, and who underwent standard 3- or 4-drug treatments including INH and RFP, we compared the number of days required for obtaining two and three consecutive negative sputum smears and cultures, respectively, in patients who received hospital-made suppositories or standard oral RFP administration. There was no significant difference between groups in the number of days required for negative cultures and smears; although the times were equivalent, there were more number of elderly patients and those in generally poor condition in the RFP suppository group than the oral intake group. RFP suppositories may be one method for administration of standard tuberculosis treatment in patients with difficulty in oral consumption of medication.

  19. Cellular immune responses to ESAT-6 discriminate between patients with pulmonary disease due to Mycobacterium avium complex and those with pulmonary disease due to Mycobacterium tuberculosis

    DEFF Research Database (Denmark)

    Lein, A D; von Reyn, C F; Ravn, P;

    1999-01-01

    ESAT-6 (for 6-kDa early secreted antigenic target) is a secreted antigen found almost exclusively in organisms of the Mycobacterium tuberculosis complex. We compared in vitro gamma interferon (IFN-gamma) responses by peripheral blood mononuclear cells to this antigen in patients with pulmonary...... disease due to either Mycobacterium avium complex (MAC) or Mycobacterium tuberculosis with those in healthy, skin test-negative, control subjects. Significant IFN-gamma responses to ESAT-6 were detected in 16 (59%) of 27 M. tuberculosis pulmonary disease patients, 0 (0%) of 8 MAC disease patients, and 0...... (0%) of 8 controls. Significant IFN-gamma responses to M. tuberculosis purified protein derivative were detected in 23 (85%) of 27 M. tuberculosis disease patients, 2 (25%) of 8 MAC disease patients, and 5 (63%) of 8 healthy controls. M. avium sensitin was recognized in 24 (89%) of 27 M. tuberculosis...

  20. [Use of essential oil of peppermint (Mentha piperita) in the complex treatment of patients with infiltrative pulmonary tuberculosis].

    Science.gov (United States)

    Shkurupiĭ, V A; Odintsova, O A; Kazarinova, N V; Tkrachenko, K G

    2006-01-01

    The paper describes the effects of peppermint (Mentha piperita) essential oil inhaled by patients with infiltrative pulmonary tuberculosis in the penitentiary system. This procedure is shown to be most effective in infiltrative pulmonary tuberculosis in the phase of resorption of infiltrates and/or closure of decay cavities. The efficiency is determined by the rapid positive changes in a tuberculous process, which appear as a rapider regression of tuberculous inflammation, causing small residual changes. This procedure may be used to prevent recurrences and exacerbations of pulmonary tuberculosis.

  1. Treatment outcome of new culture positive pulmonary tuberculosis in Norway

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    Heldal Einar

    2005-02-01

    Full Text Available Abstract Background The key elements in tuberculosis (TB control are to cure the individual patient, interrupt transmission of TB to others and prevent the tubercle bacilli from becoming drug resistant. Incomplete treatment may result in excretion of bacteria that may also acquire drug resistance and cause increased morbidity and mortality. Treatment outcome results serves as a tool to control the quality of TB treatment provided by the health care system. The aims of this study were to evaluate the treatment outcome for new cases of culture positive pulmonary TB registered in Norway during the period 1996–2002 and to identify factors associated with non-successful treatment. Methods This was a register-based cohort study. Treatment outcome was assessed according to sex, birthplace, age group, isoniazid (INH susceptibility, mode of detection and treatment periods (1996–1997, 1998–1999 and 2000–2002. Logistic regression was also used to estimate the odds ratio for treatment success vs. non-success with 95% confidence interval (CI, taking the above variables into account. Results Among the 655 patients included, the total treatment success rate was 83% (95% CI 80%–86%. The success rates for those born in Norway and abroad were 79% (95% CI 74%–84% and 86% (95% CI 83%–89% respectively. There was no difference in success rates by sex and treatment periods. Twenty-two patients (3% defaulted treatment, 58 (9% died and 26 (4% transferred out. The default rate was higher among foreign-born and male patients, whereas almost all who died were born in Norway. The majority of the transferred out group left the country, but seven were expelled from the country. In the multivariate analysis, only high age and initial INH resistance remained as significant risk factors for non-successful treatment. Conclusion Although the TB treatment success rate in Norway has increased compared to previous studies and although it has reached a reasonable target

  2. Sputum Conversion Among Patients With Smear Positive Pulmonary Tuberculosis

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    Soudbakhsh A R

    2003-06-01

    Full Text Available Introduction: In the patients with smear-positive pulmonary tuberculosis (TB bacteriologic assessment of sputum for detection of acid bacilli (AFB Has essential role. This evaluation is accomplished by direct sputum smear & sputum culture. These examinations must be done in regular and preferably monthly after beginning of treatment. These tests have two important aims, including, determining of treatment efficacy & duration of isolation."nMethods and Materials: Most of the studies have that classic six month regimen led to sputum smear conversion & negative sputum culture in 85% of patient. This treatment regimen has two phases, including, attack phase and maintenance phase. In the attack phase we use four drugs, including, Isoniazid (INH, Rifampin (RMP, Pyrazinamide (PZA and Ethambutol (EMB for the first 2 months and if necessary until the end of third month. In the maintenance phase we use INH and Rif for the remaining of treatment course. The main objectives of this study were to determine the time needed for smear conversion and assessment of probable factors which may influence the smear conversion until 4 months after beginning of therapy. The factors that were assessed, were, Age, nationality, sex, clinical symptoms, underlying diseases, chest radiography (number of cavities, smoking, drug abuse and concentration of AF13 in the sputum Generally, we did this cross sectional study on the patient's records, who had been observed in Imam Khomeni Hospital, west health service center and masih daneshvary hospital between."nResults: This study showed that from totally 218 patients, 138(74.6% patients had sputum conversion at the first 2 months of treatment and until the end of 3rd & 4th month this rate reached to 83.3% respectively. So in the end of fourth month only 32(14.7% patients did not show sputum smear conversion. On the other hand this study showed that two factors including presence of cavities in chest radiography

  3. High isoniazid resistance rates in rifampicin susceptible Mycobacterium tuberculosis pulmonary isolates from Pakistan.

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    Naima Fasih

    Full Text Available BACKGROUND: Rapid new diagnostic methods (including Xpert MTB/RIF assay use rifampicin resistance as a surrogate marker for multidrug resistant tuberculosis. Patients infected with rifampicin susceptible strains are prescribed first line anti-tuberculosis therapy. The roll out of such methods raises a concern that strains with resistance to other first line anti-tuberculosis drugs including isoniazid will be missed and inappropriate treatment given. To evaluate implications of using such methods review of resistance data from high burden settings such as ours is essential. OBJECTIVE: To determine resistance to first line anti-tuberculosis drugs amongst rifampicin susceptible pulmonary Mycobacterium tuberculosis (MTB isolates from Pakistan. MATERIALS AND METHODS: Data of pulmonary Mycobacterium tuberculosis strains isolated in Aga Khan University Hospital (AKUH laboratory (2009-2011 was retrospectively analyzed. Antimicrobial susceptibility profile of rifampicin susceptible isolates was evaluated for resistance to isoniazid, pyrazinamide, ethambutol, and streptomycin. RESULTS: Pulmonary specimens submitted to AKUH from 2009 to 2011 yielded 7738 strains of Mycobacterium tuberculosis. These included 54% (n 4183 rifampicin susceptible and 46% (n: 3555 rifampicin resistant strains. Analysis of rifampicin susceptible strains showed resistance to at least one of the first line drugs in 27% (n:1133 of isolates. Overall isoniazid resistance was 15.5% (n: 649, with an isoniazid mono-resistance rate of 4% (n: 174. Combined resistance to isoniazid, pyrazinamide, and ethambutol was noted in 1% (n: 40, while resistance to isoniazid, pyrazinamide, ethambutol, and streptomycin was observed in 1.7% (n: 70 of strains. CONCLUSIONS: Our data suggests that techniques (including Xpert MTB/RIF assay relying on rifampicin susceptibility as an indicator for initiating first line therapy will not detect patients infected with MTB strains resistant to other first line

  4. Recurrence after treatment for pulmonary multidrug-resistant tuberculosis.

    Science.gov (United States)

    Becerra, Mercedes C; Appleton, Sasha C; Franke, Molly F; Chalco, Katiuska; Bayona, Jaime; Murray, Megan B; Mitnick, Carole D

    2010-09-15

    We estimated the proportion of recurrence within 2 years among adults cured by individualized multidrug-resistant tuberculosis regimens in Peru. Among 310 individuals with at least 24 months of follow-up, 16 experienced an episode of recurrent tuberculosis. If we assume the worst for treatment effectiveness-that all 16 episodes were caused by the original tuberculosis strain-then 5.2% (95% confidence interval, 3.0%-8.2%) experienced true relapse. This is an upper-bound estimate of relapse on which new regimens must improve.

  5. A description of patients with recurrence of Pulmonary Tuberculosis in a Tuberculosis Hospital, Ermelo

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    Ubon S. Akpabio

    2011-02-01

    Full Text Available Background: Retreatment TB (tuberculosis is a serious category of pulmonary TB with a treatment outcome that could include MDR-TB (multidrug resistant TB. In the Msukaligwa municipality of Mpumalanga Province, South Africa, the burden of TB is high with poor treatment outcome indicators, thus creating some preconditions for retreatment TB. Knowledge of the characteristics of the patients and related health system factors would help in designing interventions to improve the care for patients, the adherence to medication and the prevention of retreatment TB. Aim of the study: The aim was to describe the occurrence, characteristics and management outcome of retreatment pulmonary tuberculosis in patients in a TB hospital in Ermelo.Objectives: The specific objectives were to describe the socio-demographic, behavioural and clinical factors related to recurrence of TB in patients; to determine the contribution of defaulting treatment to recurrence of TB in the study population; to identify the prevalence of resistance to TB medication amongst patients with retreatment TB; and to identify treatment outcomes in patients who have been followed up for the duration of retreatment TB.This study was set in the 58-bed TB hospital in Ermelo.The study design was cross-sectional and descriptive, and the study population comprised of patients admitted with TB at the Ermelo TB hospital between 01 January 2005 and 31 December 2007. Data were collected from the patients’ medical records and the TB registers by using a predesigned form. Data were analysed with Microsoft Excel Spreadsheet at the Centre for Statistical Consultation at the University of Stellenbosch.Results: All of the 388 patient records with retreatment TB, which formed 19.6% of TB patients admitted between 2005 and 2007, were reviewed. This comprised 66% male patients with a mean age of 41.4, and 34% female patients with a mean age of 35.3. They were mostly unemployed, and 93% had a primary

  6. Pulmonary tuberculosis in severely-malnourished or HIV-infected children with pneumonia: a review.

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Ahmed, Tahmeed; Pietroni, Mark A C; Faruque, Abu S G; Ashraf, Hasan; Bardhan, Pradip K; Hossain, Iqbal; Das, Sumon Kumar; Salam, Mohammed Abdus

    2013-09-01

    Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children

  7. Differential X-ray diagnosis of disseminated pulmonary tuberculosis and certain collagenoses

    Energy Technology Data Exchange (ETDEWEB)

    Sokolov, V.A. (Sverdlovskij Meditsinskij Inst. (USSR))

    X-ray picture has been analysed in patients of 2 groups. The 1st group included 120 patients with disseminated tuberculosis, the 2 nd one 56 patients with systemic diseases (lupus erythematosus and scleroderma). The disease initial diagnosis was erroneous in 8 cases (4.5%), i.e. in 5 patients tuberculosis was unrecognized, and in 3 the systemic disease. It is marked, that x-ray pulmonary alterations bore interstitial character in collagenoses, and focal in tuberculosis. Predominant apical posterior lung segment lesion was detected in 95% of cases in tuberculosis, while caverns were diagnosed in 65.8%. Besides, radiographic features of the gastrointestinal tract, the skeleton, and the heart damage were established in 82.9% of systemic scleroderma patients.

  8. Diagnosis of sputum-scarce HIV-associated pulmonary tuberculosis in Lima, Peru

    Science.gov (United States)

    Vargas, Daniel; García, Luis; Gilman, Robert H; Evans, Carlton; Ticona, Eduardo; Ñavincopa, Marcos; Luo, Robert F; Caviedes, Luz; Hong, Clemens; Escombe, Rod; Moore, David A J

    2010-01-01

    Sputum induction, bronchoalveolar lavage, or gastric aspiration are often needed to produce adequate diagnostic respiratory samples from people with HIV in whom tuberculosis is suspected. Since these procedures are rarely appropriate in less-developed countries, we compared the performances of a simple string test and the gold-standard sputum induction. 160 HIV-positive adults under investigation for tuberculosis, and 52 asymptomatic HIV-positive control patients underwent the string test followed by sputum induction. The string test detected tuberculosis in 14 patients in whom this disease was suspected; sputum induction detected only eight of them (McNemar's test, p=0·03). These preliminary data suggest that the string test is safe and effective for retrieval of useful clinical specimens for diagnosis of pulmonary tuberculosis, and is at least as sensitive as sputum induction. PMID:15639297

  9. Deregulated tyrosine-phenylalanine metabolism in pulmonary tuberculosis patients.

    Science.gov (United States)

    Das, Mrinal Kumar; Bishwal, Subasa Chandra; Das, Aleena; Dabral, Deepti; Badireddy, Vinod Kumar; Pandit, Bhaswati; Varghese, George M; Nanda, Ranjan Kumar

    2015-04-01

    Metabolic profiling of biofluids from tuberculosis (TB) patients would help us in understanding the disease pathophysiology and may also be useful for the development of novel diagnostics and host-directed therapy. In this pilot study we have compared the urine metabolic profiles of two groups of subjects having similar TB symptoms and categorized as active TB (ATB, n = 21) and non-TB (NTB, n = 21) based on GeneXpert test results. Silylation, gas chromatography mass spectrometry, and standard chemometric methods were employed to identify the important molecules and deregulated metabolic pathways. Eleven active TB patients were followed up on longitudinally for comparative urine metabolic profiling with healthy controls (n = 11). A set of 42 features qualified to have a variable importance parameter score of > 1.5 of a partial least-squares discriminate analysis model and fold change of > 1.5 at p value phenylalanine metabolic pathway. In the longitudinal study we observed a treatment-dependent trend in the urine metabolome of follow-up samples, and subjects declared as clinically cured showed similar metabolic profile as those of asymptomatic healthy subjects. The deregulated tyrosine-phenylalanine axis reveals a potential target for diagnostics and intervention in TB.

  10. Association of Positive History of Pulmonary Tuberculosis with Female Infertility

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    Babak Eshrati

    2007-01-01

    Full Text Available Background: The etiology of infertility has direct influence on the plan and outcome of its management.In this paper we showed the effect of history of tuberculosis (TB on female infertility among infertilecouples admitted to Royan infertility management center.Material and Methods: This case control study was performed on cases that were diagnosed withfemale infertility (308 women. Controls were women whose husbands were infertile due to some malefactor (314 women. Those who had both female and male infertility were excluded from the study. Theobserved variables were BMI>25 kg/m2, positive history of smoking, tuberculosis, sexually transmitteddisease and pelvic inflammatory diseases.Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI:1.31-29.56.The attributable risk in exposed group was about 1%.Conclusion: According to our study, positive history of tuberculosis may be responsible for femaleinfertility.

  11. Tonsillar tuberculosis, with primary pulmonary focus: A Case Report

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    Juan Antonio Lugo Machado

    2015-09-01

    Full Text Available Tuberculosis is an infectious disease that affects various organs and tissues, with greater tropism for lung disease, gastrointestinal and central nervous system tissue and even bone. However isolated cases of affection to other structures have been reported, just like this patient who came with symptoms in the tonsils and subsequently, lung involvement became apparent. The tonsillar infection in this case was considered a secondary tuberculosis with primary focus in the lungs.

  12. Coexistence of pulmonary tuberculosis and sarcoidosis: a diagnostic dilemma.

    Science.gov (United States)

    Mandal, Sanjay Kumar; Ghosh, Sudip; Mondal, Soumya Sarathi; Chatterjee, Sumanta

    2014-12-19

    Tuberculosis and sarcoidosis are multisystem diseases having different aetiology and management; however, they have similar clinical and histological characteristics. Very rarely they may coexist. We report a rare case of a 38-year-old woman who presented with chronic cough, low-grade fever and respiratory distress that was initially diagnosed as miliary tuberculosis. Diagnosis was supported by positive mycobacterial culture and initially responded to antitubercular treatment, but later recurrences led to further investigations and the diagnosis of coexisting sarcoidosis.

  13. -592 and -1082 interleukin-10 polymorphisms in pulmonary tuberculosis with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    Guadalupe Garca-Elorriaga; Leila Vera-Ramrez; Guillermo del Rey-Pineda; Csar Gonzlez-Bonilla

    2013-01-01

    Objective: To determine the polymorphisms of Interleukin-10 (IL-10) (-592, -1082) in pulmonary tuberculosis (PTB) with and without type 2 diabetes (T2D). Methods: We studied a Mexican mestizo population of 37 patients with TB in remission (TBr) and 40 with active pulmonary TB (PTB), 21 patients with TB + T2D, 47 blood donors accepted, and 13 healthy health-care workers with tuberculin skin test positive. Determination of IL-10 polymorphisms was performed by real-time Polymerase chain reaction. Results: IL-10-592C/A presented in a greater proportion in healthy individuals than in patients with type 2 diabetes and TB in a not quite significant statistically manner. IL-10-1082A/A presented more frequently in the group of patients with both diseases, not being statistically significant in comparison with the group of healthy subjects. Conclusions: This study describes two important new findings. First, it reveals that the IL-10 (-592 A/A and -592 C/C) polymorphisms were found in a greater proportion in a group of patients with T2D and TB than in healthy subjects. Second, the study provides evidence that the (-1082 G/G) polymorphism presented with greater frequency in healthy individuals than in patients with both of these diseases.

  14. Impaired pulmonary function after treatment for tuberculosis: the end of the disease?

    Science.gov (United States)

    Chushkin, Mikhail Ivanovich; Ots, Oleg Nikolayevich

    2017-01-01

    To evaluate the prevalence of pulmonary function abnormalities and to investigate the factors affecting lung function in patients treated for pulmonary tuberculosis. A total of 214 consecutive patients (132 men and 82 women; 20-82 years of age), treated for pulmonary tuberculosis and followed at a local dispensary, underwent spirometry and plethysmography at least one year after treatment. Pulmonary impairment was present in 102 (47.7%) of the 214 patients evaluated. The most common functional alteration was obstructive lung disease (seen in 34.6%). Of the 214 patients, 60 (28.0%) showed reduced pulmonary function (FEV1 below the lower limit of normal). Risk factors for reduced pulmonary function were having had culture-positive pulmonary tuberculosis in the past, being over 50 years of age, having recurrent tuberculosis, and having a lower level of education. Nearly half of all tuberculosis patients evolve to impaired pulmonary function. That underscores the need for pulmonary function testing after the end of treatment. Avaliar a prevalência de alterações da função pulmonar e investigar os fatores que afetam a função pulmonar em pacientes tratados para tuberculose pulmonar. Um total de 214 pacientes consecutivos (132 homens e 82 mulheres; 20-82 anos de idade), tratados para tuberculose pulmonar e acompanhados em um dispensário local, foi submetido a espirometria e pletismografia pelo menos um ano após o tratamento. O comprometimento pulmonar estava presente em 102 (47,7%) dos 214 pacientes avaliados. A alteração funcional mais comum foi o distúrbio ventilatório obstrutivo (observado em 34,6%). Dos 214 pacientes, 60 (28,0%) apresentaram função pulmonar reduzida (VEF1 abaixo do limite inferior de normalidade). Os fatores de risco para função pulmonar reduzida foram tuberculose pulmonar com cultura positiva no passado, idade acima de 50 anos, recidiva de tuberculose e menor nível de escolaridade. Quase metade de todos os pacientes com tuberculose

  15. Hookworm infection among patients with pulmonary tuberculosis: Impact of co-infection on the therapeutic failure of pulmonary tuberculosis

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    Ahmad Farooq Alsayed Hasanain

    2015-01-01

    Conclusion: In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response.

  16. Simultaneous occurrence of pulmonary tuberculosis and carcinomatous lymphangitis Ocorrência simultânea de tuberculose pulmonar e linfangite carcinomatosa

    Directory of Open Access Journals (Sweden)

    Felipe Francisco Tuon

    2007-02-01

    Full Text Available Tuberculosis is an important cause of mortality due to its high prevalence, considering that one third of the world’s population is infected with the tuberculosis bacillus. We report the first case of carcinomatous lymphangitis associated with active pulmonary tuberculosis. Carcinomatous lymphangitis is a rare event that may be confounded with tuberculosis because of its radiographic and clinical characteristics.Tuberculose é uma causa importante de mortalidade devido a sua alta prevalência, uma vez que um terço da população mundial encontra-se infectada com o bacilo da tuberculose. Nós relatamos o primeiro caso de linfangite carcinomatosa associada à tuberculose pulmonar ativa. A linfangite carcinomatosa é um evento raro que pode ser confundida com tuberculose pelos aspectos clínicos e radiológicos.

  17. Tuberculosis and pulmonary candidiasis co-infection present in a previously healthy patient

    Science.gov (United States)

    Jiménez Borré, Gustavo; Gómez Camargo, Doris; Chalavé Jiménez, Neylor; Bellido Rodríguez, Javier; Cuadrado Cano, Bernarda; Navarro Gómez, Shirley

    2016-01-01

    Background: The coexistance among fungal pathogens and tuberculosis pulmonary is a clinical condition that generally occurs in immunosuppressive patients, however, immunocompetent patients may have this condition less frequently. Objective: We report the case of an immunocompetent patient diagnosed with coinfection Mycobacterium tuberculosis and Candida albicans. Case Description: A female patient, who is a 22-years old, with fever and a new onset of hemoptysis. Clinical findings and diagnosis: Diminished vesicular breath sounds in the apical region and basal crackling rales in the left lung base were found in the physical examination. Microbiological tests include: chest radiography and CAT scan pictograms in high resolution, Ziehl-Neelsen stain, growth medium for fungus and mycobacteria through Sabouraudís agar method with D-glucose. Medical examinations showed Candida albicans fungus and Mycobacterium tuberculosis present in the patient. Treatment and Outcome: Patient was treated with anti-tuberculosis and anti-fungal medications, which produced good responses. Clinical relevance: Pulmonary tuberculosis and fungal co-infection are not common in immunocompetent patients. However, we can suspect that there is a presence of these diseases by detecting new onset of hemoptysis in patients. PMID:27546933

  18. Relationship between human LTA4H polymorphisms and extra-pulmonary tuberculosis in an ethnic Han Chinese population in Eastern China.

    Science.gov (United States)

    Yang, Jinghui; Chen, Jin; Yue, Jun; Liu, Lirong; Han, Min; Wang, Hongxiu

    2014-12-01

    Two single nucleotide polymorphisms in Leukotriene A4 hydrolase (LTA4H) gene were reported to be associated with protection from pulmonary tuberculosis in Vietnamese population. But these associations were not found in the Russians. To investigate the association of LTA4H polymorphisms with tuberculosis in a Han Chinese population in Eastern China, we genotyped 5 SNPs of LTA4H gene in 743 of pulmonary tuberculosis patients, 372 of extra-pulmonary tuberculosis patients and 888 of healthy controls individuals. The CC and TT homozygotes of rs1978331 and rs2540474 were identified to have higher rates (P tuberculosis (OR = 1.412; 95% CI = 1.104-1.804 and(OR = 1.380; 95% CI = 1.080-1.764). However, no significant association was found between any of the SNPs and pulmonary tuberculosis. In the extra-pulmonary tuberculosis subgroups. LTA4H gene were significantly associated with tuberculous meningitis, lymph node tuberculosis, bone tuberculosis and other extra-pulmonary tuberculosis except for pleural tuberculosis. The present findings suggest that polymorphisms in the LTA4H gene may affect susceptibility to extra-pulmonary tuberculosis and change the risk of developing the disease in the Han nationality in the East China.

  19. Platelet–lymphocyte ratios: a potential marker for pulmonary tuberculosis diagnosis in COPD patients

    Directory of Open Access Journals (Sweden)

    Chen G

    2016-11-01

    Full Text Available Guozhong Chen, Chunling Wu, Zhiying Luo, Yiming Teng, Suping Mao Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China Background: In recent decades, morbidity and mortality have been found to be significantly increased in patients with chronic obstructive pulmonary disease (COPD complicated with pulmonary tuberculosis (PTB. Platelet–lymphocyte ratio (PLR is an indicator for inflammatory diseases. This study aims to investigate whether PLR could act as a potential marker for patients with COPD complicated with PTB.Methods: In this retrospective study, laboratory characteristics of 87 COPD patients complicated with PTB (determined by Mycobacterium tuberculosis positive culture from sputum or bronchial lavage fluid and 83 COPD patients (as the control group, determined by M. tuberculosis culture negativity from sputum or bronchial lavage fluid were investigated. Data obtained on the day of admission were analyzed.Results: PLR >216.82 was identified as the optimal cutoff value for discriminating COPD patients with PTB (sensitivity 92.4%, specificity 84.5%, positive-predictive value 91.6%, negative-predictive value 86.2%, and area under the curve [AUC] was 0.87 from patients with COPD alone. The AUC of PLR was significantly greater than that of neutrophil–lymphocyte count ratio (AUC, 0.74; 95% confidence interval, 0.67–0.81; P<0.01.Conclusion: PLR could be developed as a valuable maker for identifying tuberculosis infection in COPD patients. Keywords: platelet to lymphocyte ratio, pulmonary tuberculosis, chronic obstructive pulmonary disease

  20. Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis.

    Science.gov (United States)

    Nepal, A K; Gyawali, N; Poudel, B; Mahato, R V; Lamsal, M; Gurung, R; Baral, N; Majhi, S

    2012-12-01

    Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis.

  1. The Purinergic P2X7 Receptor Is Not Required for Control of Pulmonary Mycobacterium tuberculosis Infection

    OpenAIRE

    Myers, Amy J.; Eilertson, Brandon; Fulton, Scott A; JoAnne L Flynn; Canaday, David H.

    2005-01-01

    The importance in vivo of P2X7 receptors in control of virulent Mycobacterium tuberculosis was examined in a low-dose aerosol infection mouse model. P2X7−/− mice controlled infection in lungs as well as wild-type mice, suggesting that the P2X7 receptor is not required for control of pulmonary M. tuberculosis infection.

  2. Coinfections in Intensive Care Unit with pulmonary tuberculosis and mucormycosis: A clinical dilemma

    Directory of Open Access Journals (Sweden)

    Pratibha Dube

    2016-01-01

    Full Text Available Herein, we present the case report of an adult male diabetic patient who had coinfection with Mycobacterium tuberculosis and mucormycosis, which otherwise is a rare clinical entity. Diabetes mellitus may predispose a patient to tuberculosis (TB infection which further weakens immune system thus making him susceptible to other fungal or bacterial infections which may pose various treatment difficulties. Therefore, there is a need for mycological and bacteriological investigations in patients with pulmonary TB to rule out secondary coinfections thus contributing to better management.

  3. Association of SP-D, MBL and I-NOS genetic variants with pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Vaid Mudit

    2006-01-01

    Full Text Available Background : Pulmonary tuberculosis is caused by Mycobacterium tuberculosis . It is a multifactorial disease with both host as well as pathogen factors contributing to susceptibility and protection from the disease. Various reports have highlighted important roles of lung surfactant protein D (SP-D, mannan-binding lectin (MBL and I-NOS in innate immune defense against M. tuberculosis Aims : The present study investigated the role of polymorphisms in three candidate genes encoding Lung surfactant protein D, Mannan binding lectin and Inducible Nitric oxide synthase, in susceptibility and protection to pulmonary tuberculosis. Settings and Design : A case-control association study of SNP′s in lung surfactant protein D (SP-D, mannan-binding lectin (MBL and I-NOS with pulmonary tuberculosis in Indian population was carried out. This involved sequencing of all the coding exons of lung surfactant protein D (SP-D , while, exon 1 (collagen region and exon 4 (carbohydrate recognition domain of mannan-binding lectin (MBL and exons 2, 8 and 16 of I-NOS and their flanking intronic regions for single nucleotide polymorphisms in DNA samples isolated from 30 pulmonary tuberculosis patients and 30 controls of Indian population. Statistical analysis: Various allele frequencies were calculated using online two by two table (home.clara.net/sisa/. Odds ratio and P values were calculated at 95% confidence interval (CI. Results : A total of fourteen single nucleotide polymorphisms (5 in SP-D , 5 in MBL and 4 in I-NOS were observed of which four (G459A SP-D , G274T I-NOS , G1011A and T357G MBL have not been reported earlier. Four single nucleotide polymorphisms viz. G459A of exon 7 of SP-D ( P =0.00, odds ratio (OR = 4.96, 2.18 P = 0.00 or= 3.85 1.66 P =0.00 or=4.04, 2.20< OR< 7.42 and G274T of intron 16 of I-NOS ( P =0.00 or=4.46, 2.40 Conclusion: The present study has led to identification of 4 SNP′s in SP-D , MBL and I-NOS associated with pulmonary tuberculosis

  4. Frequency of hypovitaminosis D and its associated risk factors in newly diagnosed pulmonary tuberculosis patients

    Science.gov (United States)

    Azam, Fahad; Shaheen, Abida; Arshad, Rabia

    2016-01-01

    Objective: To find out the frequency of hypovitaminosis D and its associated risk factors in newly diagnosed pulmonary tuberculosis patients prior to administration of standard anti tuberculosis therapy. Methods: This cross-sectional study was carried out in Ojha Institute of Chest Diseases-DUHS. After approval from BASR and following written informed consent eighty newly diagnosed, as per WHO criteria, tuberculosis patients were enrolled. Prior to the initiation of anti tuberculosis therapy, the serum vitamin D level was determined by 25-OH Vitamin D kit using the chemiluminescent immunoassay (CLIA) method. A cut off value of >30 ng/mL of serum vitamin D was taken as normal whereas a range between 10-30 ng/mL and <10 ng/mL were considered insufficient and deficient respectively. Frequency of socio-demographic associated risk factors of hypovitaminosis D was also determined. Results: Out of eighty newly diagnosed tuberculosis patients 33 (41.25%) were males and 47(58.75%) were females with their ages ranging from 18-50 years. 54 patients (26 male and 28 female patients) were smokers. BMI of all the patients was found to be less than the normal ranges. Hypovitaminosis was present in all the cases. Vitamin D insufficiency was found in 49 participants (20 male and 29 female) whereas 31 patients (13 male and 18 female) were found to be vitamin D deficient. Conclusion: Prevalence of serum vitamin D level derangement is very high in newly diagnosed patients with pulmonary tuberculosis in our local setting which necessitates administration of adjuvant vitamin D along with standard anti tuberculosis therapy. PMID:27182266

  5. [Immunomodulator Intensification of Etioropic Therapy in Patients with Advanced Pulmonary Tuberculosis].

    Science.gov (United States)

    Kolomiets, V M; Abramov, A V; Rachina, N V; Rubleva, N V

    2015-01-01

    The study was aimed at possible increase of the therapy efficacy in patients with advanced tuberculosis by including immunomodulators to the treatment schemes. The data concerning 6034 patients with advanced tuberculosis, mainly fibrocavernous tuberculosis of the lungs, were analysed. Four groups of the patients were randomized. In group 1 the management of the patients included etiotropic therapy and some treatment and rehabilitation measures with the use of Cycloferon. The group 2 patients in addition to the etiotropic therapy and some treatment and rehabilitation measures were given Omega-3. In group 3 the management included the etiotropic therapy and some treatment and rehabilitation measures. In group 4 the etioropic therapy was used alone. The analysis showed that 3419 patients had primary pulmonary tuberculosis, 340 patients had relapsing tuberculosis and 2275 patients had long-term process. The etiotropic therapy efficacy was estimated after an intensive phase of not more than 3 months. In the cases with Mycobacterium tuberculosis drug resistance and some other unfavourable factors it was estimated after a 5-month intensive phase. The results confirmed that inclusion of immunomodulators to the treatment schemes allowed to increase the therapy efficacy and the patients' adherence to the treatment, as well as to shorten the period of the bacteria carriage. Thus, the use of Cycloferon in the schemes of the treatment of the patients with fibrocavernous pulmonary tuberculosis allowed to shorten the period of the pathogen carriage (as well as the drug resistant forms) in 94.1 ± 3.33% of the patients in spite of concomitant diseases. The effect of Cycloferon in such cases was likely due to both its direct immunoprotective action and the improvement of the general state of the patients and their higher adherence to the treatment.

  6. Rationale and design of a randomized controlled trial of the effect of retinol and vitamin D supplementation on treatment in active pulmonary tuberculosis patients with diabetes

    DEFF Research Database (Denmark)

    Wang, Qiuzhen; Ma, Aiguo; Bygbjerg, Ib Christian;

    2013-01-01

    deficiencies, such as retinol and vitamin D, which are especially important to immunity of the body and may influence pancreas β-cell function. However, the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes, immune and nutrition state are still uncertain...

  7. Microscopy as a diagnostic tool in pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Ritu Singhal

    2015-01-01

    Full Text Available Tuberculosis continues to cast a huge impact on humanity with its high incidence and mortality, especially in developing countries. For tuberculosis case detection, microscopy continues to be indispensible, given its low cost, rapidity, simplicity of procedure and high specificity. Modifications have attempted to improve the sensitivity of microscopy which include: concentration methods such as centrifugation, N-acetyl cysteine–sodium hydroxide, bleach, ammonium sulfate or chitin. Furthermore, classical Ziehl–Neelsen (ZN staining has been subjected to varying carbol fuchsin concentrations or replaced by Kinyoun staining, fluorescent microscopy or immune-fluorescence. Currently, light emitting diode fluorescence is recognizably the most plausible method as an alternative to ZN staining.

  8. EVALUATION OF SEROLOGICAL AND MOLECULAR METHODS OVE R CONVENTIONAL METHODS IN DIAGNOSIS OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS

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    Deepika

    2012-10-01

    Full Text Available BACKGROUND : Despite advances in field of microbiology, diagn osis of Tuberculosis remains a challenge. Diagnosis of Extrapulmonary tuberculosis is more problematic due to low bacillary load in the specimen and difficulty in obtaining the specimen from the site of lesion in many cases. PCR and its modifications are a boon in diag nosis of tuberculosis in such cases. But serological methods like ELISA are still the first choice of small laboratories in India. AIM : Comparative evaluation of serological and molecular methods over conventional methods in diagnosis of extrapulmonary and pulmonary tuberculos is. METHODS : 170 different clinical specimens suspected of tuberculosis, (100 pulmonary an d 70 Extrapulmonary were examined by PCR using MPB 64 primer, culture and microscopy. A ll specimens were processed using USP methodology for inhibitors free PCR. TB Ig G, Ig M and Ig A was determined using PATHOZYME MYCO Kit. Response to ATT on clinical follow up was c onsidered as gold standard. RESULTS: Total pulmonary specimens found positive by any of the four tests was 87 (out of 100 while that for extrapulmonary samples was 63(out of 70 . F or Pulmonary Specimens the diagnostic accuracy of microscopy was 88.3%,for culture 88.3%,f or ELISA 67.4% and for PCR 94.1%.For extrapulmonary samples the diagnostic accuracy of microscopy was 30.1%,for culture 49.2%,for ELISA 44.4% and for PCR 87.3%. CONCLUSION: As diagnosis by microscopy and culture are sensitive and specific, for pulmonary spec imens, PCR should be kept reserved for clinically probable cases found negative by conventi onal tests. For Extrapulmonary specimens PCR can be used as an effective screening tool as c onventional methods are mostly negative. ELISA was found to have no role in diagnosis of pul monary TB. For Extrapulmonary TB ELISA can be used as an adjunct tool but results should b e interpreted with utmost caution after full evaluation of the patient both clinically and radiol

  9. the effect of pulmonary tuberculosis on neurocognitive function in ...

    African Journals Online (AJOL)

    SITWALA COMPUTERS

    causes AIDS weakens the immune system; and so does. 2 mycobacterium tuberculosis the causative agent of PTB. As a result, 5-10% of people with TB (but who are not. Medical Journal ..... PTB-/HIV+ group in Learning/memory domain and.

  10. USING KRIGING FOR STATISTICAL DISEASE MAPPING OF PULMONARY TUBERCULOSIS

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    M MOHAMMAD ZADE

    2003-06-01

    Full Text Available Introduction: The map of diseases is usually constructed using the information from diseases incidnce in some regions. Some factors, such as measurment error and rapid variation of diseases rates in different regions make maps so wiggly that their interpretation becomes difficult. Therefore these maps must be smoothed using statisical methods. Methods: Since disease rates of different regions reflect an spatial correlation structure, in this paper the spatial correlation structure of data is specified by fitting a variogram model, then kriging as a best linear unbiased prediction method is used to make a smooth map of diseases. Results: The tuberculosis incidence rates of 262 counties of Iran are used to demonstrate the application and accuracy of the diseases mapping method presented in this paper. The smoothing map of tuberculosis disease, obtained by kriging method shows the geographical trend of the disease in Iran. In this map, central and western regions of Iran have minimum incidence rates, and it gradually increases toward the eastern boundaries. Discussion: The object of this article is introducing kriging method for disease mapping and tuberculosis disease is used to demonstrate the application of this method. There is on dubt that the numerical results of prediction and mapping can be affected by undercount in the smir positive (S + tuberculosis data, which are gathered by the office for campaigning against diseases. However this method has a wide application in different areas of medical sciences. such as geographical epidemiology of diseases, environmental health and environmental engineering.

  11. Diabetes is a risk factor for pulmonary tuberculosis

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Daniel; Range, Nyagosya; PrayGod, George;

    2011-01-01

    Background Diabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent. Methods A case-control study was conducted in an urban...

  12. Peripheral T cell cytokine responses for diagnosis of active tuberculosis.

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    Johannes Nemeth

    Full Text Available BACKGROUND: A test for diagnosis of active Tuberculosis (TB from peripheral blood could tremendously improve clinical management of patients. METHODS: Of 178 prospectively enrolled patients with possible TB, 60 patients were diagnosed with pulmonary and 27 patients with extrapulmonary TB. The frequencies of Mycobacterium tuberculosis (MTB specific CD4(+ T cells and CD8(+ T cells producing cytokines were assessed using overnight stimulation with purified protein derivate (PPD or early secretory antigenic target (ESAT-6, respectively. RESULTS: Among patients with active TB, an increased type 1 cytokine profile consisting of mainly CD4(+ T cell derived interferon (IFN-γ was detectable. Despite contributing to the cytokine profile as a whole, the independent diagnostic performance of one cytokine producing T cells as well as polyfunctional T cells was poor. IFN-γ/Interleukin(IL-2 cytokine ratios discriminated best between active TB and other diseases. CONCLUSION: T cells producing one cytokine and polyfunctional T cells have a limited role in diagnosis of active TB. The significant shift from a "memory type" to an "effector type" cytokine profile may be useful for further development of a rapid immune-diagnostic tool for active TB.

  13. Undiagnosed pulmonary tuberculosis among prisoners in Malaysia: an overlooked risk for tuberculosis in the community.

    Science.gov (United States)

    Al-Darraji, Haider Abdulrazzaq Abed; Altice, Frederick L; Kamarulzaman, Adeeba

    2016-08-01

    To investigate the prevalence of previously undiagnosed active tuberculosis (TB) cases among prisoners in Malaysia's largest prison using an intensified TB case-finding strategy. From October 2012 to May 2013, prisoners housed in two distinct units (HIV-negative and HIV-positive) were approached to participate in the TB screening study. Consenting prisoners submitted two sputum samples that were examined using GeneXpert MTB/RIF, smear microscopy and liquid culture. Socio-demographic and clinical information was collected and correlates of active TB, defined as having either a positive GeneXpert MTB/RIF or culture results, were assessed using regression analyses. Among the total of 559 prisoners, 442 (79.1%) had complete data; 28.7% were HIV-infected, 80.8% were men and the average age was 36.4 (SD 9.8) years. Overall, 34 (7.7%) had previously undiagnosed active TB, of whom 64.7% were unable to complete their TB treatment in prison due to insufficient time (<6 months) remaining in prison. Previously undiagnosed active TB was independently associated with older age groups (AOR 11.44 and 6.06 for age ≥ 50 and age 40-49 years, respectively) and with higher levels of immunosuppression (CD4 < 200 cells/ml) in HIV-infected prisoners (AOR 3.07, 95% CI 1.03-9.17). The high prevalence of previously undiagnosed active TB in this prison highlights the inadequate performance of internationally recommended case-finding strategies and suggests that passive case-finding policies should be abandoned, especially in prison settings where HIV infection is prevalent. Moreover, partnerships between criminal justice and public health treatment systems are crucial to continue TB treatment after release. © 2016 John Wiley & Sons Ltd.

  14. Rapid Screening of MDR-TB in Cases of Extra Pulmonary Tuberculosis Using Geno Type MTBDRplus.

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    Richa Kumari

    Full Text Available Drug resistance in tuberculosis is a major public health challenge in developing countries. The limited data available on drug resistance in extra pulmonary tuberculosis stimulated us to design our study on anti-tuberculosis drug resistance pattern in cases of extra pulmonary tuberculosis in a tertiary referral hospital of North India. We performed Geno Type MTBDRplus assay in comparison with conventional drug susceptibility testing by proportion method to study the mutation patterns in rpoB, katG and inhA genes.A total of 510 extra pulmonary samples were included in this study. After the smear microscopy, all the specimens were subjected for culture on Lowenstein Jensen (LJ media. Phenotypic drug susceptibility testing (DST was performed on LJ media for all the MTB isolates and compared with the results of Geno Type MTBDRplus assay which was performed with the DNA isolated from the culture by conventional method.Of 510 specimens cultured, the total culture positivity obtained was 11.8% (60 encompassing 54 (10.6% Mycobacterium tuberculosis and 6 (1.2% non-tubercular mycobacteria (NTM. DST results by Geno Type MTBDRplus assay and solid culture methods were compared in 51 MTB isolates excluding the two Rif indeterminate and one invalid test. Geno Type MTBDRplus accurately identified 13 of 14 rifampicin-resistant strains, 14 of 15 isoniazid-resistant strains and 13 of 14 as multi drug resistant tuberculosis (MDR-TB in comparison with conventional method. Sensitivity and specificity were 92.86% and 97.30% respectively for detection of RIF resistance, 93.33% and 94.44% respectively for detection of INH resistance, 92.86% and 97.30% respectively for detection of MDR-TB, while the overall concordance of Geno Type MTBDRplus assay with conventional DST was 94.11%. The turn-around time for performing Geno Type MTBDRplus assay test was 48 hours.The problem of MDR in extra pulmonary tuberculosis (EPTB cannot be overlooked and due attention on patients

  15. A case of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.

    Science.gov (United States)

    Das, Joyutpal; Layton, Benjamin; Lamb, Harriet; Sinnott, Nicola; Leahy, Bernard C

    2015-11-01

    Serratia marcescens is a saprophytic gram-negative bacillus capable of causing a wide range of infections. A 57-year-old female was admitted to our hospital for four weeks with community acquired pneumonia. A chest x-ray, six weeks after discharge, demonstrated multiple, bilateral 'cannon ball'-like opacities and mediastinal lymphadenopathy which were highly suspicious of disseminated malignancy or tuberculosis. The only symptom that this patient had was a productive cough. She had multiple commodities, but no specific immunodeficiency disorder. Interestingly, her sputum and bronchial washing samples grew S. marcescens. The computed tomography-guided lung biopsy demonstrated necrotic granulomatous changes. There was no pathological evidence of tuberculosis or fungal infection, malignancy or vasculitis. There are only a handful of reported cases of Serratia granulomas. Thus, we are reporting a rare instance of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.

  16. Sputum smear-positive pulmonary tuberculosis: Is sputum smear examination required to discontinue airborne precautions?

    Science.gov (United States)

    Argemi, X; Albrecht, M; Hansmann, Y; Jaulhac, B; Koebel, C; Schramm, F

    2015-10-01

    Our aim was to evaluate the criteria required to discontinue airborne precautions for patients presenting with sputum smear-positive pulmonary tuberculosis as the need for sputum smear examinations is still a matter of debate. We conducted a retrospective study in the University Hospitals of Strasbourg (France) from July 2011 to July 2013. Our aim was to describe the results of sputum smear examinations and cultures obtained from treated patients presenting with drug-sensitive pulmonary tuberculosis. We included 97 patients in the study. Nearly half of patients for whom a sputum smear examination was performed had a negative sputum direct examination but a positive culture. According to the literature, those patients are still likely to be contagious. This questions the safety of discontinuing airborne precautions in this situation. We also observed a great disparity in physicians' behaviors. Only half of them waited to get a negative sputum direct examination before discontinuing airborne precautions. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Mini-invasive resection and collapse therapy in patients with bilateral pulmonary tuberculosis

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    Korpusenko I.V.

    2015-06-01

    Full Text Available Objective. Improve the effectiveness of surgical treatment in patients with bilateral destructive pulmonary tuberculosis by mini-invasive resection and collapse therapy. Materials and Methods: Retrospective analysis of 222 patients’ cards with bilateral destructive pulmonary tuberculosis who were treated in the period from 1995 to 2014 in the thoracic department of Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology". Patients were divided into 2 groups: basic (111 patients who underwent mini-invasive surgery and control (111 patients, who underwent standard surgical approach. The distribution of patients in investigated groups was representative by the majority of parameters. Results and discussion. The average duration of simultaneous bilateral VATS lung resections was 1,90 ± 0,12 hour, standard thoracotomies - 2,13 ± 0,19 per hour, estimated blood loss was 234±5,20ml and 433±3,70ml respectively. The average postoperative time in-patient was 52,40±2,63 days in basic and 80,10±3,58 days in the control group. Number of postoperative complications after lung resection with VATS was significantly lower (1.6 times, as compared with standard surgical approach. Volume of blood loss less than 400 ml was 93,40±3,20% in basic and 72,60±4,80% in the control group, the amount of intraoperative complications reduced by 2.2 times. Complete clinical response (decontamination and closing of cavities have been achieved in patients of the basic group by 1.6 times more often. Conclusions: For patients with bilateral pulmonary tuberculosis to perform mini-invasive surgical approach is the best option. Mini-invasive interventions with VATS due to its good abilities to visualize tissues and anatomical structures may significantly decrease the amount of intraoperative blood and plasma loss in the first postoperative day. It leads to the stabilization of tuberculosis process in the contralateral lung, responsible for

  18. B cells moderate inflammatory progression and enhance bacterial containment upon pulmonary challenge with Mycobacterium tuberculosis.

    Science.gov (United States)

    Maglione, Paul J; Xu, Jiayong; Chan, John

    2007-06-01

    Though much is known about the function of T lymphocytes in the adaptive immune response against Mycobacterium tuberculosis, comparably little is understood regarding the corresponding role of B lymphocytes. Indicating B cells as components of lymphoid neogenesis during pulmonary tuberculosis, we have identified ectopic germinal centers (GCs) in the lungs of infected mice. B cells in these pulmonary lymphoid aggregates express peanut agglutinin and GL7, two markers of GC B cells, as well as CXCR5, and migrate in response to the lymphoid-associated chemokine CXCL13 ex vivo. CXCL13 is negatively regulated by the presence of B cells, as its production is elevated in lungs of B cell-deficient (B cell(-/-)) mice. Upon aerosol with 100 CFU of M. tuberculosis Erdman, B cell(-/-) mice have exacerbated immunopathology corresponding with elevated pulmonary recruitment of neutrophils. Infected B cell(-/-) mice show increased production of IL-10 in the lungs, whereas IFN-gamma, TNF-alpha, and IL-10R remain unchanged from wild type. B cell(-/-) mice have enhanced susceptibility to infection when aerogenically challenged with 300 CFU of M. tuberculosis corresponding with elevated bacterial burden in the lungs but not in the spleen or liver. Adoptive transfer of B cells complements the phenotypes of B cell(-/-) mice, confirming a role for B cells in both modulation of the host response and optimal containment of the tubercle bacillus. As components of ectopic GCs, moderators of inflammatory progression, and enhancers of local immunity against bacterial challenge, B cells may have a greater role in the host defense against M. tuberculosis than previously thought.

  19. Glucose Metabolism Disorder Is Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil

    Science.gov (United States)

    Castro, Simone; Cafezeiro, Aparecida S.; Daltro, Carla; Netto, Eduardo M.; Kornfeld, Hardy; Andrade, Bruno B.

    2016-01-01

    Background Diabetes mellitus (DM) has been associated with increased risk for pulmonary tuberculosis (PTB) in endemic settings but it is unknown whether PTB risk is also increased by pre-DM. Here, we prospectively examined the association between glucose metabolism disorder (GMD) and PTB in patients with respiratory symptoms at a tuberculosis primary care reference center in Brazil. Methods Oral glucose tolerance test was performed and levels of fasting plasma glucose and glycohemoglobin (HbA1c) were measured in a cohort of 892 individuals presenting with respiratory symptoms of more than two weeks duration. Patients were also tested for PTB with sputum cultures. Prevalence of pre-DM and DM (based on HbA1c) was estimated and tested for association with incident PTB. Other TB risk factors including smoking history were analyzed. Results The majority of the study population (63.1%) exhibited GMD based on HbA1c ≥5.7%. Patients with GMD had higher prevalence of PTB compared to normoglycemic patients. Individuals with DM exhibited increased frequency of TB-related symptoms and detection of acid-fast bacilli in sputum smears. Among patients with previous DM diagnosis, sustained hyperglycemia (HbA1c ≥7.0%) was associated with increased TB prevalence. Smoking history alone was not significantly associated with TB in our study population but the combination of smoking and HbA1c ≥7.0% was associated with 6 times higher odds for PTB. Conclusions Sustained hyperglycemia and pre-DM are independently associated with active PTB. This evidence raises the question whether improving glycemic control in diabetic TB patients would reduce the risk of TB transmission and simultaneously reduce the clinical burden of disease. A better understanding of mechanisms underlying these associations, especially those suggesting that pre-DM may be a factor driving susceptibility to TB is warranted. PMID:27078026

  20. The Investigation of Close-Contacts in Soldier Patients with Pulmonary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Mustafa Harun Ugan

    2008-06-01

    Full Text Available BACKGROUND: The aim of this study is to estimate the average numbers of close contacts of soldiers patients with tuberculosis (TB, who admitted to Chest Diseases Hospital, in their troops, and to reveal active patients and the cases who needs for chemoprophylaxis, and to evaluate the treatment results. METHODS: This study was done in Pulmonary Division of GATA Haydarpasa Training Hospital between 1st of January 2005 and 31st of March 2006. Persons who worked with soldier patients bacteriologially diagnosed with TB in our hospital, in closed areas, and/or sleeping in the same dormitory were accepted as close contacts. Contacts were performed tuberculin skin test (TST, and taken their chest roentgenogram at 0, 3rd, and 6th months. More than 10 mm indurations in cases with no BCG and 15 mm indurations in cases with BCG were accepted as positive TCT. Close contacts that had positive TST or more than 6 mm increase in their controls were given the chemoprophylaxis with isoniasid for six months. Ninety-two smear positive patients with PTB were enrolled into the study. RESULTS: The mean age was 21.6±2.3 years. Of the 4501 close contacts, 89% were screened during the first period and the control rates at 3rd and 6th months decreased to 58% and 42%, respectively. 11 new tuberculosis cases were found by screening of close contacts (with an incidence of 244/100.000. TST positivity or conversion was shown in 420 contacts, and were given chemoprophylaxis. Of 165 (39.2% were completed six month therapy. COCLUSION: In our study, although the number of close contacts per patients was significantly higher, the incidence of patients in close contacts was low. [TAF Prev Med Bull. 2008; 7(3: 199-204

  1. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis.

    Science.gov (United States)

    Arshad, S; Bavan, L; Gajari, K; Paget, S N J; Baussano, I

    2010-06-01

    Although there is no evidence that imported tuberculosis increases the incidence of the disease in host countries, the rise in migration worldwide raises concerns regarding the adequacy of surveillance and control of immigrant-associated tuberculosis in low incidence countries. Assessing the performance of screening of immigrants for tuberculosis is key to rationalizing control policies for the detection and management of immigrant-associated tuberculosis. We performed a systematic review and meta-analysis to determine the yield of active screening for tuberculosis among new immigrants at the point of entry. The yield for pulmonary tuberculosis was 3.5 cases per 1,000 screened (95% CI 2.9-4.1; I(2) = 94%); for refugees, asylum seekers and regular immigrants the estimates were 11.9 (95% CI 6.7-17.2; I(2) = 92%), 2.8 (95% CI 2.0-3.7; I(2) = 96%) and 2.7 (95% CI 2.0-3.4; I(2) = 81%), respectively. The yield estimates for immigrants from Europe, Africa and Asia were 2.4 (95% CI 1.3-3.4; I(2) = 51.5%), 6.5 (95% CI 3.2-10.0; I(2) = 62%) and 11.2 (95% CI 6.2-16.1; I(2) = 95%), respectively. These results provide useful data to inform the development of coherent policies and rational screening services for the detection of immigrant-associated tuberculosis.

  2. Are intestinal helminths risk factors for developing active tuberculosis?

    DEFF Research Database (Denmark)

    Elias, Daniel; Mengistu, Getahun; Akuffo, Hannah

    2006-01-01

    OBJECTIVES: To determine the prevalence of intestinal helminth infections in active tuberculosis patients and their healthy household contacts and to assess its association with active TB in an area endemic for both types of infections. METHODS: Smear-positive pulmonary TB patients and healthy...... household contacts were tested for intestinal helminths using direct microscopy and the formol-ether concentration techniques. Three consecutive stool samples were examined before the start of TB chemotherapy. Sputum microscopy was done using the sodium hypochlorite concentration techniques. Participants...... were also tested for HIV by commercial sandwich enzyme linked immunosorbent assay. RESULTS: The study population consisted of 230 smear-positive TB patients and 510 healthy household contacts. The prevalence of intestinal helminths was 71% in patients and 36% in controls. HIV seroprevalence...

  3. Progression of chronic pulmonary tuberculosis in mice intravenously infected with ethambutol resistant Mycobacterium tuberculosis

    Directory of Open Access Journals (Sweden)

    Srivastava S

    2008-01-01

    Full Text Available Purpose: Ethambutol (EMB is an important first line drug, however little information on its molecular mechanism of resistance and pathogenicity of resistant isolates is available. Present work was designed to study virulence of the EMB resistant M. tuberculosis strains and the host responses in-vivo on infection of EMB resistant M. tuberculosis using Balb/c mouse model of infection. Methods: Three groups of Balb/c mice (female, age 4-6 wk; 21 mice in each group were infected intravenously with 106 CFU of M. tuberculosis H37Rv and two EMB resistant clinical isolates. Age and sex matched control animals were mock inoculated with Middlebrook 7H9 broth alone. At 10, 20, 30, 40, 50, 60, and 70 days post-infection three animals from each group were sacrificed by cervical dislocation and lung tissue was collected for further analysis. Results: Infection with EMB resistant M. tuberculosis led to progressive and chronic disease with significantly high bacillary load (p=0.02. Massive infiltration and exacerbated lung pathology with increased expression of IFN-γ and TNF-α was observed in lungs of mice infected with EMB resistant strains. The present study suggests that infection with EMB resistant M. tuberculosis leads to chronic infection with subsequent loss of lung function, bacterial persistence with elevated expression of TNF-α resulting in increased lung pathology. Conclusion: These findings highlight that EMB resistant M. tuberculosis regulates host immune response differentially and its pathogenicity is different from drug sensitive strains of M. tuberculosis.

  4. Hypertrophic osteoarthropathy in association with pulmonary tuberculosis: a case report; Osteoartropatia hipertrofica associada a tuberculose pulmonar: relato de caso

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    Moreira, Luiza Beatriz Melo; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Melo, Alessandro Severo Alves de [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Servico de Radiologia; Pinto, Ana Lucia de Araujo [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Servico de Pneumologia; Monteiro, Nicolau Pedro [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Medicina Clinica

    2002-02-01

    In this article the authors report a case of a patient with hypertrophic osteoarthropathy associated with pulmonary tuberculosis. This disorder is a rare complication of tuberculosis and may be associated with severe and fulminant disease. The imaging methods used in the diagnosis of this disease included lower limbs radiographs that showed bilateral periosteal reaction, and chest radiographs and computed tomography that revealed a mass in the upper lobe of the right lung. Although a fine needle aspiration was suggestive of tuberculosis, the definitive diagnosis was made after thoracotomy and histopathological examination of the mass. The patient presented symptomatic and radiological improvement after treatment of tuberculosis. (author)

  5. Interação de fatores riscos em tuberculose Interaction of factors on pulmonary tuberculosis

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    Antônio Ruffino-Netto

    1979-06-01

    Full Text Available Estudou-se o possível sinergismo dos fatores alcoolismo e tabagismo na tuberculose pulmonar, a partir de dados de um estudo caso-controle onde 854 pessoas foram entrevistadas (sendo 427 casos-pacientes portadores de tuberculose pulmonar e 427 controles e questionadas quanto ao hábito de ingestão alcoólica e o de fumar em períodos precedendo ao diagnóstico da doença. Concluiu-se que existe pequena interação destes fatores na tuberculose pulmonar; o hábito de fumar estaria relacionado com a doença tuberculose através de sua associação com a ingestão de bebidas alcoólicas.A case-control study was made of the possible synergetic effect of smoking and alcohol drinking on pulmonary tuberculosis. Analysis of the results of 854 interviews showed that there is little interactive effect in the multiplicative sense (synergism between these factors and pulmonary tuberculosis. It is suggested that the habit of smoking may be related to pulmonary tuberculosis only through its association with that of alcohol drinking.

  6. STUDY OF ATD ANGLE, FINGER RIDGE COUNT IN PULMONARY TUBERCULOSIS PATIENTS

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    Jagdish S. Chaudhari

    2015-12-01

    Full Text Available Objective: To determine whether the Dermatoglyphics parameters in Pulmonary tuberculosis patients (sputum smear positive cases and normal healthy controls were differ or not. Materials and Methods: In present study 100 cases (77 males and 23 females of Pulmonary tuberculosis (sputum smear positive in the age group of 18 to 70 were collected and studied for Dermatoglyphics parameters such as ‘ATD’ angle, total and absolute finger ridge counts. These parameters of cases were compared to those of 100 unrelated healthy subjects (controls and analyzed for statistical significance. Results and conclusion: In present study we observed decrease ‘ATD’ angle in both hands of male and female cases as compared to controls that difference was statistically highly significant. There were no statistically significant difference observed in total finger ridge count (TFRC and absolute finger ridge count (AFRC of cases compared to controls. Dermatoglyphics can be used for screening tool for Pulmonary tuberculosis contacts for genetic susceptibility to disease as a cost effective, noninvasive harmless technique.

  7. T-Cell Immunophenotyping Distinguishes Active From Latent Tuberculosis

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    Pollock, Katrina M.; Whitworth, Hilary S.; Montamat-Sicotte, Damien J.; Grass, Lisa; Cooke, Graham S.; Kapembwa, Moses S.; Kon, Onn M.; Sampson, Robert D.; Taylor, Graham P.; Lalvani, Ajit

    2013-01-01

    Background. Changes in the phenotype and function of Mycobacterium tuberculosis (M. tuberculosis)-specific CD4+ and CD8+ T-cell subsets in response to stage of infection may allow discrimination between active tuberculosis and latent tuberculosis infection. Methods. A prospective comparison of M. tuberculosis-specific cellular immunity in subjects with active tuberculosis and latent tuberculosis infection, with and without human immunodeficiency virus (HIV) coinfection. Polychromatic flow cytometry was used to measure CD4+ and CD8+ T-cell subset phenotype and secretion of interferon γ (IFN-γ), interleukin 2 (IL-2), and tumor necrosis factor α (TNF-α). Results. Frequencies of CD4+ and CD8+ cells secreting IFN-γ-only, TNF-α-only and dual IFN-γ/TNF-α were greater in active tuberculosis vs latent tuberculosis infection. All M. tuberculosis-specific CD4+ subsets, with the exception of IL-2-only cells, switched from central to effector memory phenotype in active tuberculosis vs latent tuberculosis infection, accompanied by a reduction in IL-7 receptor α (CD127) expression. The frequency of PPD-specific CD4+ TNF-α-only-secreting T cells with an effector phenotype accurately distinguished active tuberculosis from latent tuberculosis infection with an area under the curve of 0.99, substantially more discriminatory than measurement of function alone. Conclusions. Combined measurement of T-cell phenotype and function defines a highly discriminatory biomarker of tuberculosis disease activity. Unlocking the diagnostic and monitoring potential of this combined approach now requires validation in large-scale prospective studies. PMID:23966657

  8. Coexistence of leprosy and pulmonary tuberculosis: An uncommon entity

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    Ajay Kumar Verma

    2015-01-01

    Full Text Available The association of two of the oldest diseases of mankind, leprosy and tuberculosis (TB has been uncommonly reported in the literature. Herein, we report a known case of leprosy subsequently associated with sputum positive TB complicated by a type-II lepra reaction. There is a need for screening of patients for TB in patients diagnosed with leprosy to prevent the accidental misuse of an important drug, rifampicin to prevent the possibility of drug-resistant TB.

  9. Active case finding of tuberculosis in Europe: a Tuberculosis Network European Trials Group (TBNET) survey

    DEFF Research Database (Denmark)

    Bothamley, G.H.; Ditiu, L.; Migliori, G.B.

    2008-01-01

    Tuberculosis control depends on successful case finding and treatment of individuals infected with Mycobacterium tuberculosis. Passive case finding is widely practised: the present study aims to ascertain the consensus and possible improvements in active case finding across Europe. Recommendations...... of isoniazid for treatment of LTBI, with an estimated median (range) uptake of 55% (5-92.5%). Symptoms and sputum examination could be used more widely when screening for active tuberculosis. Treatment of latent tuberculosis infection might be better focused by targeted use of interferon-gamma release assays...... from national guidelines were collected from 50 countries of the World Health Organization European region using a standard questionnaire. Contacts are universally screened for active tuberculosis and latent tuberculosis infection (LTBI). Most countries (>70%) screen those with HIV infection, prisoners...

  10. Relationship of body build and development of pulmonary tuberculosis

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    Nakamura, K.

    1974-01-01

    Height, weight, Body Build Index (relative body weight), sub-scapular skinfold thickness, serum cholesterol level, hemoglobin concentration, and serum uric acid level immediately preceding detection of tuberculosis were compared between index and control cases on 145 pairs, by sex and age group (49 or under and 50 or over). Average height of index cases was greater than that of the control cases. Control cases were heavier than index cases for both sexes and age groups. Comparison of Body Build Index exhibited more distinct differences between the two groups, which were more remarkable in the older age group. Significantly thicker skinfold was demonstrated only among the female control cases. Serum cholesterol and uric acid level were significantly higher among the male control cases. No difference in hemoglobin concentration was observed between the index and control cases. Results not only support previous studies which had shown higher morbidity of tuberculosis among underweight persons, but also suggest that nutritional factors might be important in lowering the susceptibility to development of tuberculosis. (DLC)

  11. Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia

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    Gessessew Amanuel

    2009-02-01

    Full Text Available Abstract Background Delays seeking care increase transmission of pulmonary tuberculosis and hence the burden of tuberculosis, which remains high in developing countries. This study investigates patterns of health seeking behavior and determines risk factors for delayed patient consultation at public health facilities in 10 districts of Ethiopia. Methods New pulmonary TB patients ≥ 15 years old were recruited at 18 diagnostic centres. Patients were asked about their health care seeking behaviour and the time from onset of symptoms to first consultation at a public health facility. First consultation at a public health facility 30 days or longer after onset of symptoms was regarded as prolonged patient delay. Results Interviews were held with 924 pulmonary patients. Of these, 537 (58% were smear positive and 387 (42% were smear negative; 413 (45% were female; 451 (49% were rural residents; and the median age was 34 years. Prior to their first consultation at a public health facility, patients received treatment from a variety of informal sources: the Orthodox Church, where they were treated with holy water (24%; private practitioners (13%; rural drug vendors (7%; and traditional healers (3%. The overall median patient delay was 30 days (mean = 60 days. Fifty three percent [95% Confidence Intervals (CI (50%, 56%] of patients had delayed their first consultation for ≥ 30 days. Patient delay for women was 54%; 95% CI (54%, 58% and men 51%; 95% CI (47%, 55%. The delay was higher for patients who used informal treatment (median 31 days than those who did not (15 days. Prolonged patient delay (≥ 30 days was significantly associated with both patient-related and treatment-related factors. Significant patient-related factors were smear positive pulmonary disease [Adjusted Odds Ratio (AOR 1.4; 95% CI (1.1 to 1.9], rural residence [AOR 1.4; 95% CI (1.1 to 1.9], illiteracy [AOR 1.7; 95% CI (1.2 to 2.4], and lack of awareness/misperceptions of causes of

  12. Progressive Primary Pulmonary Tuberculosis Presenting as the Sudden Unexpected Death in Infancy: A Case Report

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    Dempers, Johan; Sens, Mary Ann; Wadee, Shabbir Ahmed; Kinney, Hannah C.; Odendaal, Hein J.; Wright, Colleen A.

    2010-01-01

    The classification of an unexpected infant death as the sudden infant death syndrome (SIDS) depends upon a complete autopsy and death scene investigation to exclude known causes of death. Here we report the death of a four-month-old infant in a tuberculosis endemic area that presented as a sudden unexpected death in infancy (SUDI) with no apparent explanation based on the death scene characteristics. The autopsy, however, revealed progressive primary pulmonary tuberculosis with intrathoracic adenopathy, compression of the tracheobronchial tree and miliary lesions in the liver. This case underscores the clinical difficulties in the diagnosis of infantile tuberculosis, as well as the possibility of sudden death as part of its protean manifestations. The pathology and clinical progression of tuberculosis in infants differs from older children and adults due to the immature immune response in infants. This case dramatically highlights the need for complete autopsies in all sudden and unexpected infant deaths, as well as the public health issues in a sentinel infant tuberculosis diagnosis. PMID:20705406

  13. Evaluation and Comparison of Body Mass Index and Albumin Level in Patients with Active Tuberculosis and Latent Tuberculosis Infection

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    Fatemeh Heidarnezhad

    2016-06-01

    Full Text Available Introduction: Limited data are available on the relationship between nutritional status and tuberculosis. The aim of this study was to evaluate and compare the body mass index (BMI and serum albumin level in patients with active tuberculosis (ATB and latent tuberculosis (LTB. Materials and Methods: A cross-sectional study was conducted on 17 patients newly diagnosed with pulmonary TB  who were referred in Iran, during September 2011 to March 2012 and 17 latent tuberculosis infection individuals. Standard method was performed to collect an early morning fasting blood sample for albumin (by the bromocresolgreen method. Also (BMI was calculated as body weight divided by height squared (kg/m2. Results: One-sample Kolmogorov-Smirnov test was used to check normal distribution data The mean ± Standard deviation(SD for albumin in the patients and controls were 3.62±0/56 and 4.68±0.25, respectively. BMI in the patients and controls were 19.46±2.79 and  25.4±3.46, respectively. The serum albumin level was significantly lower in the patient group, compared to the control group (P

  14. CT findings of the pulmonary tuberculosis in patients with diabetes mellitus

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    Yang, Chang Kyu; Hong, Deok Hwa; Kim, Yeong Tong; Kim, Hyung Lyul; Lee, Jong Myeong; Kim, Jong Kun; Lee, So Hyun; Jeong, Gun Young [Taejon Sun General Hospital, Taejon (Korea, Republic of)

    1998-07-01

    To evaluate the CT findings of pulmonary tuberculosis in patients with diabetes mellitus (MD),according to the diabetic control state. Materials and Methods: We retrospectively studied 34 cases of pulmonary tuberculosis accompanied by DM. We divided the right lung three lobes and ten segments and the left into two lobes and eight segments and analyzed CT findings of bronchogenic spread, cavitary lesion, ill-defined nodule, lobular consolidation, lobar and segmental consolidation, atelectasis, interlobular septal thickening, fibrotic band, and associated findings such as lymph node enlargement, pleural effusion and empyema. We also tried to determine the typical CT findings of pulmonary tuberculosis according to diabetic duration and controlled state of DM focusing by FBS 160 and HbA1C 8.0. Results: Among 34 CT scans, bronchogenic spread was seen on 29 (85.3%), cavitary lesion on 26 (76.5%), ill-defined nodules on 11 (32.4%), lobular consolidation on 14 (41.2%), lobar and segmental consolidation on 12 (35.3%), atelectasis on four (14.7%), and fibrotic band on eight (23.5%). Multiple cavities were present in 76.9% of total cavitary lesions, and consolidation with bronchogenic spread in 75%; associated findings were as follows: lymph node enlargement (n=1), pleural effusion (n=10), empyema (n=2), and pericardial effusion (n=2). In 46.7% of cases, general tubercular lesions were in an unusual location, but among cases of secondary pulmonary tuberculosis, 73.9% of lesions were in the usual location. More lobular consolidation was seen in patients with less than FBS 160 on admission, and this result was statistically significant (p<0.05); CT findings did not, however, differ according to diabetic duration and HbA1C. Conclusion: In patients with DM,general fubercular lesions were found infrequently, but in secondary tubereulosis, multiple cavitary lesions-in the usual location-were very frequent. In patients with DM, CT findings of pulmonary tuberculosis did not vary

  15. Risk Factors of Pulmonary Smear Positive Tuberculosis Incidence in Dili District Timor Leste 2014

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    Jacinta dos Santos Guterres

    2015-04-01

    Full Text Available Background and objectives: According to the WHO, the pulmonary tuberculosis (TB in Timor-Leste is estimated to have the highest mortality rate in the region which is 45 per 100,000 populations. The aim of this study was to determine the risk factors for pulmonary tuberculosis in the Dili District. Methods: The study design was a case-control. Cases were patients with positive BTA pulmonary tuberculosis, and controls were non TB patients registered at two TB clinics (Motael and Bairro-Pite and the three public health centers (Comoro, Formosa and Becora in Dili, July 2013 - February 2014. Numbers of samples were 138 people consisting of 46 cases and 92 controls (1:2. Risk factors studied were smoking habits, contact with patients, nutritional status, family income, population density, sun lighting, ventilation and the use of firewood for cooking. Data were collected through interviews, observation and measurement. Bivariate analysis was performed to determine the similarity between cases and controls and to calculate the crude OR. Multivariate analysis with logistic regression was performed to determine adjusted risk factors that contribute to the increasing TB patients. Results: There were no significant differences between cases and control groups in age, gender, education and occupation (p>0.05. Bivariate analysis showed that the risk factors of pulmonary tuberculosis were the contact with patients (OR=2.809; 95%CI:1.337-5.900, nutritional status (OR=2.380; 95%CI:1.096-5.169, the sun lighting (OR=8.090; 95%CI:3.468-18.872 and ventilation (OR=6.141; 95%CI:2.709-13.924. Multivariate analysis showed that the significant risk factors were the contact with patients (OR=3.428; 95%CI:1.455-8.075 and exposure to sunlight (OR=4.601; 95% CI:1.336-15.845. Conclusion: The contact with patients and the exposure to sunlight were the risk factors for pulmonary TB of positive BTA at the Dili District of Timor Leste. Keywords: Risk factors for tuberculosis, the

  16. Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis

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    Ioannis Kokkonouzis

    2011-01-01

    Full Text Available A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.

  17. [Multiple pulmonary nodules and posterior uveitis as unusual manifestation of pulmonary tuberculosis].

    Science.gov (United States)

    Ibarburen González-Arenas, C; Zapatero Gaviria, A; Gómez Santos, D; García-Castaño, B; Tomás Ros, M; Merino Morales, F

    1990-12-01

    Pulmonar tuberculosis still being one of the diseases more frequent in our area, this producing different clinical and radiological presentation. A case with posterior uveitis and bilateral lungs nodules which required a thoracotomy to perform a diagnosis, is presented.

  18. A Phase 2 Randomized Trial of a Rifapentine plus Moxifloxacin-Based Regimen for Treatment of Pulmonary Tuberculosis

    Science.gov (United States)

    Conde, Marcus B.; Mello, Fernanda C. Q.; Duarte, Rafael Silva; Cavalcante, Solange C.; Rolla, Valeria; Dalcolmo, Margareth; Loredo, Carla; Durovni, Betina; Armstrong, Derek T.; Efron, Anne; Barnes, Grace L.; Marzinke, Mark A.; Savic, Radojka M.; Dooley, Kelly E.; Cohn, Silvia; Moulton, Lawrence H.; Chaisson, Richard E.; Dorman, Susan E.

    2016-01-01

    Background The combination of rifapentine and moxifloxacin administered daily with other anti-tuberculosis drugs is highly active in mouse models of tuberculosis chemotherapy. The objective of this phase 2 clinical trial was to determine the bactericidal activity, safety, and tolerability of a regimen comprised of rifapentine, moxifloxacin, isoniazid, and pyrazinamide administered daily during the first 8 weeks of pulmonary tuberculosis treatment. Methods Adults with sputum smear-positive pulmonary tuberculosis were randomized to receive either rifapentine (approximately 7.5 mg/kg) plus moxifloxacin (investigational arm), or rifampin (approximately 10 mg/kg) plus ethambutol (control) daily for 8 weeks, along with isoniazid and pyrazinamide. The primary endpoint was sputum culture status at completion of 8 weeks of treatment. Results 121 participants (56% of accrual target) were enrolled. At completion of 8 weeks of treatment, negative cultures using Löwenstein-Jensen (LJ) medium occurred in 47/60 (78%) participants in the investigational arm vs. 43/51 (84%, p = 0.47) in the control arm; negative cultures using liquid medium occurred in 37/47 (79%) in the investigational arm vs. 27/41 (66%, p = 0.23) in the control arm. Time to stable culture conversion was shorter for the investigational arm vs. the control arm using liquid culture medium (p = 0.03), but there was no difference using LJ medium. Median rifapentine area under the concentration-time curve (AUC0-24) was 313 mcg*h/mL, similar to recent studies of rifapentine dosed at 450–600 mg daily. Median moxifloxacin AUC0-24 was 28.0 mcg*h/mL, much lower than in trials where rifapentine was given only intermittently with moxifloxacin. The proportion of participants discontinuing assigned treatment for reasons other than microbiological ineligibility was higher in the investigational arm vs. the control arm (11/62 [18%] vs. 3/59 [5%], p = 0.04) although the proportions of grade 3 or higher adverse events were

  19. Weight, body composition and handgrip strength among pulmonary tuberculosis patients

    DEFF Research Database (Denmark)

    Praygod, George; Range, Nyagosya; Faurholt-Jepsen, Daniel

    2011-01-01

    This study aimed to estimate deficits in weight, arm fat area (AFA), arm muscle area (AMA) and handgrip strength among smear-positive pulmonary TB (PTB+) patients starting treatment. We conducted a cross-sectional study among PTB+ patients and age- and sex-matched neighborhood controls. HIV statu...

  20. All eotaxins CCL11, CCL24 and CCL26 are increased but to various extents in pulmonary tuberculosis patients.

    Science.gov (United States)

    Sharifabadi, Abumoslem Rashidi; Hassanshahi, Gholamhossein; Ghalebi, Seyed Razi; Arababadi, Mohammad Kazemi; Khorramdelazad, Hossein; Zainodini, Nahid; Shabani, Ziba

    2014-01-01

    Mycobacterium tuberculosis is a pulmonary pathogen responsible for tuberculosis. Tuberculosis (TB) is characterized histologically by granulomas at the site of disease activity. Primary pathologic feature of TB is formation of a granuloma, and chemokines are known to play an important role in the formation of granulomas during infection. Therefore, the aim of this study was to evaluate the serum levels of CCL11, CCL24, and CCL26 in the TB patients in comparison to healthy controls. The population of this cross-sectional study included 300 patients suffering from TB and 100 healthy controls. Concentrations of CCL11, CCL24, and CCL26 were measured by enzyme linked immunosorbent assay (ELISA) technique. The results were analyzed using SPSS software package version 18. Differences were considered significant where p was less than 0.05. The results showed significant elevated serum levels of CCL11, CCL24, and CCL26 in TB patients compared to controls. According to the present results it can be concluded that CCL11, CCL24, and CCL26 (which are produced by Th2 cells and other cells which induce Th2 development) are increased in TB patients; hence, it seems that TB suppresses Th1 and the classic function of macrophages subsequently by inducing the chemokines' expression.

  1. Evaluation of voice disorders in patients with active laryngeal tuberculosis.

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    Marcia Mendonça Lucena

    Full Text Available Laryngeal tuberculosis (LTB is the most frequent larynx granulomatous disease. In general there is lung involvement, but in an important proportion of cases you can find LTB without pulmonary disease. The lesions observed in LTB, such as ulceration and fibrosis, can interfere in the process of voice production. The involvement of the mucous lining of the vocal folds can change their flexibility and, consequently, change voice quality, and the main symptom is dysphonia present in almost 90% of cases.To describe the anatomical characteristics and voice quality in LTB patients.A descriptive cross-sectional study was conducted with 24 patients.The most frequently affected sites were vocal folds in 87.5% patients, vestibular folds in 66.7%, epiglottis in 41.7%, arytenoid in 50%, aryepiglottic folds in 33.3%, and interarytenoid region in 33.3% patients. We found 95.8% cases of dysphonia. The voice acoustic analysis showed 58.3% cases of Jitter alterations, 83.3% of Shimmer and 70.8% of GNE.Voice disorders found in active laryngeal tuberculosis are similar to those reported after clinical healing of the disease, suggesting that sequelae and vocal adjustments may install during the active phase of the disease, negatively impacting the process of vocal quality reestablishment.

  2. Knowledge and practice regarding pulmonary tuberculosis among private practitioners

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    M Basu

    2013-12-01

    Full Text Available Background: India leads the world in its burden of tuberculosis (TB. General practitioners are the backbone of health care system. Objective: To assess the knowledge and practice of the allopathic private practitioners regarding TB. Method: In June 2012– October 2012, a cross-sectional study was conducted in West Bengal, India among 180 private practitioners who treat TB patients; using a self-administered semi-structured questionnaire. Results: About 58.3 % and 56.7 % study population knew full form of RNTCP (Revised National Tuberculosis Control Program and DOTS (Directly Observed Treatment Short Course respectively. The correct modes of transmission were expressed by 75.0 % of them. The most common symptom of TB was rightly answered by 46.7 %. About 43.3 % and 33.3 % replied correctly about number of sputum samples collected and timing of collection. More than half participants knew number of categories and 8.3 % knew categorisation correctly. About 66.7 % could correctly state the names of recommended 1st line anti-TB drugs; frequency of drug administration told correctly by 68.3 %. Very few Private Practitioners (PPs knew treatment regimens correctly for each category. Almost all participants knew that treatment under DOTS was given supervised. About 78.3 % PPs expressed correctly that treatment for TB was given in two phases; the duration of treatment of 6-8 months was stated by 53.3 %. Conclusion: Many gaps were found in the knowledge and practices of PPs regarding Tuberculosis. PPs should be properly trained and sensitized to use RNTCP guidelines.

  3. Biomarkers of Oxidative Stress and Personalized Treatment of Pulmonary Tuberculosis: Emerging Role of Gamma-Glutamyltransferase

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    Etienne Mokondjimobe

    2012-01-01

    Full Text Available Background. The objectives were (i to evaluate the impact of acute pulmonary tuberculosis (PTB and anti-TB therapy on the relationship between AST, ALT, and GGT levels in absence of conditions related to hepatotoxicity; (ii to evaluate the rate and the time of alterations of AST, ALT, and GGT. Design and Methods. A prospective followup of 40 adults (21 males; mean age of 34.7±5.8 years with active PTB on initial phase and continuation phase anti-TB. Results. Only 3% (n=1 developed a transient and benign ADR at day 30 without interruption of anti-TB treatment. Within normal ranges, GGT decreased significantly from day 0 to day 60, while AST and ALT increased significantly and respectively. During day 0–day 60, there was a significant, negative, and independent association between GGT and AST. Conclusion. The initial two months led to significant improvement of oxidative stress. Values of oxidative markers in normal ranges might predict low rate of ADR.

  4. A genome wide association study of pulmonary tuberculosis susceptibility in Indonesians

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    Png Eileen

    2012-01-01

    Full Text Available Abstract Background There is reason to expect strong genetic influences on the risk of developing active pulmonary tuberculosis (TB among latently infected individuals. Many of the genome wide linkage and association studies (GWAS to date have been conducted on African populations. In order to identify additional targets in genetically dissimilar populations, and to enhance our understanding of this disease, we performed a multi-stage GWAS in a Southeast Asian cohort from Indonesia. Methods In stage 1, we used the Affymetrix 100 K SNP GeneChip marker set to genotype 259 Indonesian samples. After quality control filtering, 108 cases and 115 controls were analyzed for association of 95,207 SNPs. In stage 2, we attempted validation of 2,453 SNPs with promising associations from the first stage, in 1,189 individuals from the same Indonesian cohort, and finally in stage 3 we selected 251 SNPs from this stage to test TB association in an independent Caucasian cohort (n = 3,760 from Russia. Results Our study suggests evidence of association (P = 0.0004-0.0067 for 8 independent loci (nominal significance P JAG1, DYNLRB2, EBF1, TMEFF2, CCL17, HAUS6, PENK and TXNDC4. Conclusions Mechanisms of immune defense suggested by some of the identified genes exhibit biological plausibility and may suggest novel pathways involved in the host containment of infection with TB.

  5. Co-endemicity of Pulmonary Tuberculosis and Intestinal Helminth Infection in the People's Republic of China.

    Science.gov (United States)

    Li, Xin-Xu; Ren, Zhou-Peng; Wang, Li-Xia; Zhang, Hui; Jiang, Shi-Wen; Chen, Jia-Xu; Wang, Jin-Feng; Zhou, Xiao-Nong

    2016-03-01

    Both pulmonary tuberculosis (PTB) and intestinal helminth infection (IHI) affect millions of individuals every year in China. However, the national-scale estimation of prevalence predictors and prevalence maps for these diseases, as well as co-endemic relative risk (RR) maps of both diseases' prevalence are not well developed. There are co-endemic, high prevalence areas of both diseases, whose delimitation is essential for devising effective control strategies. Bayesian geostatistical logistic regression models including socio-economic, climatic, geographical and environmental predictors were fitted separately for active PTB and IHI based on data from the national surveys for PTB and major human parasitic diseases that were completed in 2010 and 2004, respectively. Prevalence maps and co-endemic RR maps were constructed for both diseases by means of Bayesian Kriging model and Bayesian shared component model capable of appraising the fraction of variance of spatial RRs shared by both diseases, and those specific for each one, under an assumption that there are unobserved covariates common to both diseases. Our results indicate that gross domestic product (GDP) per capita had a negative association, while rural regions, the arid and polar zones and elevation had positive association with active PTB prevalence; for the IHI prevalence, GDP per capita and distance to water bodies had a negative association, the equatorial and warm zones and the normalized difference vegetation index had a positive association. Moderate to high prevalence of active PTB and low prevalence of IHI were predicted in western regions, low to moderate prevalence of active PTB and low prevalence of IHI were predicted in north-central regions and the southeast coastal regions, and moderate to high prevalence of active PTB and high prevalence of IHI were predicted in the south-western regions. Thus, co-endemic areas of active PTB and IHI were located in the south-western regions of China, which

  6. Co-endemicity of Pulmonary Tuberculosis and Intestinal Helminth Infection in the People's Republic of China.

    Directory of Open Access Journals (Sweden)

    Xin-Xu Li

    2016-03-01

    Full Text Available Both pulmonary tuberculosis (PTB and intestinal helminth infection (IHI affect millions of individuals every year in China. However, the national-scale estimation of prevalence predictors and prevalence maps for these diseases, as well as co-endemic relative risk (RR maps of both diseases' prevalence are not well developed. There are co-endemic, high prevalence areas of both diseases, whose delimitation is essential for devising effective control strategies. Bayesian geostatistical logistic regression models including socio-economic, climatic, geographical and environmental predictors were fitted separately for active PTB and IHI based on data from the national surveys for PTB and major human parasitic diseases that were completed in 2010 and 2004, respectively. Prevalence maps and co-endemic RR maps were constructed for both diseases by means of Bayesian Kriging model and Bayesian shared component model capable of appraising the fraction of variance of spatial RRs shared by both diseases, and those specific for each one, under an assumption that there are unobserved covariates common to both diseases. Our results indicate that gross domestic product (GDP per capita had a negative association, while rural regions, the arid and polar zones and elevation had positive association with active PTB prevalence; for the IHI prevalence, GDP per capita and distance to water bodies had a negative association, the equatorial and warm zones and the normalized difference vegetation index had a positive association. Moderate to high prevalence of active PTB and low prevalence of IHI were predicted in western regions, low to moderate prevalence of active PTB and low prevalence of IHI were predicted in north-central regions and the southeast coastal regions, and moderate to high prevalence of active PTB and high prevalence of IHI were predicted in the south-western regions. Thus, co-endemic areas of active PTB and IHI were located in the south-western regions of

  7. Mycobacterium tuberculosis strains exhibit differential and strain-specific molecular signatures in pulmonary epithelial cells.

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    Mvubu, Nontobeko Eunice; Pillay, Balakrishna; Gamieldien, Junaid; Bishai, William; Pillay, Manormoney

    2016-12-01

    Although pulmonary epithelial cells are integral to innate and adaptive immune responses during Mycobacterium tuberculosis infection, global transcriptomic changes in these cells remain largely unknown. Changes in gene expression induced in pulmonary epithelial cells infected with M. tuberculosis F15/LAM4/KZN, F11, F28, Beijing and Unique genotypes were investigated by RNA sequencing (RNA-Seq). The Illumina HiSeq 2000 platform generated 50 bp reads that were mapped to the human genome (Hg19) using Tophat (2.0.10). Differential gene expression induced by the different strains in infected relative to the uninfected cells was quantified and compared using Cufflinks (2.1.0) and MeV (4.0.9), respectively. Gene expression varied among the strains with the total number of genes as follows: F15/LAM4/KZN (1187), Beijing (1252), F11 (1639), F28 (870), Unique (886) and H37Rv (1179). A subset of 292 genes was commonly induced by all strains, where 52 genes were down-regulated while 240 genes were up-regulated. Differentially expressed genes were compared among the strains and the number of induced strain-specific gene signatures were as follows: F15/LAM4/KZN (138), Beijing (52), F11 (255), F28 (55), Unique (186) and H37Rv (125). Strain-specific molecular gene signatures associated with functional pathways were observed only for the Unique and H37Rv strains while certain biological functions may be associated with other strain signatures. This study demonstrated that strains of M. tuberculosis induce differential gene expression and strain-specific molecular signatures in pulmonary epithelial cells. Specific signatures induced by clinical strains of M. tuberculosis can be further explored for novel host-associated biomarkers and adjunctive immunotherapies.

  8. Serum PCT and its Relation to Body Weight Gain in Pulmonary Tuberculosis.

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    Rohini, K; Bhat, Surekha; Srikumar, P S; Mahesh Kumar, A

    2015-07-01

    The present study was aimed at assessing alterations in serum PCT in terms of its relation to body weight gain in pulmonary tuberculosis (PTB) patients undergoing treatment. Among patients (25-75 years) diagnosed with pulmonary tuberculosis, those that were new smear positive, showed sputum conversion at the end of 2 months and were declared clinically cured at the end of 6 months, were included in the study (n = 40). Serum procalcitonin was determined by BRAHMS PCT-Q kit. Patients were divided into two study groups-Group 1 (n = 21; serum PCT > 2 ng/ml at diagnosis), Group 2 (n = 19; serum PCT > 10 ng/ml at diagnosis). Body weights of all patients were obtained at three different time points, PTB-0 (at diagnosis), PTB-2 (after 2 months of intensive treatment) and PTB-6 (after 6 months of treatment). In both groups, mean body weights at PTB-2 and PTB-6 were significantly higher than those at PTB-0 and at PTB-6 were significantly higher than those at PTB-2. However, percentage body weight gain following 2 months of intensive treatment was higher in group 1 (4.05 % gain, p < 0.01) than in group 2 (2.75 % body weight gain, p < 0.05). Thus, the percentage gain in group 1 was tending more towards the desirable minimum gain of 5 % during intensive phase. Increase in serum PCT levels in pulmonary tuberculosis is inversely associated with body weight gain during treatment. Thus, PCT could play a role in regulation of body weight gain in anorectic conditions like tuberculosis.

  9. Secondary renal amyloidosis in a patient of pulmonary tuberculosis and common variable immunodeficiency

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    Balwani Manish R

    2015-04-01

    Full Text Available Common variable immunodeficiency (CVID usually manifests in the second or third decade of life with recurrent bacterial infections and hypoglobulinemia. Secondary renal amyloidosis with history of pulmonary tuberculosis is rare in CVID, although T cell dysfunction has been reported in few CVID patients. A 40-year-old male was admitted to our hospital with a 3-month history of recurrent respiratory infections and persistent pitting pedal edema. His past history revealed 3 to 5 episodes of recurrent respiratory tract infections and diarrhoea each year since last 20 years. He had been successfully treated for sputum positive pulmonary tuberculosis 8 years back. Laboratory studies disclosed high erythrocyte sedimentation rate (ESR, hypoalbuminemia and nephrotic range proteinuria. Serum immunoglobulin levels were low. CD4/CD8 ratio and CD3 level was normal. C3 and C4 complement levels were normal. Biopsy revealed amyloid A (AA positive secondary renal amyloidosis. Glomeruli showed variable widening of mesangial regions with deposition of periodic schiff stain (PAS pale positive of pink matrix showing apple green birefringence on Congo-red staining. Immunohistochemistry was AA stain positive. Immunofluorescence microscopy revealed no staining with anti-human IgG, IgM, IgA, C3, C1q, kappa and lambda light chains antisera. Patient was treated symptomatically for respiratory tract infection and was discharged with low dose angiotensin receptor blocker. An old treated tuberculosis and chronic inflammation due to recurrent respiratory tract infections were thought to be responsible for AA amyloidosis. Thus pulmonary tuberculosis should be considered in differential diagnosis of secondary causes of AA renal amyloidosis in patients of CVID especially in endemic settings.

  10. Isoniazid Mono-Resistant Tuberculosis: Impact on Treatment Outcome and Survival of Pulmonary Tuberculosis Patients in Southern Mexico 1995-2010

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    Báez-Saldaña, Renata; Delgado-Sánchez, Guadalupe; García-García, Lourdes; Cruz-Hervert, Luis Pablo; Montesinos-Castillo, Marlene; Ferreyra-Reyes, Leticia; Bobadilla-del-Valle, Miriam; Canizales-Quintero, Sergio; Ferreira-Guerrero, Elizabeth; Téllez-Vázquez, Norma; Montero-Campos, Rogelio; Yanes-Lane, Mercedes; Mongua-Rodriguez, Norma; Martínez-Gamboa, Rosa Areli; Sifuentes-Osornio, José

    2016-01-01

    Background Isoniazid mono-resistance (IMR) is the most common form of mono-resistance; its world prevalence is estimated to range between 0.0 to 9.5% globally. There is no consensus on how these patients should be treated. Objective To describe the impact of IMR tuberculosis (TB) on treatment outcome and survival among pulmonary TB patients treated under programmatic conditions in Orizaba, Veracruz, Mexico. Materials and Methods We conducted a prospective cohort study of pulmonary TB patients...

  11. Molecular detection of multidrug-resistant tuberculosis among smear-positive pulmonary tuberculosis patients in Jigjiga town, Ethiopia

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    Brhane, Mussie; Kebede, Ameha; Petros, Yohannes

    2017-01-01

    Background Molecular methods that target drug resistance mutations are suitable approaches for rapid drug susceptibility testing to detect multidrug-resistant tuberculosis (MDR-TB). The aim of the study was to determine MDR-TB cases and to analyze the frequency of gene mutations associated with rifampicin (RIF) and/or isoniazid (INH) resistance of Mycobacterium tuberculosis among smear-positive pulmonary tuberculosis patients. Methods Institution-based cross-sectional study design was employed. Sputum specimens were collected, and using a pretested questionnaire, data for associated risk factors for drug resistance were collected from 105 consecutive smear-positive pulmonary tuberculosis patients in Karamara General Hospital. Specimens were transported to Harar Health Research and Regional Laboratory, Harar, where molecular drug susceptibility testing was performed using GenoType® MTBDRplus assay. Results Of the total 105 sputum specimens, 98 (93.3%) gave interpretable results, in which 67 (68.4%) were new cases and 31 (31.6%) were previously treated cases. Of these, 80 (81.6%) were sensitive to both drugs and 18 (18.4%) were resistant to RIF and/or INH. The prevalences of MDR-TB in total cases, new, and previously treated cases were 10 (10.2%), 3 (4.5%), and 7 (22.6%), respectively. Among the ten total RIF-resistant specimens, eight (80%) had resulted because of absence of rpoB WT8 and presence of MUT3 and in all specimens, the amino acids changed were Ser531Lue. Of the 18 total INH-resistant specimens, 15 (83.3%) had mutations in the katG gene (katG MUT1, Ser315Thr1), indicating high-level resistance, while 3 (14.7%) had mutations in the inhA promoter gene (Cys15Thr), indicating low-level resistance. Conclusion Among the mutations associated with resistance to RIF and INH, the majority were in codon 531 of the rpoB gene and codon 315 of the katG gene. Relatively high prevalence of MDR-TB was observed in the study.

  12. Mannose-Binding Lectin Promoter Polymorphisms and Gene Variants in Pulmonary Tuberculosis Patients from Cantabria (Northern Spain

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    J.-Gonzalo Ocejo-Vinyals

    2012-01-01

    Full Text Available Mannose-binding lectin is a central molecule of the innate immune system. Mannose-binding lectin 2 promoter polymorphisms and structural variants have been associated with susceptibility to tuberculosis. However, contradictory results among different populations have been reported, resulting in no convincing evidence of association between mannose-binding lectin 2 and susceptibility to tuberculosis. For this reason, we conducted a study in a well genetically conserved Spanish population in order to shed light on this controversial association. We analysed the six promoter and structural mannose-binding lectin 2 gene variants in 107 patients with pulmonary tuberculosis and 441 healthy controls. Only D variant and HYPD haplotype were significantly more frequents in controls which would indicate that this allele could confer protection against pulmonary tuberculosis, but this difference disappeared after statistical correction. Neither the rest of alleles nor the haplotypes were significantly associated with the disease. These results would indicate that mannose-binding lectin promoter polymorphisms and gene variants would not be associated with an increased risk to pulmonary tuberculosis. Despite the slight trend of the D allele and HYPD haplotype in conferring protection against pulmonary tuberculosis, susceptibility to this disease would probably be due to other genetic factors, at least in our population.

  13. Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

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    Getinet Shewaseged Adenager

    2017-01-01

    Full Text Available Background. Early detection and diagnosis of tuberculosis (TB and the timely commencement of antituberculosis (anti-TB treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%, 233 (54.8%, and 262 (61.6% of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1–2.5] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70] and [AOR = 0.61 (0.39, 0.94], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care.

  14. Predicting smear negative pulmonary tuberculosis with classification trees and logistic regression: a cross-sectional study

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    Kritski Afrânio

    2006-02-01

    Full Text Available Abstract Background Smear negative pulmonary tuberculosis (SNPT accounts for 30% of pulmonary tuberculosis cases reported yearly in Brazil. This study aimed to develop a prediction model for SNPT for outpatients in areas with scarce resources. Methods The study enrolled 551 patients with clinical-radiological suspicion of SNPT, in Rio de Janeiro, Brazil. The original data was divided into two equivalent samples for generation and validation of the prediction models. Symptoms, physical signs and chest X-rays were used for constructing logistic regression and classification and regression tree models. From the logistic regression, we generated a clinical and radiological prediction score. The area under the receiver operator characteristic curve, sensitivity, and specificity were used to evaluate the model's performance in both generation and validation samples. Results It was possible to generate predictive models for SNPT with sensitivity ranging from 64% to 71% and specificity ranging from 58% to 76%. Conclusion The results suggest that those models might be useful as screening tools for estimating the risk of SNPT, optimizing the utilization of more expensive tests, and avoiding costs of unnecessary anti-tuberculosis treatment. Those models might be cost-effective tools in a health care network with hierarchical distribution of scarce resources.

  15. Consultations of health service providers amongst patients of pulmonary tuberculosis from an urban area

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    Geeta S. Pardeshi

    2008-11-01

    Full Text Available Aims: To describe the number, types and reasons of consultations amongst patients of pulmonary tuberculosis from an urban area. Settings and Design Cross sectional study was conducted amongst new patients of pulmonary tuberculosis initiated on DOTS at District Tuberculosis Centre (DTC, Yavatmal from January to June 2006. Material and Methods: The data regarding consultations were collected along a time line. The reasons for consultations were studied by in-depth interviews. Statistical analysis: Logistic regression analysis and transcripts of interviews. Results and Conclusions A total of 55 patients were studied in whom median duration between first consultation to treatment initiation was 15 days. A majority of cases (87.27% had first consulted a private practitioner. A total of 32 patients reported more than two consultations and 19 had consulted more than two private health service providers. Amongst the movements between consultations, a majority were from private to government. Only four patients had come to DTC without any prior consultation. Many patients came to government health service provider on their own when the symptomatic treatment prescribed by the private practitioners did not relieve their symptoms.

  16. Plasma drug activity assay for treatment optimization in tuberculosis patients.

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    Heysell, Scott K; Mtabho, Charles; Mpagama, Stellah; Mwaigwisya, Solomon; Pholwat, Suporn; Ndusilo, Norah; Gratz, Jean; Aarnoutse, Rob E; Kibiki, Gibson S; Houpt, Eric R

    2011-12-01

    Low antituberculosis (TB) drug levels are common, but their clinical significance remains unclear, and methods of measurement are resource intensive. Subjects initiating treatment for sputum smear-positive pulmonary TB were enrolled from Kibong'oto National TB Hospital, Tanzania, and levels of isoniazid, rifampin, ethambutol, and pyrazinamide were measured at the time of typical peak plasma concentration (C(2 h)). To evaluate the significance of the effect of observed drug levels on Mycobacterium tuberculosis growth, a plasma TB drug activity (TDA) assay was developed using the Bactec MGIT system. Time to detection of plasma-cocultured M. tuberculosis versus time to detection of control growth was defined as a TDA ratio. TDA assays were later performed using the subject's own M. tuberculosis isolate and C(2 h) plasma from the Tanzanian cohort and compared to drug levels and clinical outcomes. Sixteen subjects with a mean age of 37.8 years ± 10.7 were enrolled. Fourteen (88%) had C(2 h) rifampin levels and 11 (69%) had isoniazid levels below 90% of the lower limit of the expected range. Plasma spiked with various concentrations of antituberculosis medications found TDA assay results to be unaffected by ethambutol or pyrazinamide. Yet with a range of isoniazid and rifampin concentrations, TDA exhibited a statistically significant correlation with drug level and drug MIC, and a TDA of ~1.0 indicated the presence of multidrug-resistant TB. In Tanzania, low (≤ 2.0) TDA was significantly associated with both lower isoniazid and rifampin C(2 h) levels, and very low (≤ 1.5) TDA corresponded to a trend toward lack of cure. Study of TDA compared to additional clinical outcomes and as a therapeutic management tool is warranted.

  17. Clinical features of 203 infants with pulmonary tuberculosis%婴儿肺结核203例临床特征分析

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    龚春竹; 朱朝敏

    2014-01-01

    Objectives To summarize the clinical features and relevant factors of 203 cases with infantile pulmonary tuberculosis. Methods Clinical data of 203 infantile with pulmonary tuberculosis were retrospectively reviewed. Results Among 203 infants, 127 (62.6%) were from country, 76 (37.4%) from city;64.5%of city infants have received BCG vaccination, which is higher than 46.5%in country infants;78 cases (38.4%) have clear evidence for active tuberculosis exposure, 26 cases (12.8%) have suspicious tuberculosis exposure;175 cases (86.2%) have fever, 165 cases (81.3%) have respiratory symptoms, 107 cases (52.7%) have pulmonary signs, 80 cases (39.4%) have hepatosplenomegaly;Etiology was conifrmed in 91 cases (44.8%);54.7%of patients were found with concurrent extrapulmonary tuberculosis, and the most commonly seen was formis tuberculous meningitis. In this study, the misdiagnosis rate is 39.9%, and 84.0%patients were often misdiagnosed as bronchial pneumonia;Vaccinated BCG rate is lower in infants with severe tuberculosis (44.83%) than that of infants with mild tuberculosis (74.14%). Conclusions Infantile pulmonary tuberculosis is featured with acute onset, severe clinical performance and easily complicated with extrapulmonary tuberculosis, atypical clinical performance, and high misdiagnosed rate which needs early detection and diagnosis. Unvaccinated BCG and active tuberculosis exposure were important clues for the diagnosis of infantile pulmonary tuberculosis.%目的:总结分析婴儿肺结核的临床特点及相关因素。方法回顾性分析2001年至2011年收治的203例婴儿肺结核的临床资料。结果203例住院肺结核患儿中,来自农村127例(62.56%),城市76例(37.44%);城市患儿BCG接种率(64.47%)高于农村(46.46%),差异有统计学意义(P<0.05)。有明确活动性肺结核接触史78例(38.42%),可疑结核接触史26例(12.81%);临床表现发热175例(86.21%),呼吸道症状165例(81.28%),有肺部体征107例(52

  18. Molecular diversity of Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in Mozambique

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    Hill Véronique

    2010-07-01

    Full Text Available Abstract Background Mozambique is one of the countries with the highest burden of tuberculosis (TB in Sub-Saharan Africa, and information on the predominant genotypes of Mycobacterium tuberculosis circulating in the country are important to better understand the epidemic. This study determined the predominant strain lineages that cause TB in Mozambique. Results A total of 445 M. tuberculosis isolates from seven different provinces of Mozambique were characterized by spoligotyping and resulting profiles were compared with the international spoligotyping database SITVIT2. The four most predominant lineages observed were: the Latin-American Mediterranean (LAM, n = 165 or 37%; the East African-Indian (EAI, n = 132 or 29.7%; an evolutionary recent but yet ill-defined T clade, (n = 52 or 11.6%; and the globally-emerging Beijing clone, (n = 31 or 7%. A high spoligotype diversity was found for the EAI, LAM and T lineages. Conclusions The TB epidemic in Mozambique is caused by a wide diversity of spoligotypes with predominance of LAM, EAI, T and Beijing lineages.

  19. Molecular analysis of Rv0679c and Rv0180c genes of Mycobacterium tuberculosis from clinical isolates of pulmonary tuberculosis

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    L Rupa

    2016-01-01

    Full Text Available Context: Two novel proteins/genes Rv0679c and Rv0180c of Mycobacterium tuberculosis (MTB H37Rv were classified as a hypothetical membrane and transmembrane proteins which might have a role in the invasion. Molecular analysis of these genes in human clinical isolates of pulmonary tuberculosis (PTB patients was not well characterised. Aims: To assess the molecular diversity of Rv0679c and Rv0180c genes of MTB from clinical isolates of PTB patients. Settings and Design: DNA from 97 clinical isolates was extracted and subjected to amplification using selective primers by polymerase chain reaction (PCR. The PCR product obtained was sequenced commercially. Patients and Methods: Clinical isolates obtained from tuberculosis patients were investigated for polymorphisms in the Rv0679c and Rv0180c genes by PCR and DNA sequencing. Genomic DNA isolated by cetyltrimethylammonium bromide method was used for amplification of genes. Results: Rv0679c gene was highly conserved in 61 out of 65 clinical isolates assessed for sequence homology with wild-type H37Rv gene and was identical using ClustalW. Fifty-five out of 78 (70.5% clinical isolates assessed for Rv0180c were positive for single nucleotide polymorphism (SNP at 258th position where the nucleotide G was replaced with T (G to T. In clinical isolates of untreated cases, the frequency was 54.5% for SNP at 258th position which is low compared to cases undergoing treatment where the frequency was 73.1%. Conclusions: Molecular analysis of Rv0180c in clinical isolates of PTB assessed in this study was the first report, where an SNP at 258th position G to T was identified within the gene. Rv0679c gene was highly conserved (94%, within Indian clinical isolates as compared to reports from other nations.

  20. Causes of Delay in Diagnosis of Smear-Positive Pulmonary Tuberculosis Patients Referred to the Tuberculosis Center of Zahedan

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    Mosayeb Shahriyar

    2012-08-01

    Full Text Available Background: Tuberculosis is now the major cause of mortality in the world. This study has tried to identify the factors affecting the diagnosis of this disease by determining the relationship between delay in diagnosis and factors associated with patient and health system.Materials and Methods: This research was a cross-sectional study conducted on smear positive pulmonary tuberculosis patients referred to the tuberculosis center in the first half of 2008. Required information was completed through patient records and patient interviews.Results: A total 98 patients were studied including 42 males and 56 females. Average age of patients was 51.6±19.57. Average delay in diagnosis was 2.8±1.78 months. The average delay of patients and health system was respectively 2.6±1.76 months and 6±4.27days. Data analysis showed that there is no relationship between the delay in diagnosis and individual variables such as age, gender, occupation, etc., and examination of sputum smears at the first visit. However, there is a significant relationship between patient delay with different factors such as education (p=0.03, marital status (p=0.03, existence of hospital or medical centers in the residence (p=0.02, distance to the medical center (p=0.02 and between health system delay and residence in the city (p=0.01, distance to this medical center (p=0.03 and obtaining chest X-ray (CXR in the first visit (p=0.003.Conclusion: The results showed that with the increase of literacy, the establishment of new hospitals and health centers in remote areas and suburbs as well as chest X-ray in the first visit, the amount of delay in diagnosis can be reduced.

  1. Community-acquired Tsukamurella pneumonia in a young immunocompetent adult: a case misdiagnosed as pulmonary tuberculosis and literature review.

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    Yang, LiKun; Cao, Yan; Dan, Zijun; Wang, Zhongyuan; Wang, Xinjing

    2017-08-01

    This report describes a case of Tsukamurella pneumonia in a 24-year-old immunocompetent woman. The patient was diagnosed as having pulmonary tuberculosis and was treated for nearly 9 months. The correct diagnosis was suspected only when the results of mycobacteria nucleic acid amplification tests on cultural colonies were negative. Tsukamurella was identified from the patient's sputum and bronchoalveolar lavage fluid by using 16S rRNA sequence analysis. Here, the clinical presentation, diagnosis, and treatment strategies of Tsukamurella pneumonia are discussed, along with a literature review. Tsukamurella pneumonia may be highly underdiagnosed owing to its similarity with pulmonary tuberculosis and the habitual thinking of doctors in countries with a high tuberculosis burden. Tsukamurella should be carefully considered in the etiology of tuberculosis-like lung diseases.

  2. Primary drug resistance among pulmonary treatment-naïve tuberculosis patients in Amazonas State, Brazil.

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    da Silva Garrido, M; Ramasawmy, R; Perez-Porcuna, T M; Zaranza, E; Chrusciak Talhari, A; Martinez-Espinosa, F E; Bührer-Sékula, S

    2014-05-01

    Multidrug-resistant tuberculosis (MDR-TB) is the main indicator of previous treatment in tuberculosis (TB) patients. MDR-TB among treatment-naïve patients indicates infection with drug-resistant Mycobacterium tuberculosis strains, and such cases are considered primary drug-resistant cases. To estimate the prevalence of drug resistance in pulmonary TB (PTB) treatment-naïve patients and to identify the socio-demographic and clinical characteristics of the resistant population. A total of 205 treatment-naïve PTB patients from Manaus, Amazonas State, Brazil, were enrolled. Drug susceptibility testing (DST) was performed on all positive mycobacterial cultures using the 1% proportion method. Positive M. tuberculosis cultures were obtained from only 175 patients for DST. The prevalence of primary MDR-TB was 1.7% (3/175); 14.3% (25/175) of the cultures presented resistance to at least one of the drugs. Resistance to streptomycin, isoniazid, rifampicin and ethambutol was respectively 8.6%, 6.9%, 3.4% and 2.3%. An association between TB patients with resistance to more than one drug and known previous household contact with a TB patient was observed (P= 0.008, OR 6.7, 95%CI 1.2-67.3). Although the prevalence of primary MDR-TB currently is relatively low, it may become a major public health problem if tailored treatment is not provided, as resistance to more than one drug is significantly associated with household contact.

  3. Epidemiological aspects of pulmonary tuberculosis in Mato Grosso do Sul, Brazil

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    Antonio Flavio Ferraz

    2014-03-01

    Full Text Available OBJECTIVE: To describe the profile and analyze the cases of pulmonary tuberculosis reported in the state of Mato Grosso do Sul from 2001 to 2009, according to the chosen variable categories (gender, age, ethnicity, education, residing in the border area, indigenous population and individuals deprived of liberty. METHODS: An ecological study was conducted from data of reported cases of TB. RESULTS: Estimates of risk higher than the general population, and even extremely high, were obtained in three specific populations, which certainly requires priority attention from health policies and health network professionals to keep the transmission of tuberculosis under control, including in the population residing in the borders with Bolivia and Paraguay, the indigenous population and individuals deprived of liberty. CONCLUSIONS: This study sought to show the importance of discussing territoriality more adequately in Brazil. A continuous reevaluation of all health programs is needed for populations in each of the areas where they live. Then, it will be possible to correct the incidence rate of tuberculosis for specific populations in the state, taking into account populations in each place of residence and considering their specificities and differences. In conclusion, in the light of the present study, it is necessary to discuss more efficient strategies to control tuberculosis in the various territories of the state of Mato Grosso do Sul if we actually want to minimize this endemic to acceptable levels in our environment.

  4. Evaluation of drug resistance in pulmonary tuberculosis patients at Sureyyapasa Chest Diseases Hospital, Istanbul, Turkey.

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    Karagoz, T; Pazarli, P; Mocin, O Y; Duman, D; Duman, G; Salturk, C; Unal, O

    2008-06-01

    Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey. To determine levels of Mycobacterium tuberculosis resistance to first-line drugs in patients with pulmonary tuberculosis (PTB). Between 1 January and 31 December 2005, all hospitalised PTB patients with culture-positive M. tuberculosis specimens and corresponding drug susceptibility tests (DST) for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol, routinely performed for every tuberculosis (TB) case at our centre, were included. Of a total of 1513 cases, 1277 (84.4%) were new and 236 (15.6%) were previously treated cases. Of the 1513 isolates, 290 (19%) isolates were resistant to at least one of the drugs tested. Resistance among new and previously treated cases was respectively 16.3% (209 of 1277) and 34.3% (81/236). Any SM resistance and any INH resistance were the most common drug resistance in new cases, while any RMP resistance was the most common drug resistance in previously treated cases. Multidrug resistance was detected in 3.2% (n = 41) of new cases and in 13.5% (n = 32) of previously treated cases. Planning for TB control requires an assessment of the number and distribution of drug-resistant cases, with laboratories providing accurate and reliable results.

  5. Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus

    Institute of Scientific and Technical Information of China (English)

    Lei Pan; Zhan-Sheng Jia; Lin Chen; En-Qing Fu; Guang-Yu Li

    2005-01-01

    AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of antituberculosis.METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded.RESULTS: The rate of hepatotoxicity occurred in 26 (59%)TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P<0.01).CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.

  6. Pulmonary tuberculosis in Asian elephants (Elephas maximus): histologic lesions with correlation to local immune responses.

    Science.gov (United States)

    Landolfi, J A; Terio, K A; Miller, M; Junecko, B F; Reinhart, T

    2015-05-01

    Although Mycobacterium tuberculosis infection is an important health concern for Asian elephants (Elephas maximus), no studies have evaluated the associated local immune responses or histologic lesions. In primates including humans, latent tuberculosis is distinguished by well-organized granulomas with TH1 cytokine expression, whereas active disease is characterized by poorly organized inflammation and local imbalance in TH1/TH2 cytokines. This study examined archival, formalin-fixed, paraffin-embedded lung samples from 5 tuberculosis-negative and 9 tuberculosis-positive Asian elephants. Lesions were assessed by light microscopy, and lymphoid infiltrates were characterized by CD3 and CD20 immunolabeling. Expression of TH1 (interferon [IFN]-γ, tumor necrosis factor [TNF]-α) and TH2 (interleukin [IL]-4, IL-10, transforming growth factor [TGF]-β) cytokines was determined using in situ hybridization. In 6 of 9 samples, inflammation was similar to the pattern of primate active disease with low to moderate numbers of lymphocytes, most of which were CD20 positive. In 1 sample, inflammation was most similar to latent tuberculosis in primates with numerous CD3-positive lymphocytes. Expression of IFN-γ was detected in 3 of 8 tuberculosis-positive samples. Expression of TNF-α was detected in 3 of 8 positive samples, including the one with latent morphology. Low-level expression of IL-4 was present in 4 of 8 positive samples. Only single positive samples displayed expression of IL-10 and TGF-β. Tuberculosis-negative samples generally lacked cytokine expression. Results showed heterogeneity in lesions of elephant tuberculosis similar to those of latent and active disease in primates, with variable expression of both TH1 and TH2 cytokines.

  7. Influence of the 2009 financial crisis on detection of advanced pulmonary tuberculosis in Osaka city, Japan: a cross-sectional study

    OpenAIRE

    Danno, Katsura; Komukai, Jun; Yoshida, Hideki; Matsumoto, Kenji; Koda, Shinichi; Terakawa, Kazuhiko; Iso, Hiroyasu

    2013-01-01

    Objective To investigate the association between the economic recession and the detection of advanced cases of pulmonary tuberculosis in Osaka city from 2007 to 2009. Design A repeated cross-sectional study. Setting Osaka city has been the highest tuberculosis burden area in Japan. After the previous global financial crisis, the unemployment rate in Osaka prefecture has deteriorated from 5.3% in 2008 to 6.6% in 2009. Participants During the study period, 3406 pulmonary tuberculosis cases were...

  8. Nontuberculous mycobacteria in respiratory samples from patients with pulmonary tuberculosis in the state of Rondonia, Brazil

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    Cleoni Alves Mendes de Lima

    2013-06-01

    Full Text Available The main cause of pulmonary tuberculosis (TB is infection with Mycobacterium tuberculosis (MTB. We aimed to evaluate the contribution of nontuberculous mycobacteria (NTM to pulmonary disease in patients from the state of Rondônia using respiratory samples and epidemiological data from TB cases. Mycobacterium isolates were identified using a combination of conventional tests, polymerase chain reaction-based restriction enzyme analysis of hsp65 gene and hsp65 gene sequencing. Among the 1,812 cases suspected of having pulmonary TB, 444 yielded bacterial cultures, including 369 cases positive for MTB and 75 cases positive for NTM. Within the latter group, 14 species were identified as Mycobacterium abscessus, Mycobacterium avium, Mycobacterium fortuitum, Mycobacterium intracellulare, Mycobacterium gilvum, Mycobacterium gordonae, Mycobacterium asiaticum, Mycobacterium tusciae, Mycobacterium porcinum, Mycobacterium novocastrense, Mycobacterium simiae, Mycobacterium szulgai, Mycobacterium phlei and Mycobacterium holsaticum and 13 isolates could not be identified at the species level. The majority of NTM cases were observed in Porto Velho and the relative frequency of NTM compared with MTB was highest in Ji-Paraná. In approximately half of the TB subjects with NTM, a second sample containing NTM was obtained, confirming this as the disease-causing agent. The most frequently observed NTM species were M. abscessus and M. avium and because the former species is resistant to many antibiotics and displays unsatisfactory cure rates, the implementation of rapid identification of mycobacterium species is of considerable importance.

  9. Evidence from Chile that arsenic in drinking water may increase mortality from pulmonary tuberculosis.

    Science.gov (United States)

    Smith, Allan H; Marshall, Guillermo; Yuan, Yan; Liaw, Jane; Ferreccio, Catterina; Steinmaus, Craig

    2011-02-15

    Arsenic in drinking water causes increased mortality from several cancers, ischemic heart disease, bronchiectasis, and other diseases. This paper presents the first evidence relating arsenic exposure to pulmonary tuberculosis, by estimating mortality rate ratios for Region II of Chile compared with Region V for the years 1958-2000. The authors compared mortality rate ratios with time patterns of arsenic exposure, which increased abruptly in 1958 in Region II and then declined starting in 1971. Tuberculosis mortality rate ratios in men started increasing in 1968, 10 years after high arsenic exposure commenced. The peak male 5-year mortality rate ratio occurred during 1982-1986 (rate ratio = 2.1, 95% confidence interval: 1.7, 2.6; P cause of chronic lung disease. Finding weaker associations in women is unsurprising, because this is true of most arsenic-caused health effects. Confirmatory evidence is needed from other arsenic-exposed populations.

  10. Pulmonary tuberculosis presenting as post-operative fever of unknown origin.

    Science.gov (United States)

    Bogue, Patrick; Bolland, Mhairi; How, Peter; Benziger, Harrison

    2017-01-06

    Post-operative fever is common following emergency surgery. Investigation and management of post-operative fever can be challenging when a clear source of sepsis is not evident or the underlying source of infection is not recognised. We herein report a case of secondary pulmonary tuberculosis presenting as post-operative fever following emergency laparotomy for a perforated duodenal ulcer. This case of tuberculosis was diagnosed on day 41 post-operatively and prior inconclusive results meant that we relied mainly on re-visiting history and examination in order to identify 3 targeted investigations: plain chest X-ray, sputum sample and blood test. Accordingly, the co-management of this complex patient achieved a good outcome. 2017 BMJ Publishing Group Ltd.

  11. Active case finding of tuberculosis in Europe: a Tuberculosis Network European Trials Group (TBNET) survey

    DEFF Research Database (Denmark)

    Bothamley, G H; Ditiu, L; Migliori, G B

    2008-01-01

    Tuberculosis control depends on successful case finding and treatment of individuals infected with Mycobacterium tuberculosis. Passive case finding is widely practised: the present study aims to ascertain the consensus and possible improvements in active case finding across Europe. Recommendations...... from national guidelines were collected from 50 countries of the World Health Organization European region using a standard questionnaire. Contacts are universally screened for active tuberculosis and latent tuberculosis infection (LTBI). Most countries (>70%) screen those with HIV infection, prisoners...... and in-patient contacts. Screening of immigrants is related to their contribution to national rates of tuberculosis. Only 25 (50%) out of 50 advise a request for symptoms in their guidelines. A total of 36 (72%) out of 50 countries recommend sputum examination for those with a persistent cough; 13...

  12. Experience of active tuberculosis case finding in nearly 5 million households in India

    Science.gov (United States)

    Satyanarayana, S.; Chadha, S. S.; Das, A.; Thapa, B.; Mohanty, S.; Pandurangan, S.; Babu, E. R.; Tonsing, J.; Sachdeva, K. S.

    2016-01-01

    In India, to increase tuberculosis (TB) case detection under the National Tuberculosis Programme, active case finding (ACF) was implemented by the Global Fund-supported Project Axshya, among high-risk groups in 300 districts. Between April 2013 and December 2014, 4.9 million households covering ~20 million people were visited. Of 350 047 presumptive pulmonary TB cases (cough of ⩾2 weeks) identified, 187 586 (54%) underwent sputum smear examination and 14 447 (8%) were found to be smear-positive. ACF resulted in the detection of a large number of persons with presumptive pulmonary TB and smear-positive TB. Ensuring sputum examination of all those with presumptive TB was a major challenge. PMID:27051605

  13. Diagnostic value of symptom screening for pulmonary tuberculosis in China.

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    Jun Cheng

    Full Text Available To evaluate the diagnostic value of symptom screening for tuberculosis (TB case finding defined in National Tuberculosis Control Program in China (China NTP among elderly people(≥65 years and younger people(<65 years.We made a secondary analysis in a population-based TB prevalence survey in China in 2010. Questionnaire including information for cough and haemoptysis was completed by face to face interview, and then chest radiography was conducted in all eligible participants. Sputum smear and culture were followed for all TB suspects. We calculated the odds ratios (OR, sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV and the area under the receiver operating characteristic curve (AUC of using different symptoms for screening to detect bacteriologically positive TB in subpopulations stratified by age 65, to evaluate the performance of symptom screening for TB.Of 315 newly diagnosed bacteriologically positive TB, 131 patients (41.59% were elderly, and 48.57% of TB patients were asymptomatic. Nearly 50% patients did not present cough of any duration, and less than half present cough more than 2 weeks, a defined suspected symptom in China NTP. Cough of any duration was reported more in patients aged under 65 than those in elderly, especially for the acute cough (9.78% vs 6.87%. Those symptoms defined by China NTP were reported by less than half participants in two subpopulations. Acute cough (<2 weeks was an independent predictor of TB in people aged under 65 (adjusted OR: 3.3, 95% CI: 2.0-5.5, but not in those aged 65 and above (adjusted OR: 1.4, 95% CI: 0.7-2.9. The specificity for each symptom was significantly higher in participants aged under 65 (P<0.01, and sensitivities of most symptoms were significantly higher among elderly (P<0.05 or P<0.01. When compared with cough for 2 weeks and more, using cough of any duration for symptom screening increased the sensitivity from 42.9% to 51. % for all

  14. Effectiveness of embolization for management of hemoptysis pulmonary tuberculosis: comparison of chest radiographic study and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sang Chul; Kim, Yong Ju; Park, Joong Wha; Lee Myeong Sub; Kim Dong Jin; Hong In Soo [Yonsei Univ. College of Medicine, Wonju (Korea, Republic of)

    2001-01-01

    To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the branchial artery. Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographin findings were classified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III si either Types I or II acompainted by pleural in filtrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole the lung. Bronchial angiographic findings were divided into four groups: Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an intercostal artery; Group III comprises cases which belong to Group I or II and which a bronch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increased on

  15. Nearest patch matching for color image segmentation supporting neural network classification in pulmonary tuberculosis identification

    Science.gov (United States)

    Rulaningtyas, Riries; Suksmono, Andriyan B.; Mengko, Tati L. R.; Saptawati, Putri

    2016-03-01

    Pulmonary tuberculosis is a deadly infectious disease which occurs in many countries in Asia and Africa. In Indonesia, many people with tuberculosis disease are examined in the community health center. Examination of pulmonary tuberculosis is done through sputum smear with Ziehl - Neelsen staining using conventional light microscope. The results of Ziehl - Neelsen staining will give effect to the appearance of tuberculosis (TB) bacteria in red color and sputum background in blue color. The first examination is to detect the presence of TB bacteria from its color, then from the morphology of the TB bacteria itself. The results of Ziehl - Neelsen staining in sputum smear give the complex color images, so that the clinicians have difficulty when doing slide examination manually because it is time consuming and needs highly training to detect the presence of TB bacteria accurately. The clinicians have heavy workload to examine many sputum smear slides from the patients. To assist the clinicians when reading the sputum smear slide, this research built computer aided diagnose with color image segmentation, feature extraction, and classification method. This research used K-means clustering with patch technique to segment digital sputum smear images which separated the TB bacteria images from the background images. This segmentation method gave the good accuracy 97.68%. Then, feature extraction based on geometrical shape of TB bacteria was applied to this research. The last step, this research used neural network with back propagation method to classify TB bacteria and non TB bacteria images in sputum slides. The classification result of neural network back propagation are learning time (42.69±0.02) second, the number of epoch 5000, error rate of learning 15%, learning accuracy (98.58±0.01)%, and test accuracy (96.54±0.02)%.

  16. A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey.

    Science.gov (United States)

    Babalik, Aylin; Kilicaslan, Zeki; Caner, S Sevkan; Gungor, Gokay; Ortakoylu, M Gonenc; Gencer, Serap; McCurdy, Stephen A

    2013-01-01

    The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.

  17. Radiological patterns in HIV-associated pulmonary tuberculosis: Comparison between HAART-treated and non-HAART-treated patients

    Energy Technology Data Exchange (ETDEWEB)

    Busi Rizzi, E. E-mail: radiologia@inmi.it; Schinina, V.; Palmieri, F.; Girardi, E.; Bibbolino, C

    2003-06-01

    AIM: To evaluate whether highly active antiretroviral therapy (HAART) modifies radiographic appearances of pulmonary tuberculosis (TB), in terms of patterns and their relative frequencies, among patients with human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: Chest radiographs were obtained in 209 HIV-infected patients with culture confirmed pulmonary TB. Computed tomography (CT) images were also reviewed for 42 patients whose chest radiographs were normal or showed questionable abnormalities. Imaging was evaluated for the presence and distribution of consolidation, cavitation, interstitial changes, pleural disease, adenopathy, and were classified as a primary or post-primary pattern. RESULTS: A post-primary pattern was more frequent after 1996 when HAART came into clinical use. Forty-four percent (77/176) of patients not on HAART had a post-primary pattern in comparison with 82% (27/33) of patients receiving HAART (p<0.001). A primary pattern was significantly more frequent (p<0.001), in patients with more severe immunosuppression (CD4 lymphocyte less than 200/mm{sup 3}). CONCLUSION: HIV patients receiving HAART with pulmonary TB, had a post-primary pattern more frequently than those not receiving this treatment. This observation is consistent with the partial restoration of cell-mediated immunity that can be induced by HAART.

  18. Utility of line probe assay for the early detection of multidrug-resistant pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    K Madhuri

    2015-01-01

    Full Text Available Background: Despite endorsement of the line probe assay (LPA for the diagnosis of drug-resistant pulmonary tuberculosis patients, there is limited data available on the performance of LPAs in India, especially from high burden states like Maharashtra, for the early diagnosis and detection of drug resistance, in order to initiate timely and appropriate treatment. Objective: To evaluate the utility of the line probe assay (LPA for the early diagnosis of drug-resistant pulmonary tuberculosis as compared to the ′Gold standard′ 1% proportion method (PM. Materials and Methods: A total of 687 patients suspected of pulmonary tuberculosis were screened. One hundred samples (95 sputum and 5 BAL, positive for Acid Fast Bacilli (AFB by Ziehl Neelson (ZN smears, were included in the study. Digested and decontaminated specimens were subjected directly to the LPA (Genotype MTBDR@ plus assay and were processed in parallel using the conventional culture on the Lowenstein-Jensen (LJ medium followed by drug susceptibility testing (DST using the PM. Results: All the 100 samples gave interpretable results on LPA with a turnaround time of 24-48 hours as opposed to six to eight weeks taken by the 1% proportion method. Sensitivity for the detection of rifampicin, isoniazid, and multidrug resistance (MDR was 98.1, 92.1, and 95%, respectively, with a specificity of 97.8% for rifampicin and 98.33% for MDR detection. It also had the additional advantage of allowing a study of mutation patterns. Conclusions: High performance characteristics and a short turnaround time makes LPA an excellent diagnostic tool, for an early and accurate diagnosis, in a high MDR- TB-prevalent region, as reflected from our data.

  19. IS6110 restriction fragment length polymorphism of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in Campinas, Brazil: evidence of intercontinental distribution of strains

    Directory of Open Access Journals (Sweden)

    Ana Lucia Roscani Calusni

    2003-07-01

    Full Text Available Tuberculosis (TB is a major concern in developing countries. In Brazil, few genotyping studies have been conducted to verify the number of IS6110 copies present in local prevalent strains of Mycobacterium tuberculosis, the distribution and clustering of strains. IS6110 DNA fingerprinting was performed on a sample of M. tuberculosis isolates from patients with AFB smear-positive pulmonary TB, at a hospital in Brazil. The IS6110 profiles were analyzed and compared to a M. tuberculosis database of the Houston Tuberculosis Initiative, Houston, US. Seventy-six fingerprints were obtained from 98 patients. All M. tuberculosis strains had an IS6110 copy number between 5-21 allowing for differentiation of the isolates. Human immunodeficiency virus infection was confirmed in nearly half the patients of whom data was available. Fifty-eight strains had unique patterns, while 17 strains were grouped in 7 clusters (2 to 6 strains. When compared to the HTI database, 6 strains matched isolates from El Paso, Ciudad de Juarez, Houston, and New York. Recently acquired infections were documented in 19% of cases. The community transmission of infection is intense, since some clustered strains were recovered during the four-year study period. The intercontinental dissemination of M. tuberculosis strains is suspected by demonstration of identical fingerprints in a distant country.

  20. M. tuberculosis induces potent activation of IDO-1, but this is not essential for the immunological control of infection.

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    Antje Blumenthal

    Full Text Available Indoleamine 2,3-dioxygenesae-1 (IDO-1 catalyses the initial, rate-limiting step in tryptophan metabolism, thereby regulating tryptophan availability and the formation of downstream metabolites, including picolinic and quinolinic acid. We found that Mycobacterium tuberculosis infection induced marked upregulation of IDO-1 expression in both human and murine macrophages in vitro and in the lungs of mice following aerosol challenge with M. tuberculosis. The absence of IDO-1 in dendritic cells enhanced the activation of mycobacteria-specific T cells in vitro. Interestingly, IDO-1-deficiency during M. tuberculosis infection in mice was not associated with altered mycobacteria-specific T cell responses in vivo. The bacterial burden of infected organs, pulmonary inflammatory responses, and survival were also comparable in M. tuberculosis-infected IDO-1 deficient and wild type animals. Tryptophan is metabolised into either picolinic acid or quinolinic acid, but only picolinic acid inhibited the growth of M. tuberculosis in vitro. By contrast macrophages infected with pathogenic mycobacteria, produced quinolinic, rather than picolinic acid, which did not reduce M. tuberculosis growth in vitro. Therefore, although M. tuberculosis induces robust expression of IDO-1 and activation of tryptophan metabolism, IDO-1-deficiency fails to impact on the immune control and the outcome of the infection in the mouse model of tuberculosis.

  1. Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis.

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    Lancelot M Pinto

    Full Text Available RATIONALE: Chest radiography is sometimes the only method available for investigating patients with possible pulmonary tuberculosis (PTB with negative sputum smears. However, interpretation of chest radiographs in this context lacks specificity for PTB, is subjective and is neither standardized nor reproducible. Efforts to improve the interpretation of chest radiography are warranted. OBJECTIVES: To develop a scoring system to aid the diagnosis of PTB, using features recorded with the Chest Radiograph Reading and Recording System (CRRS. METHODS: Chest radiographs of outpatients with possible PTB, recruited over 3 years at clinics in South Africa were read by two independent readers using the CRRS method. Multivariate analysis was used to identify features significantly associated with culture-positive PTB. These were weighted and used to generate a score. RESULTS: 473 patients were included in the analysis. Large upper lobe opacities, cavities, unilateral pleural effusion and adenopathy were significantly associated with PTB, had high inter-reader reliability, and received 2, 2, 1 and 2 points, respectively in the final score. Using a cut-off of 2, scores below this threshold had a high negative predictive value (91.5%, 95%CI 87.1,94.7, but low positive predictive value (49.4%, 95%CI 42.9,55.9. Among the 382 TB suspects with negative sputum smears, 229 patients had scores <2; the score correctly ruled out active PTB in 214 of these patients (NPV 93.4%; 95%CI 89.4,96.3. The score had a suboptimal negative predictive value in HIV-infected patients (NPV 86.4, 95% CI 75,94. CONCLUSIONS: The proposed scoring system is simple, and reliably ruled out active PTB in smear-negative HIV-uninfected patients, thus potentially reducing the need for further tests in high burden settings. Validation studies are now required.

  2. The Effect of Low CD4+ Lymphocyte Count on the Radiographic Patterns of HIV Patients with Pulmonary Tuberculosis among Nigerians.

    Science.gov (United States)

    Affusim, Christopher; Abah, Vivien; Kesieme, Emeka B; Anyanwu, Kester; Salami, Taofik A T; Eifediyi, Reuben

    2013-01-01

    Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count HIV) complicated by pulmonary tuberculosis.

  3. Chest CT findings in patients with non-cardiovascular causes of chest pain: Focusing on pulmonary tuberculosis in a tuberculosis endemic country

    Energy Technology Data Exchange (ETDEWEB)

    Lee, So Won; Shim, Sung Shine; Kim, Yoo Kyung; Ryu, Yon Ju [Mokdong Hospital, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    To review the common causes of non-cardiovascular chest pain (NCCP) according to the location and lesion type as seen on chest CT, and to evaluate CT findings in tuberculosis (TB) as a cause of NCCP. In the period 2009 to 2012, patients having NCCP without definitive evidence of acute myocardial infarction, pulmonary thromboembolism, and aortic dissection, were included. In total, 162 patients (60.5% male; 39.5% female), with a mean age of 51 years, were enrolled. CT images were evaluated by location and lesion type, for causes of NCCP. Chest CT revealed that the most common location for the cause of NCCP was the pleura (45.1%), followed by the subpleural lung parenchyma (30.2%). The most common lesion causing NCCP was TB (33.3%), followed by pneumonia (19.1%). Of the 54 TB cases, 40 (74.1%) were stable TB and 14 (25.9%) were active TB; among these 54 patients, NCCP was most commonly the result of fibrotic pleural thickening (55.6%), followed by subpleural stable pulmonary TB (14.8%). Results of chest CT revealed that TB was a major cause of NCCP in a TB endemic area. Among the TB patients, fibrotic pleural thickening in patients with stable TB was the most common cause of NCCP.

  4. Mapping the epidemiology and trends of extra-pulmonary tuberculosis in Saudi Arabia.

    Science.gov (United States)

    Varghese, Bright; Al-Hajoj, Sahal

    2015-12-01

    An extra-pulmonary tuberculosis (EPTB) infection rate of 30% in Saudi Arabia remains above the global rate. A variable rate of infection in each province has been reported and the involvement of most organs has been cited. Nationwide collective data on the current trends of infection are scarce and the factors behind the increased rate of EPTB are perplexing. This review endeavors to shed light into the epidemiology of EPTB, various types of infections sites, geographical differences in the infection rate, known risk factors, and challenges in the diagnosis and management of EPTB in Saudi Arabia.

  5. [PECULIARITES OF SIMULTANT INTERVENTIONS FOR SOME TYPES OF CHRONIC PHTHISIC PLEURITIS, COEXISTENT WITH PULMONARY TUBERCULOSIS].

    Science.gov (United States)

    Duzhiy, I D; Grehsko, I Ya; Kravets, O V; Oleshchenko, G P; Glazunova, N I

    2016-01-01

    In coincidence of chronic phthisic pleuritis in a rigid stage with pulmonary tuberculosis operative intervention is indicated of a pleuropulmonectomy type, what is a complex situation for performance and preservation of the patient's functional state. Pleuropulmonectomy in some patients is complicated by empyema and pathological processes in bronchi. Possibilities of operative interventions application, alternative to pleuropulmonectomy, were studied. Of 48 patients, to whom pleuropulmonectomy is indicated in accordance to data of clinic-roentgenological investigations, in 7--simultant operative treatment were conducted with positive results.

  6. The effectiveness study of the physiotherapy techniques with infiltrative pulmonary tuberculosis using external respiration indicators

    Directory of Open Access Journals (Sweden)

    Kalmykova Y.S.

    2012-02-01

    Full Text Available The results of the study of respiratory function of patients with infiltrative pulmonary tuberculosis to assess the ventilation ability of the lungs, as well as the presence and degree of ventilation violations. Indicated the need to examine the results of studies of lung function in these patients in order to timely correction of violations. It is established that therapeutic exercises with financial astrophysical exercises with elements of yoga postures, combined with yogic breathing exercises, as well as regulated breathing exercises, taking into account the tone of the sympathetic and parasympathetic nervous systems and measured distance is an effective and significantly improves functional indices of external respiration.

  7. [Bronchopleurocutaneous Fistula: A Rare Complication of Pulmonary Tuberculosis].

    Science.gov (United States)

    Montez, Ana Sofia José; Coutinho, Daniel; Velez, Jorge; Freitas, Filomena; Oliveira, Célia

    2015-01-01

    Introdução: A tuberculose pulmonar pode cursar com diversas complicações. As fístulas bronco-pleuro-cutâneas consistem em comunicações anormais entre o brônquio, o espaço pleural e a pele.Caso Clínico: Apresentamos o caso de um homem, 47 anos, esquizofrénico, enviado ao Serviço de Urgência por toracalgia esquerda, tosse produtiva e emagrecimento. Apresentava-se caquético, sendo evidente um orifício cutâneo torácico latero-anterior esquerdo com drenagem purulenta, na qual o exame direto revelou bacilos ácido-álcool resistentes. A radiografia torácica evidenciava infiltrado heterogéneo bilateral. Foi internado com o diagnóstico de tuberculose pulmonar fistulizada. Na expetoração, a pesquisa de bacilos ácido-álcool resistentes foi igualmente positiva, sendo evidenciado Mycobacterium tuberculosis por reação de polimerase em cadeia e exame cultural. Iniciou terapêutica antituberculosa quádrupla apresentando evolução clínica favorável.Conclusões: A formação de fístulas bronco-pleuro-cutâneas é atualmente e em países desenvolvidos, uma complicação rara de tuberculose pulmonar. Assim, apesar da tuberculose ser frequente em Portugal, a raridade deste tipo de complicações torna pertinente a apresentação deste caso clínico.

  8. STUDY OF EFFECT OF IMMUNOMODULATOR IN TREATMENT OF CATEGORY - I SPUTUM POSITIVE PULMONARY TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Rabindra Kumar

    2015-10-01

    Full Text Available BACKGROUND : Tuberculosis is amongst one of the major public health problems in the developing countries of the world today . Modern Chemotherapy kills most of the bacilli within days. WHO initiated DOTS for treating TB but still success rate of treatment is less. Immune response in most of the tuberculosis patients is inappropriate because of gross tissue destruction and progre ssion of the disease. The nature of an effective immune response to TB is incompletely understood but the most effective vaccination strategies is to stimulate T - cell responses, both CD4 and CD8, to produce Th - 1 associated cytokines. So rationale for TB i mmunotherapy is to replace immunopathology with protective antibacterial immunity. Mycobacter i um w. have such immunogenic properties, so it was used in clinical trial as an injectable immunomodulator adjuvant to treatment of sputum positive new Pulmonary T B cases taking Cat - 1 therapy. AIMS AND OBJECTIVES: To study the effect of Immunomodulator used as an adjuvant to treatment of newly diagnosed sputum positive cases of Pulmonary Tuberculosis taking Cat - I Therapy under RNTCP. MATERIAL AND METHODS : Patients w ere selected from OPD and IPD of TB & Chest Department V.S.S. Medical College Burla. It was a Double blind randomized placebo contolled study done during Jan. 2004 to Jan. 2006. Study was conducted in30 newly diagnosed cases of Pulmonary Tuberculosis of wh ich 17 were in group A and 13 were in group B after taking informed consent. The study subjects were randomly assigned to one of the two groups (A&B.Group A was treated with Cat - I and injectable Immunomodulator and Group B received Cat - I with placebo. Ana lysis of sputum status was done at 15, 30, 45 and 60 days. Sputum conversion, side effects, weight gain and relief of symptoms between both the groups were analysed. RESULTS: The majority of patients of new sputum positive pulmonary tuberculosis were found in between the age group of 21 – 40

  9. Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature

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    Amitesh Gupta

    2017-01-01

    Full Text Available One-third of patients with symptomatic venous thromboembolism (VTE manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT. Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.

  10. A case of Bochdalek hernia in adult misdiagnosed as pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Pradosh Kumar Sarangi

    2017-01-01

    Full Text Available Bochdalek hernias are congenital defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Usually it manifests in the neonatal period and occasionally in childhood. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. Patients are initially investigated and treated for other diseases, therefore diagnosis is purely incidental. Herein, we are reporting a case of symptomatic Bochdalek hernia in an 18-year-old female misdiagnosed as pulmonary tuberculosis and treated accordingly, but with no improvement. This case illustrates importance of high index of clinical suspicion and role of computed tomography in avoiding misdiagnosis and occurrence of serious complication if not treated early. [J Med Allied Sci 2017; 7(1.000: 59-63

  11. Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature

    Science.gov (United States)

    Gupta, Amitesh; Mrigpuri, Parul; Faye, Abhishek; Bandyopadhyay, Debdutta; Singla, Rupak

    2017-01-01

    One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases. PMID:28144063

  12. Fc gamma receptors regulate immune activation and susceptibility during Mycobacterium tuberculosis infection.

    Science.gov (United States)

    Maglione, Paul J; Xu, Jiayong; Casadevall, Arturo; Chan, John

    2008-03-01

    The critical role of cellular immunity during tuberculosis (TB) has been extensively studied, but the impact of Abs upon this infection remains poorly defined. Previously, we demonstrated that B cells are required for optimal protection in Mycobacterium tuberculosis-infected mice. FcgammaR modulate immunity by engaging Igs produced by B cells. We report that C57BL/6 mice deficient in inhibitory FcgammaRIIB (RIIB-/-) manifested enhanced mycobacterial containment and diminished immunopathology compared with wild-type controls. These findings corresponded with enhanced pulmonary Th1 responses, evidenced by increased IFN-gamma-producing CD4+ T cells, and elevated expression of MHC class II and costimulatory molecules B7-1 and B7-2 in the lungs. Upon M. tuberculosis infection and immune complex engagement, RIIB-/- macrophages produced more of the p40 component of the Th1-promoting cytokine IL-12. These data strongly suggest that FcgammaRIIB engagement can dampen the TB Th1 response by attenuating IL-12p40 production or activation of APCs. Conversely, C57BL/6 mice lacking the gamma-chain shared by activating FcgammaR had enhanced susceptibility and exacerbated immunopathology upon M. tuberculosis challenge, associated with increased production of the immunosuppressive cytokine IL-10. Thus, engagement of distinct FcgammaR can divergently affect cytokine production and susceptibility during M. tuberculosis infection.

  13. A STUDY TO EVALUATE PATTERN OF RIFAMPICIN RESISTANCE IN CASES OF SPUTUM POSITIVE PULMONARY TUBERCULOSIS

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    Joydeep

    2015-04-01

    Full Text Available AIMS: The emergence of drug resistance and development of multidrug resistant tuberculosis (MDR TB has become a new but significant obstacle for TB control. As Rifampicin resistance is an important indicator for drug resistant TB , rapid diagnosis of tuberculosis and detection of Rifampicin (RIF resistance are essential for knowing the magnitude of problem & early management of drug resistance TB. The aim of this study is to determine the pattern of rifampicin resistance in the sputum positive MDR TB suspects by using GeneXpert MTB/RIF and thus to focus on magnitude of the problem on drug resistance tuberculosis. ST UDY DESIGN: A cross sectional observational study carried out over a period of 2 years in a tertiary care hospital. SUBJECTS & METHODS : In this study 428 sputum positive cases of pulmonary tuberculosis who were potential MDR suspect were included , there sp utum samples were collected and tested by GeneXpert MTB/RIF assay , which is an automated cartridge based nucleic acid amplification test to detect presence of mycobacterium tuberculosis and status of Rifampicin resistance. The results are statistically ana lyzed. RESULTS : Out of 428 patients , mycobacterium tuberculosis was detected in 328 patients (76.63% & out of these 328 patients , Rifampicin resistance was found in 98 cases (29.87%. Male and female ratio was 6:1 among Rifampicin resistant cases. Regardi ng age distribution , maximum no. of patients with Rifampicin resistance were in the age group of 21 - 30 yrs (26.53% followed by 31 - 40 yrs (22.44%. In this study among cases of Rifampicin resistance , 23.47% of cases were new smear positive failure patients , retreatment cases smear positive at 4 months were 8.16% , 22.44% of cases were retreatment cases smear positive at diagnosis , 41.83% of cases were retreatment failure cases , 1.03% patient had history of contact with MDR TB and 3.06% patient was HIV seropositive. CONCLUSIONS: Rifampicin resistance cases are found

  14. Gender and HIV-associated pulmonary tuberculosis: presentation and outcome at one year after beginning antituberculosis treatment in Uganda

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    Ellner Jerrold J

    2002-09-01

    Full Text Available Abstract Background Tuberculosis is responsible for more female deaths around the earth than any other infectious disease. Reports have suggested that responses to tuberculosis may differ between men and women. We investigated gender related differences in the presentation and one year outcomes of HIV-infected adults with initial episodes of pulmonary tuberculosis in Uganda. Methods We enrolled and followed up a cohort of 105 male and 109 female HIV-infected adults on treatment for initial episodes of culture-confirmed pulmonary tuberculosis between March 1993 and March 1995. A favorable outcome was defined as being cured and alive at one year while an unfavorable outcome was not being cured or dead. Subjects were followed-up by serial medical examinations, complete blood counts, serum β2 microglobulin, CD4+ cell counts, sputum examinations, and chest x-rays. Results Male patients were older, had higher body mass indices, and lower serum β2 microglobulin levels than female patients at presentation. At one year, there was no difference between male and female patients in the likelihood of experiencing a favorable outcome (RR 1.02, 95% CI 0.89–1.17. This effect persisted after controlling for symptoms, serum β2 microglobulin, CD4+ cell count, and severity of disease on chest x-ray (OR 1.07, 95% CI 0.54–2.13 with a repeated measures model. Conclusions While differences existed between males and females with HIV-associated pulmonary tuberculosis at presentation, the outcomes at one year after the initiation of tuberculosis treatment were similar in Uganda. Women in areas with a high HIV and tuberculosis prevalence should be encouraged to present for screening at the first sign of tuberculosis symptoms.

  15. PulmonaryTuberculosisPatientswithMulti-drugResistantTuberculosisAwarenessSurvey%肺结核患者的MDR-TB知识知晓率调查

    Institute of Scientific and Technical Information of China (English)

    钟红苗; 黄图华; 叶朝红

    2013-01-01

    Objective Pulmonary tuberculosis patients with multi-drug resistant tuberculosis knowledge and awareness of the situation, in order to provide reference to carry out health education work. Methods On pulmonary outpatient follow-up treatment management of patients with pulmonary tuberculosis questionnaire was conducted. Result In 159 cases of patients with pulmonary tuberculosis were investigated, and the primary school education accounted for 67.2%,"what is MDR-TB"witting rate of 55.9%,"chronic discharging bacteria/initial treatment failure/recurrence in patients with MDR-TB/close contacts of patients with smear-positive pulmonary tuberculosis patients should be suspected MDR-TB"witting rate was 13.8%, MDR-TB"causes of"the awareness rate of 26.4%,"how to treat the awareness rate of 15.1%MDR-TB","MDR-TB can administer well what"the awareness rate of 30.2%,"how to prevent MDR-TB"rate was 23.9%.Conclusion Pulmonary tuberculosis in patients with MDR-TB knowledge awareness rate is low, should strengthen the publicity and education of MDR-TB.%  目的了解肺结核患者的MDR-TB知识知晓率情况,为有针对性开展健康教育工作提供参考。方法对肺科门诊跟踪治疗管理的肺结核患者进行询问式问卷调查。结果共调查159例肺结核患者,小学及以下学历占67.2%,“什么是MDR-TB”的知晓率为55.9%,“慢性排菌者/初治失败者/复发患者/密切接触MDR-TB患者的涂阳肺结核患者应怀疑得了MDR-TB”的知晓率为13.8%,“产生MDR-TB的原因”的知晓率为26.4%,“如何治疗MDR-TB”的知晓率为15.1%,“MDR-TB能治好吗”的知晓率为30.2%,“如何预防MDR-TB”的知晓率为23.9%。结论肺结核患者的MDR-TB知识知晓率低,应加强MDR-TB的宣传教育。

  16. Measurement of levels of fractional exhaled nitric oxide in patients with pulmonary tuberculosis.

    Science.gov (United States)

    Yhi, J Y; Park, D W; Min, J-H; Park, Y K; Kim, S-H; Kim, T-H; Sohn, J W; Yoon, H J; Shin, D H; Moon, J-Y

    2016-09-01

    The role of fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment of pulmonary tuberculosis (PTB) is uncertain. To examine the value of FeNO as a biomarker for PTB. Baseline FeNO levels were compared in 69 PTB patients and 118 healthy controls. The correlation between baseline FeNO levels and clinical variables of tuberculosis were studied. FeNO levels were checked twice in the PTB group, at diagnosis and after 2 months of anti-tuberculosis medication, and factors affecting changes in FeNO levels after treatment were analysed. FeNO levels were not significantly different in the PTB group and controls (mean ± standard deviation 27.7 ± 17.6 parts per billion [ppb] vs. 27.0 ± 10.8 ppb, P = 0.531). In a multivariate regression analysis, no variable was shown to affect FeNO levels at diagnosis. FeNO levels did not significantly change after 2 months of treatment (26.8 ± 18.3 ppb vs. 24.0 ± 10.7 ppb, P = 0.257). Only PTB with a high FeNO level (>25 ppb) was related to a decline in FeNO levels after 2 months of treatment. FeNO levels do not appear to be affected in PTB patients.

  17. SIGNIFICANCE OF ADENOSINE DEAMINASE SERUM CONCENTRATIONS IN THE DIAGNOSIS OF EXTRA-PULMONARY TUBERCULOSIS

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    Stevanovic G,

    2011-06-01

    Full Text Available Extra pulmonary tuberculosis (EPTB is a growing problem worldwide. Due to the nature of the disease, the diversity of clinical pictures as well as its minor epidemiological importance, the diagnosis is difficult and often late.In addition to standard TB diagnostic techniques use of new biochemical (surrogate markers are increased. With this work we wanted to examine the usefulness of serum adenosine deaminase levels as a diagnostic parameter for EPTB.The work included 116 patients with fever of unknown origin in which tuberculosis or infectious mononucleosis was not proven and 51 person who had proven EPTB. Correlated adenosine deaminase levels between these two groups we obtained significantly higher values ​​in patients with EPTB. The calculated sensitivity was 0.56, specificity 0.89, positive predictive value 0.80 and negative predictive value 0.72. Certain reducing of the values observed during anti TB therapy. In previous studies the diagnostic importance of adenosine deaminase in the diagnosis of tuberculosis serosityes was demonstrated. The significance of serum levels in diagnosis is rarely evaluated during EPTB. Our findings are similar to the results of authors who have conducted such testing in the pediatric population.Increased concentrations of serum adenosine deaminase have shown the potential of usable screening test and can be used as an indicative EPTB parameter. To fully assess its diagnostic significance require future clinical research.

  18. Immunological Roles of Elevated Plasma Levels of Matricellular Proteins in Japanese Patients with Pulmonary Tuberculosis

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    Beata Shiratori

    2016-12-01

    Full Text Available Elevated matricellular proteins (MCPs, including osteopontin (OPN and galectin-9 (Gal-9, were observed in the plasma of patients with Manila-type tuberculosis (TB previously. Here, we quantified plasma OPN, Gal-9, and soluble CD44 (sCD44 by enzyme-linked immunosorbent assay (ELISA, and another 29 cytokines by Luminex assay in 36 patients with pulmonary TB, six subjects with latent tuberculosis (LTBI, and 19 healthy controls (HCs from Japan for a better understanding of the roles of MCPs in TB. All TB subjects showed positive results of enzyme-linked immunospot assays (ELISPOTs. Spoligotyping showed that 20 out of 36 Mycobacterium tuberculosis (MTB strains belong to the Beijing type. The levels of OPN, Gal-9, and sCD44 were higher in TB (positivity of 61.1%, 66.7%, and 63.9%, respectively than in the HCs. Positive correlations between OPN and Gal-9, between OPN and sCD44, and negative correlation between OPN and ESAT-6-ELISPOT response, between chest X-ray severity score of cavitary TB and ESAT-6-ELISPOT response were observed. Instead of OPN, Gal-9, and sCD44, cytokines G-CSF, GM-CSF, IFN-α, IFN-γ, IL-12p70, and IL-1RA levels were higher in Beijing MTB-infected patients. These findings suggest immunoregulatory, rather than inflammatory, effect of MCPs and can advance the understanding of the roles of MCPs in the context of TB pathology.

  19. Applying patient centered approach in management of pulmonary tuberculosis: A case report from Malaysia.

    Science.gov (United States)

    Atif, M; Sulaiman, Sas; Shafi, Aa; Muttalif, Ar; Ali, I; Saleem, F

    2011-06-01

    A 24 year university student with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti tuberculosis drugs and was treated with chlorpheniramine (4mg) tablet. Patient missed twenty eight doses of anti tuberculosis drugs in continuation phase claiming that he was very busy in his studies and assignments. Upon questioning he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking prescribed medicines. His treatment was stopped based on clinical improvement, although he did not complete six months therapy. Two major reasons; false perception of being completely cured and side effects associated with anti TB drugs might be responsible for non adherence. Non sedative anti histamines like fexofenadine, citrizine or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such lifestyle. Patient had not completed full course of chemotherapy, which is preliminary requirement for a case to be classified as "cure" and "treatment completed". Moreover, patient had not defaulted for two consecutive months. Therefore, according to WHO treatment outcome categories, this patient can neither be classified as "cure" or "treatment completed" nor as "defaulter". Further elaboration of WHO treatment outcome categories is required for adequate classification of patients with similar characteristics. Likelihood of non adherence can be significantly reduced by applying the WHO recommended "Patient Centered Approach" strategy. Close friend, class mate or family member can be selected as treatment supporter to ensure adherence to treatment.

  20. [Thoracic standard radiology and x-ray computed tomography in mediastino-pulmonary tuberculosis in infants].

    Science.gov (United States)

    Bourlière-Najean, B; Boespflug, M D; Dubus, J C; Roybet, D; Panuel, M; Fauré, F; Kervella, H; Devred, P

    1995-06-01

    Primary mediastino pulmonary tuberculosis in infancy is increasing in France. Bacteriological diagnosis is difficult. The aim of the study is to assess the value of chest radiograph and CTscan for diagnosis of tuberculosis. We studied 15 infants, 3 month old to 18 month old, between November 1990 and June 1992. On plain film, lymphadenopathies were present in 13 cases and parenchymal disease in 10 cases, parenchymal nodular densities in 6 cases and pleural effusion in one case, displacement of the trachea in 6 cases. We found CTscan to be useful in delineating the lymphadenopathies and parenchymal changes. In 2 cases lymphadenopathies and in 2 cases alveolar condensation were discovered on CTscan as plain film was normal. In all cases lymphadenopathies were present in CTscan, often in right side and in all cases, lymphadenopathies were hypodense with peripheral enhancement. In conclusion, the association of right paratracheal nodes with displacement of trachea and alveolar consolidation is common in tuberculosis in infants. These findings when seen on chest radiographs must lead to perform a CTscan and suggest the diagnosis.

  1. The role of diabetes on the clinical manifestations of pulmonary tuberculosis

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Daniel; Range, Nyagosya; PrayGod, George;

    2012-01-01

    Objective: Diabetes is associated with pulmonary tuberculosis (TB), possibly due to impaired immunity, and diabetes may exacerbate the clinical manifestations of TB. Our aim was to assess the role of diabetes in the clinical manifestations of TB. Methods: We studied 1250 patients with pulmonary TB...... in an urban population in a cross-sectional study in Tanzania. All participants were tested for diabetes and HIV co-infection, and TB culture intensity was assessed. Levels of white blood cells, haemoglobin, acute phase reactants, CD4 count and HIV viral load were measured, and a qualitative morbidity...... questionnaire was used to identify the prevalence of disease-related symptoms. Results: Tuberculosis patients with diabetes had a higher neutrophil count (B 0.5 x 10 9 cells/ l, 95% CI 0.2; 0.9, P = 0.001) than non-diabetic TB patients. Serum C-reactive protein (B 18.8 mg / l, CI 95% 8.2; 29.4, P = 0...

  2. Neutrophil-Derived MMP-8 Drives AMPK-Dependent Matrix Destruction in Human Pulmonary Tuberculosis.

    Directory of Open Access Journals (Sweden)

    Catherine W M Ong

    2015-05-01

    Full Text Available Pulmonary cavities, the hallmark of tuberculosis (TB, are characterized by high mycobacterial load and perpetuate the spread of M. tuberculosis. The mechanism of matrix destruction resulting in cavitation is not well defined. Neutrophils are emerging as key mediators of TB immunopathology and their influx are associated with poor outcomes. We investigated neutrophil-dependent mechanisms involved in TB-associated matrix destruction using a cellular model, a cohort of 108 patients, and in separate patient lung biopsies. Neutrophil-derived NF-kB-dependent matrix metalloproteinase-8 (MMP-8 secretion was up-regulated in TB and caused matrix destruction both in vitro and in respiratory samples of TB patients. Collagen destruction induced by TB infection was abolished by doxycycline, a licensed MMP inhibitor. Neutrophil extracellular traps (NETs contain MMP-8 and are increased in samples from TB patients. Neutrophils lined the circumference of human pulmonary TB cavities and sputum MMP-8 concentrations reflected TB radiological and clinical disease severity. AMPK, a central regulator of catabolism, drove neutrophil MMP-8 secretion and neutrophils from AMPK-deficient patients secrete lower MMP-8 concentrations. AMPK-expressing neutrophils are present in human TB lung biopsies with phospho-AMPK detected in nuclei. These data demonstrate that neutrophil-derived MMP-8 has a key role in the immunopathology of TB and is a potential target for host-directed therapy in this infectious disease.

  3. Auxiliary diagnostic value of monocyte chemoattractant protein-1 of whole blood in active tuberculosis.

    Science.gov (United States)

    Wang, Ying; Li, Hang; Bao, Hong; Jin, Yufen; Liu, Xiaoju; Wu, Xueqiong; Yu, Ting

    2015-01-01

    The aim of this study was to study the expression level of interferon-γ (IFN-γ) and monocyte chemoattractant protein-1 (MCP-1) in peripheral blood and its auxiliary diagnostic value in active tuberculosis. A chemiluminescence enzyme immunoassay method was used to detect the levels of IFN-γ and MCP-1 in peripheral blood. Then the receiver operating characteristic curve were drawn to determine the threshold of IFN-γ and MCP-1 for diagnosis of active tuberculosis and to evaluate their diagnostic performance. The specific IFN-γ and MCP-1 levels in the active tuberculosis group were significantly higher than those in the non-tuberculous pulmonary disease group (P 0.05), but the MCP-1 levels in the non-tuberculous respiratory disease group were significantly higher than those of the healthy control group (P < 0.05). The specific IFN-γ and MCP-1 level cut off values were 256 pg/ml and 389 pg/ml as an active tuberculosis diagnostic standard. The sensitivities of IFN-γ and MCP-1 were 57.3% and 92.8%, respectively; specificities were 80% and 80.7%, respectively; the positive predictive values were 76.9% and 84.9%, respectively; negative predictive values were 61.7% and 78.7%, respectively; and accuracy rates were 76.9% and 84.9%, respectively. Compared with the detection of IFN-γ, we observed a better diagnostic performance of MCP-1 in peripheral blood in active tuberculosis. MCP-1 may become one of the active tuberculosis auxiliary diagnostic targets.

  4. Genetic diversity of Mycobacterium tuberculosis complex strains isolated from patients with pulmonary tuberculosis in Anambra State, Nigeria.

    Science.gov (United States)

    Uzoewulu, Gertrude N; Lawson, Lovett; Nnanna, Ibeh S; Rastogi, Nalin; Goyal, Madhu

    2016-03-01

    In this study, we analyzed Mycobacterium tuberculosis complex (MTC) genetic diversity in Anambra State, Nigeria based on spoligotyping followed by 5-loci exact tandem repeats (ETRs). Spoligotyping of 180 MTC strains isolated in 2009-2011 from pulmonary tuberculosis (TB) patients led to a total of 31 distinct patterns. A comparison with the SITVIT2 international database showed that all the 31 patterns could be classified as Shared-types (SITs) in this database; briefly, 26/31 SITs (n=174 isolates) matched a preexisting shared-type in the database, whereas 5/31 SITs (n=6 isolates) were newly created due to 2 or more strains belonging to an identical new pattern within this study (SIT3396) or after a match with an orphan in the database (SIT3397, SIT3398, SIT3399 and SIT3400). A total of 18/31 SITs containing 167 or 92.8% isolates were clustered within this study (2-89 isolates per cluster) while 13/31 SITs contained unique strains. Using VNTR typing, a total of 36 distinct patterns were identified; 27 patterns (n=157 isolates) matched a pattern already reported in the SITVIT2 database. Combination of both the methods generated 47 combined patterns for the 180 strains: 17 belonged to clustered isolates (n=127 isolates or 70.5%) while 30 corresponded to as many unique strains (note 23 strains could not be typed using 5-loci ETRs). No correlation was found between the spoligotyping pattern and the HIV status of the patient or drug sensitivity of the strain. This study showed that the LAM10-CAM prototype SIT61 accounted for highest number of isolates (n=89) in Anambra State, showing its relative contribution to the TB burden in the study.

  5. Prediction Model of Drug-Induced Liver Injury in Patients with Pulmonary Tuberculosis: Evaluation of the Incidence and Risk Factors

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    Farzaneh Dastan

    2017-03-01

    Full Text Available Introduction and objectives:Tuberculosis (TB still remains a major health concern both in developing and developed countries. The rate of the liver injury due to anti-TB drugs in developed countries has been reported up to 4%. The goal of this study is to assess the rate and risk factors for anti-tuberculosis drug-induced liver injury (DILI. Also, a model has been designed to predict DILI in patients with pulmonary tuberculosis.Methods:We conducted an observational study. The investigation was carried out in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Anti-tuberculosis drug treatment course and patients’ demographic data, medical and drug history, and social habits were extracted from their medical records. DILI was defined as an increase in serum alanine aminotransfrase (ALT or aspartate aminotransfrase (AST greater than three times of the upper limit of normal (ULN, with symptoms of liver injury, or five times of the ULN without symptoms.Results:In this study, 87 patients (33 male, 54 female, mean age 54.29±21.79 years with tuberculosis diagnosis were followed. Anti-tuberculosis induced liver injury was detected in 14 (16.1% patients. Concomitant use of hepatotoxic drugs (Isoniazid, Rifampin and Pyrazinamide and the abnormal baseline serum liver enzyme levels before the initiation of therapy were found as risk factors for anti-tuberculosis induced liver injury.Conclusion:Anti-tuberculosis induced liver injury is a major problem in tuberculosis patients which lead to treatment interruption in 14 (16.1% patients. Due to the lack of evidence regarding the mechanism of this side effect, we recommend to monitor anti-tuberculosis drug levels in order to study their probable correlations with DILI.   

  6. Receptor for advanced glycation end products is protective during murine tuberculosis.

    NARCIS (Netherlands)

    Zoelen, M.A. van; Wieland, C.W.; Windt, G.J. van der; Florquin, S.; Nawroth, P.P.; Bierhaus, A.; Poll, T. van der

    2012-01-01

    The development of active tuberculosis after infection with Mycobacterium tuberculosis is almost invariably associated with a persistent or transient state of relative immunodeficiency. The receptor for advanced glycation end products (RAGE) is a promiscuous receptor that is involved in pulmonary

  7. Improved sensitivity, safety and laboratory turnaround time in the diagnosis of pulmonary tuberculosis by use of bleach sedimentation

    Directory of Open Access Journals (Sweden)

    Ameh James

    2015-05-01

    Full Text Available Background: Inadequate diagnostic processes and human resources in laboratories contribute to a high burden of tuberculosis (TB in low- and middle-income countries. Direct smear microscopy is relied on for TB diagnosis; however, sensitivity rates vary. To improve sensitivity of direct microscopy, the researchers employed several approaches, including sputum digestion and concentration of acid-fast bacilli (AFB, a technique which uses commercial bleach.Objectives: This study compared methods used to diagnose active Mycobacterium tuberculosis infections.Methods: Three sputum specimens were collected from each of 340 participants in Abuja, Nigeria, over two consecutive days. Direct microscopy was performed on all specimens; following microscopy, one specimen from each patient was selected randomly for bleach sedimentation and one for Lowenstein-Jensen culture.Results: Direct microscopy produced 28.8% AFB-positive results, whilst bleach sedimentation resulted in 30.3%. When compared with the cultures, 26.5% were AFB true positive using direct microscopy and 27.1% using bleach sedimentation. Whilst the specificity rate between these two methods was not statistically significant (P = 0.548, the sensitivity rate was significant (P = 0.004.Conclusion: Based on these results, bleach increases the sensitivity of microscopy compared with direct smear and has similar specificity. When diagnosing new cases of pulmonary TB, one bleach-digested smear is as sensitive as three direct smears, reducing waiting times for patients and ensuring the safety of laboratory technicians.

  8. [An outbreak of pulmonary tuberculosis in the dormitory of construction labors suspected to have been due to exogenous reinfection].

    Science.gov (United States)

    Kurasawa, T; Sato, A; Nakatani, K; Ikeda, T; Yoshimatsu, H; Ikeda, N; Inoue, T; Kanai, K

    2000-05-01

    We report an outbreak of pulmonary tuberculosis (TB) in a dormitory of construction labors, and this outbreak is suspected to have been caused by exogenous reinfection, based on the restriction fragment length polymorphism (RFLP) analysis and other findings. After a patient entered our hospital with active TB, 12 new other patients were discovered by contacts examination. These patients lived together in the same dormitory. They were all male and single, and were aged from 43 to 63 years old. Except one patient (No. 3) previously treated for TB for three months about 2 years ago and was suspected to be the index case of this outbreak, 12 other patients did not have a medical history of TB. The bacilli cultured from 11 patients (No. 1-11) were tested by RFLP analysis, three patterns were identified, and the fingerprints from 9 patients (No. 1-9) were identical, and the patterns of incomplete resistance of some antituberculous drugs were quite similar between No. 1-9 and No. 12 and between No. 10 and No. 13, respectively. The locations of the main lesions of TB on chest X-ray pictures were the apico-posterior segments of bilateral upper lobes. No signs suspected to indicate primary tuberculosis were detected. Considering the rate of tuberculous infection in Japan among the middle age and above as well as the identical RFLP results, most of patients in this outbreak except the index case No. 3 were suspected to have TB due to the exogenous reinfection.

  9. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi

    Directory of Open Access Journals (Sweden)

    Clark Tamara D

    2004-12-01

    Full Text Available Abstract Background Wasting and micronutrient malnutrition have not been well characterized in adults with pulmonary tuberculosis. We hypothesized that micronutrient malnutrition is associated with wasting and higher plasma human immunodeficiency virus (HIV load in adults with pulmonary tuberculosis. Methods In a cross-sectional study involving 579 HIV-positive and 222 HIV-negative adults with pulmonary tuberculosis in Zomba, Malawi, anthropometry, plasma HIV load and plasma micronutrient concentrations (retinol, α-tocopherol, carotenoids, zinc, and selenium were measured. The risk of micronutrient deficiencies was examined at different severity levels of wasting. Results Body mass index (BMI, plasma retinol, carotenoid and selenium concentrations significantly decreased by increasing tertile of plasma HIV load. There were no significant differences in plasma micronutrient concentrations between HIV-negative individuals and HIV-positive individuals who were in the lowest tertile of plasma HIV load. Plasma vitamin A concentrations Conclusions These data demonstrate that wasting and higher HIV load in pulmonary tuberculosis are associated with micronutrient malnutrition.

  10. CONTRAST ENHANCED CT UNVEILED GIANT RASMUSSEN’S ANEURYSM: A RARE COMPLICATION AND CAUSE OF DEATH IN PULMONARY TUBERCULOSIS

    OpenAIRE

    2014-01-01

    Rasmussen’s aneurysm is a rare complication of pulmonary tuberculosis. Often the aneurysm ruptures in the bronchial tree causing massive hemoptysis resulting in death. We are reporting a case of partially thrombosed giant Rasmussen’s aneurysm which arose in the vicinity of a tuberculous cavity along with empyema necessitans. Unfortunately the patient died of massive hemoptysis within two days of his diagnosis.

  11. Moxifloxacin plus standard first-line therapy in the treatment of pulmonary tuberculosis: A meta-analysis.

    Science.gov (United States)

    Chen, Zhi; Liang, Jian-Qin; Wang, Jin-He; Feng, Shi-Sheng; Zhang, Guang-Yu

    2015-07-01

    The fluoroquinolone moxifloxacin has potent activity against Mycobacterium tuberculosis and has been recommended by the guidelines for the treatment of pulmonary tuberculosis (TB). Monotherapy is not recommended by the guidelines and only a few studies have evaluated the efficacy and safety of moxifloxacin plus standard first-line therapy in treating TB. The purpose of this meta-analysis was to further investigate the efficacy and safety of moxifloxacin plus standard therapy compared with standard therapy alone in treating patients with pulmonary TB. Medline, Cochrane, EMBASE and Google Scholar (until February 12, 2015) were searched for studies that evaluated the clinical efficacy and tolerability of moxifloxacin in the treatment of pulmonary TB. Rate of culture conversion and serious adverse events (SAEs) were assessed. Risk of bias and sensitivity analysis, using the leave-one-out approach, was used to assess the robustness of the findings. Six studies were included in the meta-analysis which covered 2056 patients with pulmonary TB. For all included studies, the drug regimens at least contained rifampicin and pyrazinamide and the length of treatment was at least eight weeks. The odds ratio (OR) for the negative culture rate for moxifloxacin plus first-line medications compared first-line medications alone (the control group) was 1.60 with 95% CI in 0.93-2.74 (P = 0.089), indicating the moxifloxacin plus first-line medications had no significantly greater rate of culture conversion compared with first-line medication alone. The odds ratio of SAEs for moxifloxacin plus first-line medications compared with first-line medications alone found no difference in rate of SAEs between treatment groups (OR = 0.94, P = 0.862). In conclusion, our meta-analysis suggests that there was a trend for the addition of moxifloxacin to standard first-line therapy for non-drug resistant TB resulted to increase the rate of culture conversion but this effect requires confirmation

  12. Epidemiology of extra-pulmonary tuberculosis in Israel, 1999-2010.

    Science.gov (United States)

    Mor, Z; Pinsker, G; Cedar, N; Lidji, M; Grotto, I

    2013-02-01

    The Israeli national tuberculosis (TB) surveillance system. To describe the epidemiology of extra-pulmonary tuberculosis (EPTB) in Israel between 1999 and 2010 and identify more susceptible populations. Data were retrieved from the National Tuberculosis Registry and the Israeli Bureau of Statistics. During the study period, 995 EPTB patients were notified, corresponding to 19.6% of all TB cases. The average annual male:female ratio was 0.8, and the human immunodeficiency virus (HIV) infection rate was 5%. Most EPTB affected the lymph nodes (39.8%), pleura (16.9%) and urinary system (11.1%). Most EPTB patients (81.8%) were non-Israeli born. The estimated average annual incidence in Israeli-born citizens, non-Israeli-born citizens and migrant workers was respectively 0.23, 2.2 and 7.5 per 100,000 population. The ratio of non-Israeli-born migrant workers to non-Israeli-born citizens with EPTB decreased from 1:6.3 in 1999 to 1:0.78 in 2010. Culture results were obtained for 624 (62.9%) of all cases. Of these, 41 (6.6%) were resistant to at least one first-line anti-tuberculosis drug and 8 (1.3%) were multidrug-resistant. Treatment success was achieved in 86.5%. Physicians should be aware of the possibility of EPTB in older patients, especially in the non-Israeli-born. Innovative screening procedures should be implemented for migrants from high-burden countries.

  13. Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

    Directory of Open Access Journals (Sweden)

    Korpusenko I.V

    2015-03-01

    Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

  14. Potential and development of inhaled RNAi therapeutics for the treatment of pulmonary tuberculosis.

    Science.gov (United States)

    Man, Dede K W; Chow, Michael Y T; Casettari, Luca; Gonzalez-Juarrero, Mercedes; Lam, Jenny K W

    2016-07-01

    Tuberculosis (TB), caused by the infection of Mycobacterium tuberculosis (Mtb), continues to pose a serious threat to public health, and the situation is worsening with the rapid emergence of multidrug resistant (MDR) TB. Current TB regimens require long duration of treatment, and their toxic side effects often lead to poor adherence and low success rates. There is an urgent need for shorter and more effective treatment for TB. In recent years, RNA interference (RNAi) has become a powerful tool for studying gene function by silencing the target genes. The survival of Mtb in host macrophages involves the attenuation of the antimicrobial responses mounted by the host cells. RNAi technology has helped to improve our understanding of how these bacilli interferes with the bactericidal effect and host immunity during TB infection. It has been suggested that the host-directed intervention by modulation of host pathways can be employed as a novel and effective therapy against TB. This therapeutic approach could be achieved by RNAi, which holds enormous potential beyond a laboratory to the clinic. RNAi therapy targeting TB is being investigated for enhancing host antibacterial capacity or improving drug efficacy on drug resistance strains while minimizing the associated adverse effects. One of the key challenges of RNAi therapeutics arises from the delivery of the RNAi molecules into the target cells, and inhalation could serve as a direct administration route for the treatment of pulmonary TB in a non-invasive manner. However, there are still major obstacles that need to be overcome. This review focuses on the RNAi candidates that are currently explored for the treatment of TB and discusses the major barriers of pulmonary RNAi delivery. From this, we hope to stimulate further studies of local RNAi therapeutics for pulmonary TB treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Evaluation of the detection of Mycobacterium tuberculosis with metabolic activity in culture-negative human clinical samples.

    Science.gov (United States)

    Cubero, N; Esteban, J; Palenque, E; Rosell, A; Garcia, M J

    2013-03-01

    Mycobacterium tuberculosis is assumed to remain in a quiescent state during latent infection, being unable to grow in culture. The aim of this study was to evaluate the detection of viable but non-cultivable bacilli with metabolic activity in human clinical samples using a procedure that is independent of the immunological status of the patient. The study was performed on 66 human clinical samples, from patients subjected to routine diagnosis to rule out a mycobacterial infection. Specimens from pulmonary and extra-pulmonary origins were verified to contain human DNA before testing for M. tuberculosis DNA, rRNA and transient RNA by real-time quantitative PCR. Clinical records of 55 patients were also reviewed. We were able to detect viable but non-cultivable bacilli with a metabolic activity in both pulmonary and extra-pulmonary samples. Mycobacterium tuberculosis RNA was detected in the majority of culture-positive samples whereas it was detected in one-third of culture-negative samples, 20% of them showed metabolic activity. Amplifications of the ftsZ gene and particularly of the main promoter of the ribosomal operon rrnA, namely PCL1, seem to be good targets to detect active bacilli putatively involved in latent infection. Moreover, this last target would provide information on the basal metabolic activity of the bacilli detected. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.

  16. PROFILE OF SPUTUM POSITIVE PULMONARY TUBERCULOSIS PATIENTS ON RE - TREATMENT REGIMEN

    Directory of Open Access Journals (Sweden)

    Kiran

    2015-10-01

    in our study was 86.75 %.10.8% of the patient have normal ESR and 95.1 % of patient blood were positive for CRP.42.1% of patient was ha ving clinical evidence of pulmonary tuberculosis. 8% of patients were diabetics. CONCLUSION: Many factors are responsible for recurrence of pulmonary tuberculosis Patient with HIV and Diabetes Mellitus have high chances of recurrence of pulmonary tuberculo sis due to decreased immunity. Defaulters have maximum chances of recurrence followed by Relapse cases . Treatment failure is uncommon cause of recurrent TB. Alcoholic are more likely to Default. ESR can be normal in recurrent pulmonary tuberculosis patient s.

  17. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review

    NARCIS (Netherlands)

    Tiemersma, E.W.; van der Werf, M.J.; Borgdorff, M.W.; Williams, B.G.; Nagelkerke, N.J.D.

    2011-01-01

    Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting

  18. Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Myung Jin; Lee, Kyung Soo; Kim, Tae Sung; Kim, Sung Mok [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea); Koh, Won-Jung; Kwon, O Jung [Sungkyunkwan University School of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Seoul (Korea); Kang, Eun Young [Korea University Guro Hospital, Department of Diagnostic Radiology, Korea University College of Medicine, Seoul (Korea); Kim, Seonwoo [Sungkyunkwan University School of Medicine, Biostatistics Unit of the Samsung Biomedical Research Institute, Samsung Medical Center, Seoul (Korea)

    2006-09-15

    The aim of this work was to compare thin-section CT (TSCT) findings of drug-sensitive (DS) tuberculosis (TB), multidrug-resistant (MDR) TB, and nontuberculous mycobacterial (NTM) pulmonary disease in nonAIDS adults. During 2003, 216 (113 DS TB, 35 MDR TB, and 68 NTM) patients with smear-positive sputum for acid-fast bacilli (AFB), and who were subsequently confirmed to have mycobacterial pulmonary disease, underwent thoracic TSCT. The frequency of lung lesion patterns on TSCT and patients' demographic data were compared. The commonest TSCT findings were tree-in-bud opacities and nodules. On a per-person basis, significant differences were found in the frequency of multiple cavities and bronchiectasis (P<0.001, chi-square test and multiple logistic regression analysis). Multiple cavities were more frequent in MDR TB than in the other two groups and extensive bronchiectasis in NTM disease (multiple logistic regression analysis). Patients with MDR TB were younger than those with DS TB or NTM disease (P<0.001, multiple logistic regression analysis). Previous tuberculosis treatment history was significantly more frequent in patients with MDR TB or NTM disease (P<0.001, chi-square test and multiple logistic regression analysis). In patients with positive sputum AFB, multiple cavities, young age, and previous tuberculosis treatment history imply MDR TB, whereas extensive bronchiectasis, old age, and previous tuberculosis treatment history NTM disease. (orig.)

  19. Concurrent evaluation of microscopic observation of drug susceptibility assay for pulmonary and extrapulmonary tuberculosis

    Science.gov (United States)

    Zadbuke, Sonali Sudhir; Set, Reena; Khan, Nishat; Shastri, Jayanthi

    2017-01-01

    BACKGROUND: Methods for detection and drug susceptibility of tuberculosis (TB) with solid media are inexpensive but slow and laborious. Rapid methods to diagnose TB and multidrug-resistant TB (MDR-TB) are a global priority for TB control. OBJECTIVES: A study was performed to compare the sensitivity of detection of mycobacterial growth and time of culture positivity by microscopic observation of drug susceptibility (MODS) assay with that of Lowenstein–Jensen (LJ) culture in pulmonary and extrapulmonary TB and to evaluate the concordance of the susceptibilities to isoniazid (INH) and rifampicin (RIF) by MODS and proportion method on LJ. MATERIALS AND METHODS: A prospective, laboratory-based study was conducted on a total of 300 samples from suspected cases of pulmonary and extrapulmonary TB. Samples were inoculated on LJ medium as per the standard guidelines and MODS assay was performed. RESULTS: Sensitivity of MODS assay was 80% and 83.3% and specificity was 92.9% and 83.3% for pulmonary and extrapulmonary samples, respectively. Difference between mean time to detection of Mycobacterium TB (MTB) by LJ medium and MODS was statistically significant, with MODS being faster. drug susceptibility testing (DST) by MODS when compared to economic variant of proportion method was 87.87% for RIF, 90.9% for INH, and 96.96% for MDR-TB detection. CONCLUSION: MODS assay provides rapid, safe, and sensitive detection of TB faster than the existing gold standard. It is extremely promising in effectively diagnosing MDR-TB.

  20. Use of several immunological markers to model the probability of active tuberculosis.

    Science.gov (United States)

    Petruccioli, Elisa; Navarra, Assunta; Petrone, Linda; Vanini, Valentina; Cuzzi, Gilda; Gualano, Gina; Palmieri, Fabrizio; Girardi, Enrico; Goletti, Delia

    2016-10-01

    Blood-based biomarkers tests are attractive alternative for diagnosing tuberculosis to assays depending on mycobacteria detection. Given several immunological markers we used logistic regression to model the probability of active tuberculosis in a cohort of patients with active or latent tuberculosis, showing an increased accuracy in distinguishing active from latent tuberculosis.

  1. Osteoarticular manifestations of Mycobacterium tuberculosis infection.

    Science.gov (United States)

    Zychowicz, Michael E

    2010-01-01

    Mycobacterium tuberculosis has affected humans for much of our existence. The incidence of global tuberculosis infection continues to rise, especially in concert with HIV coinfection. Many disease processes, such as diabetes, increase the likelihood of tuberculosis infection. Tuberculosis bacteria can infect any bone, joint, tendon, or bursa; however, the most common musculoskeletal site for infection includes the spine and weight-bearing joints of the hip and knee. Many patients who present with osteoarticular tuberculosis infection will have a gradual onset of pain at the site of infection. Many patients who develop a musculoskeletal tuberculosis infection will have no evidence of a pulmonary tuberculosis infection on x-ray film and many will have very mild symptoms with the initial infection. Healthcare providers must remember that many patients who develop tuberculosis infection do not progress to active tuberculosis disease; however, the latent infection may become active with immune compromise.

  2. Analysis of 305 cases of hematogenous disseminated pulmonary tuberculosis complicated with pulmonary tuberculosis%血行播散性肺结核合并肺外结核的305例分析

    Institute of Scientific and Technical Information of China (English)

    陈镇永; 李琼; 杨红霞

    2014-01-01

    目的血行播散型肺结核是结核分枝杆菌(以下简称结核菌)一次或反复多次进入血液循环,造成肺部病变以及相应的病理、病理生理学改变和临床表现者称为血行播散型肺结核,造成全身多脏器病变时则称血行播散型结核病。血行播散型肺结核是一种危重结核病,由原发型肺结核发展而来,也可由其它结核干酪样灶破溃到血源引起。%Objective Hematogenous disseminated pulmonary tuberculosis (HdPt) is caused by Mycobacterium tuberculosis diffusely inifltrating bilateral lung lobes through blood circulation once or repeatedly, which leads to pulmonary pathological changes and systemic clinical manifestations, whereas hematogenous disseminated tuberculosis involves systemic multi-organ disease. HdPt is a type of severe tuberculosis, deteriorating from primary tuberculosis or caseous lesions eroding adjacent vessels.

  3. Antibacterial Activity of Medicinal Aqueous Plant Extracts against Mycobacterium tuberculosis

    Directory of Open Access Journals (Sweden)

    Muna Mohammed Buzayan

    2012-09-01

    Full Text Available Tuberculosis (TB remains a serious health problem in many regions of the world, and the development of resistance to antibiotics by this microbe created the need for new drugs to replace those which have lost effectiveness. This study assesses the medicinal anti-Mycobacterium tuberculosis properties of natural products obtained from plants collected from Eastern Libya. In this study aqueous extracts of nine different plants were assayed for their Mycobacterium tuberculosis inhibitory activity using the BACTEC MGIT960 susceptibility test method. The aqueous extracts of Ceratonia siliqua L, Helichrysum stoechas (L. Moench and Thymus algeriensis did not show any activity against M. tuberculosis in different concentrations. The aqueous extract of Marrubium vulgare L. from Syria showed high activity against M. tuberculosis. Marrubium alysson L., Marrubium vulgare L., Pistacia lentiscus L, Quercus coccifera L, Thymus capitatus (L. Hoffm. & Link, showed varying degrees of activity against M. tuberculosis. The results of this study show that aqueous extracts from six different medicinal plants have different effects against M. tuberculosis in vitro.

  4. Tuberculosis

    Directory of Open Access Journals (Sweden)

    C. Robert Horsburgh, Jr

    2014-03-01

    Full Text Available This article reviews the published literature on tuberculosis from September 2012 to August 2013 and describes important advances in tuberculosis epidemiology, microbiology, pathology, clinical pharmacology, genetics, treatment and prevention.

  5. Tuberculosis

    OpenAIRE

    C. Robert Horsburgh, Jr

    2014-01-01

    This article reviews the published literature on tuberculosis from September 2012 to August 2013 and describes important advances in tuberculosis epidemiology, microbiology, pathology, clinical pharmacology, genetics, treatment and prevention.

  6. Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

    Science.gov (United States)

    Muñoz-Torrico, Marcela; Rendon, Adrian; Centis, Rosella; D'Ambrosio, Lia; Fuentes, Zhenia; Torres-Duque, Carlos; Mello, Fernanda; Dalcolmo, Margareth; Pérez-Padilla, Rogelio; Spanevello, Antonio; Migliori, Giovanni Battista

    2016-01-01

    The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae. RESUMO O papel da tuberculose como uma prioridade de saúde pública e a disponibilidade de ferramentas diagnósticas para avaliar o estado

  7. Effect of chemotherapy on whole-blood cytokine responses to Mycobacterium tuberculosis antigens in a small cohort of patients with pulmonary tuberculosis.

    Science.gov (United States)

    Bertholet, Sylvie; Horne, David J; Laughlin, Elsa M; Savlov, Margery; Tucakovic, Ines; Coler, Rhea N; Narita, Masahiro; Reed, Steven G

    2011-08-01

    The development of genomic and proteomic tools has enabled studies that begin to characterize the molecular targets of an effective host immune response to Mycobacterium tuberculosis, including understanding the specific immune responses associated with tuberculosis (TB) disease progression, disease resolution, and the development of latency. One application of such tools is the development of diagnostic reagents and assays useful as a test of cure. Such a test could be of considerable importance for the evaluation of new therapeutics. We and others have previously described immunodominant proteins of M. tuberculosis, including both vaccine and diagnostic candidates. In the present study, we describe the changes in immune responses to a panel of 71 M. tuberculosis antigens in six patients during the course of therapy. The levels of six cytokines were measured in 24-h whole-blood assays with these antigens, revealing that gamma interferon (IFN-γ), tumor necrosis factor (TNF), and interleukin-10 (IL-10) were differentially regulated in response to a subset of antigens. Therefore, measuring the production of these three cytokines in response to a panel of carefully selected M. tuberculosis proteins during the course of TB therapy might be a promising path toward the development of a test of cure and warrants further validation in larger cohorts of pulmonary TB patients.

  8. Expression of miR-29a in serum of patients with pulmonary tuberculosis and prediction of its function with bioinformatics analysis

    Institute of Scientific and Technical Information of China (English)

    付玉荣

    2013-01-01

    Objective To analyze the expression of miR-29a in serum of patients with pulmonary tuberculosis,and to predict and analyze function of its target genes for further studying of its biological function and regulatory

  9. Tomographic findings of lobar consolidation in primary pulmonary tuberculosis; Aspectos tomograficos da consolidacao lobar na tuberculose pulmonar primaria

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Bruno Alberto Falcao [Hopital Europeen Georges Pompidou, Paris (France); Macedo, Solange Goncalves David de [Hospital Municipal Jesus, Rio de Janeiro, RJ (Brazil). Setor de Pneumologia; Nogueira, Renata do Amaral [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil). Setor de Pediatria; Castiel, Lola Celeste Pantoja [Clinica Radiologica Dr. Samuel Castiel, Porto Velho, RO (Brazil); Penna, Claudia Renata Rezende [Hospital Municipal Jesus, Rio de Janeiro, RJ (Brazil). Servico de Radiologia Pediatrica], e-mail: cr-penna@uol.com.br

    2009-03-15

    Objective: To describe tomographic findings of lobar consolidation as early manifestation of primary pulmonary tuberculosis. Materials and methods: The present study was developed at Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil, in the period between 2002 and 2006, retrospectively evaluating tomographic findings in four children aged from 3 to 14 months with lobar consolidation as an early manifestation of primary pulmonary tuberculosis. Results: The most frequently found radiological pattern was lobar consolidation with calcifications, cavitation and intermingle necrotic areas, associated with bulging fissure. Signs of bronchogenic dissemination and lymph node enlargement were observed in all of the four children. Consolidation with a pseudotumor aspect and masslike effect was observed in one case. Conclusion: The cases included in the present study have demonstrated that primary pulmonary tuberculosis manifested as lobar consolidation presents typical tomographic images such as cavitation, hypodense areas and calcifications intermingled with consolidation. The association with lymph node enlargement with central necrosis and signs of bronchogenic dissemination reinforce the diagnosis of tuberculosis. (author)

  10. Calcified Pulmonary Nodules Identified in a 350-Year-Old-Joseon Mummy: the First Report on Ancient Pulmonary Tuberculosis from Archaeologically Obtained Pre-modern Korean Samples

    Science.gov (United States)

    2016-01-01

    We found calcified pulmonary nodules in a middle-aged female mummy discovered from 350-yr-old Joseon tomb of Korea. In the CT scan, we found six radiopaque nodules in right lung, through the levels of thoracic vertebrae 1 to 6. We also found presumptive pleural adhesions in right thoracic cavity of CT images. We re-confirmed radiological findings by our post-factum dissection on the same mummy. By the differential diagnosis, we speculate that the radiopaque calcification nodules and associated pleural adhesion could have been caused by tuberculosis. This is the first-ever report on the pulmonary tuberculosis identified in archaeologically obtained, pre-modern Korean samples. PMID:26770051

  11. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area

    Science.gov (United States)

    Jiménez‐Corona, M‐E; García‐García, L; DeRiemer, K; Ferreyra‐Reyes, L; Bobadilla‐del‐Valle, M; Cano‐Arellano, B; Canizales‐Quintero, S; Martínez‐Gamboa, A; Small, P M; Sifuentes‐Osornio, J; Ponce‐de‐León, A

    2006-01-01

    Background In most low income countries there are twice as many cases of tuberculosis (TB) reported among men than among women, a difference commonly attributed to biological and epidemiological characteristics as well as socioeconomic and cultural barriers in access to health care. The World Health Organization has encouraged gender specific comparisons in TB rates to determine whether women with TB are less likely than men with TB to be diagnosed, reported, and treated. A study was undertaken to identify gender based differences in patients with pulmonary TB and to use this information to improve TB control efforts. Methods Individuals with a cough for more than 2 weeks in southern Mexico were screened from March 1995 to April 2003. Clinical and mycobacteriological information (isolation, identification, drug susceptibility testing and IS6110 based genotyping, and spoligotyping) was collected from those with bacteriologically confirmed pulmonary TB. Patients were treated in accordance with official norms and followed to ascertain treatment outcome, retreatment, and vital status. Results 623 patients with pulmonary TB were enrolled. The male:female incidence rate ratio for overall, reactivated, and recently transmitted disease was 1.58 (95% CI 1.34 to 1.86), 1.64 (95% CI 1.36 to 1.98), and 1.41 (95% CI 1.01 to 1.96), respectively. Men were more likely than women to default from treatment (adjusted OR 3.30, 95% CI 1.46 to 7.43), to be retreated (hazard ratio (HR) 3.15, 95% CI 1.38 to 7.22), and to die from TB (HR 2.23, 95% CI 1.25 to 3.99). Conclusions Higher rates of transmitted and reactivated disease and poorer treatment outcomes among men are indicators of gender differentials in the diagnosis and treatment of pulmonary TB, and suggest specific strategies in endemic settings. PMID:16449260

  12. A prospective study of pulmonary tuberculosis in rural geriatric population of South India

    Directory of Open Access Journals (Sweden)

    Shaik KU

    2016-01-01

    Full Text Available Background: Sparse data are available documenting similarities and differences in the clinical, bacteriological and radiographic features of pulmonary tuberculosis (TB in persons aged over 60 years and those aged under 60 years. Materials and Methods: We prospectively studied 100 adult patients with pulmonary TB aged 18-59 years (n=50 and 60 years and above (n=50; elderly subjects who presented to the medicine out-patient service and were admitted in the medical wards at our medical college teaching hospital at Kuppam, Andhra Pradesh. Results: In both the groups, males were in the majority (72% in geriatric and 60% in adult group. Hemoptysis (26% in geriatric and 42% in adult and night sweats (12% in geriatric and 58% in adult were frequent in adults than geriatric patients. Chronic obstructive pulmonary disease(COPD,Hypertension and diabetes mellitus were more frequent in geriatric patients than 18-59 year old adults. Cavitations were more common in adults, whereas lower lobe involvement was more frequent in the geriatric group. In the geriatric patients 72% were completely cured compared to 92% in adult patients. Treatment failure was 20% in geriatric group compared to 6% in adults. Mortality was 8% in geriatric and 2% in adults. Adverse reactions were frequent in geriatric group (n=20 than 18-59 year old individuals. Conclusion: The present study documents important differences in clinical and radiological presentation of pulmonary TB in geriatric patients compared with adults aged 18-59 years. Geriatric patients also experienced more frequent occurrence of adverse reactions, failure of treatment and mortality.

  13. Multifactor dimensionality reduction reveals a three-locus epistatic interaction associated with susceptibility to pulmonary tuberculosis

    DEFF Research Database (Denmark)

    Collins, Ryan L; Hu, Ting; Wejse, Christian;

    2013-01-01

    for this problem. The goal of the present study was to apply MDR to mining high-order epistatic interactions in a population-based genetic study of tuberculosis (TB). Results The study used a previously published data set consisting of 19 candidate single-nucleotide polymorphisms (SNPs) in 321 pulmonary TB cases......Background Identifying high-order genetics associations with non-additive (i.e. epistatic) effects in population-based studies of common human diseases is a computational challenge. Multifactor dimensionality reduction (MDR) is a machine learning method that was designed specifically...... and 347 healthy controls from Guniea-Bissau in Africa. The ReliefF algorithm was applied first to generate a smaller set of the five most informative SNPs. MDR with 10-fold cross-validation was then applied to look at all possible combinations of two, three, four and five SNPs. The MDR model with the best...

  14. Anti-PD1 Antibody Treatment and the Development of Acute Pulmonary Tuberculosis.

    Science.gov (United States)

    Fujita, Kohei; Terashima, Tsuyoshi; Mio, Tadashi

    2016-12-01

    Recently, cancer immunotherapy by immune checkpoint inhibitors has been considered one of the pillars for the treatment of cancer. Nivolumab is the first immune checkpoint inhibitor approved for lung cancer treatment in Japan. Although nivolumab has superior survival benefits and fewer adverse events than cytotoxic agents, it can generate dysimmune toxicities, known as immune-related adverse events. Although autoimmune manifestations are well-known immune-related adverse events, the development of infectious diseases is rare. Here, we report on a patient with advanced NSCLC in whom pulmonary tuberculosis developed rapidly during nivolumab treatment and discuss the potential mechanisms as well as what is known about infections during checkpoint inhibitor therapy. Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  15. Prevalence of melioidosis in patients with suspected pulmonary tuberculosis and sputum smear negative for acid-fast bacilli in northeast Thailand.

    Science.gov (United States)

    Suntornsut, Pornpan; Kasemsupat, Kriangsak; Silairatana, Santi; Wongsuvan, Gumphol; Jutrakul, Yaowaruk; Wuthiekanun, Vanaporn; Day, Nicholas P J; Peacock, Sharon J; Limmathurotsakul, Direk

    2013-11-01

    The clinical and radiological features of pulmonary melioidosis can mimic tuberculosis. We prospectively evaluated 118 patients with suspected pulmonary tuberculosis who were acid-fast bacilli (AFB) smear negative at Udon Thani Hospital, northeast Thailand. Culture of residual sputum from AFB testing was positive for Burkholderia pseudomallei in three patients (2.5%; 95% confidence interval [CI] 0.5-7.3%). We propose that in melioidosis-endemic areas, residual sputum from AFB testing should be routinely cultured for B. pseudomallei.

  16. High prevalence of pulmonary tuberculosis and inadequate case finding in rural western Kenya.

    Science.gov (United States)

    van't Hoog, Anna H; Laserson, Kayla F; Githui, Willie A; Meme, Helen K; Agaya, Janet A; Odeny, Lazarus O; Muchiri, Benson G; Marston, Barbara J; DeCock, Kevin M; Borgdorff, Martien W

    2011-05-01

    Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high rates of HIV. To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) and the fraction attributable to HIV, and to evaluate case detection. Residents aged 15 years and older, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum sample for culture. PTB was defined by a culture positive for Mycobacterium tuberculosis or two positive smears. Persons with PTB were offered HIV testing and interviewed on care-seeking behavior. We estimated the population-attributable fraction of HIV on prevalent and notified PTB, the patient diagnostic rate, and case detection rate using provincial TB notification data. Among 20,566 participants, 123 had PTB. TB prevalence was 6.0/1,000 (95% confidence interval, 4.6-7.4) for all PTB and 2.5/1,000 (1.6-3.4) for smear-positive PTB. Of 101 prevalent TB cases tested, 52 (51%) were HIV infected, and 58 (64%) of 91 cases who were not on treatment and were interviewed had not sought care. Forty-eight percent of prevalent and 65% of notified PTB cases were attributable to HIV. For smear-positive and smear-negative PTB combined, the patient diagnostic rate was 1.4 cases detected per person-year among HIV-infected persons having PTB and 0.6 for those who were HIV uninfected, corresponding to case detection rates of 56 and 65%, respectively. Undiagnosed PTB is common in this community. TB case finding needs improvement, for instance through intensified case finding with mobile smear microscopy services, rigorous HIV testing, and improved diagnosis of smear-negative TB.

  17. A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis

    Science.gov (United States)

    Osório, Nuno S.; Castro, António Gil; Ramos, Angélica; Carvalho, Teresa; Meira, Leonor; Araújo, David; Almeida, Leonor; Boaventura, Rita; Fragata, Patrícia; Chaves, Catarina; Costa, Patrício; Portela, Miguel; Ferreira, Ivo; Magalhães, Sara Pinto; Rodrigues, Fernando; Sarmento-Castro, Rui; Duarte, Raquel; Guimarães, João Tiago; Saraiva, Margarida

    2016-01-01

    Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8–7.9), age ≥50 years (OR 2.9, 95% CI 1.7–4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4–4.4), ≥1 significant comorbidity—HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease–(OR 2.3, 95% CI 1.3–3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1–3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3–5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment. PMID:27636095

  18. A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis.

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    Bastos, Helder Novais; Osório, Nuno S; Castro, António Gil; Ramos, Angélica; Carvalho, Teresa; Meira, Leonor; Araújo, David; Almeida, Leonor; Boaventura, Rita; Fragata, Patrícia; Chaves, Catarina; Costa, Patrício; Portela, Miguel; Ferreira, Ivo; Magalhães, Sara Pinto; Rodrigues, Fernando; Sarmento-Castro, Rui; Duarte, Raquel; Guimarães, João Tiago; Saraiva, Margarida

    2016-01-01

    Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8-7.9), age ≥50 years (OR 2.9, 95% CI 1.7-4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4-4.4), ≥1 significant comorbidity-HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease-(OR 2.3, 95% CI 1.3-3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1-3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3-5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.

  19. Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India.

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    Baskaran Dhanaraj

    Full Text Available The present study measured the community prevalence and risk factors of adult pulmonary tuberculosis (PTB in Chennai city, and also studied geographical distribution and the presence of different M. tuberculosis strains in the survey area.A community-based cross sectional survey was carried out from July 2010 to October 2012 in Chennai city. Prevalence of bacteriologically positive PTB was estimated by direct standardization method. Univariate and multivariate analyses were carried out to identify significant risk factors. Drug susceptibility testing and spoligotyping was performed on isolated M. tuberculosis strains. Mapping of PTB cases was done using geographic positioning systems.Of 59,957 eligible people, 55,617 were screened by X-ray and /or TB symptoms and the prevalence of smear, culture, and bacteriologically positive PTB was estimated to be 228 (95% CI 189-265, 259 (95% CI 217-299 and 349 (95% CI 330-428 per 100,000 population, respectively. Prevalence of smear, culture, and bacteriologically positive PTB was highest amongst men aged 55-64 years. Multivariate analysis showed that occurrence of both culture and bacteriologically positive PTB disease was significantly associated with: age >35 years, past history of TB treatment, BMI <18.5 Kgs/m2, solid cooking fuel, and being a male currently consuming alcohol. The most frequent spoligotype family was East African Indian. Spatial distribution showed that a high proportion of patients were clustered in the densely populated north eastern part of the city.Our findings demonstrate that TB is a major public health problem in this urban area of south India, and support the use of intensified case finding in high risk groups. Undernutrition, slum dwelling, indoor air pollution and alcohol intake are modifiable risk factors for TB disease.

  20. Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis.

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    Martínez, Dalila; Heudebert, Gustavo; Seas, Carlos; Henostroza, German; Rodriguez, Martin; Zamudio, Carlos; Centor, Robert M; Herrera, Cesar; Gotuzzo, Eduardo; Estrada, Carlos

    2010-08-11

    Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem. To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis. Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months. Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58. A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.

  1. Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis.

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    Dalila Martínez

    Full Text Available BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB, resistance to at least isoniazid and rifampin, is a worldwide problem. OBJECTIVE: To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis. METHODS: Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú, either a presenting with a positive acid-fast bacillus smear, or b had failed therapy or had a relapse within the first 12 months. RESULTS: Among 964 patients, 82 had MDR-TB (prevalence, 8.5%. Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58. CONCLUSION: A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.

  2. Risk factors for pulmonary tuberculosis: a clinic-based case control study in The Gambia

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    Adegbola Richard A

    2006-06-01

    Full Text Available Abstract Background The tuberculosis (TB epidemic in Africa is on the rise, even in low-HIV prevalence settings. Few studies have attempted to identify possible reasons for this. We aimed to identify risk factors for pulmonary tuberculosis in those attending a general outpatients clinic in The Gambia, a sub-Saharan African country with relatively low HIV prevalence in the community and in TB patients. Methods We conducted a case control study at the Medical Research Council Outpatients' clinic in The Gambia. Pulmonary TB cases were at least 15 years old, controls were age and sex matched clinic attendees. Participants were interviewed using a structured questionnaire. Results 100 sputum smear positive TB cases and 200 clinic controls were recruited. HIV prevalence was 6.1% in cases and 3.3% in controls. Multivariable assessment of host factors showed that risk of TB was increased among the Jola ethnic group and smokers, and decreased in those in a professional occupation. Assessment of environmental factors showed an increased risk with household crowding, history of household exposure to a known TB case, and absence of a ceiling in the house. In a combined multivariable host-environment model, the risk of TB increased with crowding, exposure to a known TB case, as well as amongst the Jola ethnic group. Conclusion In The Gambia, household crowding and past household exposure to a known TB case are the standout risk factors for TB disease. Further research is needed to identify why risk of TB seems to differ according to ethnicity.

  3. Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges

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    Shirodkar, S.; Anande, L.; Dalal, A.; Desai, C.; Corrêa, G.; Laxmeshwar, C.; Mansoor, H.; Remartinez, D.; Trelles, M.; Isaakidis, P.

    2016-01-01

    Setting: While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited. Objective: To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India. Design: A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private. Results: Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected. Conclusion: In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions. PMID:27695683

  4. April 2015 Phonenix pulmonary journal club: endo-bronchial ultrasound in diagnosing tuberculosis

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    Mathew M

    2015-04-01

    Full Text Available No abstract available. Article truncated after 150 words. Lin SM, Chung FT, Huang CD, Liu WT, Kuo CH, Wang CH, Lee KY, Liu CY, Lin HC, Kuo HP. Diagnostic value of endobronchial ultrasonography for pulmonary tuberculosis. J Thorac Cardiovasc Surg. 2009;138(1:179-84. The diagnosis of tuberculosis in patients with inability to produce sputum or in patients that remain acid-fast bacilli (AFB smear negative with high index of clinical suspicion remains a challenge and often results in treatment delay. This study examined the role in using endobronchial ultrasound (EBUS to locate parenchymal infiltrates to allow for more accurate sampling of bronchial lavage fluid and transbronchial biopsies. The study examined 121 patients divided into 2 groups, 73 patients received EBUS guided bronchoscopy and 48 pts received conventional bronchoscopy with bronchoalveolar lavage (BAL and transbronchial biopsies. It should be noted that patients undergoing transbronchial biopsies in the non-EBUS group appeared to have biopsies done without the use of fluoroscopy. The results showed ...

  5. Detection and Quantification of Mycobacterium tuberculosis in the Sputum of Culture-Negative HIV-infected Pulmonary Tuberculosis Suspects: A Proof-of-Concept Study

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    Madico, Guillermo; Mpeirwe, Moses; White, Laura; Vinhas, Solange; Orr, Beverley; Orikiriza, Patrick; Miller, Nancy S.; Gaeddert, Mary; Mwanga-Amumpaire, Juliet; Palaci, Moises; Kreiswirth, Barry; Straight, Joe; Dietze, Reynaldo; Boum, Yap; Jones-López, Edward C.

    2016-01-01

    Rationale Rapid diagnosis of pulmonary tuberculosis (TB) is critical for timely initiation of treatment and interruption of transmission. Yet, despite recent advances, many patients remain undiagnosed. Culture, usually considered the most sensitive diagnostic method, is sub-optimal for paucibacillary disease. Methods We evaluated the Totally Optimized PCR (TOP) TB assay, a new molecular test that we hypothesize is more sensitive than culture. After pre-clinical studies, we estimated TOP’s per-patient sensitivity and specificity in a convenience sample of 261 HIV-infected pulmonary TB suspects enrolled into a TB diagnostic study in Mbarara, Uganda against MGIT culture, Xpert MTB/RIF and a composite reference standard. We validated results with a confirmatory PCR used for sequencing M. tuberculosis. Measurements and Results Using culture as reference, TOP had 100% sensitivity but 35% specificity. Against a composite reference standard, the sensitivity of culture (27%) and Xpert MTB/RIF (27%) was lower than TOP (99%), with similar specificity (100%, 98% and 87%, respectively). In unadjusted analyses, culture-negative/TOP-positive patients were more likely to be older (P<0·001), female (P<0·001), have salivary sputum (P = 0·05), sputum smear-negative (P<0.001) and less advanced disease on chest radiograph (P = 0.05). M. tuberculosis genotypes identified in sputum by DNA sequencing exhibit differential growth in culture. Conclusions These findings suggest that the TOP TB assay is accurately detecting M. tuberculosis DNA in the sputum of culture-negative tuberculosis suspects. Our results require prospective validation with clinical outcomes. If the operating characteristics of the TOP assay are confirmed in future studies, it will be justified as a “TB rule out” test. PMID:27391604

  6. Immune parameters differentiating active from latent tuberculosis infection in humans.

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    Lee, Ji Yeon; Jung, Young Won; Jeong, Ina; Joh, Joon-Sung; Sim, Soo Yeon; Choi, Boram; Jee, Hyeon-Gun; Lim, Dong-Gyun

    2015-12-01

    Tuberculosis remains a highly prevalent infectious disease worldwide. Identification of the immune parameters that differentiate active disease from latent infection will facilitate the development of efficient control measures as well as new diagnostic modalities for tuberculosis. Here, we investigated the cytokine production profiles of monocytes and CD4(+) T lymphocytes upon encountering mycobacterial antigens. In addition, cytokines and lipid mediators with immune-modulating activities were examined in plasma samples ex vivo. Comparison of these parameters in active tuberculosis patients and healthy subjects with latent infection revealed that, active tuberculosis was associated with diminished Th1-type cytokine secretion from CD4(+) T cells and less augmented inflammatory cytokine secretion from monocytes induced by IFN-γ than that in latent tuberculosis infection. In addition, a higher plasma concentration of lipoxin A4 and lower ratio of prostaglandin E2 to lipoxin A4 were observed in active cases than in latent infections. These findings have implications for preparing new therapeutic strategies and for differential diagnosis of the two types of tuberculosis infection.

  7. Exposure to cigarette smoke inhibits the pulmonary T-cell response to influenza virus and Mycobacterium tuberculosis.

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    Feng, Yan; Kong, Ying; Barnes, Peter F; Huang, Fang-Fang; Klucar, Peter; Wang, Xisheng; Samten, Buka; Sengupta, Mayami; Machona, Bruce; Donis, Ruben; Tvinnereim, Amy R; Shams, Homayoun

    2011-01-01

    Smoking is associated with increased susceptibility to tuberculosis and influenza. However, little information is available on the mechanisms underlying this increased susceptibility. Mice were left unexposed or were exposed to cigarette smoke and then infected with Mycobacterium tuberculosis by aerosol or influenza A by intranasal infection. Some mice were given a DNA vaccine encoding an immunogenic M. tuberculosis protein. Gamma interferon (IFN-γ) production by T cells from the lungs and spleens was measured. Cigarette smoke exposure inhibited the lung T-cell production of IFN-γ during stimulation in vitro with anti-CD3, after vaccination with a construct expressing an immunogenic mycobacterial protein, and during infection with M. tuberculosis and influenza A virus in vivo. Reduced IFN-γ production was mediated through the decreased phosphorylation of transcription factors that positively regulate IFN-γ expression. Cigarette smoke exposure increased the bacterial burden in mice infected with M. tuberculosis and increased weight loss and mortality in mice infected with influenza virus. This study provides the first demonstration that cigarette smoke exposure directly inhibits the pulmonary T-cell response to M. tuberculosis and influenza virus in a physiologically relevant animal model, increasing susceptibility to both pathogens.

  8. The correlation analysis between semi-quantitative score of high-resolution and spot forming cells in ELISPOT of patients with pulmonary tuberculosis%肺结核高分辨率CT半定量评分与酶联免疫斑点形成细胞数的相关性分析

    Institute of Scientific and Technical Information of China (English)

    方文春; 马威; 陆普选; 彭程; 邓群益; 魏方军; 陈心春

    2014-01-01

    Objective To study of HRCT findings of pulmonary tuberculosis, the relationship between CT findings with semi-quantitative score of pulmonary tuberculosis and enzyme-linked immunosorbent spot forming cell number, in order to provide proofs for pulmonary tuberculosis activity. Methods Two hundrend and three patients with pulmonary tuberculosis, who had HRCT and enzyme-linked immunospat assay, were enrolled in this study. Semi-quantitative score of CT finding were compared with enzyme-linked immanospat assay. Results There were well correction between CT findings and enazyme-linked immunospot observed in group of one side secondary pulmonary tuberculosis , two side secondary pulmonary tuberculosis, tuberculosis pleuritis and control group. The correction of hematogenous disseminated pulmonary tuberculosis was poor. Conclusion Except hematogenous disseminated pulmonary tuberculosis, semi-quantitative score of CT findings can be used as a biomarker for pulmonary tuberculosis activity.%目的:探讨肺结核高分辨率CT(HRCT)表现、半定量评分及其与酶联免疫斑点形成细胞数的相关性,为活动性肺结核临床诊断提供依据。方法①对203例临床诊断为肺结核患者进行HRCT检查和酶联免疫斑点形成细胞数分组检测。②对肺结核各组CT评分与酶联免疫斑点形成细胞数进行统计分析,比较各组间的相关性及有无差异。结果①一侧继发性肺结核组、两侧继发性肺结核组、结核性胸膜炎组及结核控制组HRCT评分分值与不同抗原的酶联免疫斑点形成细胞数检测值一致性较好。②血行播散性肺结核组HRCT评分与不同抗原的酶联免疫斑点形成细胞数检测值一致性较低。结论 HRCT评分分值中除血行播散性肺结核组外,其他各组评分分值与酶联免疫斑点形成细胞数的相关性较好,提示活动性结核病的可能性大。

  9. [Computed tomography in the differential diagnosis of disseminated pulmonary tuberculosis and fibrosing alveolitis].

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    Mursalova, G Kh

    2007-01-01

    The differential diagnostic signs of disseminated pulmonary processes were defined by computed tomography. A hundred and sixty-seven patients, including 117 (70%) with disseminated pulmonary tuberculosis (DPT) and 50 (30%) with alveolitis, were examined. Their mean age was 32.3 +/- 5.1 years; the history of disease averaged 4.6 +/- 1.2 years. Acute, subacute, and chronic DPT was observed in 17 (14.5%), 32 (27.3%), and 68 (58.1%) patients, respectively. Idiopathic fibrosing alveolitis (IFA) was seen in 38 patients; 12 patients had exogenous allergic alveolitis (EAA). IFA and EAA were chronic. Patients with DPT had most commonly signs, such as focal masses (45.3%), intra- and interlobular septal thickening (35%), lung tissue reticulation (35%), centrilobular empyema (29%), only focal masses being detected in its acute form, and other signs being more pronounced in its subacute and particularly chronic form. Glassy dark patches, the opal glass syndrome, were a common sign in patients with alveolitis. Septal thickening, lung tissue meshwork, and centrilobular emphysema were encountered only in patients with IDA and small-nodular focal masses and bronchial wall thickening were present in those with EAA.

  10. Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

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    Subhakar Kandi

    2013-01-01

    Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

  11. Risk factors for death during pulmonary tuberculosis treatment in Korea: a multicenter retrospective cohort study.

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    Kwon, Yong-Soo; Kim, Yee Hyung; Song, Jae-Uk; Jeon, Kyeongman; Song, Junwhi; Ryu, Yon Ju; Choi, Jae Chol; Kim, Ho Cheol; Koh, Won-Jung

    2014-09-01

    The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea.

  12. SPATIAL DISTRIBUTION OF PULMONARY TUBERCULOSIS IN URBAN AREAS: A CASE FROM BELÉM, BRAZIL

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    Marco Aurélio Arbage LOBO

    2016-12-01

    Full Text Available The precise location of areas with high incidence of pulmonary tuberculosis (TB is important to improve public health actions. Official data records of the addresses and neighborhoods where the infected people live allow the mapping of the disease on this spatial scale. However, great socioeconomic diversity often exists inside neighborhoods, wherein high- and low-income families reside. This situation hampers the location of those areas that require close attention. Objective: This study aimed to estimate the risk of pulmonary TB infections in census tracts in Belém City (Brazil from data on neighborhoods. Methods: A partial least-squares regression model was constructed in the scale of neighborhoods based on the record of addresses of TB-infected people and socioeconomic data from official sources. The model was then slightly modified and used to estimate the risk of TB prevalence in urban census tracts. The results were mapped using a geographical information system. Results: The percentages of explained variance of the set of independent variables and dependent variable were 86.4% and 30.2%, respectively. These values indicated that the model was acceptable for its purpose. Conclusion: The model’s results were consistent with the spatial distribution of socioeconomic and environmental characteristics of Belém City.

  13. Cost-effectiveness of a new strategy to detect pulmonary tuberculosis in household contacts in Myanmar.

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    Htet, K K K; Liabsuetrakul, T; Thein, S

    2017-02-01

    Guidelines regarding household contact tracing for pulmonary tuberculosis (TB) in different countries vary according to case detection methods. To compare costs spent on detecting one TB case among household contacts between different contact tracing strategies in Mandalay City, Myanmar. Cost estimation of case detection and diagnostic procedures using two different strategies were calculated. A modified conventional model included screening for TB signs and symptoms, sputum examination for those with positive signs and symptoms and chest X-ray (CXR) for those with negative sputum results. An interventional model included CXR, sputum examination if CXR was abnormal and Xpert® MTB/RIF assay for those with negative sputum results. Estimated costs in each model were stratified by age <15 and 15 years. The additional cost per TB case detected using the interventional model was US$35.41 compared to the modified conventional model. The probability that the interventional model was cost-effective using a threshold of US$100 per case detected was 81% (83% for those aged 15 years and 65% for those aged <15 years). The interventional model was more cost-effective in detecting one more pulmonary TB case among household contacts than the modified conventional model.

  14. Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection

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    Radovic M

    2016-06-01

    Full Text Available Milan Radovic,1,2 Lidija Ristic,1,2 Zorica Ciric,1,2 Violeta Dinic-Radovic,3 Ivana Stankovic,1,2 Tatjana Pejcic,1,2 Milan Rancic,1,2 Dragan Bogdanovic4 1Department of Internal Medicine, Faculty of Medicine, University of Nis, 2Clinic for Lung Diseases, 3Clinic for Gastroenterology and Hepatology, Clinical Centre of Nis, 4Public Health Institute Nis, Nis, Republic of Serbia Background: During the treatment phase of active pulmonary tuberculosis (PTB, respiratory function impairment is usually restrictive. This may become obstructive, as a PTB-associated airflow obstruction (AFO or as a later manifestation of underlying COPD.Purpose: The aim of the study was to examine the potential causes and risks for AFO development in PTB by exploring the aspects of spirometry limitations and clinical implications for the underlying COPD detection, taking into account various confounding factors.Patients and methods: Prospective, nest case–control study on 40 new cases of PTB with initial restrictive respiratory function impairment, diagnosed and treated according to the directly observed treatment short course (DOTS strategy.Results: From all observed patients, 37.5% of them developed AFO upon the completion of PTB treatment, with significantly increased average of forced vital capacity (% (P<0.01. Their changes in forced expiratory volume in the first second (% during the PTB treatment were strongly associated with the air pollution exposure in living (0.474%–20.971% for 95% confidence interval [CI]; P=0.041 and working environments (3.928%–20.379% for 95% CI; P=0.005, initial radiological extent of PTB lesions (0.018%–0.700% for 95% CI; P=0.047, leukocyte count (0.020%–1.328% for 95% CI; P=0.043, and C-reactive protein serum level (0.046%–0.205% for 95% CI; P=0.003 compared to the other patients. The multivariate logistic regression analysis model shows initial radiological extent of pulmonary tuberculosis lesions (OR 1.01–1.05 for 95% CI; P=0

  15. The adrenal gland and the patient with pulmonary tuberculosis infected with human immunodeficiency virus

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    Ifedayo Adeola Odeniyi

    2017-01-01

    Full Text Available Background: The adrenal gland is not spared from the involvement by tuberculosis. One of the recognized causes of adrenal insufficiency (AI is tuberculosis. AI, mostly at the subclinical level, is common in persons with pulmonary tuberculosis (PTB infection, occurring in about 23% of patients. Coinfection with PTB and human immunodeficiency virus (HIV may compromise adrenocortical function and produce significant adrenocortical insufficiency. Objective: To determine if coinfection with tuberculosis and HIV have a compound effect on adrenocortical function in persons with HIV and PTB coinfection. Materials and Methods: Persons with sputum-positive PTB, treatment naive, who met our inclusion criteria, were selected. All the recruited patients were screened for HIV and those positive for HIV infection had confirmatory test. A baseline blood samples for cortisol, fasting plasma glucose, full blood count, and electrolytes were collected between 8.00 h and 9.00 h immediately before administration of adrenocorticotropic hormone (ACTH. The persons received an intravenous bolus injection of 1 μg ACTH (Alliance Pharmaceuticals Ltd., Chippenham, Wiltshire SN15 2BB and blood sample was drawn for cortisol level at 30 min. Results: Forty-four people with PTB infection and forty people with PTB and HIV coinfection met the inclusion criteria of the study. The adrenal response to 1 μg ACTH stimulation in participants with PTB and PTB and HIV coinfection showed that the mean basal cortisol level in the 2 groups was not statistically significant; however, 30-min post-ACTH stimulation cortisol level was 630.84 ± 372.17 and 980.36 ± 344.82 nmol/L (P < 0.001 and increment was 367.79 ± 334.87 and 740.77 ± 317.97 nmol/L (P < 0.001, respectively. Fourteen persons (31.8% with PTB has subnormal adrenal response to ACTH stimulation while only 2 (5% persons with PTB and HIV coinfection has subnormal response. Conclusion: AI, at subclinical level, was less frequent in

  16. Pulmonary Langerhans cell histiocytosis with cervical lymph node involvement, and coexistence with pulmonary tuberculosis and right pneumothorax: a case report and review of literature.

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    Gao, Limin; Li, Huifang; Li, Gandi; Liu, Weiping; Li, Jinnan; Zhang, Wenyan

    2015-01-01

    We report an uncommon 22-year-old male Pulmonary Langerhans Cell Histiocytosis (PLCH) case which co-existed with pulmonary tuberculosis (TB). Unlike the common PLCH cases, this PLCH case has cervical lymph node involvement and right pneumothorax. The diagnosis was established by the imaging of lung and the biopsies of the lung and left neck lymph node. Imaging of the chest showed characteristic small nodules and thin-walled cysts and right pneumothorax. The LCH cells in the lung and left neck lymph node were characterized by large convoluted nuclei with cerebriform indentations of the nuclear envelope and longitudinal grooves. The nuclei contained small eosinophilic nucleoli and moderate amount cytoplasm. Immunohistochemically, the histiocytoid cells were positive for Langerin, CD1a and S-100. Acid-fast bacilli were found in sputum and lung biopsy tissue. To the best of our knowledge, this is the first case of PLCH with cervical lymph node involvement, and coexisted with pulmonary tuberculosis, right pneumothorax. A contribution of this case and review three of the five cases of PLCH with extrapulmonary involvement to lymph nodes resolved spontaneously after smoking cessation constitute a novel addition that it is inappropriate to regard pulmonary/nodal LCH as multi-organ or disseminated disease, and the treatment methods are the same whether the PLCH patient with lymph node involvement or not.

  17. Pulmonary Langerhans cell histiocytosis with cervical lymph node involvement, and coexistence with pulmonary tuberculosis and right pneumothorax: a case report and review of literature

    Science.gov (United States)

    Gao, Limin; Li, Huifang; Li, Gandi; Liu, Weiping; Li, Jinnan; Zhang, Wenyan

    2015-01-01

    We report an uncommon 22-year-old male Pulmonary Langerhans Cell Histiocytosis (PLCH) case which co-existed with pulmonary tuberculosis (TB). Unlike the common PLCH cases, this PLCH case has cervical lymph node involvement and right pneumothorax. The diagnosis was established by the imaging of lung and the biopsies of the lung and left neck lymph node. Imaging of the chest showed characteristic small nodules and thin-walled cysts and right pneumothorax. The LCH cells in the lung and left neck lymph node were characterized by large convoluted nuclei with cerebriform indentations of the nuclear envelope and longitudinal grooves. The nuclei contained small eosinophilic nucleoli and moderate amount cytoplasm. Immunohistochemically, the histiocytoid cells were positive for Langerin, CD1a and S-100. Acid-fast bacilli were found in sputum and lung biopsy tissue. To the best of our knowledge, this is the first case of PLCH with cervical lymph node involvement, and coexisted with pulmonary tuberculosis, right pneumothorax. A contribution of this case and review three of the five cases of PLCH with extrapulmonary involvement to lymph nodes resolved spontaneously after smoking cessation constitute a novel addition that it is inappropriate to regard pulmonary/nodal LCH as multi-organ or disseminated disease, and the treatment methods are the same whether the PLCH patient with lymph node involvement or not. PMID:25973117

  18. Cost Effectiveness of DOTS and Non-DOTS Strategies for Smear-positive Pulmonary Tuberculosis in Beijing

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The cost-effectiveness of DOTS (Directly Observed Treatment, short course) and non-DOTS strategies for smear-positive pulmonary tuberculosis in Beijing was evaluated. Cost calculation was based on the expenses of drugs, chest X-ray films, sputum smears and cultures for the patients. Effectiveness of the intervention was assessed in two aspects: direct benefits to the patients treated and indirect benefits to the others through reduced transmission of tuberculosis; disability adjusted life of year (DALY) was used as an index. The results showed that one DALY could be saved with 45.7 Yuan by DOTS and 471.4 Yuan by non-DOTS. DOTS is a good control strategy for smear-positive tuberculosis.

  19. Prevalence of latent tuberculosis infection among health care workers in a hospital for pulmonary diseases

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    Diel Roland

    2009-01-01

    Full Text Available Abstract Background Little is known about the prevalence of latent tuberculosis infections (LTBI in health care workers (HCW in low-incidence countries especially in hospitals for pulmonary diseases. With Interferon-gamma release assays (IGRA, a new method for diagnosis of LTBI is available which is more specific than the tuberculin skin test (TST. Objectives The study was designed to estimate prevalence of LTBI among 270 HCW in a Hospital of Pulmonary Diseases routinely screened for TB. Methods LTBI was assessed by the QuantiFERON-Gold In Tube (QFT-IT. Information on gender, age, workplace, job title, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire. Adjusted odds ratios for potential risk factors for LTBI were calculated. Results The prevalence of LTBI was 7.2%. In HCW younger than 30 years LTBI prevalence was 3.5% and in those older than 50 years 22%. Physicians and nurses showed a higher prevalence rate than other professions (10.8% to 4.5%. The putative risk factors for LTBI were age (>50 year OR 9.3, 95%CI 2.5–33.7, working as physicians/nurses (OR 3. 95%CI 1.2–10.4 and no previous TST in medical history (OR 4.4, 95%CI 1.01–18.9 when compared to those with a negative TST. Conclusion Prevalence of LTBI assessed by QFT-IT is low, this indicates a low infection risk even in hospitals for pulmonary diseases. No statement can be made regarding the occupational risk as compared to the general population because there are no LTBI prevalence data from Germany available. The higher LTBI prevalence rate in older HCWs might be due to the cohort effect or the longer time at risk.

  20. Treatment delay among pulmonary tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia

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    Hussen Awol

    2012-06-01

    Full Text Available Abstract Background Tuberculosis (TB is a major public health problem in Africa with Ethiopia being the most affected. Treatment delay is an important indicator of access to TB diagnosis and treatment. However, little is known about factors associated with treatment delay of pulmonary TB among pastoralists. Health facility based cross sectional study was conducted on 129 pulmonary TB patients in pastoralist community. The study was conducted in three health centers and a hospital. Time between onset of TB symptoms and first visit to a professional health care provider (patient delay, and the time between first visits to the professional health care provider to the date of diagnosis (provider's delay were analyzed using SPSS 16.0 statistical software. Findings A total of 129 new smear positive pulmonary TB patients participated in the study. The median total delay was 97 days. The median patient and health provider delays were 63 and 34 days, respectively. Ninety six percent of the patients were delayed for more than the twenty one days cutoff point. Patient delay was positively associated with first visit to traditional healer/private clinic/drug shop, rural residence, being illiterate, living in more than 10 kilometers from health facility; severity of illness at first presentation to health facility. Provider delay was positively associated with rural residence, being illiterate, patient with good functional status, patients in contact with more than two health providers, and place of first visit being traditional healer/private clinic/drug shop. Conclusions This study showed that majority of smear positive patients delayed either for diagnosis or treatment, thus continue to serve as reservoirs of infection. This indicates that there is a need for intervention to decrease patient and provider delays. Effort to reduce delays in pastoralist communities should focus on improving access to services in rural communities, engaging traditional and

  1. Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis.

    Science.gov (United States)

    Gupta, Nalini; Singh, Gurmeet C; Rana, Manoj K

    2015-01-01

    Diagnosis of pulmonary tuberculosis (TB) is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]). The records of patients diagnosed to have pulmonary TB, over a period of 1-year were evaluated. Patients with positive acid-fast bacilli (AFB) culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14) histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin-eosin and Ziehl-Neelsen staining. Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each). Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%). Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

  2. Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Nalini Gupta

    2015-01-01

    Full Text Available Background: Diagnosis of pulmonary tuberculosis (TB is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]. Materials and Methods: The records of patients diagnosed to have pulmonary TB, over a period of 1-year were evaluated. Patients with positive acid-fast bacilli (AFB culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14 histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin-eosin and Ziehl-Neelsen staining. Results: Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each. Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%. Conclusion: Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

  3. Oral Tolerance to Environmental Mycobacteria Interferes with Intradermal, but Not Pulmonary, Immunization against Tuberculosis.

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    Dominique N Price

    2016-05-01

    Full Text Available Bacille Calmette-Guérin (BCG is currently the only approved vaccine against tuberculosis (TB and is administered in over 150 countries worldwide. Despite its widespread use, the vaccine has a variable protective efficacy of 0-80%, with the lowest efficacy rates in tropical regions where TB is most prevalent. This variability is partially due to ubiquitous environmental mycobacteria (EM found in soil and water sources, with high EM prevalence coinciding with areas of poor vaccine efficacy. In an effort to elucidate the mechanisms underlying EM interference with BCG vaccine efficacy, we exposed mice chronically to Mycobacterium avium (M. avium, a specific EM, by two different routes, the oral and intradermal route, to mimic human exposure. After intradermal BCG immunization in mice exposed to oral M. avium, we saw a significant decrease in the pro-inflammatory cytokine IFN-γ, and an increase in T regulatory cells and the immunosuppressive cytokine IL-10 compared to naïve BCG-vaccinated animals. To circumvent the immunosuppressive effect of oral M. avium exposure, we vaccinated mice by the pulmonary route with BCG. Inhaled BCG immunization rescued IFN-γ levels and increased CD4 and CD8 T cell recruitment into airways in M. avium-presensitized mice. In contrast, intradermal BCG vaccination was ineffective at T cell recruitment into the airway. Pulmonary BCG vaccination proved protective against Mtb infection regardless of previous oral M. avium exposure, compared to intradermal BCG immunization. In conclusion, our data indicate that vaccination against TB by the pulmonary route increases BCG vaccine efficacy by avoiding the immunosuppressive interference generated by chronic oral exposure to EM. This has implications in TB-burdened countries where drug resistance is on the rise and health care options are limited due to economic considerations. A successful vaccine against TB is necessary in these areas as it is both effective and economical.

  4. Oral Tolerance to Environmental Mycobacteria Interferes with Intradermal, but Not Pulmonary, Immunization against Tuberculosis.

    Science.gov (United States)

    Price, Dominique N; Kusewitt, Donna F; Lino, Christopher A; McBride, Amber A; Muttil, Pavan

    2016-05-01

    Bacille Calmette-Guérin (BCG) is currently the only approved vaccine against tuberculosis (TB) and is administered in over 150 countries worldwide. Despite its widespread use, the vaccine has a variable protective efficacy of 0-80%, with the lowest efficacy rates in tropical regions where TB is most prevalent. This variability is partially due to ubiquitous environmental mycobacteria (EM) found in soil and water sources, with high EM prevalence coinciding with areas of poor vaccine efficacy. In an effort to elucidate the mechanisms underlying EM interference with BCG vaccine efficacy, we exposed mice chronically to Mycobacterium avium (M. avium), a specific EM, by two different routes, the oral and intradermal route, to mimic human exposure. After intradermal BCG immunization in mice exposed to oral M. avium, we saw a significant decrease in the pro-inflammatory cytokine IFN-γ, and an increase in T regulatory cells and the immunosuppressive cytokine IL-10 compared to naïve BCG-vaccinated animals. To circumvent the immunosuppressive effect of oral M. avium exposure, we vaccinated mice by the pulmonary route with BCG. Inhaled BCG immunization rescued IFN-γ levels and increased CD4 and CD8 T cell recruitment into airways in M. avium-presensitized mice. In contrast, intradermal BCG vaccination was ineffective at T cell recruitment into the airway. Pulmonary BCG vaccination proved protective against Mtb infection regardless of previous oral M. avium exposure, compared to intradermal BCG immunization. In conclusion, our data indicate that vaccination against TB by the pulmonary route increases BCG vaccine efficacy by avoiding the immunosuppressive interference generated by chronic oral exposure to EM. This has implications in TB-burdened countries where drug resistance is on the rise and health care options are limited due to economic considerations. A successful vaccine against TB is necessary in these areas as it is both effective and economical.

  5. A case of pulmonary tuberculosis presenting as diffuse alveolar haemorrhage: is there a role for anticardiolipin antibodies?

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    Lauria Francesco N

    2010-02-01

    Full Text Available Abstract Background Diffuse alveolar haemorrhage (DAH has been rarely reported in association with pulmonary infections. Case Presentation We report the case of a 43 year old immunocompetent man presenting with dyspnoea, fever and haemoptysis. Chest imaging showed bilateral ground glass opacities. Microbiological and molecular tests were positive for Mycobacterium tuberculosis and treatment with isoniazid, rifampicin, ethambutol and pyrazinamide was successful. In this case the diagnosis of DAH relies on clinical, radiological and endoscopic findings. Routine blood tests documented the presence of anticardiolipin antibodies. In the reported case the diagnostic criteria of antiphospholipid syndrome were not fulfilled. Conclusions The transient presence of anticardiolipin antibodies in association with an unusual clinical presentation of pulmonary tuberculosis is intriguing although a causal relationship cannot be established.

  6. Seasonal variation of newly notified pulmonary tuberculosis cases from 2004 to 2013 in Wuhan, China.

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    Xiaobing Yang

    Full Text Available BACKGROUND: Although there was a report about the seasonal variation in Wuhan city, it only analyzed the prevalence data of pulmonary tuberculosis (TB cases, and just studied the seasonality by subgroup of smear positive and negative from 2006 to 2010 by spectral analysis. In this study, we investigated the seasonality of the total newly notified pulmonary TB cases by subgroups such as time period, sex, age, occupation, district, and sputum smear result from 2004 to 2013 in Wuhan by a popular seasonal adjustment model (TRAMO-SEATS. METHODS: Monthly pulmonary TB cases from 2004 to 2013 in Wuhan were analyzed by the TRAMO-SEATS seasonal adjustment program. Seasonal amplitude was calculated and compared within the subgroups. RESULTS: From 2004 to 2013, there were 77.76 thousand newly notified pulmonary TB cases in Wuhan, China. There was a dominant peak spring peak (March with seasonal amplitude of 56.81% and a second summer peak (September of 43.40%, compared with the trough month (December. The spring seasonal amplitude in 2004-2008 was higher than that of 2009-2013(P0.05. However, there were significant differences in spring seasonal amplitude by occupation, with amplitude ranging from 59.37% to 113.22% (P0.05. There were significant differences in summer seasonal amplitude by age, with amplitude ranging from 36.05% to 100.09% (P<0.05. Also, there were significant differences in summer seasonal amplitude by occupation, with amplitude ranging from 43.40% to 109.88% (P<0.05. CONCLUSIONS: There was an apparent seasonal variation in pulmonary TB cases in Wuhan. We speculated that spring peak in our study was most likely caused by the increased reactivation of the latent TB due to vitamin D deficiency and high PM2.5 concentration, while the summer peak was mainly resulted from the enhanced winter transmission due to indoor crowding in winter, overcrowding of public transportation over the period of the Spring Festival and health care seeking delay in

  7. Differential combination of cytokine and interferon- γ +874 T/A polymorphisms determines disease severity in pulmonary tuberculosis.

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    Ambreen Ansari

    Full Text Available BACKGROUND: Mycobacterium tuberculosis infects nearly 1/3 of the world population and this reservoir forms the largest pool from which new cases arise. Among the cytokines, IFN-γ is a key determinant in protection against tuberculosis. Single nucleotide polymorphisms (SNPs in IFN-γ gene (+874 T/A which determine TT high ((hi, AA low ((lo and TA intermediate ((int responder phenotypes have shown variable associations with tuberculosis disease outcome in different ethnic populations. The objective of the current study was to analyze IFN-γ gene combinations with other IFN-γ regulating cytokine genes (IL-10, TNF -α, IL-6 to see the effect of gene- combinations on disease severity outcome in pulmonary tuberculosis. METHODS AND FINDINGS: Study groups comprised of pulmonary TB patients stratified according to lung tissue involvement into mild (Pmd = 74 or advance (Pad = 23 lung disease and compared with healthy controls (TBNA = 166. Genotype analysis was carried out using amplification refractory mutation system-PCR (ARMS-PCR. IFN-γ gene (+874 T/A functional SNP combinations in TNFα (-308 G/A, IL-10 (-1082 A/G and IL-6 (-174 G/C were analyzed. Single gene analysis (Pearson χ² showed a dominant association of IFN-γ TT (hi genotype (p = 0.001 and T allele (p = 0.001 with mild disease. IFN-γ(lo -IL-10(lo genotype combination was associated with advanced disease (p = 0.002. IFN-γ(hi -IL-6(hi combination was associated with mild disease (p = 0.0005 while IFN-γ(lo -IL-6(int was associated with protection against both forms of pulmonary disease (p = 0.002. CONCLUSION: Our results show that a limited number of IFN-γ gene combinations with other cytokine functional SNPs determine the outcome of disease severity in tuberculosis.

  8. Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review

    Institute of Scientific and Technical Information of China (English)

    Wen-fang YANG; Fei HAN; Xiao-hui ZHANG; Ping ZHANG; Jiang-hua CHEN

    2013-01-01

    The diagnosis of extra-pulmonary tuberculosis (TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy (22.86%,16/70).The peritoneum (31.42%,22/70),bone (21.42%,15/70),and lymph node (20%,14/70) were the most frequently infected.Single organ infection was common (90%,63/70).Fever (58.57%,41/70),pain (35.71%,25/70),and enlarged lymph node (20%,14/70) were the most common symptoms.Biopsy (67.14%,47/70) and culture (40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol (44.29%,31/70) was the most common therapy.The majority of patients improved (82.86%,58/70); however,12 cases got worse (17.14%),with 10 of them dying (14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.

  9. CONTRAST ENHANCED CT UNVEILED GIANT RASMUSSEN’S ANEURYSM: A RARE COMPLICATION AND CAUSE OF DEATH IN PULMONARY TUBERCULOSIS

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    Sanjeev

    2014-05-01

    Full Text Available Rasmussen’s aneurysm is a rare complication of pulmonary tuberculosis. Often the aneurysm ruptures in the bronchial tree causing massive hemoptysis resulting in death. We are reporting a case of partially thrombosed giant Rasmussen’s aneurysm which arose in the vicinity of a tuberculous cavity along with empyema necessitans. Unfortunately the patient died of massive hemoptysis within two days of his diagnosis.

  10. Prevalence of acute epiglottitis and its association with pulmonary tuberculosis in adults in a tertiary care hospital of Nepal

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    Thapa, Narmaya

    2008-12-01

    Full Text Available Introduction: Acute epiglottitis is a relatively uncommon disease in both children and adults. It can be a serious life threatening disease because of its potential for sudden upper airway obstruction. Objective: To determine the prevalence of acute epiglottitis and to find out its association with Pulmonary Tuberculosis. Methods: All cases of acute epiglottitis admitted in ENT and Head and Neck Surgery ward of TUTH, Kathmandu, Nepal, from April 2001 to September 2007, were enrolled. Routine investigations including x-rays and blood cultures were done. The patients were further investigated to rule out the presence of Pulmonary Tuberculosis.The standard treatment protocol we used included Injection Ampicillin 500 mg intravenously six hourly for 72 hours followed by oral Ampicillin 500mg for 7 days, with analgesics and intravenous steroid (Hydrocortisone 200mg if required. Study Design: Prospective longitudinal study. Results: Majority of the patients presented with a history sore throat (83.3%, dysphagia (78.6% and odynophagia (78.6%. On examination all the patients were found to have swollen and congested epiglottis. Positive "Thumb sign" on plain X-ray soft tissue neck lateral view was found in almost all the patients (95.2%. Four patients presented with stridor and patient needed emergency tracheostomy. None of the investigations done to detect Pulmonary Tuberculosis was found to be positive. Conclusion: Acute epiglottitis is a rare disease which now occurs more commonly in adults. The annual prevalence of Acute Epiglottitis in adult in TUTH is 4.8 per 1000. This study did not find any association of acute epiglottitis with pulmonary tuberculosis.

  11. A retrospective review of a tertiary Hospital’s isolation and de-isolation policy for suspected pulmonary tuberculosis

    OpenAIRE

    2014-01-01

    Background Effective protocols for the isolation and de-isolation of patients with suspected pulmonary tuberculosis (PTB) are essential determinants of health-care costs. Early de-isolation needs to be balanced with the need to prevent nosocomial transmission of PTB. The aim of our study was to evaluate the efficiency of our hospital’s current protocol for isolating and de-isolating patients with suspected PTB, in particular assessing the timeliness to de-isolation of patients with AFB smear ...

  12. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review

    NARCIS (Netherlands)

    Tiemersma, E.W.; van der Werf, M.J.; Borgdorff, M.W.; Williams, B.G.; Nagelkerke, N.J.D.

    2011-01-01

    Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epid

  13. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review

    NARCIS (Netherlands)

    Tiemersma, E.W.; van der Werf, M.J.; Borgdorff, M.W.; Williams, B.G.; Nagelkerke, N.J.D.

    2011-01-01

    Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epid

  14. Tuberculose pulmonar: achados na tomografia computadorizada de alta resolução do tórax em pacientes com doença em atividade comprovada bacteriologicamente Pulmonary tuberculosis: findings on high resolution computerized tomography of active disease on patients with bacteriological confirmation

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    CRISTIANE ALÓ CAMPOS

    2002-01-01

    Full Text Available Objetivo: Descrever os achados em pacientes com tuberculose pulmonar em atividade na tomografia computadorizada de alta resolução e o padrão de distribuição das lesões pelo parênquima pulmonar. Casuística e método: Foram analisadas retrospectivamente as tomografias de alta resolução de 42 pacientes com diagnóstico bacteriológico de tuberculose pulmonar ou forte suspeita clínica, com posterior confirmação bacteriológica. Resultados: Os principais sinais sugestivos de atividade encontrados foram nódulos do espaço aéreo (83%, nódulos centrolobulares (74%, aspecto de árvore em brotamento (67%, cavitações (67%, espessamento das paredes brônquicas (55%, consolidações (48%, opacidade em vidro fosco (21%, e espessamento do interstício pulmonar (9%. Conclusão: A tomografia computadorizada de alta resolução do tórax pode sugerir fortemente atividade da doença, sendo particularmente útil nos pacientes com baciloscopias negativas e/ou radiografias indeterminadas, permitindo a instituição de tratamento adequado, antes mesmo do crescimento da micobactéria em meio de cultura.Background: The aim of this study was to describe the signs of active tuberculosis in patients submitted to high resolution computerized tomography and the distribution of lesions along the pulmonary parenchyma. Material and methods: The high resolution CTs performed on 42 patients with tuberculosis either bacteriologically diagnosed or clinical suspected and later confirmed by bacteriological tests were studied. Results: The signs of disease activity observed were airspace nodule (83%, centrilobular nodule (74%, tree-in-bud pattern (67%, cavitations (67%, bronchial thickening (55%, parenchymal consolidations (48%, ground glass opacity (21% and thickening of the inter and intralobular septa (9%. Conclusion: High resolution computed tomography can be strongly suggestive of disease activity, is particularly helpful in patients with negative smear and

  15. Sociodemographic, Epidemiological, and Clinical Risk Factors for Childhood Pulmonary Tuberculosis in Severely Malnourished Children Presenting With Pneumonia

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    Mohammod Jobayer Chisti MBBS, MMed, PhD

    2015-07-01

    Full Text Available We aimed to evaluate sociodemographic, epidemiological, and clinical risk factors for pulmonary tuberculosis (PTB in children presenting with severe acute malnutrition (SAM and pneumonia. Children aged 0 to 59 months with SAM and radiologic pneumonia from April 2011 to July 2012 were studied in Bangladesh. Children with confirmed PTB (by culture and/or X-pert MTB/RIF (cases = 27 and without PTB (controls = 81; randomly selected from 378 children were compared. The cases more often had the history of contact with active PTB patient (P < .01 and exposure to cigarette smoke (P = .04 compared with the controls. In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with working mother (P = .05 and positive tuberculin skin test (TST; P = .02. Thus, pneumonia in SAM children is a common presentation of PTB and further highlights the importance of the use of simple TST and/or history of contact with active TB patients in diagnosing PTB in such children, especially in resource-limited settings.

  16. Adjunctive micronutrient supplementation for pulmonary tuberculosis Suplementación con micronutrientes como tratamiento adjunto para tuberculosis pulmonar

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    Rodrigo X Armijos

    2010-06-01

    Full Text Available OBJECTIVE: To assess the effect of micronutrient supplementation on tuberculosis (TB patient outcomes. MATERIAL AND METHODS: The randomized, double-blinded, placebo-controlled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/ tratamiento acortado estrictamente supervisado (TAES/ DOTS at IMSS in Ciudad Juarez, Chihuahua, Mexico, who were recruited during August 2005-July 2006. Consecutive patients received zinc and vitamin A supplements or matched placebo for four months. Dietary intake, blood zinc and vitamin A, immune response (IFN-γ,TNF-α, and IL-10 mRNA, and sputum smear conversion were measured. RESULTS: The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased (p= 0.03. This occurred subsequent to increased TNF-α and IFN-γ and decreased IL-'0 observed at month 2. Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy. CONCLUSIONS: The earlier elimination of bacilli from sputum was associated with improved zinc status and Th' immune response. The therapeutic effect of vitamin A was less evident.OBJETIVO: Determinar el efecto de la suplementación con zinc y vitamina A o placebo en pacientes tratados por tuberculosis (TB. MATERIAL Y MÉTODOS: Se realizó un ensayo aleatorizado en pacientes tuberculosos que iniciaron el tratamiento acortado estrictamente supervisado/ directly observed treatment short course (TAES/DOTS en las clínicas del IMSS, Ciudad Juárez, Chihuahua, México, reclutados durante agosto 2005-julio 2006. A cada paciente en forma aleatoria se le designó un código para recibir ya sea micronutrientes o placebo por cuatro meses, bajo el diseño doble ciego. Se evaluó la ingesta dietética, niveles de zinc y vitamina A en sangre, respuesta inmune (IFN-γ,TNF-α, IL-l0 mRNA en sangre y bacilo ácido alcohol resistente (BAAR en esputo. RESULTADOS: Al

  17. Prevalence of Pre-Extensively Drug-Resistant Tuberculosis (Pre XDR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) among Pulmonary Multidrug Resistant Tuberculosis (MDR-TB) at a Tertiary Care Center in Mumbai

    OpenAIRE

    Unnati D. Desai; Joshi, Jyotsna M

    2016-01-01

    Background: India is a high burden country for Tuberculosis (TB). As per the World Health Organization (WHO) statistics, 24000 cases of Multi Drug Resistant (MDR) TB were diagnosed in India in 2014. MDR-TB patients consist of a heterogeneous cohort and management has its challenges. Aims and objectives: We studied the prevalence of PreExtensively Drug Resistant TB (Pre XDR-TB) and Extensively Drug Resistant TB (XDR-TB) among patients of pulmonary MDR-TB not previous...

  18. CD163 levels, pro- and anti-inflammatory cytokine secretion of monocytes in children with pulmonary tuberculosis.

    Science.gov (United States)

    Aktas Cetin, Esin; Pur Ozyigit, Leyla; Gelmez, Yusuf Metin; Cakir, Erkan; Gedik, Ahmet Hakan; Deniz, Gunnur

    2017-05-01

    Childhood tuberculosis (TB) comprises an important part of the world's TB burden. Monocytes set up the early phase of infection because of innate immune responses. Understanding the changes in monocyte subsets during multisystem infectious diseases may be important for the development of novel diagnostic and therapeutic strategies. The aim of this study was to evaluate the monocyte phenotype together with the cytokine secretion profiles of children with pulmonary tuberculosis. Thirteen patients with pulmonary TB were enrolled as study group, and 14 healthy subjects as control group. Surface expressions of CD16, CD14, CD62L, CD163, CCR2, and HLA-DR of monocytes were analyzed by flow cytometry. The presence of IFN-γ, TNF-α, IL-10, IL-12, IL-23, and soluble form of CD163 (sCD163) in the antigen- and LPS-stimulated whole blood culture supernatants were detected using ELISA and Luminex. Higher percentages of CD14(++) CD16(+) and CD14(+) CD16(++) monocyte subsets, and CCR2, CD62L and CD163 expression on circulating monocytes in children with pulmonary tuberculosis were obtained. Diminished levels of ESAT-6/CFP-10-induced IL-10 and increased levels of TB-antigen and LPS-stimulated sCD163 were found in childhood with pulmonary TB. High expression of CD14(++) CD16(+) , CD14(+) CD16(++) , CD14(+) CCR2(+) , and CD14(+) CD62L(+) cells in childhood TB, and monocyte-derived cytokines reflected both pro- and anti-inflammatory profiles. Higher sCD163 and CD14(+) CD163(+) monocytes might help physicians in the differential diagnosis of pulmonary TB in children. Pediatr Pulmonol. 2017;52:675-683. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

    Institute of Scientific and Technical Information of China (English)

    LAI Yu Ji; LIU Er Yong; WANG Li Ming; Jamie P MORANO; WANG Ning; Kaveh KHOSHNOOD; ZHOU Lin; CHENG Shi Ming

    2015-01-01

    Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics. Methods A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis. Results Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (≤200 cells/µL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death. Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.

  20. Association of HLA-A, -B, and -DRB1 with pulmonary tuberculosis in western Javanese Indonesia.

    Science.gov (United States)

    Yuliwulandari, Rika; Sachrowardi, Qomariyah; Nakajima, Humiaki; Kashiwase, Koichi; Hirayasu, Kouyuki; Mabuchi, Akihiko; Sofro, Abdul Salam Mudzakir; Tokunaga, Katsushi

    2010-07-01

    Genetic studies of pulmonary tuberculosis (PTB), including those of human leukocyte antigen (HLA) genes, have been reported in several populations. Some studies also have reported these genes to have a stronger role in severe tuberculosis. We investigated HLA class I and II alleles and haplotypes to ascertain their role in susceptibility and resistance to new and recurrent PTB in 257 PTB patients (216 new and 41 recurrent PTB patients) and 236 healthy controls in Western Javanese (Indonesia). HLA-B*4006 was associated with new PTB (p = 0.044, p(adj) = ns), whereas HLA-B*1802, HLA-B*4001 and HLA-DRB1*1101 were associated with recurrent PTB (p = 0.013, p(adj) = 0.016; p = 0.015, p(adj) = 0.028; and p = 0.008, p(adj) = 0.027 for new PTB vs recurrent PTB, respectively). Except for HLA-B*4006, those associations remained significant after adjustment for age and gender by logistic regression analysis, although they disappeared after correction for multiple testing. Haplotype HLA-B*1802-DRB1*1202 was associated with susceptibility to recurrent PTB (p = 0.014, odds ratio = 3.8, 95% confidence interval = 1.18-12.27). In contrast, HLA-DRB1*1202 in the absence of HLA-B*1802 showed a significant association with resistance to recurrent PTB (p = 8.2 x 10(-4), odds ratio = 0.32, 95% confidence interval = 0.16-0.64), suggesting that stronger susceptibility effect of HLA-B*1802 masked the protective effect of HLA-DRB1*1202. Further studies using larger number of patients with recurrent PTB will be needed to confirm our findings.

  1. Expression and function of the purinergic receptor P2X7 in patients with pulmonary tuberculosis.

    Science.gov (United States)

    Franco-Martínez, S; Niño-Moreno, P; Bernal-Silva, S; Baranda, L; Rocha-Meza, M; Portales-Cervantes, L; Layseca-Espinosa, E; González-Amaro, R; Portales-Pérez, D

    2006-11-01

    P2X(7) is a channel receptor gated by adenosine triphosphate (ATP) that is involved in the killing of intracellular mycobacteria. To explore further the role of P2X(7) in immunity against Mycobacterium tuberculosis, we studied its expression and function in 19 patients with pulmonary tuberculosis (TB) and 19 healthy contacts. Flow cytometry analysis showed a similar and variable expression of P2X(7) in TB patients and healthy subjects. In contrast, P2X(7) mARN levels were significantly higher in TB patients. When the function of the P2X(7) receptor in peripheral blood mononuclear cells (PBMC) was assessed by the effect of exogenous ATP on apoptosis, the uptake of the fluorescent marker Lucifer yellow or extracellular signal regulated kinase (ERK) phosphorylation, no significant differences were detected in patients and controls. However, mRNA macroarray analysis showed that upon stimulation with ATP, the PBMC from TB patients showed a significant induction of a higher number of cytokine genes (27 of 96), and a lower number of apoptosis genes (20 of 96) compared to healthy controls (17 and 76 genes, respectively). These results suggest that although the PBMC from TB patients do not show apparent abnormalities in the expression of P2X(7), and the intracellular signals generated through it, the pattern of gene expression induced by ATP in these cells is different from that found in healthy contacts. This phenomenon suggests a defective function of P2X(7) in the immune cells from TB patients, a condition that may contribute to the inability of these patients to eliminate the mycobacteria.

  2. Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia.

    Science.gov (United States)

    Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Ali, Irfhan; Asif, Muhammad; Babar, Zaheer-Ud-Din

    2014-07-19

    According to the World Health Organization's recent report, in Malaysia, tuberculosis (TB) treatment success rate for new smear positive pulmonary tuberculosis (PTB) patients is still below the global success target of 85%. In this study, we evaluated TB treatment outcome among new smear positive PTB patients, and identified the predictors of unsuccessful treatment outcome and longer duration of treatment (i.e., > 6 months). The population in this study consisted of all new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. During the study period, a standardized data collection form was used to obtain socio-demographic, clinical and treatment related data of the patients from their medical charts and TB notification forms (Tuberculosis Information System; TBIS). These data sources were reviewed at the time of the diagnosis of the patients and then at the subsequent follow-up visits until their final treatment outcomes were available. The treatment outcomes of the patients were reported in line with six outcome categories recommended by World Health Organization. Multiple logistic regression analysis was used to find the independent risk factors for unsuccessful treatment outcome and longer treatment duration. Data were analyzed using the PASW (Predictive Analysis SoftWare, version 19.0. Armonk, NY: IBM Corp). Among the 336 PTB patients (236 male and 100 female) notified during the study period, the treatment success rate was 67.26% (n = 226). Out of 110 patients in unsuccessful outcome category, 30 defaulted from the treatment, 59 died and 21 were transferred to other health care facilities. The mean duration of TB treatment was 8.19 (SD 1.65) months. In multiple logistic regression analysis, risk factors for unsuccessful treatment outcome were foreign nationality, male gender and being illiterate. Similarly, risk factors for mortality due to TB included high-grade sputum and presence

  3. ROLE OF IL-5 AND EOTAXIN IN DEVELOPMENT OF BLOOD EOSINOPHILIC REACTION DURING PULMONARY TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    U. V. Kolobovnikova

    2011-01-01

    Full Text Available Abstract. The  study  considers  some  aspects  of  pathogenetic  mechanisms  underlying  blood  eosinophilic  reactions  developing  in  pulmonary  tuberculosis,  taking  into  account  some  novel  data  obtained  by  means  of  modern  immunological  techniques.  It  was  revealed  that  IL-5  is  among  key  factors  determining  eosinophilic  reactions  of  blood  following  infection  with  M.  tuberculosis.  Blood  serum  IL-5  concentrations  proved  to  be  significantly  higher  in  patients  with  tuberculosis  accompanied  by  eosinophilia.  In  these  cases,  eotaxin  is  a  chemokine,  which  selectively  acts  upon  eosinophilic  cells.  Its  effects  include  prolonged  persistence  of  eosinophils  in  bloodstream,  along  with  initiation  of  eosinophil  adherence  to  vascular  endothelium,  thus  enabling  subsequent  migration  of  eosinophilic  leukocytes  to  the  foci  of  specific  granulomatous  inflammation.  (Med.  Immunol.,  2011,  vol.  13,  N  2-3,  pp  273-278

  4. 52例影像学病灶稳定痰菌阳性肺部结核分析%52 cases shows the of Analysis of 52 cases of sputum positive pulmonary tuberculosis with lesion stability in iconography

    Institute of Scientific and Technical Information of China (English)

    陈永忠

    2012-01-01

    目的 探讨影像学肺部病灶提示稳定而痰菌阳性肺部结核患者的原因.方法 对52例影像学(胸部CT、胸片)提示肺部无结核病灶或结核病灶稳定而痰找结核菌两次阳性或一次涂阳合并培养阳性的病例进行临床分析.结果 影像学表现肺部无病灶或提示肺部病灶稳定的患者仍有可能痰找结核菌阳性,为活动性的肺部结核病患者.结论 肺部影像学表现对判断结核病活动与否有一定的局限性,支气管内膜结核肺部影像无异常表现.对肺部表现为陈旧性病灶的患者和有临床表现而无病灶的患者一定要反复多次痰找结核菌,以防误诊.%Objective To explore the etiological fart or of sputum positive pulmonary tuberculosis with lesion stability in iconogra phy. Methods Clinical data in 52 cases of sputum positive pulmonary tuberculosis with lesion stability in iconography were analyzed. Results Some sputum positive pulmonary tuberculosis with lesion stability in iconography may be activitive pulmonary TB. Conclusion Lung imaging findings to judge whether or not TB activities has some limitations. Patients with old lesions, and with pulmonary manifesta tions, but without lesions must be repeated for sputum finding Mycobacterium tuberculosis to prevent misdiagnosis.

  5. Monitoring delays in diagnosis of pulmonary tuberculosis in eight cities in Colombia.

    Science.gov (United States)

    Rodríguez, David A; Verdonck, Kristien; Bissell, Karen; Victoria, Juan José; Khogali, Mohammed; Marín, Diana; Moreno, Ernesto

    2016-01-01

    Objective To measure time between onset of tuberculosis (TB) symptoms and start of treatment, and to identify factors associated with delay in eight Colombian cities. Methods Operational research with a retrospective analytical cohort design was conducted in 2014 using routinely collected data about new smear-positive pulmonary TB patients from eight cities in Colombia (Barranquilla, Bogotá, Bucaramanga, Cali, Cúcuta, Medellín, Pereira, and Villavicencio). Date of symptom onset was sourced from TB surveillance databases. Data on all other variables came from National TB Program (NTP) registers. Results There were 2 545 new cases of smear-positive pulmonary TB, but a plausible date of symptom onset was available for only 1 456 (57%). Median number of days between symptom onset and treatment start was 51 days (interquartile range: 27-101). A total of 72% of patients had a delay (> 30 days between symptom onset and treatment start), and 28% had a 3+ bacillary load at diagnosis. Based on multiple logistic regression, three factors were significantly associated with delay: being uninsured (odds ratio (OR): 1.30; 95% confidence interval (CI): 1.01-1.68) and having an unknown HIV status (OR: 1.81; CI: 1.04-3.17), which increased risk, and coming from a neighborhood with NTP-employed community health workers, which decreased risk (OR: 0.56; CI: 0.34-0.90). Conclusions Delays still prevent timely TB diagnosis and treatment in Colombia. As the country aims for TB elimination, delays must be reduced, especially in cities and vulnerable neighborhoods, to stop community transmission. The NTP should focus not only on the number of cases detected but also on how long it takes to detect them. To monitor interventions designed to reduce delays, additional dates in the process should be recorded routinely. In addition, reliability and completeness of data are crucial for monitoring.

  6. Differential diagnosis of acute miliary pulmonary tuberculosis from widespread-metastatic cancer for postoperative lung cancer patients: two cases

    Science.gov (United States)

    Zhao, Wei; Tian, Yuke; Peng, Feng; Long, Jianlin; Liu, Lan; Lu, You

    2017-01-01

    Pulmonary infections and lung cancer can resemble each other on radiographic images, which makes it difficult to diagnosis accurately and apply an appropriate therapy. Here we report two cases that two postoperative patients with lung adenocarcinoma developed diffuse nodules in bilateral lungs in a month which needed to be distinguished between metastatic malignancies and infectious diseases. Although there are much similarities in disease characteristics of two cases, patient in case one was diagnosed as acute miliary pulmonary tuberculosis (TB) while patient in case two was diagnosed as metastatic disease. The symptoms and pulmonary foci on CT scan of patient in case one improved distinctly after the immediate anti-TB treatment, but the disease of patient in case two progressed after chemotherapy. These findings caution us that differential diagnosis is crucial and have significance in guiding clinical work.

  7. Host biomarkers detected in saliva show promise as markers for the diagnosis of pulmonary tuberculosis disease and monitoring of the response to tuberculosis treatment.

    Science.gov (United States)

    Jacobs, Ruschca; Tshehla, Enock; Malherbe, Stephanus; Kriel, Magdalena; Loxton, Andre G; Stanley, Kim; van der Spuy, Gian; Walzl, Gerhard; Chegou, Novel N

    2016-05-01

    There is an urgent need for new tools for the rapid diagnosis of tuberculosis (TB) disease in resource-constrained settings. Tests based on host immunological biomarkers maybe useful, especially if based on easily available samples. We investigated host biomarkers detected in saliva samples from individuals with suspected pulmonary TB disease, as tools for the diagnosis of TB disease and monitoring of the response to treatment. We collected saliva samples from 104 individuals that presented with symptoms requiring investigation for TB disease at a primary health care clinic in the outskirts of Cape Town, South Africa, prior to assessment for TB disease. We evaluated the concentrations of 33 host markers in stored saliva samples using a multiplex cytokine platform. Using a combination of clinical, radiological and laboratory results and a pre-established diagnostic algorithm, participants were later classified as having TB disease or other respiratory diseases (ORD). The diagnostic potentials of individual analytes were analysed by the receiver operator characteristics curve approach while the predictive abilities of combinations of analytes for TB disease were analysed by general discriminant analysis, with leave-one-out cross validation. Of the 104 individuals enrolled, 32 were pulmonary TB cases. There were significant differences in the levels of 10 of the markers investigated between the patients with TB disease and those with ORDs. However, the optimal diagnostic biosignature was a seven-marker combination of salivary CRP, ferritin, serum amyloid P, MCP-1, alpha-2-macroglobulin, fibrinogen and tissue plasminogen activator. This biosignature diagnosed TB disease with a sensitivity of 78.1% (95% CI, 59.6-90.1%) and specificity of 83.3% (95% CI, 72.3-90.7%) after leave-one-out cross validation. When compared to baseline levels, the concentrations of 9 markers including granzyme A, MCP-1, IL-1β, IL-9, IL-10, IL-15, MIP-1β, ferritin and serum amyloid A changed

  8. Adjuvant interferon gamma in patients with drug – resistant pulmonary tuberculosis: a pilot study

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    Carbonell Dalia

    2004-10-01

    Full Text Available Abstract Background Tuberculosis (TB is increasing in the world and drug-resistant (DR disease beckons new treatments. Methods To evaluate the action of interferon (IFN gamma as immunoadjuvant to chemotherapy on pulmonary DR-TB patients, a pilot, open label clinical trial was carried out in the Cuban reference ward for the management of this disease. The eight subjects existing in the country at the moment received, as in-patients, 1 × 106 IU of recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to the indicated chemotherapy, according to their antibiograms and WHO guidelines. Sputum samples collection for direct smear observation and culture as well as routine clinical and thorax radiography assessments were done monthly. Results Sputum smears and cultures became negative for acid-fast-bacilli before three months of treatment in all patients. Lesion size was reduced at the end of 6 months treatment; the lesions disappeared in one case. Clinical improvement was also evident; body mass index increased in general. Interferon gamma was well tolerated. Few adverse events were registered, mostly mild; fever and arthralgias prevailed. Conclusions These data suggest that IFN gamma is useful and well tolerated as adjunctive therapy in patients with DR-TB. Further controlled clinical trials are encouraged.

  9. The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region

    Directory of Open Access Journals (Sweden)

    J. C. Nájera-Ortiz

    2012-01-01

    Full Text Available Objective. To analyse survival in patients with pulmonary tuberculosis (PTB and factors associated with such survival. Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004–2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression. Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years and treatment duration (under six months were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant. Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years.

  10. [Side effects of chemotherapy in patients with pulmonary tuberculosis and concomitant diseases].

    Science.gov (United States)

    Nikolaeva, O D

    2003-01-01

    As many as 395 patients with pulmonary tuberculosis concurrent with other illnesses were examined. It has been ascertained that in 57.8 percent of cases there occurs a side effect in the wake of the antituberculous drug administration. The following were recognized as ill effects of the drugs employed--allergic reactions, candidiasis, disbacteriosis, toxic reactions,--in 25.44%, 3.07%, 7.02%, and 64.47% of cases respectively. Revealed in the above series was a marked side effect on the digestive organs, neurotoxic reactions, toxic effect on the cardiovascular system in 28.08%, 15.35%, 10.53% of cases respectively. The most frequently seen side effect was due to rifampicin (23.25%), streptomycin (18.42%), isoniazid (17.08%). The least number of complications was with taking etambutol--3.94%. In 43.42% of cases, the identified side effect necessitates withdrawal of the drug, in 56.58% of cases, the management of the concomitant medical problems, a change in routes of administration of medicines, and combined employment of antihistaminic drugs and hyposensitizing methodological approaches to the management of the condition permitted carrying on with the therapy instituted.

  11. The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region

    Science.gov (United States)

    Nájera-Ortiz, J. C.; Sánchez-Pérez, H. J.; Ochoa-Díaz-López, H.; Leal-Fernández, G.; Navarro-Giné, A.

    2012-01-01

    Objective. To analyse survival in patients with pulmonary tuberculosis (PTB) and factors associated with such survival. Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004–2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression. Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years) and treatment duration (under six months) were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant. Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years. PMID:22701170

  12. Predictors of favorable results in pulmonary tuberculosis treatment (Recife, Pernambuco, Brazil, 2001-2004).

    Science.gov (United States)

    Sassaki, Cinthia Midori; Scatena, Lucia Marina; Gonzales, Roxana Isabel Cardozo; Ruffino-Netto, Antonio; Hinos, Paula; Villa, Tereza Cristina Scatena

    2010-06-01

    Based on data available in the Information System for Notifiable Diseases, predictive factors of favorable results were identified in the treatment of pulmonary tuberculosis, diagnosed between 2001 and 2004 and living in Recife-PE, Brazil. Uni- and multivariate logistic regression methods were used. In multivariate analysis, the following factors remained: Age (years), 0 to 9 (OR = 4.27; p = 0.001) and 10 to 19 (OR = 1.78; p = 0.011), greater chance of cure than over 60; Education (years), 8 to 11 (OR = 1.52; p = 0.049), greater chance of cure than no education; Type of entry, ne wcase s (OR = 3.31; p abandonment; Time (months) 2, 5--6 (OR = 9.15; p < 0.001); 6--9 (OR = 27.28; p < 0.001) and More than 9 (OR = 24.78; p < 0.001), greater chances of cure than less than 5; Health Unit District, DSII (OR = 1.60; p = 0.018) and DSIIV (OR = 2.87; p < 0.001), greater chance sof cure than DS II.

  13. Prospective cross-sectional evaluation of the small membrane filtration method for diagnosis of pulmonary tuberculosis.

    Science.gov (United States)

    Jones-López, Edward; Manabe, Yukari C; Palaci, Moises; Kayiza, Carol; Armstrong, Derek; Nakiyingi, Lydia; Ssengooba, Willy; Gaeddert, Mary; Kubiak, Rachel; Almeida Júnior, Pedro; Alland, David; Dietze, Reynaldo; Joloba, Moses; Ellner, Jerrold J; Dorman, Susan E

    2014-07-01

    Smear microscopy has suboptimal sensitivity, and there is a need to improve its performance since it is commonly used to diagnose tuberculosis (TB). We prospectively evaluated the diagnostic accuracy of the small membrane filtration (SMF) method, an approach that uses a vacuum manifold and is designed to concentrate bacilli onto a filter that can be examined microscopically. We enrolled hospitalized adults suspected to have pulmonary TB in Kampala, Uganda. We obtained a clinical history and three spontaneously expectorated sputum specimens for smear microscopy (direct, concentrated, and SMF), MGIT (mycobacterial growth indicator tube) 960 and Lowenstein-Jensen (LJ) cultures, and Xpert MTB/RIF testing. We performed per-specimen (primary) and per-patient analyses. From October 2012 to June 2013, we enrolled 212 patients (579 sputum specimens). The participants were mostly female (63.2%), and 81.6% were HIV infected; their median CD4 cell count was 47 cells/μl. Overall, 19.0%, 20.4%, 27.1%, 25.2%, and 25.9% of specimens tested positive by direct smear, concentrated smear, MGIT culture, LJ culture, and Xpert test, respectively. In the per-specimen analysis, the sensitivity of the SMF method (48.5%; 95% confidence interval [CI], 37.4 to 59.6) was lower than those of direct smear (60.9%; 51.4 to 70.5 [P = 0.0001]) and concentrated smear (63.3%; 53.6 to 73.1 [P filtration failure rate.

  14. CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection

    DEFF Research Database (Denmark)

    Andersen, Aase B.; Range, Nyagosya; Changalucha, John;

    2012-01-01

    ABSTRACT: BACKGROUND: The interaction of HIV and tuberculosis (TB) on CD4 levels over time has previously been divergently reported and only in small study populations with short or no follow-up. METHODS: CD4 counts were assessed from time of diagnosis till the end of TB treatment in a cohort...... of pulmonary TB patients with and without HIV co-infection and compared with cross-sectional data on age- and sex-matched non-TB controls from the same area. RESULTS: Of 1605 study participants, 1250 were PTB patients and 355 were non-TB controls. At baseline, HIV was associated with 246 (95% CI: 203; 279......) cells per uL lower CD4 counts. All PTB patients had 100 cells per uL lower CD4 counts than the healthy controls. The CD4 levels were largely unchanged during five-months of TB treatment. HIV infected patients not receiving ART at any time and those already on ART at baseline had no increase in CD4...

  15. THE SOCIAL AND CLINICAL CHARACTERISTIC OF PATIENTS WITH THE ISOLATED GENITAL TUBERCULOSIS ASSOCIATED WITH INFERTILITY, THE ACTIVE AND CLINICALLY CURED TUBERCULOSIS OF RESPIRATORY ORGANS IN COMBINATION WITH PREGNANCY

    Directory of Open Access Journals (Sweden)

    A. V. Mordyk

    2015-01-01

    Full Text Available Due to the high incidence of tuberculosis of women of reproductive age research at 270 patients was conducted. The group of research included women with infertility and genital tuberculosis, pregnant women with active tuberculosis of lungs, pregnant women with clinically cured tuberculosis of respiratory organs. Pregnant women with tuberculosis of lungs were more often from sociopathic families, had venereal diseases, HIV infection, hepatitises.

  16. Rule out pulmonary tuberculosis: clinical and radiographic clues for the internist.

    Science.gov (United States)

    Curley, Catherine Anne

    2015-01-01

    As tuberculosis rates decline in the United States, clinicians are less likely to consider it early in a patient's illness. Certain clinical and radiographic features increase the likelihood of tuberculosis. This review covers the clinical and radiographic features of tuberculosis, the initial evaluation of the patient, the use of airborne infection isolation, and the utility of new molecular techniques in diagnosing tuberculosis. Copyright© 2015 The Cleveland Clinic Foundation.

  17. Classification and regression tree (CART model to predict pulmonary tuberculosis in hospitalized patients

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    Aguiar Fabio S

    2012-08-01

    Full Text Available Abstract Background Tuberculosis (TB remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Methods Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART model was generated and validated. The area under the ROC curve (AUC, sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. Results We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. Conclusions The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with

  18. The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

    NARCIS (Netherlands)

    A.H. Fuady (Ahmad); Pakasi, T.A. (Trevino A.); Mansyur, M. (Muchtaruddin)

    2014-01-01

    markdownabstract__Background:__ Indonesia has not resolved tuberculosis burden since its prevalence and incidence has remained high. As the capital of Indonesia with a large population and a high number of tuberculosis cases, Jakarta has a distinctive condition of tuberculosis burden. This study aim

  19. The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

    NARCIS (Netherlands)

    A.H. Fuady (Ahmad); Pakasi, T.A. (Trevino A.); Mansyur, M. (Muchtaruddin)

    2014-01-01

    markdownabstract__Background:__ Indonesia has not resolved tuberculosis burden since its prevalence and incidence has remained high. As the capital of Indonesia with a large population and a high number of tuberculosis cases, Jakarta has a distinctive condition of tuberculosis burden. This study aim

  20. The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

    NARCIS (Netherlands)

    A.H. Fuady (Ahmad); Pakasi, T.A. (Trevino A.); Mansyur, M. (Muchtaruddin)

    2014-01-01

    markdownabstract__Background:__ Indonesia has not resolved tuberculosis burden since its prevalence and incidence has remained high. As the capital of Indonesia with a large population and a high number of tuberculosis cases, Jakarta has a distinctive condition of tuberculosis burden. This study

  1. Real-time fluorescence Loop-Mediated Isothermal Amplification (LAMP) for rapid and reliable diagnosis of pulmonary tuberculosis.

    Science.gov (United States)

    Cao, Donglin; Hu, Liangshan; Lin, Maorui; Li, Mingyou; Ye, Zebing; Sun, Hongtao; Huang, Jiwei; Yang, Huawen; Tian, Junzhang

    2015-02-01

    A reliable, simple and rapid diagnostic method that can be helpful in pulmonary tuberculosis diagnosis is urgently needed. Loop-mediated Isothermal Amplification (LAMP) allows DNA to be amplified rapidly at a constant temperature. In this study, real-time fluorescence LAMP was evaluated to rapidly detect Mycobacterium tuberculosis in sputum and was compared to the performance of real-time fluorescence quantitative PCR (Q-PCR). All the standard MTB strains were successfully detected and limit of detection (LOD) was 10(2)CFU/mL by real-time fluorescence LAMP within 20min. In light of MTB in sputum, the real-time fluorescence LAMP method yielded a sensitivity of 98.0% and a specificity of 78.3%, compared to Q-PCR assay, which yielded a sensitivity of 96.0% and a specificity of 82.6% for PTB diagnosis. There was an excellent overall agreement between LAMP and Q-PCR for PTB (κ=0.315) and non-PTB (κ=0.862). Therefore, the real-time fluorescence LAMP assay is a rapid, sensitive, and specific method to detect pulmonary tuberculosis.

  2. Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai

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    Tauro, Carolyn Kavita; Gawde, Nilesh Chandrakant

    2015-01-01

    Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai's private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector. PMID:26379705

  3. ASSESSMENT OF CLINICAL PROFILE AND TREATMENT OUTCOME OF EXTRA PULMONARY TUBERCULOSIS PATIENTS UNDER RNTCP IN RURAL MEDICAL COLLEGE, SOUTH INDIA

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    Siddeswaraswamy

    2014-09-01

    Full Text Available : BACKGROUND: Few reports exist detailing the clinical profile and treatment outcome of extra pulmonary tuberculosis (EPTB registered in DOTS centers in a rural medical college. AIM: The primary objective of this study was to describe the demographic, clinical profile and treatment outcome of EPTB. MATERIALS AND METHODS: A cross sectional study that reviewed the routinely collected data of patients with EPTB registered for treatment under DOTS for the period of 1 November 2010 to 31 September 2013 was carried out at Sri Siddhartha medical college. RESULTS: Among 747 cases registered for treatment of all forms of tuberculosis, 406 (54.35% had EPTB, majority of cases were aged 20 -40 years (193, 47.50% and males (239, 58.9% but lymph node and genitourinary TB most commonly affected females. In the present study pleural effusion (35.70% was most common followed by CNS involvement (19.50%. All patients were treated with the standard RNTCP treatment regimen. The observed treatment outcomes were treatment completion of 82.01%, default of 8.86%, and failure of 0.24% and death 8.86%. Patient treated with category II, HIV-positive patients and diabetic patients had adverse treatment outcomes. CONCLUSION: The burden of EPTB is more among the productive age group and in males. Plural TB is most common followed by CNS involvement. A well-defined program specified protocols for the diagnosis and treatment of extra pulmonary tuberculosis cases should be more effectively addressed in RNTCP.

  4. Tuberculosis

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    Elena Morán López

    2001-04-01

    Full Text Available En la actualidad la incidencia de la tuberculosis ha aumentado. El Mycobacterium tuberculosis infecta frecuentemente a las personas con SIDA, debido a que en estos pacientes hay una reducción de la resistencia mediada por células T, lo que propicia que este bacilo pueda desarrollar la enfermedad con una frecuencia superior a la de las personas sanas. La transmisión de la enfermedad puede ser por vía directa, de un individuo afectado a otro, fundamentalmente por las gotitas de saliva que contengan a este microorganismo, o por vía indirecta por la inhalación del bacilo que se puede encontrar por meses en los objetos de uso diario, debido a su gran resistencia. Las micobacterias que producen tuberculosis en el hombre inmunocompetente son la Mycobacterium tuberculosis y la bovis, otros tipos pueden provocar tuberculosis en individuos inmunocomprometidos. La patogenicidad de este bacilo está relacionada con su capacidad para escapar de la destrucción inducida por los macrófagos y para provocar hipersensibilidad de tipo retardado. Esta enfermedad tiene muy pocas manifestaciones bucales, lo que se observa generalmente es una úlcera que toma como asiento fundamental el dorso de la lengua. La tuberculosis amenaza con convertirse en una enfermedad incurable por la deficiente administración de los programas contra ésta, por lo que la OMS plantea para su detección y tratamiento el DOTS (tratamiento observado directamente, de corta duración que comienza a tener resultados satisfactorios, aunque en el último quinquenio, el 88 % de los pacientes que se estimaban como infectados por tuberculosis no recibieron DOTS.At present, the incidence of tuberculosis is on the rise. Mycobacterium tuberculosis often infests AIDS patients due to the fact that these persons´T-cell mediated resistance is reduced, which favors the development of the disease at a higher rate than in healthy people. The disease can be transmitted directly, that is , from an

  5. Native New Zealand plants with inhibitory activity towards Mycobacterium tuberculosis

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    Swift Simon

    2010-06-01

    Full Text Available Abstract Background Plants have long been investigated as a source of antibiotics and other bioactives for the treatment of human disease. New Zealand contains a diverse and unique flora, however, few of its endemic plants have been used to treat tuberculosis. One plant, Laurelia novae-zelandiae, was reportedly used by indigenous Maori for the treatment of tubercular lesions. Methods Laurelia novae-zelandiae and 44 other native plants were tested for direct anti-bacterial activity. Plants were extracted with different solvents and extracts screened for inhibition of the surrogate species, Mycobacterium smegmatis. Active plant samples were then tested for bacteriostatic activity towards M. tuberculosis and other clinically-important species. Results Extracts of six native plants were active against M. smegmatis. Many of these were also inhibitory towards M. tuberculosis including Laurelia novae-zelandiae (Pukatea. M. excelsa (Pohutukawa was the only plant extract tested that was active against Staphylococcus aureus. Conclusions Our data provide support for the traditional use of Pukatea in treating tuberculosis. In addition, our analyses indicate that other native plant species possess antibiotic activity.

  6. Effect of Antioxidant Vitamins C and E Supplementation on its Plasma Levels and on Lipid Profile in Pulmonary Tuberculosis Patients26

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    M. Madhavi

    2009-01-01

    Full Text Available Problem statement: Patients with active pulmonary Tuberculosis (TB are malnourished as indicated by reductions in lean mass, anthropometric indices and micronutrient status. Supplementation with vitamins may prove to be beneficial. Limited information is available on the supplementation of vitamin C and E in pulmonary TB patients. Hence, the present study was undertaken to address the question whether any benefit could be demonstrated with supplementation of antioxidant vitamins C and E and in combination in pulmonary TB patients. Approach: A five arm study was carried out for a period of 6 months in which the normal healthy volunteers served as control group and the sputum positive category I pulmonary TB patients served as the treatment group. Three out of the four patient groups received the antioxidant vitamin supplementation of either vitamin C, vitamin E or in combination along with ATT, whereas fourth group received ATT alone. Plasma concentrations of vitamin C and E were analyzed pre, during and post Anti-Tuberculosis Therapy (ATT to establish the role of oral supplementation of these vitamins. Sputum culture was also done at all the three times points for Mycobacterium tuberculosis. To study the possible interaction and influence of the supplemented vitamins on LDL-C and HDL-C and other lipid parameters a lipid profile was carried out. Results: (1 All the patients in the treatment groups turned sputum at the end of 2 months of treatment. (2 There was a significant improvement in the body weights of the patients upon supplementation with antioxidant vitamins. (3 There was a significant increase in the of plasma ascorbic acid and α-tocopherol levels after 6 months of treatment in the vitamin C and vitamin E supplemented groups. (4 The HDL-C levels increased significantly in the antioxidant vitamin supplemented groups. (5 Lower levels of LDL-C were observed in the antioxidant vitamin supplemented groups when compared to the un

  7. Isoniazid Mono-Resistant Tuberculosis: Impact on Treatment Outcome and Survival of Pulmonary Tuberculosis Patients in Southern Mexico 1995-2010

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    Báez-Saldaña, Renata; Delgado-Sánchez, Guadalupe; García-García, Lourdes; Cruz-Hervert, Luis Pablo; Montesinos-Castillo, Marlene; Ferreyra-Reyes, Leticia; Bobadilla-del-Valle, Miriam; Canizales-Quintero, Sergio; Ferreira-Guerrero, Elizabeth; Téllez-Vázquez, Norma; Montero-Campos, Rogelio; Yanes-Lane, Mercedes; Mongua-Rodriguez, Norma; Martínez-Gamboa, Rosa Areli; Sifuentes-Osornio, José; Ponce-de-León, Alfredo

    2016-01-01

    Background Isoniazid mono-resistance (IMR) is the most common form of mono-resistance; its world prevalence is estimated to range between 0.0 to 9.5% globally. There is no consensus on how these patients should be treated. Objective To describe the impact of IMR tuberculosis (TB) on treatment outcome and survival among pulmonary TB patients treated under programmatic conditions in Orizaba, Veracruz, Mexico. Materials and Methods We conducted a prospective cohort study of pulmonary TB patients in Southern Mexico. From 1995 to 2010 patients with acid-fast bacilli or culture proven Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. We included patients who harbored isoniazid mono-resistant (IMR) strains and patients with strains susceptible to isoniazid, rifampicin, ethambutol and streptomycin. All patients were treated following Mexican TB Program guidelines. We performed annual follow-up to ascertain treatment outcome, recurrence, relapse and mortality. Results Between 1995 and 2010 1,243 patients with pulmonary TB were recruited; 902/1,243 (72.57%) had drug susceptibility testing; 716 (79.38%) harbored pan-susceptible and 88 (9.75%) IMR strains. Having any contact with a person with TB (adjusted odds ratio (aOR)) 1.85, 95% Confidence interval (CI) 1.15–2.96) and homelessness (adjusted odds ratio (aOR) 2.76, 95% CI 1.08–6.99) were associated with IMR. IMR patients had a higher probability of failure (adjusted hazard ratio (HR) 12.35, 95% CI 3.38–45.15) and death due to TB among HIV negative patients (aHR 3.30. 95% CI 1.00–10.84). All the models were adjusted for socio-demographic and clinical variables. Conclusions The results from our study provide evidence that the standardized treatment schedule with first line drugs in new and previously treated cases with pulmonary TB and IMR produces a high frequency of treatment failure and death due to tuberculosis. We recommend re-evaluating the optimal

  8. Tuberculous liver abscess in an immunocompetent child with pulmonary tuberculosis as a cause of fever of unknown origin.

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    Çalışkan, Bahar; Somer, Ayper; Hatipoğlu, Nevin; Keser, Melike; Yekeler, Ensar; Gün, Feryal; Güllüoğlu, Mine; Salman, Tansu; Salman, Nuran

    2015-01-01

    Infectious diseases are the leading cause of FUO. A case of prolonged fever with hepatic and pulmonary tuberculosis as a final diagnosis is herein presented. A 4-year-old, otherwise healthy boy presented with an axillary temperature of up to 39.5ºC for the previous 3 weeks. His medical history revealed an occasional increase in body temperature up to 38.5ºC for the last 6 months. Physical examination revealed coarse breath sounds on the basal lung area. Chest X-ray showed mediastinal lymphadenomegaly and computed tomography revealed paratracheal conglomerated lymph nodes and a groundglass appearance on the right lung. There were multiple contrast-enhanced, hypoechoic nodules with central necrosis in the liver parenchyma on abdominal magnetic resonance imaging. Open liver biopsy yielded chronic granulomatous inflammation compatible with pathological findings of tuberculosis infection. The culture specimen was positive for Mycobacterium tuberculosis. The patient improved rapidly after antituberculous therapy was initiated. Tuberculosis, especially in its disseminated form, poses a distinct diagnostic challenge in cases of prolonged fever with unproven etiology, and thus persistence should be exercised in disclosing the cause of such fevers.

  9. Nutritional status in multi-drug resistance-pulmonary tuberculosis patients

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    Amit Kumar

    2014-12-01

    Full Text Available Introduction: Malnutrition and tuberculosis are the major concerns of underdeveloped regions of the world. Undernutrition increases the risk of tuberculosis (TB and in turn TB can lead to Malnutrition. Undernutrition is therefore highly prevalent among people with TB. It has been demonstrated that undernutrition is a risk factor for progression from TB infection to active TB disease and severe form viz. MDR-TB. Undernutrition is a predictor of increased risk of death and TB relapse. Objectives: To study the effect of nutrition in MDR-TB patients at DR-TB centre, Dehradun. Methodology: The Observational cross sectional study was conducted at Drug Resistant Tuberculosis (DR-TB Centre of HIMS, Dehradun over a   period of 12 months to include all the cases reported from 1st October, 2011 (start of DR-TB Centre at HIMS, Dehradun to 30th April, 2014. 376 Subjects were recruited from 1598 suspected MDR TB subjects who were screened by Drug Susceptibility Testing (DST results. Results: Out of 376 MDR-TB patients, 258 (68.6% subjects were found to be undernourished. The mean body mass index (BMI was 17.33+1.99 kg/m2. Though undernutrition was more common among Males (61.2% but female’s BMI was more affected by MDR in comparison to males. Treatment success was better amongst males between 21- 60 year age group with normal BMI having mono drug resistance with no adverse reaction. The majority 47 (18.2% of adverse effect was found in undernourished patients. Treatment outcome was also poor among undernourished (76.9% MDR-TB patients. Conclusion: Prevalence of undernutrition was high (68.6% among subjects and the mean BMI was lower in female. Adverse drug reaction, poor treatment outcome are attributes of Undernutrition.

  10. Therapeutic Drug Monitoring in the Treatment of Active Tuberculosis

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    Aylin Babalik

    2011-01-01

    Full Text Available Therapeutic drug monitoring ensures optimal dosing while aiming to reduce toxicity. However, due to the high costs and complexity of testing, therapeutic drug monitoring is not routinely used in the treatment of individuals with active tuberculosis, despite the efficacy demonstrated in several randomized trials. This study reviewed data spanning five years regarding the frequency of finding low drug levels in patients with tuberculosis, the dosing adjustments that were required to achieve adequate levels and the factors associated with low drug levels.

  11. Dietary Vitamin D3 suppresses pulmonary immunopathology associated with late stage tuberculosis in C3HeB/FeJ mice

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    Reeme, Allison E.; Robinson, Richard T.

    2015-01-01

    Tuberculosis (TB) is a significant human disease caused by inhalation of Mycobacterium tuberculosis (Mtb). Left untreated, TB mortality is associated with a failure to resolve pulmonary immunopathology. There is currently widespread interest in using Vitamin D3 (VitD3) as an adjunct therapy for TB, as numerous in vitro studies have shown that VitD3 has direct and indirect mycobactericidal activities. However, to date there have been no in vivo studies addressing whether VitD3 affects experimental TB outcome. Here we use C3HeB/FeJ mice to determine if dietary VitD3 influences the outcome of experimental TB. We observed that although Mtb burdens did not differ between mice on a VitD3-replete diet (VitDHI mice) and mice on a VitD3-deficient diet (VitDLO mice), the inflammatory response in VitDHI mice was significantly attenuated relative to VitDLO controls. Specifically, the expression of multiple inflammatory pathways was reduced in the lungs at later disease stages, as were splenocyte IL12/23p40- and IFNγ-levels following ex vivo restimulation. Dietary VitD3 also suppressed the accumulation of T cells in the mediastinal lymph nodes and lung granulomatous regions, while concomitantly accelerating the accumulation of F4/80+ and Ly6C/Ly6G+ lineages. The altered inflammatory profile of VitDHI mice also associated with reductions in pulmonary immunopathology. VitD receptor deficient (vdr−/−) radiation bone marrow chimeras demonstrate that reductions in pulmonary TB-immunopathology are dependent on hematopoietic VitD-responsiveness. Collectively, our data support a model wherein the in vivo role of VitD3 during TB is not to promote Mtb killing, but rather to function through hematopoietic cells to reduce Mtb-elicited immunopathology. PMID:26729807

  12. Interferon-gamma assay in combination with tuberculin skin test are insufficient for the diagnosis of culture-negative pulmonary tuberculosis.

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    Marcin Wlodarczyk

    Full Text Available OBJECTIVE: Early diagnosis of infectious cases and treatment of tuberculosis (TB are important strategies for reducing the incidence of this disease. Unfortunately, traditional TB diagnostic methods are time-consuming and often unreliable. This study compared the accuracy and reliability of the tuberculin skin test (TST and interferon (IFN-γ-based assay (IGRA for the diagnosis of active pulmonary TB Polish cases that could or could not be confirmed by M. tuberculosis (M.tb culture. METHODS: In total, 126 adult patients with clinically active TB or non-mycobacterial, community-acquired lung diseases (NMLD hospitalised at the Regional Specialised Hospital of Tuberculosis, Lung Diseases and Rehabilitation in Tuszyn, Poland were enrolled in the present study. Sensitivity, specificity, positive predicted value (PPV, negative predicted value (NPV, and analytic accuracy (Acc of TST and IGRA testing for the diagnosis of culture-positive and culture-negative TB patients were calculated. The quantities of IFN-γ produced in the response to M.tb specific antigens (TB Ag - Nil in the cultures of blood from patients with active TB and NMLD patients were also analysed. RESULTS: The IGRA sensitivity in culture-positive and culture-negative TB patients was similar, measuring 65.1% and 55.6%, respectively. The sensitivity of TST did not differ from the parameters designated for IGRA, measuring 55.8% in culture-positive and 64.9% in culture-negative TB. The sensitivity of TST and IGRA was age-dependent and decreased significantly with the age of the patients. No differences in the frequency or intensity of M.tb-stimulated IFN-γ production, as assessed by IGRA testing between culture-positive and culture-negative TB were noticed. Significantly lower concentrations of IFN-γ were observed in patients with advanced TB forms compared with those with mild or moderate TB pathologies. CONCLUSIONS: Our results do not show that a combination of IGRA and TST might be a

  13. Interferon-gamma assay in combination with tuberculin skin test are insufficient for the diagnosis of culture-negative pulmonary tuberculosis.

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    Wlodarczyk, Marcin; Rudnicka, Wieslawa; Janiszewska-Drobinska, Beata; Kielnierowski, Grzegorz; Kowalewicz-Kulbat, Magdalena; Fol, Marek; Druszczynska, Magdalena

    2014-01-01

    Early diagnosis of infectious cases and treatment of tuberculosis (TB) are important strategies for reducing the incidence of this disease. Unfortunately, traditional TB diagnostic methods are time-consuming and often unreliable. This study compared the accuracy and reliability of the tuberculin skin test (TST) and interferon (IFN)-γ-based assay (IGRA) for the diagnosis of active pulmonary TB Polish cases that could or could not be confirmed by M. tuberculosis (M.tb) culture. In total, 126 adult patients with clinically active TB or non-mycobacterial, community-acquired lung diseases (NMLD) hospitalised at the Regional Specialised Hospital of Tuberculosis, Lung Diseases and Rehabilitation in Tuszyn, Poland were enrolled in the present study. Sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and analytic accuracy (Acc) of TST and IGRA testing for the diagnosis of culture-positive and culture-negative TB patients were calculated. The quantities of IFN-γ produced in the response to M.tb specific antigens (TB Ag - Nil) in the cultures of blood from patients with active TB and NMLD patients were also analysed. The IGRA sensitivity in culture-positive and culture-negative TB patients was similar, measuring 65.1% and 55.6%, respectively. The sensitivity of TST did not differ from the parameters designated for IGRA, measuring 55.8% in culture-positive and 64.9% in culture-negative TB. The sensitivity of TST and IGRA was age-dependent and decreased significantly with the age of the patients. No differences in the frequency or intensity of M.tb-stimulated IFN-γ production, as assessed by IGRA testing between culture-positive and culture-negative TB were noticed. Significantly lower concentrations of IFN-γ were observed in patients with advanced TB forms compared with those with mild or moderate TB pathologies. Our results do not show that a combination of IGRA and TST might be a step forward in the diagnosis of culture-negative TB

  14. Diagnostic value of serum adenosine deaminase levels in sputum smear negative pulmonary tuberculosis patients in Nepalese population

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    Anil Chander; Chandrika Devi Shrestha

    2012-01-01

    Objective: To assess the levels of adenosine deaminase (ADA) in serum in patients with sputum smear negative pulmonary tuberculosis (SNPTB) and to compare it with serum ADA levels in patients with non-tuberculous pulmonary disease - chronic obstructive pulmonary disease (COPD) and with healthy control group and to explore its validity as a diagnostic marker in serum in SNPTB patients.Methods:Three groups of study populations were made. Group I: SNPTB - 142 cases, Group II:non-tubercular pulmonary disease - COPD - 40 cases, Group III: healthy controls - 80 cases. Serum samples were collected and ADA assay was done by the method of Guisti and Galanti. Results: ADA levels (Mean±SD, U/L) in the three groups were as follows: Group I: 42.26±21.22, Group II: 23.31±8.22, Group III: 18.88±6.67. Difference between Group I and Group III was statistically significant (P < 0.0001). The test showed a high specificity 91.25% (95% confidence interval - CI 83.00 - 95.7) and a sensitivity of 83.10% (95% CI 76.08-88.37) in Group I. Positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy in Group I were 94.00%, 69.52%, 9.49, 0.18 and 82.43% respectively.Conclusions: Overall assessment of the use of serum ADA levels as a diagnostic biochemical marker in smear-negative pulmonary tuberculosis patients showed promising results. Studies with a larger population group are required to validate its use as a routine diagnostic test in these cases.

  15. Evaluación en salud pública: lecciones aprendidas de la gestión de la tuberculosis pulmonar Measurement in Public Health: what pulmonary tuberculosis management has taught us

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    C. Patrick Chaulk

    2008-08-01

    Full Text Available Las tasas de tuberculosis pulmonar están aumentando en todo el mundo, incluida España. Uno de los retos principales al tratar esta enfermedad es conseguir un buen cumplimiento terapéutico, puesto que alrededor de un 30-35% de los pacientes no sigue la pauta de medicación prescrita. Este artículo revisa un conjunto de estrategias de evaluación y medidas de la práctica para valorar la efectividad de los programas comunitarios orientados a reforzar el cumplimiento terapéutico de los pacientes con tuberculosis pulmonar activa. Se revisan 4 estrategias de evaluación tradicionales (estudio de un caso, estudio retrospectivo y de casos controles, predicción/pronóstico y análisis de coste-efectividad y 2 enfoques de evaluación emergentes y prometedores (evaluación de calidad de vida e indicadores de continuidad de la asistencia. Varias de las estrategias de evaluación revisadas indican que los programas de tratamiento mediante la terapia de observación directa (directly observed therapy [DOT], amplios, comunitarios y centrados en el paciente, alcanzan los índices más altos de cumplimiento terapéutico. Se recomienda la utilización conjunta de varias de estas estrategias de evaluación para crear un cuerpo de evidencia que refleje el impacto de los programas de intervención comunitaria en la mejora de