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Sample records for extrapulmonary tuberculosis varies

  1. Imaging in extrapulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Sanjay Gambhir

    2017-03-01

    Full Text Available Tuberculosis (TB remains a major global public health problem, with 1.5 million deaths annually worldwide. One in five cases of TB present as extrapulmonary TB (EPTB, posing major diagnostic and management challenges. Mycobacterium tuberculosis adapts to a quiescent physiological state and is notable for its complex interaction with the host, producing poorly understood disease states ranging from latent infection to active clinical disease. New tools in the diagnostic armamentarium are urgently required for the rapid diagnosis of TB and monitoring of TB treatments, and to gain new insights into pathogenesis. The typical and atypical imaging features of EPTB are reviewed herein, and the roles of several imaging modalities for the diagnosis and management of EPTB are discussed.

  2. Extrapulmonary tuberculosis: Fine needle aspiration cytology ...

    African Journals Online (AJOL)

    Background: The increasing prevalence of extrapulmonary manifestation of tuberculosis with the HIV scourge is a cause for concern. Objective: To determine the role of fine needle aspiration cytology (FNAC) in the diagnosis of extrapulmonary tuberculosis. Patients and Methods: This is a consecutive 9-year analysis of ...

  3. Unusual manifestation of extrapulmonary tuberculosis.

    Science.gov (United States)

    Alghamdi, Aisha A; Awan, Faiza S; Maniyar, Iqbal H; Alghamdi, Naif A

    2013-01-01

    Though commonly encountered, extrapulmonary tuberculosis (TB) can sometimes present with variable clinical picture intricating the diagnosis (Avasthi et al., 2010). The nonspecific symptoms include pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis, and, rarely, variety of hematological abnormalities, namely, anemia, pancytopenia, and leukemoid reaction (Avasthi et al., 2010). When it presents with bone marrow (BM) involvement, prognosis is usually poor (Avasthi et al., 2010, Qasim et al., 2003, and Singh et al., 2001). We, hereby, report a case of extra-pulmonary TB with a six-month history of fever associated with dizziness, fatigability, and cough. During the hospital stay, the patient showed a spectrum of interesting hematological findings, including severe pancytopenia on peripheral smear, necrotizing caseating granulomas consistent with TB on bone marrow examination. The patient showed a good clinical as well as hematological response to antituberculosis treatment. This paper highlights the significance of a hematological picture in the final confirmation of TB, which may otherwise be passed off as nutritional or other unrelated causes.

  4. Enigma of Extrapulmonary Tuberculosis: Where Do We Stand?

    OpenAIRE

    Inayat, Faisal; Jafar, Munnam S; Ali, Nouman Safdar; Hussain, Qulsoom; Hurairah, Abu

    2017-01-01

    Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay its diagnosis and treatment. The present study illustrates the importance of ruling out extrapulmonary tuberculosis in patients presenting with nonspecific symptoms of abdominal diseases. Furthermore, we discuss the variety of clinical presentations, diagnostic challenges, current therapeutic protocols, and prognostic factors associated with extrapulmonary tuberculosis. Early diagnosis and ...

  5. Extrapulmonary tuberculosis: are statistical reports accurate?

    Science.gov (United States)

    2014-01-01

    Before discussing the epidemiology of extrapulmonary tuberculosis (EPTB) and particularly urogenital tuberculosis (UGTB), unification of the terminology is necessary. The term ‘urogenital tuberculosis’ is preferable to ‘genitourinary tuberculosis’, as renal and urinary tract tuberculosis is more common than genital tuberculosis. Some understand the term ‘extrapulmonary tuberculosis’ as a specific tuberculosis (TB) lesion of all organs excluding the bronchus, lungs, pleura and intrathoracic bronchopulmonary lymph nodes, but others consider pleural TB as one form of EPTB – and it is a reason for very different proportions in the spectrum of EPTB. Enigmatic tendencies have also been revealed in patients' distribution – in neighbouring regions the incidence rate may differ significantly. Although there is no clear explanation for these tendencies, careful study of the epidemiology of EPTB in different conditions will improve early diagnosis. PMID:25165556

  6. Diagnosis of extrapulmonary tuberculosis by PCR.

    Science.gov (United States)

    Mehta, Promod K; Raj, Ankush; Singh, Netrapal; Khuller, Gopal K

    2012-10-01

    During the last two decades, the resurgence of tuberculosis (TB) has been documented in both developed and developing nations, and much of this increase in TB burden coincided with human immunodeficiency virus (HIV) epidemics. Since then, the disease pattern has changed with a higher incidence of extrapulmonary tuberculosis (EPTB) as well as disseminated TB. EPTB cases include TB lymphadenitis, pleural TB, TB meningitis, osteoarticular TB, genitourinary TB, abdominal TB, cutaneous TB, ocular TB, TB pericarditis and breast TB, although any organ can be involved. Diagnosis of EPTB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granulomas on histopathology and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis of EPTB. Novel diagnostic modalities such as nucleic acid amplification (NAA) can be useful in varied forms of EPTB. This review is primarily focused on the diagnosis of several clinical forms of EPTB by polymerase chain reaction (PCR) using different gene targets. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

  7. Factors associated with mortality in extrapulmonary tuberculosis ...

    African Journals Online (AJOL)

    Objectives: To investigate the clinical manifestations and factors associated with mortality in patients with extrapulmonary tuberculosis (EPTB) at the Korle-Bu Teaching Hospital Chest Clinic in Accra, Ghana. Design: We conducted a retrospective chart review of patients treated for EPTB at the Chest Clinic between January ...

  8. factors associated with mortality in extrapulmonary tuberculosis ...

    African Journals Online (AJOL)

    SUMMARY. Objectives: To investigate the clinical manifestations and factors associated with mortality in patients with extrapulmonary tuberculosis (EPTB) at the Korle-Bu. Teaching Hospital Chest Clinic in Accra, Ghana. Design: We conducted a retrospective chart review of patients treated for EPTB at the Chest Clinic ...

  9. Extra-pulmonary tuberculosis in Uyo, South - South, Nigeria | Abudu ...

    African Journals Online (AJOL)

    Background: Tuberculosis is a disease of the poor, affecting the pulmonary and extra-pulmonary organs. Objectives: To assess the frequency and morphologic pattern of extra-pulmonary tuberculosis as well as determining the occurrence of other acid fast organisms from extra-pulmonary tissue biopsies using common ...

  10. Extra-pulmonary tuberculosis in Saudi Arabia.

    Science.gov (United States)

    Al-Otaibi, Fawzia; El Hazmi, Malak M

    2010-01-01

    Studies from developed countries have reported that extra-pulmonary tuberculosis (EPTB) is on the rise due to the human immunodeficiency virus (HIV) epidemic. However, similar studies from high-burden countries with low prevalence of HIV like Saudi Arabia are lacking. Therefore, we conducted this study to investigate demographic and clinical characteristics of patients with pulmonary and extra-pulmonary tuberculosis. A retrospective analysis was carried out on all patients (n=431) with a culture - proven diagnosis of tuberculosis seen at University teaching hospital, Riyadh, Saudi Arabia from January 2001 to December 2007. A total of 183 (42.5%) pulmonary tuberculosis (PTB) and 248 (57.5%) extra-pulmonary TB (EPTB) cases were compared in terms of age, sex, and nationality. There were 372 Saudis (SA) (86.3%) and the remaining non-Saudis (NSA) 59 (13.7%). The age distribution of the PTB patients had a bimodal distribution. EPTB was more common at young age (20-29 years). The proportion of EPTB cases was significantly higher among NSA patients (72.9%) compared to SA patients (55.1%). Females had higher proportion (59.5%) of EPTB than males (55.6%). The most common site was lymph node tuberculosis (42%). In conclusion, our data suggest that EPTB was relatively common in younger age, female gender and NSA. Tuberculosis (TB) control program may target those populations for EPTB case-finding.

  11. Primary disseminated extrapulmonary multidrug resistant tuberculosis

    Directory of Open Access Journals (Sweden)

    S K Das

    2012-01-01

    Full Text Available Disseminated tuberculosis is a common mode of presentation of tuberculosis in patients both with and without HIV/AIDS in India. However, primary multidrug resistance in disseminated tuberculosis involving only the extrapulmonary sites in an immunocompetent adult is rare. Here, we report a case of a 19-year-old man who had disseminated tuberculosis involving left pleura, pericardium, peritoneum and intraabdominal lymph nodes. He was initially taking WHO category I antituberculous drugs, but was not responding in spite of 5 months of chemotherapy. Culture of the pleural biopsy specimen grew Mycobacterium tuberculosis which was resistant to isoniazid and rifampicin. He was put on therapy for multidrug resistant tuberculosis,following 24 months of chemotherapyhe had an uneventful recovery.

  12. Enigma of Extrapulmonary Tuberculosis: Where Do We Stand?

    Science.gov (United States)

    Jafar, Munnam S; Ali, Nouman Safdar; Hussain, Qulsoom; Hurairah, Abu

    2017-01-01

    Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay its diagnosis and treatment. The present study illustrates the importance of ruling out extrapulmonary tuberculosis in patients presenting with nonspecific symptoms of abdominal diseases. Furthermore, we discuss the variety of clinical presentations, diagnostic challenges, current therapeutic protocols, and prognostic factors associated with extrapulmonary tuberculosis. Early diagnosis and effective treatment may decrease morbidity and mortality in such patients. PMID:29021926

  13. Extra-pulmonary tuberculosis: a biomarker analysis.

    Science.gov (United States)

    Fortún, J; Martín-Dávila, P; Gómez-Mampaso, E; Vallejo, A; Cuartero, C; González-García, A; Rubí, J; Pallarés, E; Moreno, S

    2014-08-01

    Studies on biomarkers in tuberculosis are focused on pulmonary forms of this disease (PTB), and only limited information is currently available on biomarkers of extra-pulmonary tuberculosis (EPTB). Serum samples from 24 patients with PTB, 29 patients with EPTB and 27 healthy controls were obtained, and the levels of interferon-gamma, chemokine ligand 9, mannose-binding lectin (MBL), tumor marker Ca-125 and adenosine deaminase were determined. The circulating levels of all tested biomarkers in the serum were significantly higher in PTB and EPTB patients than in controls. However, there were no significant differences in the levels of the biomarkers between patients with PTB and EPTB, with the exception of serum levels of MBL which were significantly higher in patients with EPTB than in patients with PTB (p = 0.01). In patients with EPTB, no significant differences were observed in biomarker levels among patients with or without concomitant PTB involvement. Based on MBL serum levels, ROC curve analysis showed an AUC of 0.85 for EPTB versus non-EPTB. The optimal cut-off value of MBL serum levels for EPTB versus non-EPTB was 1,000 μg/ml, with a sensitivity and specificity of 79.3 and 78.0 %, respectively. Biomarkers usually present as acute phase reactants and do not enable pulmonary forms to be differentiated from more serious or extra-pulmonary forms. MBL may be an exception.

  14. Gallium-67 citrate scan in extrapulmonary tuberculosis

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    Lin Wanyu [Taichung Veterans General Hospital (Taiwan). Dept. of Nuclear Medicine; Hsieh Jihfang [Chi-Mei Foundation Hospital, Tainan (Taiwan)

    1999-07-01

    Aim: Whole-body gallium scan was performed to evaluate the usefulness of gallium scan for detecting extrapulmonary tuberculosis (TB) lesions. Methods: Thirty-seven patients with extrapulmonary TB were included in this study. Four patients were found to have two lesions. Totally, 41 lesions were identified, including 19 TB arthritis, 8 spinal TB, 5 TB meningitis, 3 TB lymphadenopathy, 2 TB pericarditis, 1 TB peritonitis, 1 intestinal TB, 1 skin TB and 1 renal TB. Results: Of the 41 extrapulmonary TB lesions, gallium scan detected 32 lesions with a sensitivity of 78%. All the patients with TB meningitis showed negative gallium scan. When the five cases of TB meningitis were excluded, the detection sensitivity of gallium scan increased to 88.9% (32/36). Conclusion: Our data revealed that gallium scan is a convenient and useful method for evaluating extrapulmonary TB lesions other than TB-meningitis. We suggest that gallium scan be included in the clinical routine for patients with suspected extrapulmonary TB. (orig.) [German] Ziel: Es wurden Ganzkoerper-Gallium-Szintigramme angefertigt, um den Nutzen der Gallium-Szintigraphie zur Erfassung von extrapulmonalen Tuberkuloseherden (TB) zu erfassen. Methoden: 37 Patienten mit extrapulmonaler TB wurden eingeschlossen. 4 Patienten hatten 2 Laesionen. Insgesamt wurden 41 Laesionen identifiziert, hierunter 19 TB-Arthritis, 8 spinale TB, 5 TB-Meningitis, 3 TB-Lymphadenopathie, 2 TB-Perikarditis, 1 TB-Peritonitis, 1 intestinale TB, 1 Haut-TB und eine Nieren-TB. Ergebnisse: Von den 41 extrapulmonalen TB-Herden erfasste die Gallium-Szintigraphie 32 Herde mit einer Sensitivitaet von 78%. Alle Patienten mit TB-Meningitis zeigten einen negativen Gallium-Scan. Wenn die 5 Faelle mit TB-Meningitis ausgeschlossen wurden, stieg die Sensitivititaet der Gallium-Szintigraphie auf 88,9% (32/36). Schlussfolgerung: Die Daten zeigen, dass die Gallium-Szintigraphie eine einfache und nuetzliche Methode zur Erfassung extrapulmonaler TB-Herde ist

  15. Who are the patients with extrapulmonary tuberculosis?

    Directory of Open Access Journals (Sweden)

    Inês Sanches

    2015-03-01

    Full Text Available Introduction: Tuberculosis (TB remains a major global public health problem and 20% of all cases are extrapulmonar. The purpose of this study was to identify risk factors associated with extrapulmonar tuberculosis. Methods: We carried out a transversal study which included all patients with extrapulmonary tuberculosis registered in a TB reference center in northern Portugal, between January 2008 and January 2012. We evaluated demographic data, comorbidities, BCG vaccination and previous tuberculosis treatments. Multivariable logistic regression was used to identify independent risk factors (p < 0.05. Results: Among the 386 patients studied, 260 (67.4% had pulmonary tuberculosis (PTB and 126 (32.6% extrapulmonary TB (EPTB. Age over 40 years old (OR = 2.09; 95%CI: 1.29–3.38, female gender (OR = 1.63; 95%CI = 1.02–2.6 and HIV infection (OR = 2.72, 95%CI = 1.25–5.93 were independent risk factors for EPTB. Alcoholism (OR = 2.22, 95%CI: 1.00–4.95 was associated with higher risk for PTB. Previous liver disease (OR = 22.30; 95%IC: 1.89–263.57 was an independent risk factor for peritoneal TB. HIV co-infection (OR = 12.97; 95%IC: 1.71–48.42 and the presence of previous TB treatment (OR = 7.62; 95%IC: 1.00–57.9 increase the risk of disseminated disease. Conclusion: We identified independent risk factors for EPTB. Recognizing risk factors associated with EPTB is essential for suspicion of disease and may help make an accurate diagnosis. Keywords: Extrapulmonar tuberculosis, Risk factors, HIV co-infection

  16. Extrapulmonary tuberculosis by nationality, The Netherlands, 1993-2001

    NARCIS (Netherlands)

    te Beek, Lowieke A. M.; van der Werf, Marieke J.; Richter, Clemens; Borgdorff, Martien W.

    2006-01-01

    This study describes the epidemiology of extrapulmonary tuberculosis (TB) in the Netherlands from 1993 through 2001. We assessed whether the increasing numbers of inhabitants with a non-Western ethnic background had an effect on the number of extrapulmonary patients. We used data from the

  17. A molecular epidemiological assessment of extrapulmonary tuberculosis in San Francisco.

    Science.gov (United States)

    Ong, Adrian; Creasman, Jennifer; Hopewell, Philip C; Gonzalez, Leah C; Wong, Maida; Jasmer, Robert M; Daley, Charles L

    2004-01-01

    The epidemiology of extrapulmonary tuberculosis (TB) is not well understood. We studied all cases of extrapulmonary TB reported in San Francisco during 1991-2000 to determine risk factors for extrapulmonary TB and the proportion caused by recent infection. Isolates were analyzed by IS6110-based restriction fragment-length polymorphisms analysis. There were 480 cases of extrapulmonary TB, of which 363 (76%) were culture positive; isolates were genotyped for 301 cases (83%). Multivariate analysis identified young age, female sex, and HIV infection as independent risk factors for nonrespiratory TB (excluding pulmonary, pleural, and disseminated TB). Pleural TB was less common in HIV-seropositive persons and women than were nonrespiratory forms of extrapulmonary TB. Pleural TB is different from other forms of extrapulmonary TB and is associated with the highest clustering rate (35% of cases) of all forms of TB. This high rate of clustering occurs because pleural TB is often an early manifestation of recent infection.

  18. Diagnosis and Treatment of Extrapulmonary Tuberculosis

    Science.gov (United States)

    2015-01-01

    Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment. PMID:25861336

  19. Extrapulmonary tuberculosis: epidemiology and risk factors.

    Science.gov (United States)

    García-Rodríguez, José Francisco; Álvarez-Díaz, Hortensia; Lorenzo-García, María Virginia; Mariño-Callejo, Ana; Fernández-Rial, Álvaro; Sesma-Sánchez, Pascual

    2011-01-01

    To describe the epidemiology and risk factors associated with extra-pulmonary tuberculosis (EPTB). Cases of tuberculosis (TB) diagnosed from 1991 to 2008 in a Caucasian population were classified as EPTB or pulmonary TB (PTB). Of all cases, 63.7% were followed up in a specialist TB unit. A standardised protocol for data collection was used, including: gender, age, BCG vaccination, contact with PTB patient, smoking habit, alcohol abuse, diabetes mellitus, immunosuppressive drugs/steroids and HIV-status. These variables were compared between EPTB and PTB groups. Statistical analysis was based on logistic regression. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. Among the 2,161 cases diagnosed, 1,186 were PTB and 705 EPTB. The overall TB incidence had fallen from 79.9/100,000 in 1992 to 27.1/100,000 in 2008, PEPTB cases decreased more slowly than PTB. EPTB increased from 30.6% of cases in 1991-1996 to 37.6% in 2003-2008 (lymphatic site increased 27%), by trend test PEPTB, while alcohol abuse (OR 0.33; 95% CI: 0.20-0.52), smoking habit (OR 0.45; 95%CI: 0.34-0.59), contact with PTB patients (OR 0.57; 95% CI: 0.44-0.76) and BCG vaccination (OR 0.64; 95% CI: 0.44-0.92) had a protective effect. The proportion of female gender and age of patients increased over time, whilst there was a decrease in BCG vaccinated patients. Whilst there has been a reduction in the overall incidence of TB, the proportion of EPTB increased. The proportional increase in EPTB could be explained by an increase in life expectancy and the predominance of women in the population, and by a decline in BCG vaccinated patients. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  20. The extrapulmonary dissemination of tuberculosis: A meta-analysis.

    Science.gov (United States)

    Webster, Andrew Scott; Shandera, Wayne Xavier

    2014-03-01

    The epidemiology of the forty percent of tuberculosis patients who present with disseminated and/or extrapulmonary disease is in need of further study. Further study of such dissemination using published data from international indices may provide data which assist with control of tuberculosis. For each clinical or epidemiologic factor studied, summary odds ratios and corresponding 95% confidence intervals were calculated showing associations between such factors and documented extrapulmonary dissemination of tuberculosis. Eighteen studies fulfilled criteria for study of the clinical factors and nine for the cytokine studies. Significant factors associated with a greater risk of extrapulmonary dissemination were female gender (summary odds ratio, 1.92 (95% confidence intervals, 1.72-2.13), I-squared 86.9), age under 45 (1.37, 1.18-1.60, 63.7), and as well the absence of smoking, drinking and diabetes but not HIV infection (1.10, 0.91-1.32, 80.5). Among cytokines, the macrophage receptor protein P2X7 was associated most strongly associated with extrapulmonary dissemination of tuberculosis (2.28, 0.88-5.90, 92.9). Young age, female gender, and the macrophage purinergic receptor protein P2X7 were major factors associated with extrapulmonary dissemination of tuberculosis. Published by Elsevier Ltd.

  1. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases.

    Science.gov (United States)

    Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Binici, Irfan; Baran, Ali Irfan; Karahocagil, Mustafa Kasım; Saydan, Muhammed Rıdvan

    2015-06-24

    Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. Of these 411 cases, 208 (50.6%) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4%). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6%), while EPTB was more commonly detected in women (52.2%) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7%), clinical-radiological data (21.7%) and biopsy (6.1%); while biopsy (71.5%), sputum/fluid analysis (18.8%) and clinical-radiological data (4.9%) were used for confirming EPTB (p EPTB involvement were lymph nodes (39.4%), followed by pleura (23.6%), peritoneum (9.9%) and bone (7.4%). Extrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.

  2. Clinical Audit on The Management of Extra-pulmonary Tuberculosis ...

    African Journals Online (AJOL)

    Clinical Audit on The Management of Extra-pulmonary Tuberculosis, Jimma Hospital. Dagimlidet Tesfaye, Amare Mengistu, Indryas Lemma. Abstract. No abstract - Available on PDF. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Article Metrics. Metrics ...

  3. Unusual presentation of extrapulmonary tuberculosis: a case report ...

    African Journals Online (AJOL)

    This case study highlights an unusual manifestation of extrapulmonary tuberculosis (TB) in a person living with HIV, namely mammary TB. Clinicians practising in settings where HIV and TB are endemic need to be aware of the clinical presentation, diagnosis and management of mammary TB.

  4. Extrapulmonary tuberculosis among adults: Experience at Chris ...

    African Journals Online (AJOL)

    2014-01-22

    Jan 22, 2014 ... In this study, pleural and lymph node tuberculosis rates were similar to those reported from Hong Kong, where 42% had pleural and 37% lymph node tuberculosis.[7] In a composite of several studies of EPTB, lymph node tuberculosis (35%) and pleural tuberculosis. (20%) were commonest.[1] Among ...

  5. [Extrapulmonary tuberculosis in Poland in the years 1974-2010].

    Science.gov (United States)

    Rowińska-Zakrzewska, Ewa; Korzeniewska-Koseła, Maria; Roszkowski-Śliż, Kazimierz

    2013-01-01

    The incidence of tuberculosis in Poland decreased from 128.5 in 100 000 in 1970 to 19.1 in 100 000 in 2010. In many countries, but not in Poland, according to the improvement of the epidemiological situation of tuberculosis (TB), the proportion of the extrapulmonary form of this disease is increasing. The aim of this study was to describe changes in extrapulmonary TB epidemiology in Poland from 1974 to 2010. Retrospective analysis of data from National TB Register on tuberculosis in Poland in the years 1974-2010. The percentage of extrapulmonary tuberculosis among all cases of tuberculosis, the differences in the proportion of extrapulmonary tuberculosis, and differences in various locations of lesions in this form of disease in relation to sex and age groups were assessed. Information was collected from about 626,093 cases of tuberculosis reported to the Register during the period 1972-2010. In 62,251 cases extrapulmonary tuberculosis was the only form of the disease (9.9% of all tuberculosis cases). The study material consisted of 396,344 male and 196,184 female cases; 30,885 subjects were 0-19 years of age, 191,542 were 20-39 years old, 237,256 were 40-59 years old, and 166,410 subjects were ≥ 60 years old. We compared data from the years 1974-1982 with more recent data (2002-2010). The test of proportions for two independent samples was used to assess the significance of differences in proportions. The proportion of extrapulmonary tuberculosis (EPTB) among all TB cases was 11.2% in the years 1974-1982 and only 8.2% in the years 2002-2010. This difference was significant. The proportion of EPTB among all TB cases was higher in women than in men and was higher in people aged 0-19 years than in other age groups. The location of extrapulmonary tuberculosis was different in women and in men. Pleural TB was the most common form of extrapulmonary tuberculosis in both sexes with a predominance of males. Peripheral lymph nodes, bones and joints, urinary, genital, and

  6. GENEXPERT - IS IT AN EXPERT IN DIAGNOSIS OF EXTRAPULMONARY TUBERCULOSIS?

    Directory of Open Access Journals (Sweden)

    Mitali Mukund Nayak

    2017-06-01

    Full Text Available BACKGROUND Six countries in Asia account for 60% of the total new tuberculosis cases occurring globally with India leading the count. India accounts for approximately 25% of global incidence of tuberculosis with almost 2 deaths every 3 minutes due to tuberculosis alone. GeneXpert is a comparatively newer diagnostic test for detecting Mycobacterium tuberculosis complex, which uses the PCR to test specimens and simultaneously detects resistance to rifampicin, thus allowing diagnosis of DR-TB within a couple of hours. The present study was conducted to find the sensitivity and specificity of GeneXpert in extrapulmonary samples (lymph node and pleural fluid and compare the results with those of smear and AFB culture with an aim to provide rapid diagnostic test to patients with suspected extrapulmonary tuberculosis. MATERIALS AND METHODS A retrospective data analysis of reports of extrapulmonary samples (lymph node and pleural fluid of 45 patients sent for AFB smear, GeneXpert and AFB culture during routine investigations were studied. RESULTS Sensitivity of GeneXpert in lymph node samples was found to be 94.12% and specificity was 30.77% with positive predictive value of 64% and negative predictive value of 80%. The sensitivity of GeneXpert in pleural fluid samples was found to be 60% with 100% specificity. The positive predictive value was 100% and negative predictive value was 83.33%. CONCLUSION The overall sensitivity of GeneXpert was 96.67% with specificity of 100%, positive predictive value of 100% and negative predictive value of 83.33%. Thus, it is a valuable test for diagnosing extrapulmonary tuberculosis at the earliest with an added advantage of detecting resistance for rifampicin.

  7. Extrapulmonary tuberculosis among females in South Asia—gap analysis

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    Jaishri Mehraj

    2016-01-01

    Full Text Available The percentage of extrapulmonary tuberculosis (EPTB among new and relapse tuberculosis cases in South Asia (Afghanistan, Pakistan, India, and Bangladesh ranged from 19% to 23% in 2014. While tuberculosis was reportedly more prevalent in males, a higher preponderance of EPTB was observed in females. National tuberculosis control programs are highly focused on pulmonary tuberculosis. This creates gaps in the surveillance, diagnosis, and study of EPTB among females, which is especially pronounced in the South Asian setting. We have reviewed recently published literatures from January 2010 to June 2016 reporting EPTB in females with a view to evaluate the current epidemiology, risk factors, diagnostic modalities, and treatment outcomes. We report significant gaps in the surveillance of EPTB among women in South Asia, emphasizing the need for greater focus on EPTB in females to overcome current surveillance and knowledge gaps.

  8. Extrapulmonary tuberculosis among females in South Asia-gap analysis.

    Science.gov (United States)

    Mehraj, Jaishri; Khan, Zain Yar; Saeed, Dania Khalid; Shakoor, Sadia; Hasan, Rumina

    2016-12-01

    The percentage of extrapulmonary tuberculosis (EPTB) among new and relapse tuberculosis cases in South Asia (Afghanistan, Pakistan, India, and Bangladesh) ranged from 19% to 23% in 2014. While tuberculosis was reportedly more prevalent in males, a higher preponderance of EPTB was observed in females. National tuberculosis control programs are highly focused on pulmonary tuberculosis. This creates gaps in the surveillance, diagnosis, and study of EPTB among females, which is especially pronounced in the South Asian setting. We have reviewed recently published literatures from January 2010 to June 2016 reporting EPTB in females with a view to evaluate the current epidemiology, risk factors, diagnostic modalities, and treatment outcomes. We report significant gaps in the surveillance of EPTB among women in South Asia, emphasizing the need for greater focus on EPTB in females to overcome current surveillance and knowledge gaps. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  9. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011

    OpenAIRE

    Solovic, I.; Jonsson, J.; Korzeniewska-Kosela, M.; Chiotan, D. I.; Pace-Asciak, A.; Slump, E.; Rumetshofer, R; Abubakar, I; Kos, S.; Svetina-Sorli, P.; Haas, Walter; Bauer, T.; Sandgren, A; Werf, Marieke

    2013-01-01

    In the European Union (EU) 72,334 tuberculosis (TB) cases were notified in 2011, of which 16,116 (22%) had extrapulmonary tuberculosis (EPTB). The percentage of TB cases with EPTB ranged from 4% to 48% in the reporting countries. This difference might be explained by differences in risk factors for EPTB or challenges in diagnosis. To assess the practices in diagnosis of EPTB we asked European Union/European Economic Area (EU/EEA) countries to participate in a report describing the diagnostic ...

  10. Extrapulmonary tuberculosis: Fine needle aspiration cytology ...

    African Journals Online (AJOL)

    2011-02-14

    Feb 14, 2011 ... alcohol and stained using Leishman, Papanicoula, Hematoxylin and Eosin and Ziehl ... be curtailed by FNAC, a relatively cheap and less invasive procedure with a high ... tuberculosis impact on health.[8-11] The clinical ...

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

    Directory of Open Access Journals (Sweden)

    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

  12. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis.

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    Norbis, Luca; Alagna, Riccardo; Tortoli, Enrico; Codecasa, Luigi Ruffo; Migliori, Giovanni Battista; Cirillo, Daniela M

    2014-05-01

    Extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Culture, the classical gold standard for tuberculosis, suffers from increased technical and logistical constraints in EPTB cases. In this review the authors outline current diagnostic options for the main forms of EPTB. The authors also discuss the opportunities and challenges linked in particular to microbiological diagnostics and to the attempts to find a new gold standard test for EPTB. Finally, new biomarkers and tests currently under evaluation are hopefully on the way to introduce significant improvements in EPTB diagnosis, for which clinical suspicion will nevertheless be essential.

  13. [Extrapulmonary tuberculosis: a review of 102 cases in Pereira, Colombia].

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    Arciniegas, William; Orjuela, Dora Luisa

    2006-03-01

    Tuberculosis continues to be a serious public health problem worldwide. At the local institutional level, the magnitude of the problem must be assessed in terms of diagnosis efficiency and adequate use of resources. to determine the disease focus and to summarize the epidemiologic, clinical, microbiologic, and diagnostic data, along with associated hospital costs in a third level public hospital. A retrospective study based on clinical records of 102 patients with extrapulmonary tuberculosis occurring between 2000 and 2004 and discharged from the Hospital Universitario San Jorge in Pereira, Colombia, was carried out. The average patient age was 31.6 years; 62.7% were men and 70.6% were urban dwellers. The most frequent form was pleural TB with 47 cases, followed by the meningeal (19), lymphadenitis (13), peritoneal (5), miliary (4), genitourinary (4), pharyngeal (4), osteoarticular (3), skeletal (2), and pericardial (1) forms. The diagnostic methods were biopsy in 68 cases (66.6%), and clinical diagnosis in 28 (27.4%). Zielh-Neelsen stain diagnosed 3.9% of cases and bacterial culture 5.8%. The average hospital stay was 13 days. The average cost was of US dollar 2,410 per case. Fifteen patients died; of these 9 had AIDS and 8 had meningitis. The most frequent extrapulmonary forms were pleural tuberculosis, meningeal tuberculosis and lymphadenitis. The principal diagnostic method was the biopsy. A prolonged hospital stay was associated with a delay in diagnosis and AIDS infection. The highest mortality was associated with AIDS and the meningeal form of tuberculosis.

  14. Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model.

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    Gomes, Teresa; Reis-Santos, Bárbara; Bertolde, Adelmo; Johnson, John L; Riley, Lee W; Maciel, Ethel Leonor

    2014-01-08

    Although extrapulmonary tuberculosis (EPTB) is less frequent than Pulmonary Tuberculosis (PTB) and is a secondary target for national TB control programs, its significance has increased worldwide during the HIV epidemic. The objective of this study was to examine the epidemiology of EPTB in Brazil between 2007 and 2011. Cross-sectional study involving all cases of TB reported to the Brazilian Notifiable Diseases Surveillance System (Sistema de Informações de Agravo de Notificação - SINAN) in Brazil between 2007 and 2011. Sociodemographic and clinical characteristics of patients with exclusively PTB and exclusively EPTB were compared. Following analysis with Pearson's chi-square test, variables with p EPTB, 13,989 (3.27%; 95% CI 3.21% - 3.32%) were concurrent pulmonary and extrapulmonary TB. Patients with EPTB were mainly white (16.7%), and most (29.1%) patients had five to eight years of education. Among comorbidities, HIV infection was prominent (OR 2.15; 95% CI 2.09 - 2.21), although the proportion of cases awaiting test results or untested was high (39%). Ethanol use (OR 0.45; 95% CI 0.43 - 0.46), diabetes mellitus (OR 0.54; 95% CI 0.51 - 0.57) and mental illness (OR 0.88; 95% CI 0.82 - 0.95) were associated with PTB. Thirteen percent of patients diagnosed with TB in Brazil have only EPTB. More effective diagnostic strategies and control measures are needed to reduce the number of cases of extrapulmonary TB in Brazil.

  15. Assessment of Extrapulmonary Tuberculosis in Two Provinces of Turkey.

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    Tatar, Dursun; Senol, Gunes; Alptekin, Serpil; Gunes, Ebru; Aydin, Mert; Gunes, Ozdal

    2016-03-01

    Tuberculosis (TB) is one of the main health issues in Turkey. Extrapulmonary TB cases have significant proportion comparing pulmonary TB cases. The aim of the study was to evaluate the extrapulmonary tuberculosis (EPTB) cases in two regions of Turkey, which have different demographic and socioeconomic characteristics. In this retrospective cohort study, EPTB cases between 2000 and 2005 in Van and Izmir Provinces of Turkey were analyzed and compared for symptoms, age groups, vaccination status, diagnostic procedures and social-economical conditions within two provinces. Descriptive analytic methods were used. Total of 397 EPTB cases were reviewed retrospectively in Izmir and Van provinces. Pleural TB was most often seen EPTB form (47.6% vs. 32.6%) and female/male ratio was similar in both groups. Patients were in older ages in Izmir Province. Chest pain (20% vs. 32%), cough (33% vs. 26%) and night sweatiness (29% vs. 36%) were leading complaints. Low BCG vaccination rate and higher childhood EPTB were found in Van group, in contrary elderly EPTB was more often in of Izmir group. Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

  16. PCR as a diagnostic tool for extra-pulmonary tuberculosis.

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    Ajantha, Ganavalli S; Shetty, Praveen C; Kulkarni, Raghavendra D; Biradar, Umesh

    2013-06-01

    Extra-Pulmonary Tuberculosis (EPTB) accounts for approximately 40% of the tuberculosis cases. Though it is not communicable, it is a significant cause of morbidity. This study was conducted to know the efficacy of the Polymerase Chain Reaction (PCR) as an additional tool, along with the conventional methods, in the diagnosis of EPTB. Clinical samples were collected from suspected cases of EPTB. The Ziehl-Neelsen staining (ZNS), culture on the Lowenstein-Jensen medium (LJM) and PCR testing with the use of a commercial kit were performed on the homogenized samples. A total of 182 samples which were received for the molecular diagnosis of EPTB were also tested by ZNS and culture on LJM for the presence of Mycobacterium tuberculosis. Of these, 22 were positive by at least one of the tests which were used. PCR detected the maximum number of cases of EPTB, followed by culture. The results of PCR and the conventional tests were analyzed by using McNemar's test for the correlated proportions-the exact method of 'IBM SPSS Statistics 20'. The analysis showed a statistical significance. Whenever they are feasible, using all the available tests in combination increases the laboratory detection rates of M. tuberculosis from clinical samples. PCR must be included in the diagnostic panel of EPTB.

  17. Mapping the pattern and trends of extrapulmonary tuberculosis

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    S Rama Prakasha

    2013-01-01

    Full Text Available Background and Objectives: There has been a rapid expansion of the directly observed treatment short-term (DOTS under the revised national tuberculosis control program throughout India in the last decade. Few reports exist detailing individual DOTS centers′ experiences with regard to extrapulmonary tuberculosis (EPTB in a medical college hospital setting. Materials and Methods: This is a retrospective, record-based study of patients with the diagnosis of EPTB, in all age groups. Data on all consecutive EPTB cases diagnosed at the K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore from 1 January 2005 to 31 December 2011 at the DOTS centre attached to this hospital were collected, analyzed by Mantel-Haenszel Chi square for linear trend and described in proportion or percentages. Results: Among 1267 cases registered for treatment of all forms of tuberculosis, 528 (41.67% had EPTB. Around half of the cases of EPTB (269, 51% were among adult age groups and the majority of cases (342, 64.77% received Category-I treatment. Pleural TB was the commonest type of EPTB (n = 148, 28.03%, followed by lymph node TB (n = 131, 24.81%. Involvement of lymph nodes was the commonest manifestation among the less than 14 years′ age group (27, 58.7%, while involvement of pleura was more common among > 65 years′ age group (23, 45.1%. The difference in the occurrence of EPTB by site between males and females is statistically significant with a P value of <0.005. There is a significant increase in the number of cases of tuberculosis affecting bones and joints, and other forms of tuberculosis over the years. Conclusion: The burden of EPTB is more among the productive age group. Increase in the trend of bone and joint tuberculosis, and other rare forms of EPTB is a point of concern highlighting the importance of strengthening the services towards this group.

  18. Immunocytochemistry versus nucleic acid amplification in fine needle aspirates and tissues of extrapulmonary tuberculosis

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    Madhu Mati Goel

    2012-01-01

    Full Text Available Background: Immunocytochemistry (ICC is an established routine diagnostic adjunct to cytology and histology for tumor diagnosis but has received little attention for diagnosis of tuberculosis. Aims: To have an objective method of direct visualization of mycobacteria or their products in clinical extrapulmonary tuberculosis (EPTB specimens, immunocytochemical localization of M. tuberculosis antigen by staining with species specific monoclonal antibody to 38-kDa antigen of Mycobacterium tuberculosis complex. Materials and Methods: Immunostaining with specific monoclonal antibody to 38-kDa antigen of Mycobacterium tuberculosis complex was done in fresh and archival fine needle aspirates and tissue granulomata of 302 cases of extrapulmonary tuberculosis and was compared with the molecular diagnostic i.e., nucleic amplification and conventional [Cytomorphology, Ziehl Neelsen (ZN staining and culture] tests and 386 controls. Results: Diagnostic indices by Bayesian analysis for all types of archival and fresh material varied from 64 to 76% in nucleic acid amplification (NAA and 96 to 98% in ICC. There was no significant difference in the diagnostic indices of ZN staining and/ or ICC in fresh or archival material whereas the sensitivity of NAA differed significantly in fresh versus archival material both in cytology (71.4% vs 52.1% and histology (51.1% vs 38.8%. ICC can be easily used on archival smears and formalin-fixed paraffin-embedded tissue sections with almost equal sensitivity and specificity as with fresh material, in contrast to NAA which showed significant difference in test results on archival and fresh material. Conclusions: Low detection sensitivity of MTB DNA in archival material from known tuberculous cases showed the limitation of in-house NAA-based molecular diagnosis. ICC was found to be sensitive, specific and a better technique than NAA and can be used as an adjunct to conventional morphology and ZN staining for the diagnosis of

  19. The Transcriptional Signature of Active Tuberculosis Reflects Symptom Status in Extra-Pulmonary and Pulmonary Tuberculosis.

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    Simon Blankley

    Full Text Available Mycobacterium tuberculosis infection is a leading cause of infectious death worldwide. Gene-expression microarray studies profiling the blood transcriptional response of tuberculosis (TB patients have been undertaken in order to better understand the host immune response as well as to identify potential biomarkers of disease. To date most of these studies have focused on pulmonary TB patients with gene-expression profiles of extra-pulmonary TB patients yet to be compared to those of patients with pulmonary TB or sarcoidosis.A novel cohort of patients with extra-pulmonary TB and sarcoidosis was recruited and the transcriptional response of these patients compared to those with pulmonary TB using a variety of transcriptomic approaches including testing a previously defined 380 gene meta-signature of active TB.The 380 meta-signature broadly differentiated active TB from healthy controls in this new dataset consisting of pulmonary and extra-pulmonary TB. The top 15 genes from this meta-signature had a lower sensitivity for differentiating extra-pulmonary TB from healthy controls as compared to pulmonary TB. We found the blood transcriptional responses in pulmonary and extra-pulmonary TB to be heterogeneous and to reflect the extent of symptoms of disease.The transcriptional signature in extra-pulmonary TB demonstrated heterogeneity of gene expression reflective of symptom status, while the signature of pulmonary TB was distinct, based on a higher proportion of symptomatic individuals. These findings are of importance for the rational design and implementation of mRNA based TB diagnostics.

  20. Mapping the pattern and trends of extrapulmonary tuberculosis.

    Science.gov (United States)

    Prakasha, S Rama; Suresh, G; D'sa, Ivor Peter; Shetty, Shobha S; Kumar, S Ganesh

    2013-04-01

    There has been a rapid expansion of the directly observed treatment short-term (DOTS) under the revised national tuberculosis control program throughout India in the last decade. Few reports exist detailing individual DOTS centers' experiences with regard to extrapulmonary tuberculosis (EPTB) in a medical college hospital setting. This is a retrospective, record-based study of patients with the diagnosis of EPTB, in all age groups. Data on all consecutive EPTB cases diagnosed at the K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore from 1 January 2005 to 31 December 2011 at the DOTS centre attached to this hospital were collected, analyzed by Mantel-Haenszel Chi square for linear trend and described in proportion or percentages. Among 1267 cases registered for treatment of all forms of tuberculosis, 528 (41.67%) had EPTB. Around half of the cases of EPTB (269, 51%) were among adult age groups and the majority of cases (342, 64.77%) received Category-I treatment. Pleural TB was the commonest type of EPTB (n = 148, 28.03%), followed by lymph node TB (n = 131, 24.81%). Involvement of lymph nodes was the commonest manifestation among the less than 14 years' age group (27, 58.7%), while involvement of pleura was more common among > 65 years' age group (23, 45.1%). The difference in the occurrence of EPTB by site between males and females is statistically significant with a P value of EPTB is more among the productive age group. Increase in the trend of bone and joint tuberculosis, and other rare forms of EPTB is a point of concern highlighting the importance of strengthening the services towards this group.

  1. Association of HIV infection with extrapulmonary tuberculosis: a systematic review.

    Science.gov (United States)

    Shivakoti, Rupak; Sharma, Davina; Mamoon, Gabeena; Pham, Kiemanh

    2017-02-01

    HIV/AIDS is a known risk factor for the development of pulmonary tuberculosis (PTB). However, the association is less clear between HIV and extrapulmonary tuberculosis (EPTB). We conducted a systematic review to determine the association between HIV and EPTB. We searched the electronic databases Medline, Embase, and relevant conference literature using defined search terms for EPTB and HIV. Only publications in English and only studies reporting adjusted estimates were included, while our search criteria did not include restriction by age or geographic location of study participants. Qualitative and quantitative analyses (including I 2 test for heterogeneity) were performed. Sixteen studies (15 cross-sectional and 1 case-control) conducted from 1984 to 2016 were included in the final analyses after screening 5163 articles and conference abstracts. Our qualitative analysis showed heterogeneity in study design and study population characteristics along with a medium/high risk of bias in the majority of studies. While most of the individual studies showed increased odds of EPTB compared with PTB among HIV-infected individuals, we did not provide an overall pooled estimate, as the I 2 value was high at 93% for the cross-sectional studies. While an association between HIV and EPTB is observed in most individual studies, the high heterogeneity and risk of bias in these studies highlight the need for further well-designed prospective cohort studies to assess the true risk of EPTB in the HIV-infected patient population.

  2. Site of extrapulmonary tuberculosis is associated with HIV infection.

    Science.gov (United States)

    Leeds, Ira L; Magee, Matthew J; Kurbatova, Ekaterina V; del Rio, Carlos; Blumberg, Henry M; Leonard, Michael K; Kraft, Colleen S

    2012-07-01

    In the United States, the proportion of patients with extrapulmonary tuberculosis (EPTB) has increased relative to cases of pulmonary tuberculosis. Patients with central nervous system (CNS)/meningeal and disseminated EPTB and those with human immunodeficiency virus (HIV)/AIDS have increased mortality. The purpose of our study was to determine risk factors associated with particular types of EPTB. We retrospectively reviewed 320 cases of EPTB from 1995-2007 at a single urban US public hospital. Medical records were reviewed to determine site of EPTB and patient demographic and clinical characteristics. Multivariable logistic regression analyses were performed to determine independent associations between patient characteristics and site of disease. Patients were predominantly male (67%), African American (82%), and US-born (76%). Mean age was 40 years (range 18-89). The most common sites of EPTB were lymphatic (28%), disseminated (23%), and CNS/meningeal (22%) disease. One hundred fifty-four (48.1%) were HIV-infected, 40% had concomitant pulmonary tuberculosis, and 14.7% died within 12 months of EPTB diagnosis. Multivariable analysis demonstrated that HIV-infected patients were less likely to have pleural (adjusted odds ratio [AOR] 0.3; 95% confidence interval [CI] .2, .6) as site of EPTB disease than HIV-uninfected patients. Among patients with EPTB and HIV-infection, patients with CD4 lymphocyte cell count EPTB (CNS/meningeal and/or disseminated) (AOR 1.6; 95% CI, 1.0, 2.4). Among patients hospitalized with EPTB, patients coinfected with HIV and low CD4 counts were more likely to have CNS/meningeal and disseminated disease. Care for similar patients should include consideration of these forms of EPTB since they carry a high risk of death.

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

    Science.gov (United States)

    Furini, Adriana Antônia da Cruz; Pedro, Heloisa da Silveira Paro; Rodrigues, Jean Francisco; Montenegro, Lilian Maria Lapa; Machado, Ricardo Luiz Dantas; Franco, Célia; Schindler, Haiana Charifker; Batista, Ida Maria Foschiani Dias; Rossit, Andrea Regina Baptista

    2013-01-01

    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. 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. 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). 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.

  4. 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.

  5. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011.

    Science.gov (United States)

    Solovic, I; Jonsson, J; Korzeniewska-Koseła, M; Chiotan, D I; Pace-Asciak, A; Slump, E; Rumetshofer, R; Abubakar, I; Kos, S; Svetina-Sorli, P; Haas, W; Bauer, T; Sandgren, A; van der Werf, M J

    2013-03-21

    In the European Union (EU) 72,334 tuberculosis (TB) cases were notified in 2011, of which 16,116 (22%) had extrapulmonary tuberculosis (EPTB). The percentage of TB cases with EPTB ranged from 4% to 48% in the reporting countries. This difference might be explained by differences in risk factors for EPTB or challenges in diagnosis. To assess the practices in diagnosis of EPTB we asked European Union/European Economic Area (EU/EEA) countries to participate in a report describing the diagnostic procedures and challenges in diagnosing EPTB. Eleven EU Member States participated and reports showed that in the majority EPTB is diagnosed by a pulmonologist, sometimes in collaboration with the doctor who is specialised in the organ where the symptoms presented. In most countries a medical history and examination is followed by invasive procedures, puncture or biopsy, to collect material for confirmation of the disease (by culture/histology/cytology). Some countries also use the tuberculin skin test or an interferon-gamma-release-assay. A wide variety of radiological tests may be used. Countries that reported challenges in the diagnosis of EPTB reported that EPTB is often not considered because it is a rare disease and most medical professionals will not have experience in diagnosing EPTB. The fact that EPTB can present with a variety of symptoms that may mimic symptoms of other pathologies does pose a further challenge in diagnosis. In addition, obtaining an appropriate sample for confirmation of EPTB was frequently mentioned as a challenge. In summary, diagnosis of EPTB poses challenges due to the diversity of symptoms with which EPTB may present, the low level of suspicion of clinicians, and due to the difficulty in obtaining an adequate sample for confirmation.

  6. Clonal Diversity and Drug Resistance in Mycobacterium tuberculosis Isolated from Extra-pulmonary Samples in Central India - a Pilot Study

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    P Desikan

    2014-01-01

    Full Text Available In India, extrapulmonary tuberculosis (EPTB accounts for 10 - 15% of all types of tuberculosis. To identify and compare predominant spoligotypes and drug-resistance patterns in strains of Mycobacterium tuberculosis isolated from extrapulmonary and pulmonary specimens in central India, drug susceptibility testing and spoligotyping were carried out. Spoligotyping data was analyzed using SITVIT2 database. ST11/EAI3_Ind with 33% isolates among extrapulmonary specimens and ST26/CAS1_DEL with 28% isolates among pulmonary specimens were the most predominant lineages. Multidrug resistance was found in 5.5% of the strains isolated from extrapulmonary specimens in contrast to 17% isolated from pulmonary specimens.

  7. Molecular typing of mycobacteria isolated from extrapulmonary tuberculosis patients at Debre Birhan Referral Hospital, central Ethiopia.

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    Garedew, Legesse; Mihret, Adane; Ameni, Gobena

    2013-07-01

    Extrapulmonary tuberculosis (EPTB) constitutes about 10% to 20% of all cases of tuberculosis in immunocompetent patients and more than 50% of the cases in HIV-positive individuals worldwide. Little information is available on the clonal diversity of Mycobacterium species in Ethiopia from EPTB. This study was carried out on smear-negative EPTB patients to molecularly characterize Mycobacterium tuberculosis complex strains. A questionnaire, smear staining, culture, deletion typing, and spoligotyping were employed. The proportional distribution of EPTB and isolates did not vary substantially (p > 0.05) amongst the socio-demographic parameters considered in the current investigation. Out of 98 fine needle aspirates processed for culture, 36.7% (36/98) were positive for mycobacterial growth. Further speciation of those culture-positive isolates showed that 88.9% were M. tuberculosis and the remaining could be non-tuberculous mycobacterial species. Spoligotyping revealed 16 clusters out of which 2 were new to the SITVIT database. The most dominant spoligotypes were SIT54, SIT53, and SIT149 in decreasing order. SIT54, SIT134, SIT173, SIT345, SIT357, SIT926, SIT91088, and SIT1580 were reported for the first time in Ethiopia. The family with the highest frequency identified was M. tuberculosis family T1, followed by family 33. Most of the strains belonged to Euro-American (61.4%) and Indo-Oceanic (36.3%) lineages. The present study shows the importance of M. tuberculosis as a major cause of EPTB in the study area. Moreover, the majority of isolates of M. tuberculosis were found in clusters, suggesting the possibility of the existence of recent transmission. This warrants strengthening of the control programs for EPTB in the study area.

  8. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India.

    Science.gov (United States)

    Sharma, Surendra K; Ryan, H; Khaparde, Sunil; Sachdeva, K S; Singh, Achintya D; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

    2017-04-01

    Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

  9. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

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    Surendra K Sharma

    2017-01-01

    Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

  10. Sociodemographic factors that contribute to the development of extrapulmonary tuberculosis were identified.

    Science.gov (United States)

    Cailhol, Johann; Decludt, Bénédicte; Che, Didier

    2005-10-01

    The majority of cases of tuberculosis occur among males, but the majority of cases with extrapulmonary tuberculosis (EPTB) occur among females. The aim of this study was to identify independent risk factors associated with EPTB. A multivariable logistic regression model was used. Eighteen thousand, six hundred seventeen cases of tuberculosis, notified through the French national mandatory network between 1 January 1997 through 31 December 2001, were included in the analysis. Because of multiple interactions, different multivariable models were built for each area of birth (Europe, North Africa, Sub-Saharan Africa, and Asia). Risk factors for EPTB vary according to area of birth. Women born in Asia or North Africa were at a higher risk of developing an EPTB than men. In Sub-Saharan Africa, age was associated with EPTB. Human immunodeficiency virus infection was an independent risk factor for EPTB in the European groups only with an OR of 2.48 (CI 99% 1.84-3.34). This analysis contributes to a better understanding of host-related factors associated with EPTB. As clinical presentation of EPTB is extremely variable, the identification of groups at higher risk may help in the early detection of cases.

  11. Extrapulmonary tuberculosis in Kabul, Afghanistan: a hospital-based retrospective review.

    Science.gov (United States)

    Fader, Tim; Parks, John; Khan, Najeeb Ullah; Manning, Richard; Stokes, Sonya; Nasir, Nasir Ahmad

    2010-02-01

    The purpose of this study is to amplify the knowledge base of the epidemiology, symptoms, and signs of extrapulmonary tuberculosis (EPTB) in Afghanistan. This is a retrospective review of EPTB diagnosed at CURE International Hospital and CURE Family Health Center (FHC) in Kabul, Afghanistan during a recent 20-month period. One hundred eighteen cases were identified from patients presenting to the hospital and FHC. This group represents the spectrum of EPTB seen at a single referral center in Kabul. The ratio of females to males was 2.03:1. Lymph node tuberculosis comprised the greatest number of EPTB cases (37.3%, n=44). The central nervous system was the next most frequent site of EPTB involvement (20.3%, n=24), followed in descending order by skeletal, pleural, abdominal, cutaneous, genitourinary, pericardial, miliary, and breast tuberculosis. The 2:1 ratio of female to male EPTB cases coincides with the unusual epidemiologic pattern seen in smear-positive pulmonary TB in Afghanistan. As the first epidemiological report of EPTB from Afghanistan, this study illustrates the varied presentations of EPTB that should be known by healthcare workers throughout the country. Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. Genetic Diversity and Dynamic Distribution of Mycobacterium tuberculosis Isolates Causing Pulmonary and Extrapulmonary Tuberculosis in Thailand

    Science.gov (United States)

    Srilohasin, Prapaporn; Tokunaga, Katsushi; Nishida, Nao; Prammananan, Therdsak; Smittipat, Nat; Mahasirimongkol, Surakameth; Chaiyasirinroje, Boonchai; Yanai, Hideki; Palittapongarnpim, Prasit

    2014-01-01

    This study examined the genetic diversity and dynamicity of circulating Mycobacterium tuberculosis strains in Thailand using nearly neutral molecular markers. The single nucleotide polymorphism (SNP)-based genotypes of 1,414 culture-positive M. tuberculosis isolates from 1,282 pulmonary tuberculosis (PTB) and 132 extrapulmonary TB (EPTB) patients collected from 1995 to 2011 were characterized. Among the eight SNP cluster groups (SCG), SCG2 (44.1%), which included the Beijing (BJ) genotype, and SCG1 (39.4%), an East African Indian genotype, were dominant. Comparisons between the genotypes of M. tuberculosis isolates causing PTB and EPTB in HIV-negative cases revealed similar prevalence trends although genetic diversity was higher in the PTB patients. The identification of 10 reported sequence types (STs) and three novel STs was hypothesized to indicate preferential expansion of the SCG2 genotype, especially the modern BJ ST10 (15.6%) and ancestral BJ ST19 (13.1%). An association between SCG2 and SCG1 genotypes and particular patient age groups implies the existence of different genetic advantages among the bacterial populations. The results revealed that increasing numbers of young patients were infected with M. tuberculosis SCGs 2 and 5, which contrasts with the reduction of the SCG1 genotype. Our results indicate the selection and dissemination of potent M. tuberculosis genotypes in this population. The determination of heterogeneity and dynamic population changes of circulating M. tuberculosis strains in countries using the Mycobacterium bovis BCG (bacillus Calmette-Guérin) vaccine are beneficial for vaccine development and control strategies. PMID:25297330

  13. [Treatment duration of extra-pulmonary tuberculosis: 6 months or more? TB-INFO database analysis].

    Science.gov (United States)

    Bouchikh, S; Stirnemann, J; Prendki, V; Porcher, R; Kesthmand, H; Morin, A-S; Cruaud, P; Rouaghe, S; Farge, D; Fain, O

    2012-12-01

    The recommended duration of pulmonary tuberculosis therapy is 6 months. For extrapulmonary tuberculosis, treatment duration depends on tuberculosis involvement and HIV status. The objective of this study was to describe the main characteristics of a cohort of extrapulmonary tuberculosis patients, to compare patients with a 6-month treatment to those with more than a 6-month treatment, and to analyze the compliance of medical centres with recommended duration of treatment. A retrospective cohort study of 210 patients with extrapulmonary tuberculosis was carried from January 1999 to December 2006 in two hospitals in the north-east of Paris. These patients were treated with quadruple therapy during two months, followed by dual therapy during 4 months (n=77) or more (n=66). The characteristics of each group were compared by uni- and multivariate analysis. The primary endpoint was the rate of relapse or treatment failure at 24-month follow-up after treatment completion. No relapse was observed after 24 months of follow-up after the end of treatment in the two groups. In univariate analysis, patients with lymph node tuberculosis were more often treated for 6 months than at other sites of tuberculosis (respectively 61% versus 40.9%; P=0.02); the decision of treatment duration was related to medical practices (79.2% treated 6 months in one hospital versus 20.7% in the other, P<0.001); patients living in private residence were more often treated during 6 months than patients living in residence (24.2% versus 10.3%, P=0.042). In multivariate analysis, only hospital (P=0.046), sex (P=0.007) and private residence were significantly different in each group. A period of 6 months seems to be sufficient to treat extrapulmonary tuberculosis (except for neuromeningeal localization). Copyright © 2012. Published by Elsevier SAS.

  14. Tuberculosis during fundamental societal changes in Estonia with special reference to extrapulmonary manifestations.

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    Pehme, Lea; Hollo, Vahur; Rahu, Mati; Altraja, Alan

    2005-04-01

    To characterize the incidence of extrapulmonary tuberculosis (EPTB) in Estonia, by site and age, in conditions of marked pulmonary tuberculosis (TB) increase, ie, during the period of fundamental societal changes, but where TB incidence has not been influenced by HIV infection. A retrospective study. All new cases of EPTB (n = 622) detected in Estonia from 1991 to 2000. The incidence of pulmonary TB in Estonia increased from 21.5 in 1991 to 44.6/100,000 in 2000. In contrast, the incidence of EPTB did not increase at the same pace, changing only from 3.6 in 1991 to 4.7/100,000 in 2000. The increase in the incidence of EPTB was significantly lower than that of pulmonary TB (p EPTB among overall TB steadily decreased from 17.0% in 1991 to 10.1% in 2000. The incidence of EPTB forms with a long latency period (eg, osteoarticular and urogenital TB) remained unchanged, while that of EPTB forms with a short latency period (eg, intrathoracic lymph node TB) increased (p EPTB than in pulmonary TB and varied according to site. There was no increase in the incidence of EPTB during 10 years despite the dramatic increase in overall TB. The proportion of EPTB among all TB tended to decrease with increasing age, and different EPTB sites prevailed in different age groups.

  15. Sequelae of extrapulmonary tuberculosis after treatment: Addressing patient needs

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    Bushra Jamil

    2016-01-01

    Conclusion: Early reliable diagnosis and anti-TB treatment, often with steroids, is essential for control of disease and prevention of complications. Patients need to be monitored clinically and supported psychologically, logistically, and socially to return to lead productive lives after extrapulmonary TB infections.

  16. Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme.

    Science.gov (United States)

    Cherian, J J; Lobo, I; Sukhlecha, A; Chawan, U; Kshirsagar, N A; Nair, B L; Sawardekar, L

    2017-04-01

    Extrapulmonary tuberculosis (EPTB) constitutes 15-20% of tuberculosis cases in India. Earlier studies have evaluated treatment outcomes of EPTB with little information on outcomes of individual site of EPTB. The objective was to study the outcome of Directly Observed Treatment Short course (DOTS) treatment of EPTB in different organ systems under Revised National Tuberculosis Control Programme. Multi-centric retrospectives record review was carried out in three states in India. Data were collected from TB registers and analysed. Of the total 2219 patients studied, there were more males in age group 15-45. The commonest sites of EPTB were lymph node (34.4%) and pleural effusion (25.2%) followed by abdominal (12.8%) and central nervous system (CNS) (9.4%). Lymph node involvement was more common in females (58%) and pleural effusion in males (70%). Overall treatment completion rate was 84% in EPTB patients. Treatment completion was 86% in HIV negative EPTB patients compared to 66% in HIV positive patients. Individually, treatment completion rate observed as follows: lymph node 90.9%, genitourinary 92.6%, bone and joint 86%, pleural effusion 84.7%, abdominal 76% and CNS (tuberculoma and meningitis) 63.7%. The site of EPTB was not recorded in 173 (7.8%) patients. Treatment outcome of EPTB was poor in HIV infected patients and those with CNS tuberculosis. More efforts are needed to improve the treatment completion rates in these groups of patients. Copyright © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  17. Detection of ofloxacin resistance by nitrate reductase assay in Mycobacterium tuberculosis isolates from extrapulmonary tuberculosis

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    Neeta Shrivastava

    2017-01-01

    Full Text Available Context: Increased use of fluoroquinolones to treat community-acquired infections has led to the decreased susceptibility to Mycobacterium tuberculosis. There is a paucity of data on ofloxacin (OFX resistance detection by nitrate reductase assay (NRA. Hence, the present study was carried out to find the efficacy of NRA for detection of OFX resistance in M. tuberculosis isolated from extrapulmonary tuberculosis (EPTB cases. Aims: (1 To compare sensitivity, specificity and median time required to obtain results by NRA with economic variant proportion method (PM for detection of OFX resistance.(2 To determine the extent of OFX resistance in clinical isolates of M. tuberculosis. Settings and Design: Seventy-three M. tuberculosis isolates from cases of EPTB were subjected to economic variant of PM for isoniazid, rifampicin and OFX. NRA was done for detection of OFX resistance. Subjects and Methods: Seventy-three isolates from clinical samples of suspected EPTB received in the Department of Microbiology were included in the study. Drug susceptibility test was performed on Lowenstein–Jensen medium with and without drugs. Statistical Analysis Used: Of turnaround time was done by Mann–Whitney test on SPSS (version 19, released in 2010, IBM Corp, Armonk NY,P < 0.05. Results: OFX resistance was seen in nine isolates. The sensitivity and specificity of OFX resistance by NRA was 100% and 96.87%, respectively. Median time required to obtain results by NRA was 10 days as compared to 28 days by PM. Conclusions: NRA is a specific and sensitive method for detection of OFX resistance in resource-restricted settings.

  18. Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience

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    Oishi, Masahiro

    2015-10-01

    Full Text Available Introduction Although the incidence of tuberculosis (TB in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB. Objective This study aims to investigate the current situation of head and neck extrapulmonary TB (EPTB diagnosed in our department. Methods We retrospectively reviewed the clinical records of 47 patients diagnosed with EPTB in the head and neck in our department between January 2005 and December 2014. The extracted data included sex and age distribution, development site, chief complaint, presence or absence of concomitant active pulmonary TB (PTB or history of TB, tuberculin skin test (TST results, interferon-gamma release assay (IGRA results, and duration from the first visit to the final diagnosis of EPTB. Results The subjects consisted of 20 men and 27 women, and age ranged from 6 to 84 years. The most common site was the cervical lymph nodes (30 patients, with the supraclavicular nodes being the most commonly affected (60%. Histopathological examination was performed on 28 patients. TST was positive in 9 out of 9 patients and the IGRA was positive in 18 out of 19 patients. We observed concomitant PTB in 15 out of the 47 patients. Mean duration from the first visit to the final diagnosis of EPTB was 56 days. Conclusion The clinical symptoms of TB, especially those in the head and neck region, are varied. Otolaryngologists should be especially aware of the extrapulmonary manifestations of TB to ensure early diagnosis and treatment from the public health viewpoint.

  19. Epidemiology of extrapulmonary and disseminated tuberculosis in a tertiary care center in Oman.

    Science.gov (United States)

    Gaifer, Zied

    2017-01-01

    The incidence of extrapulmonary and disseminated tuberculosis (TB) cases is increasing worldwide, and this growth significantly impacts TB-related morbidity and mortality. Little is known about the host risk factors for extrapulmonary and disseminated TB. In this study, we examined those risk factors. We conducted a retrospective review of all TB cases admitted to Sultan Qaboos University Hospital from 2006 to 2015. We compared extrapulmonary TB (EPTB) cases with pulmonary and disseminated TB cases. We evaluated the risk factors associated with the development of extrapulmonary and disseminated TB using logistic regression analysis. We reviewed 260 TB cases, of which EPTB comprised 37%, PTB comprised 53%, and disseminated TB comprised 10%. The most common sites of infection in the EPTB group were the lymph nodes and the abdomen. Disseminated TB and TB meningitis were more common in expatriates than in Omanis. Patients with EPTB were less likely to smoke compared to a patient with PTB. Patients with disseminated TB had a higher mortality when compared to patients with EPTB (adjusted odds ratio [OR], 0.004; 95% confidence intervals [CI]: 0.001-0.054;P = 0.001) and PTB (adjusted OR, 0.022; 95% CI: 0.004-0.115;P = 0.001). Human immunodeficiency virus (HIV) was the main risk factor for patients with disseminated TB when compared to patients with extrapulmonary and PTB. The rates of extrapulmonary and disseminated TB in Oman are higher than what has been recognized. Expatriates, patients with HIV, and smokers are at high risk for disseminated TB. In these patients, suspected extrapulmonary sites should be evaluated and sampled to exclude disseminated TB.

  20. Epidemiology of extrapulmonary and disseminated tuberculosis in a tertiary care center in Oman

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    Zied Gaifer

    2017-01-01

    Full Text Available Background: The incidence of extrapulmonary and disseminated tuberculosis (TB cases is increasing worldwide, and this growth significantly impacts TB-related morbidity and mortality. Little is known about the host risk factors for extrapulmonary and disseminated TB. In this study, we examined those risk factors. Materials and Methods: We conducted a retrospective review of all TB cases admitted to Sultan Qaboos University Hospital from 2006 to 2015. We compared extrapulmonary TB (EPTB cases with pulmonary and disseminated TB cases. We evaluated the risk factors associated with the development of extrapulmonary and disseminated TB using logistic regression analysis. Results: We reviewed 260 TB cases, of which EPTB comprised 37%, PTB comprised 53%, and disseminated TB comprised 10%. The most common sites of infection in the EPTB group were the lymph nodes and the abdomen. Disseminated TB and TB meningitis were more common in expatriates than in Omanis. Patients with EPTB were less likely to smoke compared to a patient with PTB. Patients with disseminated TB had a higher mortality when compared to patients with EPTB (adjusted odds ratio [OR], 0.004; 95% confidence intervals [CI]: 0.001–0.054;P = 0.001 and PTB (adjusted OR, 0.022; 95% CI: 0.004–0.115;P = 0.001. Human immunodeficiency virus (HIV was the main risk factor for patients with disseminated TB when compared to patients with extrapulmonary and PTB. Conclusion: The rates of extrapulmonary and disseminated TB in Oman are higher than what has been recognized. Expatriates, patients with HIV, and smokers are at high risk for disseminated TB. In these patients, suspected extrapulmonary sites should be evaluated and sampled to exclude disseminated TB.

  1. Utility of multiplex real-time PCR in the diagnosis of extrapulmonary tuberculosis

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    Reena Raveendran

    Full Text Available Abstract Objective The diagnosis of extrapulmonary tuberculosis is still a challenge because of its pauci-bacillary nature. The aim of the study was to evaluate the role of a multiplex PCR assay in the diagnosis of extrapulmonary tuberculosis and to compare the efficiency of two targets, IS6110 and MPB64 to detect Mycobacterium tuberculosis. Methods 150 extrapulmonary samples (61 pus/aspirate, 46 tissue, 32 body fluids, and 11 urine from clinically suspected cases of tuberculosis were included in the study. All the samples were subjected to direct fluorescent microscopy, TB culture (BacT/ALERT 3D, biomerieux, Durham, North Carolina, USA and a Multiplexed Tandem PCR targeting two mycobacterial DNA sequences, IS6110 and MPB64. Master-Mix reagents and primers were prepared by AusDiagnostics Pvt. Ltd (Alexandria, New South Wales, Australia. The performance of the assay was assessed using a composite gold standard, which included clinical characteristics, microbiology smear as well as culture, histopathology, cytology, radiology, and response to antitubercular therapy. Results 20.3%, 23.6%, and 45.3% of specimens were positive by smear, culture, and PCR, respectively. The sensitivity and specificity of the multiplex PCR was 91.9% and 88.4%, respectively, using the composite gold standard. Positive and negative predictive values of the PCR were estimated as 85.1% and 93.8%, respectively. Higher positivity was observed with target IS6110 (44.6% as compared to target MPB64 (18.9%. The sensitivities of IS6110 and MPB64 individual targets were 90.3% and 64.5%, respectively, and specificities were 88.4% and 97.7%, respectively. Conclusion PCR can play an important role in rapid and accurate diagnosis of extrapulmonary tuberculosis. IS6110 alone is an effective target in our part of the country.

  2. Extrapulmonary tuberculosis in colombian children: Epidemiological and clinical data in a reference hospital.

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    Sepulveda, Eileen Viviana Fonseca; Yunda, Luisa Fernanda Imbachí; Herrera, Kelly Christina Márquez; Moreno, German Camacho

    2017-01-01

    The pediatric population is at increased risk of disseminated and extrapulmonary tuberculosis (TB). There is little information on children affected by this entity. The demographic, clinical, and outcome characteristics of the treatment of children with extrapulmonary TB, treated at a national reference institution between January 1, 2008, and December 31, 2016, are described and analyzed in this work. This was a retrospective observational study. Cases of extrapulmonary TB were identified, and variables were collected based on each criterion used for diagnosis and treatment outcomes. A descriptive analysis of the variables collected was performed. Ninety-three cases were identified, of which 32 (34.4%) met the criteria for extrapulmonary TB. The mean age was 10.2 years (range 0.8-17 years), and the most frequent site of extrapulmonary TB was lymph node 40.6%, meningeal 21.9%, and ocular 18.8%. Bacteriological confirmation was obtained in 8 cases (25%) while the remaining 24 cases (75%) were classified as cases of clinically diagnosed TB. Two patients (6.2%) died during treatment although their decease was not attributable to TB. The clinical criterion was fundamental to establish the diagnosis. The microbiological isolation rate was low. Molecular biology tools increase bacteriological performance although their extended use is limited by cost. Regional multicenter studies are required to identify the target population and the tools necessary for timely management and treatment.

  3. Comparative Diagnostic Utility of Neopterin and IFN-γ/IL-2 in Extrapulmonary Tuberculosis.

    Science.gov (United States)

    Goyal, Nisha; Kashyap, Bineeta; Singh, N P; Kaur, Iqbal R

    2017-10-01

    Resurgence of TB has emphasized the need for newer methods of diagnosis. Extrapulmonary tuberculosis (EPTB), being paucibacillary, is a diagnostic dilemma. The aim of the present study was to correlate IFN-γ/IL-2 with neopterin in diagnosis of EPTB. Extrapulmonary specimens from 69 clinically diagnosed cases were stained by Ziehl-Neelsen and cultured on Lowenstein-Jensen medium for Mycobacterium tuberculosis. ELISA was used to assess serum IFN-γ, IL-2 and neopterin levels. Median serum levels of IFN-γ/IL-2 and neopterin were 3.22 and 21.6 nmol/L in clinically diagnosed EPTB cases and 0.52 and 4.20 nmol/L in healthy controls respectively (p EPTB cases (spearman's rho = 0.453, p EPTB.

  4. Extrapulmonary tuberculosis: Mycobacterium tuberculosis strains and host risk factors in a large urban setting in Brazil.

    Science.gov (United States)

    Gomes, Teresa; Vinhas, Solange Alves; Reis-Santos, Bárbara; Palaci, Moisés; Peres, Renata Lyrio; Aguiar, Paola P; Ribeiro, Fabiola Karla Correa; Marques, Hebert Silva; Dettoni, Valdério do Valle; Johnson, John L; Riley, Lee W; Maciel, Ethel Leonor

    2013-01-01

    Factors related to the development of extrapulmonary forms of tuberculosis (EPTB) are still poorly understood, particularly in high-endemic countries like Brazil. The objective of the paper is to determine host and Mycobacterium tuberculosis (MTB) strain-related factors associated with the development of EPTB in Espírito Santo state, Brazil. We conducted a retrospective laboratory-based surveillance study of new tuberculosis (TB) cases diagnosed in Espírito Santo state, Brazil between 1998 and 2007. We genotyped 612 isolates of MTB from 606 TB patients using spoligotyping and IS6110-restriction fragment length polymorphism (RFLP) typing and compared sociodemographic and clinical characteristics of patients with pulmonary TB (PTB) and EPTB. Among 606 patients, 464 (77%) had PTB, 79 (13%) had EPTB, 51 (8%) had both, and 12 (2%) had miliary TB. The IS6110 RFLP analysis demonstrated that 250 (41%) isolates belonged to clustered RFLP patterns, 27 (11%) of which were from EPTB. We identified 73 clusters including 35 (48%) composed of 2 isolates each. By spoligotyping, 506 (83%) MTB isolates fell into known patterns and 106 (17%) fell into patterns with no family assignment; 297 (48%) isolates belonged to the Latin-American Mediterranean family. Higher school level (4-7 years OR: 0.16 95% CI 0.34-0.73 and > 8 years of education, OR 0.06 95% CI 0.009-0.50) white ethnicity (OR: 2.54 95% CI 1.03-6.25) and HIV infection (OR: 16.83 95% CI 5.23-54.18) were associated with EPTB. No specific strain lineage or percentage of clustering was associated with EPTB. These results demonstrate that risk factors for EPTB are related more to host than to MTB strain lineage characteristics.

  5. Extrapulmonary tuberculosis: Mycobacterium tuberculosis strains and host risk factors in a large urban setting in Brazil.

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    Teresa Gomes

    Full Text Available Factors related to the development of extrapulmonary forms of tuberculosis (EPTB are still poorly understood, particularly in high-endemic countries like Brazil. The objective of the paper is to determine host and Mycobacterium tuberculosis (MTB strain-related factors associated with the development of EPTB in Espírito Santo state, Brazil.We conducted a retrospective laboratory-based surveillance study of new tuberculosis (TB cases diagnosed in Espírito Santo state, Brazil between 1998 and 2007. We genotyped 612 isolates of MTB from 606 TB patients using spoligotyping and IS6110-restriction fragment length polymorphism (RFLP typing and compared sociodemographic and clinical characteristics of patients with pulmonary TB (PTB and EPTB. Among 606 patients, 464 (77% had PTB, 79 (13% had EPTB, 51 (8% had both, and 12 (2% had miliary TB. The IS6110 RFLP analysis demonstrated that 250 (41% isolates belonged to clustered RFLP patterns, 27 (11% of which were from EPTB. We identified 73 clusters including 35 (48% composed of 2 isolates each. By spoligotyping, 506 (83% MTB isolates fell into known patterns and 106 (17% fell into patterns with no family assignment; 297 (48% isolates belonged to the Latin-American Mediterranean family. Higher school level (4-7 years OR: 0.16 95% CI 0.34-0.73 and > 8 years of education, OR 0.06 95% CI 0.009-0.50 white ethnicity (OR: 2.54 95% CI 1.03-6.25 and HIV infection (OR: 16.83 95% CI 5.23-54.18 were associated with EPTB. No specific strain lineage or percentage of clustering was associated with EPTB.These results demonstrate that risk factors for EPTB are related more to host than to MTB strain lineage characteristics.

  6. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality

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    Magee, M. J.; Foote, M; Ray, S. M.; Gandhi, N. R.; Kempker, R. R.

    2016-01-01

    Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ?16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported T...

  7. Modeling the impact of novel diagnostic tests on pediatric and extrapulmonary tuberculosis

    OpenAIRE

    Denkinger, CM; Kampmann, B; Ahmed, S.; Dowdy, DW

    2014-01-01

    Background Extrapulmonary tuberculosis (EPTB) and most pediatric TB cannot be diagnosed using sputum-based assays. The epidemiological impact of different strategies to diagnose EPTB and pediatric TB is unclear. Methods We developed a dynamic epidemic model of TB in a hypothetical population with epidemiological characteristics similar to India. We evaluated the impact of four alternative diagnostic test platforms on adult EPTB and pediatric TB mortality over 10 years: (1) Nucleic acid amplif...

  8. Extrapulmonary and Pulmonary Tuberculosis in Antananarivo (Madagascar): High Clustering Rate in Female Patients

    OpenAIRE

    Rasolofo Razanamparany, Voahangy; Ménard, Didier; Aurégan, Guy; Gicquel, Brigitte; Chanteau, Suzanne

    2002-01-01

    Antananarivo, the capital city of Madagascar, has an endemic focus of tuberculosis (TB). We specifically studied patients with extrapulmonary TB (EPTB) and grouped patients according to infected body site. The strains were characterized by IS6110 fingerprinting and compared with those isolated from patients with pulmonary TB (PTB) during the same period in order to determine the possible association between the genotype and the clinical expression of TB. A total of 316 TB patients were includ...

  9. Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis

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    V Makeshkumar

    2014-01-01

    Full Text Available Background & objectives: Diagnosis of extrapulmonary tuberculosis (EPTB is difficult using conventional diagnostic methods. This study was conducted to evaluate the use of polymerase chain reaction (PCR in diagnosis of definitive and probable extrapulmonary tuberculosis patients, and to assess the performance of insertion sequence (IS 6110 based PCR assay as compared to conventional culture by Lowenstein-Jensen (LJ method for the diagnosis of EPTB. Methods: A total of 178 non repeated clinical specimens were collected from clinically suspected extrapulmonary tuberculosis patients. The specimens included 59 ascitic fluid, 54 pleural fluid, 25 cerebrospinal fluid (CSF, 12 fine needle aspiration (FNA, 8 urine, 7 pus, 6 synovial fluid, 2 skin tissue, one pericardial fluid, one liver abscess, one pancreatic cyst fluid, one omental biopsy and one semen sample. All these clinical samples were subjected to Ziehl-Neelsen staining (ZN for acid fast bacilli (AFB and culture on LJ medium. PCR was performed by targeting 123bp fragment of insertion sequence IS6110 of Mycobacterium tuberculosis (MTB. Results: Of the 178 specimens, 10 (5.61% were ZN smear positive for AFB, six (3.37% were L-J culture positive from 10 AFB smear positive cases and 48 (26.96% were PCR IS 6110 positive for M. tuberculosis. Interpretation & conclusions: PCR using IS6110 primer was able to pick up more EPTB patients compared to conventional L-J culture method for detection of M. tuberculosis. False positive PCR IS6110 in three CSF samples may be due to latent TB infection which was limitation in this study.

  10. Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis

    Science.gov (United States)

    Makeshkumar, V.; Madhavan, Radha; Narayanan, Sujatha

    2014-01-01

    Background & objectives: Diagnosis of extrapulmonary tuberculosis (EPTB) is difficult using conventional diagnostic methods. This study was conducted to evaluate the use of polymerase chain reaction (PCR) in diagnosis of definitive and probable extrapulmonary tuberculosis patients, and to assess the performance of insertion sequence (IS) 6110 based PCR assay as compared to conventional culture by Lowenstein-Jensen (LJ) method for the diagnosis of EPTB. Methods: A total of 178 non repeated clinical specimens were collected from clinically suspected extrapulmonary tuberculosis patients. The specimens included 59 ascitic fluid, 54 pleural fluid, 25 cerebrospinal fluid (CSF), 12 fine needle aspiration (FNA), 8 urine, 7 pus, 6 synovial fluid, 2 skin tissue, one pericardial fluid, one liver abscess, one pancreatic cyst fluid, one omental biopsy and one semen sample. All these clinical samples were subjected to Ziehl-Neelsen staining (ZN) for acid fast bacilli (AFB) and culture on LJ medium. PCR was performed by targeting 123bp fragment of insertion sequence IS6110 of Mycobacterium tuberculosis (MTB). Results: Of the 178 specimens, 10 (5.61%) were ZN smear positive for AFB, six (3.37%) were L-J culture positive from 10 AFB smear positive cases and 48 (26.96%) were PCR IS 6110 positive for M. tuberculosis. Interpretation & conclusions: PCR using IS6110 primer was able to pick up more EPTB patients compared to conventional L-J culture method for detection of M. tuberculosis. False positive PCR IS6110 in three CSF samples may be due to latent TB infection which was limitation in this study. PMID:24604051

  11. The burden and treatment outcomes of extra-pulmonary tuberculosis in Bhutan.

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    Jamtsho, T; Harries, A D; Malhotra, S; Wangchuk, D; Dophu, U; Dorji, T; Dendup, T

    2013-03-21

    All tuberculosis (TB) registration sites in Bhutan. Cross-sectional study involving a retrospective review of TB registers and TB treatment cards. To determine: 1) the number and proportion of all TB cases registered as extra-pulmonary TB (EPTB) from 2001 to 2010, 2) the age and sex of the patients and the categories and types of EPTB registered in 2010, and 3) their treatment outcomes. The proportion of all TB cases registered as EPTB over a period of 10 years varied from 30% to 40%. In 2010, 505 patients were registered with EPTB, of whom 50% were male, 21% were children, and 96% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 67%, followed by abdominal TB and spinal/bone/kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB. Bhutan has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Further work is needed to better understand how EPTB is diagnosed throughout the country.

  12. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis.

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    Lin, J N; Lai, C H; Chen, Y H; Lee, S S J; Tsai, S S; Huang, C K; Chung, H C; Liang, S H; Lin, H H

    2009-05-01

    Tuberculosis (TB) continues to be a major global health problem. Extra-pulmonary TB (EPTB) manifests with protean symptoms, and establishing a diagnosis is more difficult than pulmonary TB (PTB). A university-affiliated hospital in southern Taiwan. To analyse the risk factors for EPTB compared with PTB. This retrospective study compared patients with EPTB and PTB in southern Taiwan by analysing their demographic data and clinical underlying diseases. Risk factors for EPTB were further analysed. A total of 766 TB patients were enrolled in this study, with 102 (13.3%) EPTB and 664 (86.7%) PTB cases. Of the 766 patients, 3% of PTB patients had EPTB, while 19.6% of EPTB patients also had PTB. The most frequently involved EPTB site was the bone and joints (24.5%). The incidence of EPTB vs. PTB decreased significantly for each decade increase in patient age. Multivariate logistic regression analysis showed that being female, not being diabetic, having end-stage renal disease and not smoking were independent risk factors for EPTB. This study defines the risk factors for EPTB compared with PTB. Awareness of these factors is essential for physicians to have a high index of suspicion for accurate and timely diagnosis.

  13. Performance of real-time PCR Xpert ®MTB/RIF in diagnosing extrapulmonary tuberculosis.

    Science.gov (United States)

    Mazzola, Ester; Arosio, Marco; Nava, Alice; Fanti, Diana; Gesu, Giovanni; Farina, Claudio

    2016-12-01

    The real time PCR Xpert ® MTB/RIF is fundamental for rapid diagnosis in paucibacillary respiratory samples and for the detection of multidrug-resistant TB cases. This paper aimed to determine its performance on different extrapulmonary samples. We determined sensitivity, specificity, positive and negative predictive value on respiratory and non-respiratory samples collected from January 2010 to June 2014. The protocol for the Xpert ® MTB/RIF PCR suggested by Cepheid was strictly followed for all specimens. In 12257 respiratory samples we observed a sensitivity of 87.1% and a specificity of 99.9%. There were 2818 extrapulmonary specimens, of which 250 were followed by a positive culture for Mycobacterium tuberculosis complex, whereas 72 samples were culture-negative: tuberculosis was clinically confirmed in 71 of them and was excluded for one sample. The sensitivity of the test on urine, pus and CSF samples was 88.2%, 95.6% and 100% respectively. In contrast, the sensitivity of gastric aspirates and biopsies was 81.8% and 83.6% respectively, whereas results of total cavitary fluids were significantly worse than expected (53.7% sensitivity). Our experience shows that Xpert MTB/RIF assay is an accurate, sensitive, and specific test for the rapid detection of pulmonary and extra-pulmonary TB with the only exception of cavitary fluids.

  14. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006.

    Science.gov (United States)

    Peto, Heather M; Pratt, Robert H; Harrington, Theresa A; LoBue, Philip A; Armstrong, Lori R

    2009-11-01

    Almost one-fifth of United States tuberculosis cases are extrapulmonary; unexplained slower annual case count decreases have occurred in extrapulmonary tuberculosis (EPTB), compared with annual case count decreases in pulmonary tuberculosis (PTB) cases. We describe the epidemiology of EPTB by means of US national tuberculosis surveillance data. US tuberculosis cases reported from 1993 to 2006 were classified as either EPTB or PTB. EPTB encompassed lymphatic, pleural, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB cases. We excluded cases with concurrent extrapulmonary-pulmonary tuberculosis and cases of disseminated (miliary) tuberculosis. Demographic characteristics, drug susceptibility test results, and risk factors, including human immunodeficiency virus (HIV) status, were compared for EPTB and PTB cases. Among 253,299 cases, 73.6% were PTB and 18.7% were EPTB, including lymphatic (40.4%), pleural (19.8%), bone and/or joint (11.3%), genitourinary (6.5%), meningeal (5.4%), peritoneal (4.9%), and unclassified EPTB (11.8%) cases. Compared with PTB, EPTB was associated with female sex (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.7-1.8) and foreign birth (OR, 1.5; CI, 1.5-1.6), almost equally associated with HIV status (OR, 1.1; CI, 1.1-1.1), and negatively associated with multidrug resistance (OR, 0.6; CI, 0.5-0.6) and several tuberculosis risk factors, especially homelessness (OR, 0.3; CI, 0.3-0.3) and excess alcohol use (OR, 0.3; CI, 0.3-0.3). Slower annual decreases in EPTB case counts, compared with annual decreases in PTB case counts, from 1993 through 2006 have caused EPTB to increase from 15.7% of tuberculosis cases in 1993 to 21.0% in 2006. EPTB epidemiology and risk factors differ from those of PTB, and the proportion of EPTB has increased from 1993 through 2006. Further study is needed to identify causes of the proportional increase in EPTB.

  15. Analysis of extrapulmonary tuberculosis in Spain: 2007-2012 National Study.

    Science.gov (United States)

    Culqui-Lévano, Dante R; Rodriguez-Valín, Elena; Donado-Campos, Juan de Mata

    2017-02-01

    This study sought to study the epidemiological characteristics of the extrapulmonary tuberculosis (EPTB) in relation to pulmonary tuberculosis (PTB) from 2007 to 2012 in Spain, and plot its trend across the same period. We conducted an analytical cross-sectional study in which the following variables were analysed: age; sex; disease site; history of antituberculosis treatment; country of birth; presence of HIV infection; and culture results. Age-related differences were ascertained using the test of comparison of proportions, and crude and adjusted ORs were calculated using linear regression models. Of the total of 44,050 cases of tuberculosis reported in the period 2007-2012 and included in the study, 31,508 (71.53%) were pulmonary tuberculosis and 12,542 (28.47%) were EPTB. EPTB rates decreased across all age groups. The main EPTB risk factor was presence of HIV infection (OR 1.39). Persons aged under 65 years had a lower risk of EPTB. Although persons aged over 65 years displayed the highest incidence, there was nevertheless a downward trend across all age groups. Whereas children showed a significant decrease in tuberculous meningitis, this was not so for all extrapulmonary forms. EPTB rates among persons born outside Spain were much higher than those among the Spanish population. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  16. Extrapulmonary tuberculosis among adults: experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

    Science.gov (United States)

    Karstaedt, Alan S

    2013-10-11

    Extrapulmonary tuberculosis (EPTB) occurs in 15 - 20% of immunocompetent and 20 - 70% of HIV-infected patients with tuberculosis. There are few recent incidence data for EPTB. Adults (N=2 963) with culture-proven EPTB seen over 2 years at Chris Hani Baragwanath Academic Hospital, the main referral hospital serving Soweto, Johannesburg, South Africa, were retrospectively studied for pattern and incidence. The commonest sites of EPTB were the pleura (39.1%), lymph nodes (31.0%), blood (21.8%), meninges (7.3%), and peritoneum (2.9%). Disseminated tuberculosis occurred in 25.0%. The median age was 33 years (range 18 - 87 years). Males comprised 53.2% overall, with a female majority in the peritonitis group. For Soweto, the incidence of adult EPTB was 88.6/100 000 population, rising to 139.4/100 000 and 125.7/100 000 in the 25 - 34-year and 35 - 44-year age groups, respectively. There was no secondary peak in the elderly (17.9/100 000). This retrospective cohort showed a high incidence of EPTB, most marked in the 25 - 44-year age group. Culture of extrapulmonary sites is of importance to confirm diagnosis of tuberculosis and to ensure antituberculosis drug susceptibility testing.

  17. Clinical manifestations of pulmonary and extra-pulmonary tuberculosis

    African Journals Online (AJOL)

    Lymph node tuberculosis. Tuberculous lymphadenitis usually presents as painless swelling of one or more lymph nodes. The nodes most commonly involved are those of the posterior or anterior cervical chain or those in the supraclavicular fossa. Frequently the process is bilateral and other noncontiguous groups of nodes ...

  18. Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia.

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    Alemu Fanosie

    Full Text Available Extrapulmonary Tuberculosis (EPTB and Human Immunodeficiency Virus (HIV infection are interrelated as a result of immune depression. The aim of this study was to determine the prevalence of Mycobacterium tuberculosis complex isolates and the burden of HIV co-infection among EPTB suspected patients.An institution based cross-sectional study was conducted among EPTB suspected patients at the University of Gondar Hospital. Socio-demographic characteristics and other clinical data were collected using a pretested questionnaire. GeneXpert MTB/RIF assay was performed to diagnosis Mycobacterium tuberculosis complex and Rifampicin resistance. All samples were also investigated by cytology and culture. The HIV statuses of all patients were screened initially by KHB, and all positive cases were further re-tested by STAT-pack. Data was analyzed using SPSS version 20 computer software and a P-value of < 0.05 was taken as statistically significant.A total of 141 extrapulmonary suspected patients were enrolled in this study. The overall prevalence of culture confirmed extrapulmonary tuberculosis infection was 29.8%, but the GeneXpert result showed a 26.2% prevalence of Mycobacterium tuberculosis complex infection. The 78.4% prevalence of extrapulmonary tuberculosis infection was found to be higher among the adult population. The prevalence of HIV infection among EPTB suspected patients was 14.1%, while it was 32.4% among GeneXpert-confirmed extrapulmonary TB cases (12/37. Tuberculosis lymphadenitis was the predominant (78.4% type of EPTB infection followed by tuberculosis cold abscess (10.7%. Adult hood, previous history of contact with known pulmonary tuberculosis patients, and HIV co-infection showed a statistically significant association with extrapulmonary tuberculosis infection (P<0.013.The prevalence of culture confirmed-EPTB infection was high, and a higher EPTB-HIV co-infection was also observed.

  19. Extrapulmonary tuberculosis in non-human immunodeficiency virus-infected adults in an endemic region.

    Science.gov (United States)

    Ozvaran, Mustafa Kürşat; Baran, Reha; Tor, Meltem; Dilek, Ilknur; Demiryontar, Dilay; Arinç, Sibel; Toker, Nil; Chousein, Efsun Uğur; Soğukpinar, Ozlem

    2007-07-01

    Extrapulmonary tuberculosis (EPTB) still constitutes an important clinical problem. We aimed to evaluate the incidence and features of extrapulmonary tuberculosis. We retrospectively evaluated 14,266 tuberculosis patients diagnosed between January 1999 and December 2003 in a tertiary care hospital in Istanbul. As many as 2,435 patients (17.1%) with EPTB were evaluated for the incidence and features. Of the 14,266 patients, 4,154 were female (29%) and 10,112 were male (71%) and were aged between 14 and 86 years with a mean age of 35 +/- 14 years. As many as 660 (17.9%) patients were diagnosed as EPTB in 1999, 568 (17.8%) in 2000, 357 (13.7%) in 2001, 462 (22%) in 2002 and 388 (14.5%) in 2003. EPTB presented most commonly as pleurisy (66%), followed by lymphadenitis (23%). Lymphadenitis and pleurisy were more commonly observed among female TB patients (60%) and among male TB patients (59%) respectively. EPTB showed a significant female predilection (26.8%) compared to male patients (13.1%). Multi-organ involvement was observed in 37 (1.5%) patients (two organs in 33 and three organs in 4). As many as 197 (8%) EPTB cases had pulmonary tuberculosis simultaneously. EPTB still constitutes an important clinical problem. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis cases. In the current study, we present our experience of the incidence and features of EPTB patients without HIV infection. In this study, EPTB cases constituted one-fifth of all tuberculosis cases presented to our center in the study period.

  20. Extrapulmonary tuberculosis in non-human immunodeficiency virus-infected adults in an endemic region

    Directory of Open Access Journals (Sweden)

    Ozvaran Mustafa

    2007-01-01

    Full Text Available Aims: Extrapulmonary tuberculosis (EPTB still constitutes an important clinical problem. We aimed to evaluate the incidence and features of extrapulmonary tuberculosis. Materials and Methods: We retrospectively evaluated 14,266 tuberculosis patients diagnosed between January 1999 and December 2003 in a tertiary care hospital in Istanbul. As many as 2,435 patients (17.1% with EPTB were evaluated for the incidence and features. Results: Of the 14,266 patients, 4,154 were female (29% and 10,112 were male (71% and were aged between 14 and 86 years with a mean age of 35 ± 14 years. As many as 660 (17.9% patients were diagnosed as EPTB in 1999, 568 (17.8% in 2000, 357 (13.7% in 2001, 462 (22% in 2002 and 388 (14.5% in 2003. EPTB presented most commonly as pleurisy (66%, followed by lymphadenitis (23%. Lymphadenitis and pleurisy were more commonly observed among female TB patients (60% and among male TB patients (59% respectively. EPTB showed a significant female predilection (26.8% compared to male patients (13.1%. Multi-organ involvement was observed in 37 (1.5% patients (two organs in 33 and three organs in 4. As many as 197 (8% EPTB cases had pulmonary tuberculosis simultaneously. Conclusions: EPTB still constitutes an important clinical problem. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis cases. In the current study, we present our experience of the incidence and features of EPTB patients without HIV infection. In this study, EPTB cases constituted one-fifth of all tuberculosis cases presented to our center in the study period.

  1. Detection of 123 bp fragment of insertion element IS6110 Mycobacterium tuberculosis for diagnosis of extrapulmonary tuberculosis.

    Science.gov (United States)

    Maurya, A K; Kant, S; Nag, V L; Kushwaha, Ras; Dhole, T N

    2012-01-01

    Extrapulmonary tuberculosis (EPTB) is emerging problem in developing and developed countries. The diagnosis of EPTB in its different clinical presentations remains a true challenge. IS6110-based polymerase chain reaction (PCR) is used for rapid identification and positivity rate of the Mycobacterium tuberculosis complex in clinical isolates of different sites of EPTB. The present study was carried out to study the prevalence of M. tuberculosis complex in clinical isolates of EPTB at tertiary care centres in Lucknow. Seven hundred fifty-six specimens were collected from the suspected cases of EPTB which were processed for Mycobacteria by Ziehl Neelson (ZN) staining and BACTEC culture. All the specimens were also processed for IS6110-based PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of the M. tuberculosis complex. Of these 756 specimens, 71(9.3%) were positive for acid fast bacilli (AFB) by ZN staining, 227(30.1%) were positive for mycobacteria by BACTEC culture and IS6110 PCR were positive for M. tuberculosis complex in 165 (20.7%) isolates. We found a significant difference in sensitivities of different tests (PEPTB case in tertiary care hospitals in Northern India. 72.7% of M. tuberculosis complex was confirmed by IS6110-PCR in culture isolates from different sites of EPTB. The high prevalence of the M. tuberculosis complex was seen in lymph node aspirate and synovial fluid. However, utility of PCR may play a potentially significant role in strengthening the diagnosis of EPTB especially targeting IS6110.

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

    Directory of Open Access Journals (Sweden)

    Bright Varghese

    2015-01-01

    Full Text Available 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.

  3. Pediatric Extrapulmonary Tuberculosis: Clinical Spectrum, Risk Factors and Diagnostic Challenges in a Low Prevalence Region.

    Science.gov (United States)

    Santiago-García, Begoña; Blázquez-Gamero, Daniel; Baquero-Artigao, Fernando; Ruíz-Contreras, Jesús; Bellón, Jose M; Muñoz-Fernández, Maria A; Mellado-Peña, María J

    2016-11-01

    Children are at higher risk of tuberculosis (TB) dissemination and extrapulmonary disease, contributing greatly to TB-associated morbidity and long-term sequelae. However, there are very few studies that assess the impact and clinical spectrum of pediatric extrapulmonary TB (EPTB) in low-prevalence regions. Children EPTB. During the study period, 93 of 526 pediatric TB cases had EPTB (17.7%). The most common site was lymphatic TB (34.5%). The source case was not identified in most extrapulmonary cases, contrary to pulmonary TB (28% vs. 63.3%; P EPTB cases (EPTB presented higher rate of bacteriologic confirmation (66% vs. 49.4%; P EPTB was associated with the child's foreign origin [odds ratio (OR) 2.3 (1.1-5.3)], immune disorders [OR 5.8 (1.9-17.1)] and drug resistance [OR 2.4 (1.1-5.4)]. In our low-prevalence region, childhood EPTB was linked to immigrant status, immune disorders and drug resistance, and presented high rate of complications. Our study underscores the relevance of improved diagnostic tools and systematic TB screening in high risk populations.

  4. Neopterin and oxidative stress markers in the diagnosis of extrapulmonary tuberculosis.

    Science.gov (United States)

    Goyal, Nisha; Kashyap, Bineeta; Singh, N P; Kaur, Iqbal R

    2017-11-01

    Extrapulmonary tuberculosis (EPTB) often presents with nonspecific signs and symptoms. Further the paucibacillary nature of extrapulmonary specimens and irregular distribution of bacilli lower the sensitivity of conventional diagnostic methods making EPTB, a diagnostic dilemma. To study neopterin, protein carbonyl and malondialdehyde (MDA) in EPTB. Sixty nine clinically confirmed cases with an equal number of age and sex matched healthy controls were enrolled. Ziehl-Neelsen staining for acid fast bacilli and culture on Lowenstein-Jensen medium were performed on all the extrapulmonary specimens. Serum neopterin and protein carbonyl levels were estimated using commercial ELISA kits. Malondialdehyde was determined by measuring thiobarbituric acid reactive substances. Serum neopterin, protein carbonyl and MDA levels were significantly discriminative for cases of EPTB from healthy controls (p < 0.05). Levels of all the three biomarkers under study significantly differed between culture as well as smear positive and negative cases. A positive correlation between neopterin and protein carbonyl was seen among the cases. So far few studies have integrated combination of validated host biomarkers for active disease in EPTB. Our study suggests the potential diagnostic role of neopterin, protein carbonyl and MDA in EPTB.

  5. Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa.

    Science.gov (United States)

    Hoogendoorn, J C; Ranoto, L; Muditambi, N; Railton, J; Maswanganyi, M; Struthers, H E; McIntyre, J A; Peters, R P H

    2017-09-01

    Scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage EPTB (n = 399 in 2009 vs. 336 in 2013; P EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.

  6. Extra-pulmonary manifestations in a large metropolitan area with a low incidence of tuberculosis.

    Science.gov (United States)

    Gonzalez, O Y; Adams, G; Teeter, L D; Bui, T T; Musser, J M; Graviss, E A

    2003-12-01

    The increases in extra-pulmonary tuberculosis (EPTB) have been largely due to human immunodeficiency virus co-infection. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis (PTB) cases. To evaluate covariates associated with EPTB. A 4-year cohort of EPTB patients was compared with PTB cases. Enrollees were assessed for TB risk, medical records were reviewed, and Mycobacterium tuberculosis isolates were fingerprinted. We identified 538 EPTB cases (28.6%) in a total of 1878 enrollees. The most common sites of infection were lymph nodes (43%) and pleura (23%). EPTB cases included 320 (59%) males, 382 (71%) patients were culture-positive, and 332 (86.9%) patient isolates were fingerprinted. Fewer EPTB than PTB patients belonged to clustered M. tuberculosis strains (58% vs. 65%; P = 0.02). A multivariate model identified an increased risk for EPTB among African Americans (OR = 1.9, P = 0.01), HIV-seropositive (OR = 3.1, P EPTB. Mortality at 6 months is partly due to the dissemination of M. tuberculosis and the severity of the underlying co-morbidity.

  7. Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.

    Science.gov (United States)

    Kipp, Aaron M; Stout, Jason E; Hamilton, Carol Dukes; Van Rie, Annelies

    2008-04-04

    The proportion of extrapulmonary tuberculosis (EPTB) reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important. Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB. Among all patients with tuberculosis, 1,366 (22.3%) had EPTB, 563 (9.2%) were HIV co-infected, and 1,299 (21.2%) were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth) and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39). Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71) and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23). Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB.

  8. Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 – 2006

    Directory of Open Access Journals (Sweden)

    Kipp Aaron M

    2008-04-01

    Full Text Available Abstract Background The proportion of extrapulmonary tuberculosis (EPTB reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important. Methods Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB. Results Among all patients with tuberculosis, 1,366 (22.3% had EPTB, 563 (9.2% were HIV co-infected, and 1,299 (21.2% were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39. Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71 and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23. Conclusion Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB.

  9. Extrapulmonary Tuberculosis: A retrospective Study at a tertiary care hospital in Palpa, Nepal

    Directory of Open Access Journals (Sweden)

    Chandan Kumar Thakur

    2013-12-01

    Full Text Available Background: Extra-pulmonary tuberculosis (EPTB is a significant global health problem. Related studies to it in different places and diff erent durations are indicated by many previous research findings. Findings of this study could be beneficial for its preventive and control strategies. Methodology: Retrospective analysis of clinical specimens submitted to Central laboratory of Lumbini Medical College and Teaching Hospital (LMCTH for extrapulmonary tuberculosis was performed. Total 261 samples submitted from April 2011 to February 2013 were included for analysis in this study. Results: Total 20.7% (54/261 prevalence of EPTB was reported. Based on sites involved; lymph node 87.03%, pleural effusion7.40%, peritoneal5.55% were found. Genderwise equal prevalence was seen among male and females. Age-wise prevalence among patients between 21-40 years was reported. Conclusion: Our finding indicates great necessity for further large scale study on prevalence of EPTB in this location for its prevention and control.

  10. Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

    Directory of Open Access Journals (Sweden)

    A. K. Maurya

    2015-01-01

    Full Text Available The reports of nontuberculous mycobacteria (NTM associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3% were positive for AFB by ZN staining and 227 cases (30.1% were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4% strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6% strains were confirmed as M. tuberculosis complex, and 62 (27.4% were confirmed as NTM. The most common NTM species identified were M. fortuitum 17 (27.5% and M. intracellulare 13 (20.9%. The rapid identification of NTM species may help in targeted therapy and management of the diseases.

  11. Prevalence of nontuberculous mycobacteria among extrapulmonary tuberculosis cases in tertiary care centers in Northern India.

    Science.gov (United States)

    Maurya, A K; Nag, V L; Kant, S; Kushwaha, R A S; Kumar, M; Singh, A K; Dhole, T N

    2015-01-01

    The reports of nontuberculous mycobacteria (NTM) associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3%) were positive for AFB by ZN staining and 227 cases (30.1%) were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4%) strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6%) strains were confirmed as M. tuberculosis complex, and 62 (27.4%) were confirmed as NTM. The most common NTM species identified were M. fortuitum 17 (27.5%) and M. intracellulare 13 (20.9%). The rapid identification of NTM species may help in targeted therapy and management of the diseases.

  12. [Extrapulmonary tuberculosis at "Benéfico Jurídico" hospital in the 1999-2003 period].

    Science.gov (United States)

    García Silvera, Eberto; Yera Pérez, Dulce María; Valdés Díaz, Solangel; Hernández Hernández, Marisela; Rives Rodríiguez, Rolando

    2006-01-01

    A retrospective and descriptive study was conducted on patients diagnosed with extrapul-monary tuberculosis and discharged from "Benéfico Juridico" neumological hospital in the 1999-2003 period. The objective was to describe the perfor-mance of this disease. As a result, it was find out that of a total number of 353 diagnosed patients, 14% had extrapulmonary tuberculosis, 58% of these patients were in the 35-54 years age group, being the average age 39 years. The most frequent clinical manifestation was pleural (81%) followed by ganglionic tuberculosis (15%). Sixty one percent of cases were diagnosed based on clinical indications. Only 8% of patients were diagnosed by isolation of tuberculosis bacillus in a Lowestein-Jensen culture.

  13. Similar seasonal peak in clustered and unique extra-pulmonary tuberculosis notifications: winter crowding hypothesis ruled out?

    NARCIS (Netherlands)

    Top, R.; Boshuizen, H.C.; Dekkers, A.

    2013-01-01

    BACKGROUND: The incidence of extra-pulmonary tuberculosis (EPTB) in the Netherlands shows a seasonal trend, with a peak in spring and a trough in autumn. Possible causes of this peak are winter crowding and a seasonal decrease in immune competence in spring. A third explanation may be a reporting

  14. 'Remote FASH' tele-sonography - a novel tool to assist diagnosing HIV-associated extrapulmonary tuberculosis in remote areas

    NARCIS (Netherlands)

    Janssen, S.; Grobusch, M. P.; Heller, T.

    2013-01-01

    Diagnosis of tuberculosis (TB) is complex, especially in HIV positive patients. Ultrasound can aid diagnosis of extrapulmonary TB (EPTB), but experienced sonographers are often not available in endemic settings. We describe a novel tool to aid diagnosis of EPTB using telemedicine and a previously

  15. Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006-2011

    OpenAIRE

    Xiaoqing Wang; Zhenhua Yang; Yanyong Fu; Guoqin Zhang; Xu Wang; Yuhua Zhang; Xiexiu Wang

    2014-01-01

    Background The proportion of extrapulmonary tuberculosis (EPTB) among all the reported tuberculosis (TB) cases has increased in different populations. Despite the large burden of TB in China, the epidemiology of EPTB in China remains largely understudied and the risk factors for having EPTB diagnosis in China have not been identified. Methods To gain insight to EPTB epidemiology in China, we analyzed TB surveillance data collected in Tianjin, China, during 2006 to 2011. The frequency of EPTB ...

  16. Detection of 123 bp fragment of insertion element IS6110 Mycobacterium tuberculosis for diagnosis of extrapulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    A K Maurya

    2012-01-01

    Full Text Available Purpose: Extrapulmonary tuberculosis (EPTB is emerging problem in developing and developed countries. The diagnosis of EPTB in its different clinical presentations remains a true challenge. IS6110-based polymerase chain reaction (PCR is used for rapid identification and positivity rate of the Mycobacterium tuberculosis complex in clinical isolates of different sites of EPTB. The present study was carried out to study the prevalence of M. tuberculosis complex in clinical isolates of EPTB at tertiary care centres in Lucknow. Materials and Methods: Seven hundred fifty-six specimens were collected from the suspected cases of EPTB which were processed for Mycobacteria by Ziehl Neelson (ZN staining and BACTEC culture. All the specimens were also processed for IS6110-based PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of the M. tuberculosis complex. Results: Of these 756 specimens, 71(9.3% were positive for acid fast bacilli (AFB by ZN staining, 227(30.1% were positive for mycobacteria by BACTEC culture and IS6110 PCR were positive for M. tuberculosis complex in 165 (20.7% isolates. We found a significant difference in sensitivities of different tests (P<0.05. Conclusions: This study reveals the positivity of M. tuberculosis complex in clinical isolates of EPTB case in tertiary care hospitals in Northern India. 72.7% of M. tuberculosis complex was confirmed by IS6110-PCR in culture isolates from different sites of EPTB. The high prevalence of the M. tuberculosis complex was seen in lymph node aspirate and synovial fluid. However, utility of PCR may play a potentially significant role in strengthening the diagnosis of EPTB especially targeting IS6110.

  17. Interferon-gamma response to the treatment of active pulmonary and extra-pulmonary tuberculosis.

    Science.gov (United States)

    Liang, L; Shi, R; Liu, X; Yuan, X; Zheng, S; Zhang, G; Wang, W; Wang, J; England, K; Via, L E; Cai, Y; Goldfeder, L C; Dodd, L E; Barry, C E; Chen, R Y

    2017-10-01

    Interferon-gamma (IFN-γ) release assays (IGRAs) are used to diagnose tuberculosis (TB) but not to measure treatment response. To measure IFN-γ response to active anti-tuberculosis treatment. Patients from the Henan Provincial Chest Hospital, Henan, China, with TB symptoms and/or signs were enrolled into this prospective, observational cohort study and followed for 6 months of treatment, with blood and sputum samples collected at 0, 2, 4, 6, 8, 16 and 24 weeks. The QuantiFERON® TB-Gold assay was run on collected blood samples. Participants received a follow-up telephone call at 24 months to determine relapse status. Of the 152 TB patients enrolled, 135 were eligible for this analysis: 118 pulmonary (PTB) and 17 extra-pulmonary TB (EPTB) patients. IFN-γ levels declined significantly over time among all patients (P = 0.002), with this decline driven by PTB patients (P = 0.001), largely during the initial 8 weeks of treatment (P = 0.019). IFN-γ levels did not change among EPTB patients over time or against baseline culture or drug resistance status. After 6 months of effective anti-tuberculosis treatment, IFN-γ levels decreased significantly in PTB patients, largely over the initial 8 weeks of treatment. IFN-γ concentrations may offer some value for monitoring anti-tuberculosis treatment response among PTB patients.

  18. Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia.

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    Fanosie, Alemu; Gelaw, Baye; Tessema, Belay; Tesfay, Wogahta; Admasu, Aschalew; Yitayew, Gashaw

    2016-01-01

    Extrapulmonary Tuberculosis (EPTB) and Human Immunodeficiency Virus (HIV) infection are interrelated as a result of immune depression. The aim of this study was to determine the prevalence of Mycobacterium tuberculosis complex isolates and the burden of HIV co-infection among EPTB suspected patients. An institution based cross-sectional study was conducted among EPTB suspected patients at the University of Gondar Hospital. Socio-demographic characteristics and other clinical data were collected using a pretested questionnaire. GeneXpert MTB/RIF assay was performed to diagnosis Mycobacterium tuberculosis complex and Rifampicin resistance. All samples were also investigated by cytology and culture. The HIV statuses of all patients were screened initially by KHB, and all positive cases were further re-tested by STAT-pack. Data was analyzed using SPSS version 20 computer software and a P-value of tuberculosis infection was 29.8%, but the GeneXpert result showed a 26.2% prevalence of Mycobacterium tuberculosis complex infection. The 78.4% prevalence of extrapulmonary tuberculosis infection was found to be higher among the adult population. The prevalence of HIV infection among EPTB suspected patients was 14.1%, while it was 32.4% among GeneXpert-confirmed extrapulmonary TB cases (12/37). Tuberculosis lymphadenitis was the predominant (78.4%) type of EPTB infection followed by tuberculosis cold abscess (10.7%). Adult hood, previous history of contact with known pulmonary tuberculosis patients, and HIV co-infection showed a statistically significant association with extrapulmonary tuberculosis infection (P<0.013). The prevalence of culture confirmed-EPTB infection was high, and a higher EPTB-HIV co-infection was also observed.

  19. Significance of IFN-ɤ/IL-2 Ratio as a Circulating Diagnostic Biomarker in Extrapulmonary Tuberculosis.

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    Goyal, N; Kashyap, B; Kaur, I R

    2016-05-01

    Extrapulmonary tuberculosis (EPTB) remains a challenging diagnosis both for clinicians and microbiologists. We hypothesized that the profile of IFN-ɤ/IL-2 ratio in clinically diagnosed cases of EPTB would be distinct from that of age- and sex-matched healthy controls. Therefore, in our study, we have assessed the ratio of serum levels of IFN-ɤ and IL-2 in clinically diagnosed cases of EPTB to assess their potential role as diagnostic biomarkers. Sixty-nine (69) clinically confirmed EPTB cases and 69 age- and sex-matched healthy controls were included in the study. All the extrapulmonary specimens were subjected to Ziehl-Neelsen staining for acid-fast bacilli and culture on Lowenstein-Jensen (LJ) medium. Detection of serum levels of IFN-ɤ and IL-2 was carried out using commercially available ELISA kits following manufacturers' instructions. The ratio of serum levels of IFN-ɤ and IFN-ɤ/IL-2 was discriminative for the diagnosis of EPTB cases (p  0.05). Distribution of all biomarkers significantly differed between culture-positive and culture-negative cases (p EPTB, IL-2 has a limited utility in the diagnosis of EPTB. Further elaborate studies to validate these results are required. © 2016 The Foundation for the Scandinavian Journal of Immunology.

  20. Establishing a serologic decision tree model of extrapulmonary tuberculosis by MALDI-TOF MS analysis.

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    Deng, Chuiwen; Lin, Minggui; Hu, Chaojun; Li, Yanfeng; Gao, Yang; Cheng, Xiaoxing; Zhang, Fengchun; Dong, Mei; Li, Yongzhe

    2011-10-01

    Matrix-assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) combined with weak cationic exchange (WCX) magnetic beads was used to establish a decision tree model that distinguished extrapulmonary tuberculosis (EPTB) from non-EPTB individuals. Eight-one patients with EPTB and 112 non-EPTB individuals (72 disease controls and 40 healthy controls) were involved in this study. The model was set up by 5 of 19 differentially expressed peaks (P EPTB from non-EPTB with a sensitivity of 97.7% and a specificity of 84.1%. The test set verified that this model had good sensitivity and specificity: 94.4% and 83.6%, respectively. In conclusion, MALDI-TOF MS combined with WCX magnetic beads is a powerful technology for constructing a decision tree model and the model we built could serve as a potential diagnostic tool for EPTB. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region.

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    Carlos Pérez-Guzmán

    2014-03-01

    Full Text Available Objective. To describe the clinical features of extrapulmonary tuberculosis (EXPTB and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico. Materials and methods. Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed. Results. EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB. One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011. Conclusions. The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.

  2. Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region.

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    Pérez-Guzmán, Carlos; Vargas, Mario H; Arellano-Macías, María del Rosario; Hernández-Cobos, Silvia; García-Ituarte, Aurea Zelindabeth; Serna-Vela, Francisco Javier

    2014-04-01

    To describe the clinical features of extrapulmonary tuberculosis (EXPTB) and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico. Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed. EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB). One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011. The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years) might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.

  3. Increased risk of pulmonary and extra-pulmonary tuberculosis in patients with rheumatic diseases.

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    Lu, M-C; Lai, C-L; Tsai, C-C; Koo, M; Lai, N-S

    2015-12-01

    Impaired immunity in patients with rheumatic diseases can increase the risk of pulmonary tuberculosis (PTB). However, it is less clear whether rheumatic diseases affect the risk of extra-pulmonary tuberculosis (EPTB). To investigate the risk of PTB and EPTB in patients with rheumatic diseases using a population-based database. From Taiwan's National Health Insurance Research Database, 8536 patients with tuberculosis (TB) were frequency-matched with 42,680 controls for sex, 10-year age group and index year. Subjects were retrospectively traced back for their first diagnosis of rheumatic diseases. The association between TB and rheumatic diseases was assessed using multivariate logistic regression analyses. The risk of developing PTB was significantly higher in patients with systemic lupus erythematosus (adjusted odds ratio [aOR] 4.90, P EPTB were significantly higher in RA patients (aOR 4.67, P EPTB were associated with various rheumatic diseases. Rheumatologists should be vigilant to the possibility of TB, and particularly EPTB, in their patients.

  4. National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin.

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    Ade, Serge; Harries, Anthony D; Trébucq, Arnaud; Ade, Gabriel; Agodokpessi, Gildas; Adjonou, Christine; Azon, Sophie; Anagonou, Sévérin

    2014-01-01

    In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB). To describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment. This was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (pEPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.

  5. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007

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    Koroglu Mehmet

    2011-03-01

    Full Text Available Abstract Background Extrapulmonary tuberculosis (EPTB has an increasing rate in Turkey. The reason remains largely unknown. A better understanding of the demographic and microbial characteristics of EPTB in the Turkish population would extend the knowledgebase of EPTB and allow us to develop better strategies to control tuberculosis (TB. Methods We retrospectively evaluated clinical and laboratory data of 397 bacteriologically-confirmed TB cases diagnosed during an eight year-period using by chi-square analysis and multivariate logistic regression model. Results Of the 397 study patients, 103 (25.9% had EPTB and 294 (74.1% had pulmonary tuberculosis (PTB. The most commonly seen two types of EPTB were genitourinary TB (27.2% and meningeal TB (19.4%. TB in bone/joints, pleural cavity, lymph nodes, skin, and peritoneal cavity occurred at a frequency ranging from 9.7% to 10.7%. The age distribution was significantly different (P Conclusions EPTB accounted for a significant proportion of TB cases in Malatya, Turkey between 2001 and 2007. The current study has provided an insight into the dynamics of EPTB in Malatya, Turkey. However, the risk factors for having EPTB in Malatya, Turkey remain to be assessed in future studies using population-based or randomly selected sample.

  6. Extrapulmonary tuberculosis in Lady Reading Hospital Peshawar, NWFP, Pakistan: survey of biopsy results.

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    Ullah, Shafi; Shah, Syed Humayun; Aziz-ur-Rehman; Kamal, Arshad; Begum, Norin; Khan, Ghaazaan

    2008-01-01

    Tuberculosis is a disease of poor countries. In the recent years, there has been an increase in the occurrence of extra-pulmonary tuberculosis (EPTB) world over. As very little data is available regarding the situation of EPTB in NWFP, this study was conducted to asses its frequency in various organ systems of the body and to evaluate the role of demographic factors like sex and age in its causation. A total of 525 cases of EPTB diagnosed histopathologically in the Department of Pathology, Lady Reading Hospital Peshawar in the years 2002-2005 were included in the study. Age, sex and sites of biopsies were recorded. High female preponderance was noted with a M:F ratio of 1:2. Mean age was 35 years and 70% of the patients were in the age group 15-45 years. Lymph nodes were the most common site of EPTB, involved in 66.4% of the cases. EPTB has high rates in females in their reproductive age. Tuberculous lymphadenitis is the most common form of EPTB. High occurrence of EPTB in female population needs immediate attention of tuberculosis control programs.

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

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    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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009.

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    Ducomble, T; Tolksdorf, K; Karagiannis, I; Hauer, B; Brodhun, B; Haas, W; Fiebig, L

    2013-03-21

    Tuberculosis (TB) surveillance commonly focuses on pulmonary (PTB) where the main organ affected is the lung. This might lead to underestimate extrapulmonary TB (EPTB) forms, where in addition to the lung other sites are affected by TB. In Germany, TB notification data provide the main site and the secondary site of disease. To gain an overview of all the different EPTB forms, we analysed German TB notification data between 2002 and 2009 using information on both main and secondary disease site to describe all individual EPTB forms. Further, we assessed factors associated with meningitis using multivariable logistic regression. Solely analysing the main site of disease, lead to one third of EPTB manifestations being overlooked. Case characteristics varied substantially across individual extrapulmonary forms. Of 46,349 TB patients, 422 (0.9%) had meningitis as main or secondary site. Of those, 105 (25%) of the 415 with available information had died. Multivariable analysis showed that meningitis was more likely in children younger than five years and between five and nine years-old (odds ratio (OR): 4.90; 95% confidence interval (CI): 3.40–7.07 and OR: 2.65; 95% CI: 1.40–5.00), in females (OR: 1.42; 95% CI: 1.17–1.73), and in those born in the World Health Organization (WHO) regions of south-east Asia (OR: 2.38; 95% CI: 1.66–3.43) and eastern Mediterranean (OR: 1.51; 95% CI: 1.02–2.23). Overall, EPTB manifestations, including meningitis, which is often fatal, were underestimated by routine analysis. We thus recommend using all information on disease manifestation generated by surveillance to monitor severe forms and to transfer the gained knowledge to TB case management where awareness of EPTB is most important.

  9. Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study

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    Christensen AS

    2014-11-01

    Full Text Available Anne-Sophie Halkjær Christensen,1 Casper Roed,1 Peter H Andersen,2 Åse Bengård Andersen,3 Niels Obel1 1Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, 2Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, 3Department of Infectious Diseases, Odense University Hospital, Odense, Denmark 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 and it was investigated whether mortality was associated with family-related risk factors. Methods: A nationwide cohort study was conducted including: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB, 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included. Results: Overall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77–1.96 for PTB patients and 1.24 (95% CI 1.12–1.37 for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract, liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57–4.91 as did the siblings of the PTB

  10. Epidemiology of extra-pulmonary tuberculosis in Israel, 1999-2010.

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    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.

  11. Time trend and clinical pattern of extrapulmonary tuberculosis in Serbia, 1993-2007

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    Pešut Dragica P.

    2012-01-01

    Full Text Available Background/Aim. Increased incidence of extrapulmonary tuberculosis (XPTB is reported worldwide. Serbia is a country in socio-economic transition period with lowmiddle HIV prevalence and intermediate-to-low tuberculosis (TB incidence rate, 100% directly observed treatment (DOT coverage, and mandatory BCG vaccination at birth. The aim of the study was to examine the incidence trend and clinical features of XPTB in Serbia during a 15-year period. Methods. This retrospective observational study included XPTB cases diagnosed in the period between 1st January 1993 and 31st Decembre 2007, according to the reports of the National Referral Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data. Results. While the overall TB incidence rate showed a slight, not significant decreasing trend (p = 0.535, a significant increase was found for XPTB (y = 1.7996 + 0.089x; R2 = 0.4141; p = 0.01. A total of 2,858 XPTB cases (newly diagnosed and 10% relapses gave an average age specific incidence rate of 2.51/100,000 population (95% confidence interval, SD = 0.6182 with 8.9% annual increase. The male-to-female ratio was 0.54. Lymph nodes were most frequently affected site (48.5% followed by genitourinary (20.5%, pleural (12%, and osseo-arthicular (10.3% TB. Treatment outcome was successful in 88.29% of patients (cured and completed, 3.64% died, 5.18% interrupted, 0.57% displaced, and 2.3% unknown. Conclusion. Increasing trend of XPTB incidence rate may be a result of increased morbidity due to still present risk factors, possible higher detection rate in Serbia and better notification. A high coverage of newborns with BCG vaccination at birth might contribute to a decreased number and rare XPTB cases in children.

  12. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study

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    Verma Sharat C

    2008-01-01

    Full Text Available Abstract Background Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB. However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. Methods A retrospective analysis was carried out on 474 Tuberculosis (TB patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. Results The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages ( Conclusion Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.

  13. Extra-pulmonary tuberculosis: differential aspects and role of 16S-rRNA in urine.

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    Fortún, J; Martín-Dávila, P; Gómez-Mampaso, E; González-García, A; Barbolla, I; Gómez-García, I; Wikman, P; Ortíz, J; Navas, E; Cuartero, C; Gijón, D; Moreno, S

    2014-04-01

    Early diagnosis of extra-pulmonary tuberculosis (EPTB) is important for successful treatment. All cases of EPTB diagnosed at Ramon y Cajal Hospital, Madrid, Spain, from 1997 to 2008 were analysed and compared with pulmonary tuberculosis (PTB) patients to identify differential parameters that could serve to predict the presence of EPTB at initial presentation. Different microbiological techniques were analysed, including amplification of 16S-rRNA in urine. During the study period, 814 cases of TB were diagnosed at our centre; 330 (40.5%) were EPTB. Concomitant PTB was detected in 45% of EPTB cases. The main clinical forms of EPTB were lymphadenitis (86, 26%), miliary TB (60, 18%), and multifocal TB (43, 13%). Variables independently associated with EPTB were human immunodeficiency virus (HIV) infection (OR 3.6, 95%CI 2.4-5.4), older age (>60 years) (OR 3.7, 95%CI 2.5-5.6) and mortality (OR 2.9, 95%CI 1.3-6.3). 16S-rRNA in urine was performed in 82 EPTB patients (25%), among whom a positive result was obtained in 70%; in the PTB group, a positive result was found in 5 of 28 patients (18%) (P EPTB. In this study, mortality was significantly higher in patients with EPTB. A positive 16S-rRNA test result in urine is a useful marker of EPTB.

  14. Extrapulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan.

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    Chandir, Subhash; Chandir, Subash; Hussain, Hamidah; Salahuddin, Naseem; Amir, Mohammad; Ali, Farheen; Lotia, Ismat; Khan, Amir Javed

    2010-02-01

    To describe the types and treatment outcomes of the extra-pulmonary tuberculosis (EPTB) cases in a tertiary care hospital in a high burden tuberculosis country. A retrospective case series study was conducted at Liaquat National Hospital (LNH), the largest private tertiary care hospital in Karachi, Pakistan. All cases diagnosed and treated as EPTB between November 2005 and February 2007 were included. Data was retrieved from medical records on demographics, clinical, laboratory, and outcome status. A total of 194 patients treated for EPTB were identified. Mean age of patients was 34 +/- 16.4 years, and 75% of patients were female. Lymph nodes and spine were the most common sites involved (60%). The cure rate was 40.7%. There was no difference in cure rate of males and females (p=0.99). EPTB is an important clinical problem in Pakistan. Due to lack of guidelines for diagnosis and duration of treatment in EPTB most physicians in Pakistan treat patients based on clinical symptoms and for prolonged duration of 12, to even as long as 24 months. The National TB Program, and chest and infectious disease societies must develop standardized guidelines for the diagnosis and treatment of EPTB.

  15. Therapy duration and long-term outcomes in extra-pulmonary tuberculosis.

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    Pusch, Tobias; Pasipanodya, Jotam G; Hall, Ronald G; Gumbo, Tawanda

    2014-03-01

    Tuberculosis is classified as either pulmonary or extra-pulmonary (EPTB). While much focus has been paid to pulmonary tuberculosis, EPTB has received scant attention. Moreover, EPTB is viewed as one wastebasket diagnosis, as "the other" which is not pulmonary. This is a retrospective cohort study of all patients treated for EPTB in the state of Texas between January 2000 and December 2005, who had no pulmonary disease. Clinical and epidemiological factors were abstracted from electronic records of the Report of Verified Case of Tuberculosis. The long-term outcome, which is death by December 2011, was established using the Social Security Administration Death Master File database. Survival in EPTB patients was compared to those with latent tuberculosis, as well as between different types of EPTB, using Cox proportional hazard models. A hybrid of the machine learning method of classification and regression tree analyses and standard regression models was used to identify high-order interactions and clinical factors predictive of long-term all-cause mortality. Four hundred and thirty eight patients met study criteria; the median study follow-up period for the cohort was 7.8 (inter-quartile range 6.0-10.1) years. The overall all-cause mortality rate was 0.025 (95% confidence interval [CI]: 0.021-0.030) per 100 person-year of follow-up. The significant predictors of poor long-term outcome were age (hazard ratio [HR] for each year of age-at-diagnosis was 1.05 [CI: 1.04-1.06], treatment duration, type of EPTB and HIV-infection (HR = 2.16; CI: 1.22, 3.83). Mortality in genitourinary tuberculosis was no different from latent tuberculosis, while meningitis had the poorest long-term outcome of 46.2%. Compared to meningitis the HR for death was 0.50 (CI: 0.27-0.91) for lymphatic disease, 0.42 (CI: 0.21-0.81) for bone/joint disease, and 0.59 (CI: 0.27-1.31) for peritonitis. The relationship between mortality and therapy duration for each type of EPTB was a unique "V" shaped

  16. Predictors of pulmonary involvement in patients with extra-pulmonary tuberculosis

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    Malak M El-Hazmi

    2012-01-01

    Full Text Available Objectives: The aim of this study is to assess the value of chest radiographs (CXRs and sputum examinations in detecting pulmonary involvement of tuberculosis (TB in patients with extra-pulmonary tuberculosis (EPTB. Materials and Methods: A retrospective analysis was performed among 248 EPTB patients with culture-proven diagnosis of tuberculosis seen between January 2001 and December 2007 at a tertiary teaching hospital, Riyadh, Saudi Arabia. Demographics, clinical, laboratory and radiological findings were reviewed and assessed. This study was approved by the hospital ethics and research committee. Results: One hundred twenty five of 233 EPTB patients (53.6% had abnormal CXR findings. There was a significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings (30/57 and those with normal CXR findings (4/17 (P = 0.04. Of 17 HIV-negative/unknown HIV-status EPTB patients with normal CXR results, 4 patients (23.5% had positive sputum culture results. Intrathoracic lymphadenopathy (P < 0.001, pleural TB (P < 0. 001 and disseminated TB (P = 0.004 were associated with an increased risk of abnormal CXR findings. Patients with cough (52.9%, weight loss (41.2% and night sweats (26.5% are more likely to have positive sputum culture results. Conclusion: CXR findings are predictive of positive sputum culture results. However, the rate of normal CXR among EPTB patients with positive sputum culture results was relatively high. Therefore, respiratory specimen cultures should be obtained in TB suspects with a normal CXR to identify potentially infectious cases of TB.

  17. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007.

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    Gunal, Selami; Yang, Zhenhua; Agarwal, Mansi; Koroglu, Mehmet; Arıcı, Zeynep Kazgan; Durmaz, Riza

    2011-03-08

    Extrapulmonary tuberculosis (EPTB) has an increasing rate in Turkey. The reason remains largely unknown. A better understanding of the demographic and microbial characteristics of EPTB in the Turkish population would extend the knowledgebase of EPTB and allow us to develop better strategies to control tuberculosis (TB). We retrospectively evaluated clinical and laboratory data of 397 bacteriologically-confirmed TB cases diagnosed during an eight year-period using by chi-square analysis and multivariate logistic regression model. Of the 397 study patients, 103 (25.9%) had EPTB and 294 (74.1%) had pulmonary tuberculosis (PTB). The most commonly seen two types of EPTB were genitourinary TB (27.2%) and meningeal TB (19.4%). TB in bone/joints, pleural cavity, lymph nodes, skin, and peritoneal cavity occurred at a frequency ranging from 9.7% to 10.7%. The age distribution was significantly different (PEPTB, with patients older than 45 years tending to have an increased risk of EPTB. Furthermore, the distribution of different types of EPTB differed significantly among age groups (P=0.03). Meningeal and bone and/or joint TB were more commonly observed among the male patients, while lymphatic, genitourinary, and peritoneal TB cases were more frequently seen among females. Unique strain infection was statistically significantly associated with EPTB (OR: 2.82, 95% CI [1.59, 5.00]) EPTB accounted for a significant proportion of TB cases in Malatya, Turkey between 2001 and 2007. The current study has provided an insight into the dynamics of EPTB in Malatya, Turkey. However, the risk factors for having EPTB in Malatya, Turkey remain to be assessed in future studies using population-based or randomly selected sample. © 2011 Gunal et al; licensee BioMed Central Ltd.

  18. Glutaraldehyde test for the rapid diagnosis of pulmonary and extra-pulmonary tuberculosis in an area with high tuberculosis incidence.

    Science.gov (United States)

    Ahmed, Ben Hadj Hassine; Manel, Marzouk; Mohamed, Dhaou; Jalel, Boukadida

    2017-11-01

    Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide. The primary method for controlling TB is the rapid and accurate identification of infected individuals. Immune response exploitation represents one of the main methods used for early TB diagnosis; however, few studies have reported that whole blood originating from TB-infected patients gels faster in the presence of aldehyde than blood originating from healthy subjects, which is the focus of the current study. The study objectives are to determine the diagnostic value of a glutaraldehyde test (GT) in pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) and to assess its performance compared with light-emitting diode fluorescence microscopy (LED-FM). This study included 272 specimens (176 suspected PTB specimens and 96 suspected EPTB specimens). Of the 272 patients, 98 patients had TB infection confirmed by culture (64 PTB cases and 34 EPTB cases), and 174 patients had no TB infection. The gold standard technique (culture) was used as reference to verify the GT's performance. The GT showed a high sensitivity (96.9%) and specificity (82.1%) for PTB with a good positive predictive value (PPV = 75.6%) and negative predictive value (NPV = 97.9%). For EPTB, the GT showed a sensitivity of 91.2% and a specificity of 77.4%, with PPV = 68.9% and NPV = 94.1%. LED-FM had lower sensitivities for PTB (65.6%) and EPTB (42.1%) and an excellent specificity of 100%, with PPV = 100% and NPV = 100%. We concluded that GT is rapid, easy, simple and cost-effective and does not require qualified personnel with a specific background or sophisticated equipment like molecular biology or mycobacterium-specific genotyping techniques. These qualities make the GT attractive for use in low- and high-income countries in addition to other conventional methods, particularly culture, which continues to be the gold standard.

  19. Performance of a pyrosequencing platform in diagnosing drug-resistant extra-pulmonary tuberculosis in India.

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    Georghiou, S B; Ajbani, K; Rodrigues, C; Rodwell, T C

    2016-02-01

    Pyrosequencing diagnostic assays have shown great utility in identifying and characterizing pulmonary drug-resistant tuberculosis (TB) infections. However, the method has yet to be evaluated for the diagnosis of drug-resistant extra-pulmonary TB (EPTB). To evaluate the performance of a pyrosequencing platform in establishing molecular drug resistance profiles for 79 clinical EPTB specimens at a referral center for drug-resistant TB in India. Genotypic drug resistance profiles were established for all 79 non-pulmonary, culture-positive TB clinical specimens. Acid-fast bacilli smear microscopy, MGIT™ 960™ culture and drug susceptibility testing were performed on all specimens for reference. In comparison to MGIT 960, the sensitivity and specificity of pyrosequencing in detecting drug resistance among specimens was found to be respectively 100% and 100%, 67% and 98%, and 100% and 100% for isoniazid, rifampicin, and the fluoroquinolones. No EPTB specimens were phenotypically resistant to any of the injectables, but the specificity of the assay was determined to be 100%, 98%, and 98% for amikacin, kanamycin, and capreomycin. Pyrosequencing is a rapid, appropriate technology for the diagnosis of isoniazid-, fluoroquinolone-, and potentially injectable drug-resistant EPTB clinical specimens, and should be considered as an alternative to conventional growth-based diagnostic methods for EPTB when resistance to these drugs is suspected.

  20. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality.

    Science.gov (United States)

    Magee, M J; Foote, M; Ray, S M; Gandhi, N R; Kempker, R R

    2016-07-01

    Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ⩾16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27·8%) had any EPTB including 258 (19·5%) with only EPTB and 111 (8·4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11·9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1·04, 95% confidence interval (CI) 0·70-1·56]. The risk of death was 23·8% in patients with EPTB and diabetes vs. 9·8% in those with no diabetes (P Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.

  1. Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis.

    Science.gov (United States)

    Guler, Selma Ates; Bozkus, Fulsen; Inci, Mehmet Fatih; Kokoglu, Omer Faruk; Ucmak, Hasan; Ozden, Sevinc; Yuksel, Murvet

    2015-01-01

    It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB. © 2014 S. Karger AG, Basel.

  2. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study.

    Science.gov (United States)

    Sreeramareddy, Chandrashekhar T; Panduru, Kishore V; Verma, Sharat C; Joshi, Hari S; Bates, Michael N

    2008-01-24

    Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12-3.68) and female gender (OR 1.69, 95% CI 1.12-2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB. Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.

  3. High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study.

    Science.gov (United States)

    Sama, J N; Chida, N; Polan, R M; Nuzzo, J; Page, K; Shah, M

    2016-09-01

    The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. We categorised patients as having 'only PTB' (infection in the lung parenchyma), 'EPTB/PTB' (infection in the lung and an additional site), and 'only EPTB' (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin.

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    Serge Ade

    Full Text Available BACKGROUND: In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB. OBJECTIVE: To describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P, the proportion whose bodyweight increased during treatment. MATERIAL AND FINDINGS: This was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001, children <15 years (p<0.001 and HIV-positive patients (p = 0.005 with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001. Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86% patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001 with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0-14.8 while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART. HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03. CONCLUSION: Patients with EPTB generally do well in Bénin, although

  5. National Profile and Treatment Outcomes of Patients with Extrapulmonary Tuberculosis in Bénin

    Science.gov (United States)

    Ade, Serge; Harries, Anthony D.; Trébucq, Arnaud; Ade, Gabriel; Agodokpessi, Gildas; Adjonou, Christine; Azon, Sophie; Anagonou, Sévérin

    2014-01-01

    Background In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB). Objective To describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment. Material and Findings This was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children lymph node tuberculosis accounted for 66% of all EPTB. Children lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0–14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03). Conclusion Patients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients. PMID:24755603

  6. Extrapulmonary tuberculosis. Radiological imaging of an almost forgotten transformation artist; Extrapulmonale Tuberkulose. Die radiologische Bildgebung eines fast vergessenen Verwandlungskuenstlers

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    Heye, T.; Kauczor, H.U.; Horsch, W. [Universitaetsklinikum Heidelberg (Germany). Diagnostische und Interventionelle Radiologie; Stoijkovic, M.; Junghanss, T. [Universitaetsklinikum Heidelberg (Germany). Sektion Klinische Tropenmedizin

    2011-11-15

    Tuberculosis (TB) continues to be one of the infectious diseases with the world's highest rates of avoidable morbidity and mortality. A continuing downward trend has only been observed in highly industrialized countries, including Germany with 4,400 cases in the year 2009 representing an incidence of 5.5 per 100,000 persons. At the same time, the exposure to this patient group and the clinical experience are decreasing. Tuberculosis may affect any organ. The lung was the manifestation site in 80 % of cases, and extrapulmonary manifestations were recorded in 20 % of cases in Germany in the year 2008. Lymph node involvement is most common with a rate of approximately 50 % of all extrapulmonary cases followed by the pleura in 18 % of cases, genitourinary tract in 13 % of cases, bones and joints in 6 % of cases, gastrointestinal tract in 6 % of cases, the central nervous system in 3 % of cases and the spine in 3 % of cases. Symptoms like fever, night sweats and weight loss are non-specific and may be absent. The aim of the review is to raise awareness of this disease, which is increasingly falling into oblivion, with its various radiological manifestations and to point out clinical-epidemiological and demographic factors that raise suspicion of tuberculosis. (orig.)

  7. Glutaraldehyde test for the rapid diagnosis of pulmonary and extra-pulmonary tuberculosis in an area with high tuberculosis incidence

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    Ben Hadj Hassine Ahmed

    Full Text Available BACKGROUND Tuberculosis (TB remains one of the leading causes of morbidity and mortality worldwide. The primary method for controlling TB is the rapid and accurate identification of infected individuals. Immune response exploitation represents one of the main methods used for early TB diagnosis; however, few studies have reported that whole blood originating from TB-infected patients gels faster in the presence of aldehyde than blood originating from healthy subjects, which is the focus of the current study. OBJECTIVES The study objectives are to determine the diagnostic value of a glutaraldehyde test (GT in pulmonary tuberculosis (PTB and extra-pulmonary tuberculosis (EPTB and to assess its performance compared with light-emitting diode fluorescence microscopy (LED-FM. MATERIALS AND METHODS This study included 272 specimens (176 suspected PTB specimens and 96 suspected EPTB specimens. Of the 272 patients, 98 patients had TB infection confirmed by culture (64 PTB cases and 34 EPTB cases, and 174 patients had no TB infection. The gold standard technique (culture was used as reference to verify the GT's performance. RESULTS The GT showed a high sensitivity (96.9% and specificity (82.1% for PTB with a good positive predictive value (PPV = 75.6% and negative predictive value (NPV = 97.9%. For EPTB, the GT showed a sensitivity of 91.2% and a specificity of 77.4%, with PPV = 68.9% and NPV = 94.1%. LED-FM had lower sensitivities for PTB (65.6% and EPTB (42.1% and an excellent specificity of 100%, with PPV = 100% and NPV = 100%. CONCLUSION We concluded that GT is rapid, easy, simple and cost-effective and does not require qualified personnel with a specific background or sophisticated equipment like molecular biology or mycobacterium-specific genotyping techniques. These qualities make the GT attractive for use in low- and high-income countries in addition to other conventional methods, particularly culture, which continues to be the gold standard.

  8. Exploring the sociodemographic and clinical features of extrapulmonary tuberculosis in Saudi Arabia.

    Science.gov (United States)

    Al-Hajoj, Sahal; Shoukri, Mohammed; Memish, Ziad; AlHakeem, Raafat; AlRabiah, Fahad; Varghese, Bright

    2015-01-01

    Saudi Arabia annually reports a relatively higher proportion (28-32%) of extrapulmonary tuberculosis (EPTB) cases in comparison to other global regions. However, there were few studies conducted so far to determine the sociodemographic factors and clinical manifestations associated with EPTB at a nationwide level. A retrospective analysis on culture positive EPTB isolates collected from all the provinces of the country were conducted for a period of 12 months to determine the spectrum of diversity in EPTB infection sites and the confounding factors. A detailed clinical and demographical data analysis was carried out along with first line drug susceptibility testing. Intra-thoracic and extra-thoracic lymph nodes (44.6%) were the most common sites of infection followed by gastrointestinal (17.3%) and central nervous systems (11.8%). Male patients were mostly infected (58.8%), in contrary to the global trend. Any drug resistance was observed in 23.1% isolates with a 2.1% of multi-drug resistance. HIV reactivity was found only in 2.2% cases. A higher proportion of Saudi nationals (58.8%) were infected compared to the immigrants, descending mostly from South Asia (34.4%) and South East Asia (31.2%). The Saudi population predominated with all forms of EPTB while immigrants showed no significant variations. Saudi Arabia faces a serious threat from EPTB, particularly to the central nervous system and gastrointestinal systems. More effective diagnostic strategies and control measures must be implemented to reduce the high rate of EPTB in the country. In addition, these findings warrant further detailed research to explore all related comorbid conditions of EPTB development, particularly the host-related factors.

  9. Exploring the sociodemographic and clinical features of extrapulmonary tuberculosis in Saudi Arabia.

    Directory of Open Access Journals (Sweden)

    Sahal Al-Hajoj

    Full Text Available Saudi Arabia annually reports a relatively higher proportion (28-32% of extrapulmonary tuberculosis (EPTB cases in comparison to other global regions. However, there were few studies conducted so far to determine the sociodemographic factors and clinical manifestations associated with EPTB at a nationwide level.A retrospective analysis on culture positive EPTB isolates collected from all the provinces of the country were conducted for a period of 12 months to determine the spectrum of diversity in EPTB infection sites and the confounding factors. A detailed clinical and demographical data analysis was carried out along with first line drug susceptibility testing.Intra-thoracic and extra-thoracic lymph nodes (44.6% were the most common sites of infection followed by gastrointestinal (17.3% and central nervous systems (11.8%. Male patients were mostly infected (58.8%, in contrary to the global trend. Any drug resistance was observed in 23.1% isolates with a 2.1% of multi-drug resistance. HIV reactivity was found only in 2.2% cases. A higher proportion of Saudi nationals (58.8% were infected compared to the immigrants, descending mostly from South Asia (34.4% and South East Asia (31.2%. The Saudi population predominated with all forms of EPTB while immigrants showed no significant variations.Saudi Arabia faces a serious threat from EPTB, particularly to the central nervous system and gastrointestinal systems. More effective diagnostic strategies and control measures must be implemented to reduce the high rate of EPTB in the country. In addition, these findings warrant further detailed research to explore all related comorbid conditions of EPTB development, particularly the host-related factors.

  10. Segmentation of Extrapulmonary Tuberculosis Infection Using Modified Automatic Seeded Region Growing

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    Nordin Abdul

    2009-01-01

    Full Text Available Abstract In the image segmentation process of positron emission tomography combined with computed tomography (PET/CT imaging, previous works used information in CT only for segmenting the image without utilizing the information that can be provided by PET. This paper proposes to utilize the hot spot values in PET to guide the segmentation in CT, in automatic image segmentation using seeded region growing (SRG technique. This automatic segmentation routine can be used as part of automatic diagnostic tools. In addition to the original initial seed selection using hot spot values in PET, this paper also introduces a new SRG growing criterion, the sliding windows. Fourteen images of patients having extrapulmonary tuberculosis have been examined using the above-mentioned method. To evaluate the performance of the modified SRG, three fidelity criteria are measured: percentage of under-segmentation area, percentage of over-segmentation area, and average time consumption. In terms of the under-segmentation percentage, SRG with average of the region growing criterion shows the least error percentage (51.85%. Meanwhile, SRG with local averaging and variance yielded the best results (2.67% for the over-segmentation percentage. In terms of the time complexity, the modified SRG with local averaging and variance growing criterion shows the best performance with 5.273 s average execution time. The results indicate that the proposed methods yield fairly good performance in terms of the over- and under-segmentation area. The results also demonstrated that the hot spot values in PET can be used to guide the automatic segmentation in CT image.

  11. Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study.

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    Christensen, Anne-Sophie Halkjær; Roed, Casper; Andersen, Peter H; Andersen, Ase Bengård; Obel, Niels

    2014-01-01

    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 and it was investigated whether mortality was associated with family-related risk factors. A NATIONWIDE COHORT STUDY WAS CONDUCTED INCLUDING: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB), 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included. Overall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77-1.96) for PTB patients and 1.24 (95% CI 1.12-1.37) for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57-4.91) as did the siblings of the PTB patients compared with the siblings of population controls (mortality rate ratio 2.16; 95% CI 1.62-2.87). We conclude that adult PTB patients have an almost two-fold increased long-term mortality whereas EPTB patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug

  12. Genotypic, Phenotypic and Clinical Validation of GeneXpert in Extra-Pulmonary and Pulmonary Tuberculosis in India

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    Singh, Urvashi B.; Pandey, Pooja; Mehta, Girija; Bhatnagar, Anuj K.; Mohan, Anant; Goyal, Vinay; Ahuja, Vineet; Ramachandran, Ranjani; Sachdeva, Kuldeep S.; Samantaray, Jyotish C.

    2016-01-01

    Background Newer molecular diagnostics have brought paradigm shift in early diagnosis of tuberculosis [TB]. WHO recommended use of GeneXpert MTB/RIF [Xpert] for Extra-pulmonary [EP] TB; critics have since questioned its efficiency. Methods The present study was designed to assess the performance of GeneXpert in 761 extra-pulmonary and 384 pulmonary specimens from patients clinically suspected of TB and compare with Phenotypic, Genotypic and Composite reference standards [CRS]. Results Comparison of GeneXpert results to CRS, demonstrated sensitivity of 100% and 90.68%, specificity of 100% and 99.62% for pulmonary and extra-pulmonary samples. On comparison with culture, sensitivity for Rifampicin [Rif] resistance detection was 87.5% and 81.82% respectively, while specificity was 100% for both pulmonary and extra-pulmonary TB. On comparison to sequencing of rpoB gene [Rif resistance determining region, RRDR], sensitivity was respectively 93.33% and 90% while specificity was 100% in both pulmonary and extra-pulmonary TB. GeneXpert assay missed 533CCG mutation in one sputum and dual mutation [517 & 519] in one pus sample, detected by sequencing. Sequencing picked dual mutation [529, 530] in a sputum sample sensitive to Rif, demonstrating, not all RRDR mutations lead to resistance. Conclusions Current study reports observations in a patient care setting in a high burden region, from a large collection of pulmonary and extra-pulmonary samples and puts to rest questions regarding sensitivity, specificity, detection of infrequent mutations and mutations responsible for low-level Rif resistance by GeneXpert. Improvements in the assay could offer further improvement in sensitivity of detection in different patient samples; nevertheless it may be difficult to improve sensitivity of Rif resistance detection if only one gene is targeted. Assay specificity was high both for TB detection and Rif resistance detection. Despite a few misses, the assay offers major boost to early

  13. Pregabalin-induced first degree atrioventricular block in a young patient treated for pain from extrapulmonary tuberculosis.

    Science.gov (United States)

    Schiavo, Alessandra; Stagnaro, Francesca M; Salzano, Andrea; Marra, Alberto M; Bobbio, Emanuele; Valente, Pietro; Grassi, Simona; Miniero, Martina; Arcopinto, Michele; Matarazzo, Margherita; Napoli, Raffaele; Cittadini, Antonio

    2017-09-28

    Pregabalin, widely used in the treatment of several pain disorders, is usually well tolerated. Uncommonly, the drug may induce cardiac side effects, rarely prolongation of the PR interval. The latter has never been described in patients with healthy heart or normal renal function. We characterize a unique case of a young man with extrapulmonary tuberculosis and no detectable or known cardiac or kidney diseases, treated with pregabalin to control the severe pain due to the involvement of the spinal cord by the tuberculosis, showing an atrioventricular (AV) block due to pregabalin administration. The reported case emphasizes the need of monitoring PR interval during treatment with pregabalin, even in patients without background of cardiac or renal diseases.

  14. Evaluation of polymerase chain reaction using primer MPB 64 for diagnosis of clinically suspected cases of extrapulmonary tuberculosis

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    Dnyaneshwari P. Ghadage

    2014-01-01

    Full Text Available Background: Pulmonary tuberculosis can be easily diagnosed by simple techniques such as microscopy. However, extrapulmonary tuberculosis (EPTB often presents a diagnostic dilemma. Microscopy and culture have proved to be insensitive techniques for diagnosis of EPTB. There is an urgent need for rapid and sensitive diagnostic methods. Aim: The present study was conducted to evaluate the role of polymerase chain reaction (PCR in the early diagnosis of clinically suspected cases of EPTB. Materials and Methods: A total of 80 clinical specimens comprising pleural fluid, cerebrospinal fluid, ascitic fluid, fine-needle aspiration biopsy, and pus and biopsy from clinically suspected EPTB cases were processed and followed up by conventional methods and PCR using MPB64 primer. Results: Tuberculous pleural effusion (71% was found to be the most common clinical presentation of EPTB. Overall, PCR could detect EPTB in 61.2% cases. Microscopy and culture could detect 18.7% and 22.5% EPTB cases, respectively. PCR was positive in all tissue samples suggestive of tuberculosis on histopathological examination. Of the 62 EPTB patients who responded to antituberculosis treatment (ATT, 49 patients were PCR positive. Conclusion: PCR using MPB64 had a significant advantage over the conventional methods to detect the presence of M. tuberculosis in specimens of clinically suspected EPTB patients for early diagnosis of tuberculosis.

  15. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens.

    Science.gov (United States)

    Zeka, Arzu N; Tasbakan, Sezai; Cavusoglu, Cengiz

    2011-12-01

    Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. The rapid diagnosis of tuberculosis and detection of rifampin (RIF) resistance are essential for early disease management. The GeneXpert MTB/RIF assay is a novel integrated diagnostic device for the diagnosis of tuberculosis and rapid detection of RIF resistance in clinical specimens. We determined the performance of the MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in smear-positive and smear-negative pulmonary and extrapulmonary specimens obtained from possible tuberculosis patients. Two hundred fifty-three pulmonary and 176 extrapulmonary specimens obtained from 429 patients were included in the study. One hundred ten (89 culture positive and 21 culture negative for M. tuberculosis) of the 429 patients were considered to have tuberculosis. In pulmonary specimens, sensitivities were 100% (27/27) and 68.6% (24/35) for smear-positive and smear-negative specimens, respectively. It had a lower sensitivity with extrapulmonary specimens: 100% for smear-positive specimens (4/4) and 47.7% for smear-negative specimens (21/44). The test accurately detected the absence of tuberculosis in all 319 patients without tuberculosis studied. The MTB/RIF assay also detected 1 RIF-resistant specimen and 88 RIF-susceptible specimens, and the results were confirmed by drug susceptibility testing. We concluded that the MTB/RIF test is a simple method, and routine staff with minimal training can use the system. The test appeared to be as sensitive as culture with smear-positive specimens but less sensitive with smear-negative pulmonary and extrapulmonary specimens that include low numbers of bacilli.

  16. Modeling the impact of novel diagnostic tests on pediatric and extrapulmonary tuberculosis.

    Science.gov (United States)

    Denkinger, Claudia M; Kampmann, Beate; Ahmed, Syed; Dowdy, David W

    2014-09-03

    Extrapulmonary tuberculosis (EPTB) and most pediatric TB cannot be diagnosed using sputum-based assays. The epidemiological impact of different strategies to diagnose EPTB and pediatric TB is unclear. We developed a dynamic epidemic model of TB in a hypothetical population with epidemiological characteristics similar to India. We evaluated the impact of four alternative diagnostic test platforms on adult EPTB and pediatric TB mortality over 10 years: (1) Nucleic acid amplification test optimized for diagnosis of EPTB ("NAAT-EPTB"); (2) NAAT optimized for pediatric TB ("NAAT-Peds"); (3) more deployable NAAT for sputum-based diagnosis of adult pulmonary TB ("point-of-care (POC) sputum NAAT"); and (4) more deployable NAAT capable of diagnosing all forms of TB using non-invasive, non-sputum specimens ("POC non-sputum NAAT"). NAAT-EPTB lowered adult EPTB mortality by a projected 7.6% (95% uncertainty range [UR]: 6.5-8.8%). NAAT-Peds lowered pediatric TB mortality by 6.8% (UR: 4.9-8.4%). POC sputum NAAT, though only able to diagnose pulmonary TB, reduced projected pediatric TB deaths by 13.3% (UR: 4.6-15.7%) and adult EPTB deaths by 8.4% (UR 2.0-9.3%) simply by averting transmission of disease. POC non-sputum NAAT had the greatest effect, lowering pediatric TB mortality by 34.7% (UR: 26.8-38.7), and adult EPTB mortality by 38.5% (UR: 30.7-41.2). The relative impact of a POC sputum NAAT (i.e., enhanced deployability) versus NAAT-EPTB (i.e., enhanced ability to specifically diagnose TB-NSP) on adult EPTB mortality depends most strongly on factors that influence transmission, with settings of higher transmission (e.g., higher per-person transmission rate, lower diagnostic rate) favoring POC sputum NAAT. Although novel tests for pediatric TB and EPTB are likely to reduce TB mortality, major reductions in pediatric and EPTB incidence and mortality also require better diagnostic tests for adult pulmonary TB that reach a larger population.

  17. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need

    OpenAIRE

    Purohit, Manju; Mustafa, Tehmina

    2015-01-01

    During the last decade, remarkable progress has been made in the diagnostics of pulmonary tuberculosis; however, diagnostic challenges in extra-pulmonary tuberculosis (EPTB) remain to be addressed. Diagnosis of EPTB is difficult due to the pauci-bacillary nature of disease, the variable clinical presentation, and need for invasive procedures to secure appropriate sample, and lack of laboratory facilities in the resource-limited settings. A more accurate test to diagnose various forms of EPTB,...

  18. API TB Consensus Guidelines 2006: Management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations.

    Science.gov (United States)

    2006-03-01

    The World Health Organization (WHO) has declared Tuberculosis (TB) a global emergency in 1993. Prevalence of TB and Human Immunodeficiency Virus (HIV) co-infection worldwide is 0.18% and about 8% TB cases have HIV infection. Effective chemotherapy has been available for treatment of TB for over 50 years now. In World Health Organization (WHO)-International Union Against Tuberculosis and Lung Disease (IUATLD) Working Group Global Anti-Tuberculosis Drug Resistance Surveillance (1994-1997), the incidence of MDR TB in Delhi was found to be 14%, of which primary multi-drug resistance was only 1.4%, indicating that most of MDR TB is acquired as a result of poor chemotherapy. Since TB is an infectious disease caused by Mycobacterium (M) tuberculosis the diagnosis of TB should (as far as possible) be by demonstration of M. tuberculosis on culture or acid-fast bacilli (AFB) on smear examination. The World Health Organization (WHO) has strongly recommended sputum smear examination as the preferred screening test and suggests examination of 3 deeply coughed out sputum samples - spot sample on day 1, overnight sample and a spot sample in the morning on day 2. Recently it has been shown that sputum smear positivity is greater than 90% where greater than 5 ml of sputum is used for smear diagnosis of pulmonary TB. Culture of M. tuberculosis is the gold standard for diagnosis of TB. Culture of mycobacteria is a much more sensitive test than smear examination and has been estimated to detect 10-100 viable mycobacteria per ml of sample and in case of active disease they are found to be 81% sensitive and 98.5% specific. Culture methods are also required for further drug sensitivity testing in cases of suspected drug resistant cases. Isoniazid and rifampicin resistance can be reliably measured; resistance to pyrazinamide, ethambutol, and streptomycin is more difficult due to limitations of technique. The therapeutic index for a given drug is low for certain second-line drugs such as

  19. Evaluation of molecular detection of extrapulmonary tuberculosis and resistance to rifampicin with GeneXpert® MTB/RIF.

    Science.gov (United States)

    Marouane, C; Smaoui, S; Kammoun, S; Slim, L; Messadi-Akrout, F

    2016-02-01

    We aimed to evaluate the GeneXpert® MTB/RIF test for the diagnosis of extrapulmonary tuberculosis. The test simultaneously detects Mycobacterium tuberculosis complex and resistance to rifampicin. We analyzed 153 clinical samples collected in a tertiary hospital in Sfax, Tunisia, between 2013 and 2014. We performed the GeneXpert® test, a Ziehl-Neelsen and auramine-rhodamine staining, conventional culture on MGIT 960 and LJ media, and we tested the resistance to anti-tuberculosis drugs on MGIT 960 and LJ media for each sample. Diagnosis was based on clinical, radiological, microbiological, pathological, and therapeutic data. We considered that 59 patients out of 153 presented with tuberculosis. PCR was positive in 50 samples and all of these samples were susceptible to rifampicin. Sensitivity, specificity, positive predictive value, and negative predictive value of the GeneXpert® test were 84.7%, 96.8%, 94.3%, and 91%, respectively, compared with diagnosis. We observed a statistically significant difference between the direct test and the GeneXpert® test, and between culture and the GeneXpert® test. No statistically significant difference was observed between pathological results and the GeneXpert® test. Sensitivity of the GeneXpert® test was 87.5% in biopsies, 80% in pus and abscesses, and 66.7% in biological fluids. All strains were susceptible to rifampicin with culture and GeneXpert® test. The GeneXpert® test helped detect a higher proportion of M. tuberculosis complex. It does not replace conventional diagnostic methods but it is a useful addition to achieve better sensitivity and obtain rapid results. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Evaluation of an immunochromatographic test for discrimination between Mycobacterium tuberculosis complex & non tuberculous mycobacteria in clinical isolates from extra-pulmonary tuberculosis.

    Science.gov (United States)

    Maurya, Anand Kumar; Nag, Vijaya Lakshmi; Kant, Surya; Kushwaha, Ram Aawadh Singh; Kumar, Manoj; Mishra, Vikas; Rahman, W; Dhole, Tapan N

    2012-06-01

    Accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of the patients, and to reduce its spread. Clinical presentation of Mycobacterium tuberculosis complex (MTBC) and non tuberculous mycobacteria (NTM) may or may not be the same, but the treatment regimen is always different for both the infections. Differentiation between MTBC and NTM by routine laboratory methods is time consuming and cumbersome. This study was aimed to evaluate an immunochromatographic test (ICT), based on mouse monoclonal anti-MPT64, for simple and rapid discrimination between MTBC and NTM in clinical isolates from extra-pulmonary tuberculosis cases. A total of 800 clinical samples were collected from patients suspected to have extra-pulmonary tuberculosis. Preliminary diagnosis has been done by direct Ziehl-Neelsen (ZN) staining followed by culture in BACTEC system. A total of 150 clinical isolates, which were found positive in BD 460 TB system during September 2009 to September 2010 were selected for the screening by ICT test. p-nitro-α-acetylamino- β-hydroxy propiophenone (NAP) test was performed for differentiation of MTBC and NTM. M. tuberculosis complex was further confirmed by IS6110 PCR of BACTEC culture positive isolates, this served as the reference method for MTBC identification and comparative evaluation of the ICT kit. Of the 150 BACTEC culture positive isolates tested by ICT kit, 101 (67.3%) were found positive for MTBC and remaining 49 (32.7%) were considered as NTM. These results were further confirmed by IS6110 PCR that served as the reference method for detection of MTBC. H 37 Rv reference strain was taken as a control for ICT test and IS6110 PCR. The reference strain showed the presence of MPT64 antigen band in the ICT test. Similar bands were formed in 101 of 102 MTBC isolates tested, proving 99.1 per cent sensitivity and no bands were detected in 48 (100%) NTM isolates tested, proving 100 per cent specificity of the ICT kit. Our findings show

  1. Comparative Evaluation of Several Gene Targets for Designing a Multiplex-PCR for an Early Diagnosis of Extrapulmonary Tuberculosis.

    Science.gov (United States)

    Raj, Ankush; Singh, Netrapal; Gupta, Krishna B; Chaudhary, Dhruva; Yadav, Aparna; Chaudhary, Anil; Agarwal, Kshitij; Varma-Basil, Mandira; Prasad, Rajendra; Khuller, Gopal K; Mehta, Promod K

    2016-01-01

    Diagnosis of extrapulmonary tuberculosis (EPTB) poses serious challenges. A careful selection of appropriate gene targets is essential for designing a multiplex-polymerase chain reaction (M-PCR) assay. We compared several gene targets of Mycobacterium tuberculosis, including IS6110, devR, and genes encoding MPB-64 (mpb64), 38kDa (pstS1), 65kDa (hsp65), 30kDa (fbpB), ESAT-6 (esat6), and CFP-10 (cfp10) proteins, using PCR assays on 105 EPTB specimens. From these data, we chose the two best gene targets to design an M-PCR. Among all gene targets tested, mpb64 showed the highest sensitivity (84% in confirmed cases and 77.5% in clinically suspected cases), followed by IS6110, hsp65, 38kDa, 30kDa, esat6, cfp10, and devR. We used mpb64+IS6110 for designing an M-PCR assay. Our M-PCR assay demonstrated a high sensitivity of 96% in confirmed EPTB cases and 88.75% in clinically suspected EPTB cases with a high specificity of 100%, taking clinical diagnosis as the gold standard. These M-PCR results along with the clinical findings may facilitate an early diagnosis of EPTB patients and clinical management of disease.

  2. Commercial Serological Tests for the Diagnosis of Active Pulmonary and Extrapulmonary Tuberculosis: An Updated Systematic Review and Meta-Analysis

    Science.gov (United States)

    Steingart, Karen R.; Flores, Laura L.; Dendukuri, Nandini; Schiller, Ian; Laal, Suman; Ramsay, Andrew; Hopewell, Philip C.; Pai, Madhukar

    2011-01-01

    Background Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries. Methods and Findings We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%–87%) in smear-positive (seven studies) and 59% (95% CI 10%–96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%–98%) and 91% (95% CI 79%–96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%–65%]; pooled specificity 98% [95% CI 96%–99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%–64%) and comparable pooled specificity (98%, 95% CI 94%–99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB. Conclusions Despite expansion of the literature since 2006

  3. Prevalence and determinants of extrapulmonary involvement in patients with pulmonary tuberculosis in a Sub-Saharan African country: a cross-sectional study.

    Science.gov (United States)

    Yone, Eric Walter Pefura; Kengne, André Pascal; Moifo, Boniface; Kuaban, Christopher

    2013-02-01

    Determinants of extrapulmonary involvement during pulmonary tuberculosis (PTB) have not been extensively investigated. We assessed the prevalence and determinants of extrapulmonary involvement during PTB in a Sub-Saharan African country with a high prevalence of both TB and human immunodeficiency virus (HIV) infection. The medical records of patients aged ≥ 15 y, admitted for a first episode of TB to the Pneumology Service of Yaoundé Jamot Hospital, Cameroon, between 2009 and 2010 were considered. Determinants of extrapulmonary involvement were investigated through logistic regression. A total of 984 patients (58.9% male), with a median age (25(th)-75(th) percentiles) of 32 (25-41) y were admitted for a first episode of TB, including 629 (63.9%) with isolated PTB, 127 (12.9%) with isolated extrapulmonary TB (EPTB), and 228 (23.2%) with both PTB and EPTB (PTB/EPTB). Therefore, the prevalence of EPTB among those with PTB was 26.6% (228/857). The main determinants of EPTB among patients with PTB were male sex (adjusted odds ratio (OR) 2.71, 95% confidence interval (95% CI) 1.71-4.03), HIV infection (OR 2.20, 95% CI 1.36-3.55), absence of fibrotic lung lesions (OR 1.96, 95% CI 1.23-3.14), smear-negative PTB (OR 7.20, 95% CI 4.13-12.56), anaemia (OR 1.60, 95% CI 1.03-2.50), and leukopenia (OR 2.59, 95% CI 1.12-5.98). About a quarter of patients with PTB in this setting also have extrapulmonary involvement. EPTB is less contagious, less frequent than PTB, and less well addressed by programs in developing countries, while its identification is important for optimizing care. The presence of determinants of EPTB among patients with PTB should motivate active investigation of extrapulmonary involvement in order to improve management.

  4. A high prevalence of culture-positive extrapulmonary tuberculosis in a large Dutch teaching hospital

    NARCIS (Netherlands)

    D.A. Hesselink (Dennis); S.M. Yoo; G.T. Verhoeven; J.W. Brouwers; F.J. Smit (Frank); J.L.C.M. van Saase (Jan)

    2003-01-01

    textabstractBACKGROUND: In the Netherlands the incidence of tuberculosis (TB) has increased during the last decade. Growing immigration and international travel were important determining factors. To determine if this has resulted in altered clinical manifestations of the disease,

  5. Point-of-Care Ultrasound for Extrapulmonary Tuberculosis in India: A Prospective Cohort Study in HIV-Positive and HIV-Negative Presumptive Tuberculosis Patients.

    Science.gov (United States)

    Weber, Stefan F; Saravu, Kavitha; Heller, Tom; Kadavigere, Rajagopal; Vishwanath, Shashidhar; Gehring, Stephan; Bélard, Sabine; And Pocus Eti Study Group

    2017-10-16

    Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Point-of-care ultrasound (POCUS) for human immunodeficiency virus (HIV)-associated EPTB is applied in sub-Saharan Africa. This study aimed at evaluating the applicability of POCUS for diagnosing EPTB in HIV-positive and HIV-negative presumptive tuberculosis (TB) patients in India, a country of moderate relative TB and HIV burden. Presumptive TB patients at Kasturba Hospital, Manipal, India, prospectively underwent POCUS evaluating for pericardial, pleural and ascitic effusion, abdominal lymphadenopathy, and hepatic and splenic microabscesses. Findings were correlated with TB category (confirmed TB, clinical TB, unlikely TB), HIV status, and discharge diagnoses. A total of 425 patients underwent POCUS; 81 (20%) were HIV-positive. POCUS findings were more common in HIV/TB coinfected patients than in HIV-positive patients with unlikely TB (24/40 (60%) versus 9/41 (22%), P EPTB. In HIV-negative patients, POCUS detected features associated with EPTB but also of malignancy and other infectious diseases.

  6. Similar seasonal peak in clustered and unique extra-pulmonary tuberculosis notifications: winter crowding hypothesis ruled out?

    Science.gov (United States)

    Top, R; Boshuizen, H; Dekkers, A; Korthals Altes, H

    2013-11-01

    The incidence of extra-pulmonary tuberculosis (EPTB) in the Netherlands shows a seasonal trend, with a peak in spring and a trough in autumn. Possible causes of this peak are winter crowding and a seasonal decrease in immune competence in spring. A third explanation may be a reporting bias. To investigate the role of winter crowding by a time-series analysis of notification data. DNA fingerprinting clustering status can differentiate between recent and remote infections. Seasonality in clustered cases would reflect enhanced transmission in winter and/or seasonally lowered immunity, while seasonality in unique cases would only reflect seasonally lowered immunity. We fitted (seasonal) auto-regressive moving average models to culture-positive TB notifications in the Netherlands (1993-2008) to assess seasonality. We then used seasonal trend Loess decompositions to derive the seasonal pattern, and compared the heights of the seasonal peaks. Clustered and unique EPTB notifications showed a seasonal trend that was absent in clustered and unique PTB notifications. The seasonal peak in clustered EPTB cases was not significantly higher than in unique EPTB cases. The similar timing and height of the seasonal peak of clustered and unique EPTB cases suggests that winter crowding is unlikely to cause the seasonal trend in notifications.

  7. Risk factors for false-negative results of T-SPOT.TB and tuberculin skin test in extrapulmonary tuberculosis.

    Science.gov (United States)

    Lee, Y-M; Park, K-H; Kim, S-M; Park, S J; Lee, S-O; Choi, S-H; Kim, Y S; Woo, J H; Kim, S-H

    2013-12-01

    T-SPOT.TB, a recently developed T cell-based assay, has shown promise in diagnosing extrapulmonary tuberculosis (EPTB). However, a limited number of reports have compared the risk factors for false-negative results of tuberculin skin tests (TSTs) and T-SPOT.TB assays in patients with EPTB. We, thus, conducted a prospective, blinded, observational study to evaluate the risk factors for false-negative T-SPOT.TB and TST results in patients with EPTB. Between April 2008 and November 2011, all adult patients with suspected EPTB were prospectively enrolled at Asan Medical Center, Seoul, South Korea (an intermediate TB-burden country). Only patients with confirmed and probable EPTB who underwent TST and T-SPOT.TB were included in the final analysis. Of the 324 patients who underwent both TST and T-SPOT.TB testing, 128 patients with 96 (75 %) culture- or polymerase chain reaction (PCR)-confirmed and 32 (25 %) probable EPTB were finally analyzed. T-SPOT.TB assays were less likely to yield false-negative results than TSTs [17 % (22/128) vs. 54 % (69/128), p EPTB than TST, especially in patients with immunosuppression or miliary TB.

  8. Secretion of IFN-γ Associated with Galectin-9 Production by Pleural Fluid Cells from a Patient with Extrapulmonary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Jingge Zhao

    2017-06-01

    Full Text Available In this study, we investigated the role of a matricellular protein galectin-9 (Gal-9 in pleural effusion related to tuberculosis (TB. Plasma and pleural fluid of a patient with extrapulmonary TB were analyzed for cytokine content by ELISA and Luminex. Peripheral blood mononuclear cells (PBMCs and pleural fluid cells (PFCs were examined for interferon-γ (IFN-γ secretion by the enzyme-linked immunospot (ELISPOT assay or IFN-γ ELISA, for apoptosis and necrosis by Cell Death Detection ELISA, and also underwent cell sorting. The results indicate that compared to plasma, pleural fluid had increased levels of IFN-γ (1.6 vs. 55.5 pg/mL, IL-10, IL-12p40, vascular endothelial growth factor (VEGF, and Gal-9 (3.0 vs. 936.0 pg/mL, respectively. PFCs culture supernatant exhibited higher concentration of Gal-9 compared to PBMCs in culture, consistent with enriched Gal-9 staining in the granuloma that is in closer vicinity to PFCs compared to PBMCs. PFCS displayed higher IFN-γ secretion after stimulation with TB antigens ESAT-6/CFP-10. Furthermore, in PFCs, Gal-9 alone could stimulate IFN-γ synthesis in culture or ELISPOT, which was inhibited by a Gal-9 antagonist lactose, and which may promote apoptosis and necrosis. These findings suggest that Gal-9 could modulate immune responses and participate in immunopathology of pleural effusion during TB.

  9. Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006-2011.

    Science.gov (United States)

    Wang, Xiaoqing; Yang, Zhenhua; Fu, Yanyong; Zhang, Guoqin; Wang, Xu; Zhang, Yuhua; Wang, Xiexiu

    2014-01-01

    The proportion of extrapulmonary tuberculosis (EPTB) among all the reported tuberculosis (TB) cases has increased in different populations. Despite the large burden of TB in China, the epidemiology of EPTB in China remains largely understudied and the risk factors for having EPTB diagnosis in China have not been identified. To gain insight to EPTB epidemiology in China, we analyzed TB surveillance data collected in Tianjin, China, during 2006 to 2011. The frequency of EPTB among all TB cases and within different socio-demographic groups of the study patients aged 15 years and older was determined for EPTB in general and by specific types. The distribution of socio-demographic characteristics was compared between pulmonary TB (PTB) group and EPTB group by chi-square test. Crude and multiple logistic regression-derived adjusted odds ratios (aOR) and 95% confidence intervals (CI) were determined to assess the associations between having EPTB diagnosis and each individual explanatory variable in question. About one-tenth (1,512/14,561) of the patients investigated in this study had EPTB. Of these 1,512 EPTB cases, about two thirds were pleural TB. Significant difference in age, occupation, and urbanity of residence were found between PTB and EPTB groups (pEPTB diagnosis were more likely to be 65 years or older (aOR = 1.22, 95% CI: 1.02, 1.46), to be retired (aOR = 1.37, 95% CI: 1.08, 1.75), and to live in urban areas (aOR = 1 38, 95% CI: 1.22, 1.55). The findings of this study extends the knowledgebase of EPTB epidemiology in developing countries and highlight the need for improved EPTB detection in China, especially in subpopulations with high risk for EPTB or having limited access to medical facilities with adequate capacity for EPTB diagnosis.

  10. Diagnostic Accuracy of Xpert MTB/RIF for Extrapulmonary Tuberculosis Specimens: Establishing a Laboratory Testing Algorithm for South Africa

    Science.gov (United States)

    Beylis, Natalie; Nicol, Mark; Nkuna, Gloria; Molapo, Sebaka; Berrie, Leigh; Duse, Adriano; Stevens, Wendy Susan

    2014-01-01

    South Africa implemented Xpert MTB/RIF as the initial diagnostic test for pulmonary tuberculosis (TB). Xpert MTB/RIF's accuracy for diagnosing extrapulmonary tuberculosis (EPTB) was investigated. EPTB specimens (n = 7,916) from hospitalized patients received over a 6-month period at a high-throughput TB referral laboratory in Johannesburg were investigated. Large-volume specimens were centrifuged, tissue biopsy specimens homogenized, and all specimens checked for growth of contaminating bacteria on blood agar. Contaminated samples received NALC-NaOH (N-acetyl-l-cysteine–sodium hydroxide) decontamination prior to liquid culture. Residual specimens (volumes > 1 ml) after inoculation of culture (n = 1,175) were tested using the Xpert MTB/RIF sputum protocol. Using culture as the reference, Xpert MTB/RIF's overall sensitivity was 59% (95% confidence interval [95% CI], 53% to 65%) and specificity was 92% (CI, 90% to 94%), with the highest sensitivities of 91% (95% CI, 78% to 97%) for pus, 80% (95% CI, 56% to 94%) for lymph node aspirates, and 51% (95% CI, 44% to 58%) for fluids (ascitic, 59%; pleural, 47%). A difference in sensitivities was noticed between specimens classified as having a thick (87% [95% CI, 76% to 94%]) versus clear (watery) (48% [95% CI, 36% to 61%]) appearance. This was unchanged with traces of blood (52% [95% CI, 44% to 60%]) or precentrifugation (57% [95% CI, 28% to 82%]) among clear specimens. Xpert MTB/RIF generated an additional 124 specimen results that were contaminated by Mycobacterial Growth Indicator Tubes (MGIT; 10.5%) and diagnosed rifampin (RIF) resistance earlier (9.6% [25/260]). Xpert MTB/RIF's performance on EPTB specimens provides very promising results and should be considered for incorporation into national TB guidelines. Xpert MTB/RIF is less affected by contaminating bacteria and reduces laboratory labor and diagnostic delay compared to traditional methods. PMID:24622091

  11. Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006-2011.

    Directory of Open Access Journals (Sweden)

    Xiaoqing Wang

    Full Text Available The proportion of extrapulmonary tuberculosis (EPTB among all the reported tuberculosis (TB cases has increased in different populations. Despite the large burden of TB in China, the epidemiology of EPTB in China remains largely understudied and the risk factors for having EPTB diagnosis in China have not been identified.To gain insight to EPTB epidemiology in China, we analyzed TB surveillance data collected in Tianjin, China, during 2006 to 2011. The frequency of EPTB among all TB cases and within different socio-demographic groups of the study patients aged 15 years and older was determined for EPTB in general and by specific types. The distribution of socio-demographic characteristics was compared between pulmonary TB (PTB group and EPTB group by chi-square test. Crude and multiple logistic regression-derived adjusted odds ratios (aOR and 95% confidence intervals (CI were determined to assess the associations between having EPTB diagnosis and each individual explanatory variable in question.About one-tenth (1,512/14,561 of the patients investigated in this study had EPTB. Of these 1,512 EPTB cases, about two thirds were pleural TB. Significant difference in age, occupation, and urbanity of residence were found between PTB and EPTB groups (p<0.05. Patients with EPTB diagnosis were more likely to be 65 years or older (aOR = 1.22, 95% CI: 1.02, 1.46, to be retired (aOR = 1.37, 95% CI: 1.08, 1.75, and to live in urban areas (aOR = 1 38, 95% CI: 1.22, 1.55.The findings of this study extends the knowledgebase of EPTB epidemiology in developing countries and highlight the need for improved EPTB detection in China, especially in subpopulations with high risk for EPTB or having limited access to medical facilities with adequate capacity for EPTB diagnosis.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis.

    Science.gov (United States)

    Fan, Lin; Chen, Zhou; Hao, Xiao-Hui; Hu, Zhong-Yi; Xiao, He-Ping

    2012-08-01

    Interferon -gamma release assays (IGRAs) provide a new diagnostic method for Mycobacterium tuberculosis (TB) infection. However, the diagnostic value of IGRAs for extrapulmonary TB (EPTB) has not been clarified. We searched several databases and selected papers with strict inclusion criteria, evaluated the evidence of commercially available IGRAs (QuantiFERON(®) -TB Gold QFT-G or QFT-GIT and T-SPOT(®) .TB) on blood and the tuberculin skin test (TST) using random effects models. Twenty studies with 1711 patients were included. After excluding indeterminate results, pooled sensitivity for the diagnosis of EPTB was 72% [95% confidence interval (CI) 65-79%] for QFT-G or GIT and 90% (95% CI, 86-93%) for T-SPOT; in high-income countries the sensitivity of QFT-G or GIT (79%, 95% CI 72-86%) was much higher than that (29%, 95% CI 14-48%) in low/middle-income countries. Pooled specificity for EPTB was 82% (95% CI 78-87%) for QFT-G or GIT and 68% (95% CI 64-73%) for T-SPOT. Pooled sensitivity of TST from four studies in high-income countries was lower than that of IGRAs. T-SPOT was more sensitive in detecting EPTB than QFT-G or GIT and TST. However, both IGRAs and TST have similar specificity for EPTB. IGRAs have limited value as diagnostic tools to screen and rule out EPTB, especially in low/middle-income countries. The immune status of patients does not affect the diagnostic accuracy of IGRAs for EPTB. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

  14. Imaging characteristics of extrapulmonary tuberculosis lesions on dual time point imaging (DTPI) of FDG PET/CT.

    Science.gov (United States)

    Razak, Hairil Rashmizal Abdul; Geso, Moshi; Abdul Rahim, Noraini; Nordin, Abdul Jalil

    2011-12-01

    This study aimed to evaluate the diagnostic value of dual time point imaging (DTPI) of 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT) for detecting the infective lesions in patients with extrapulmonary tuberculosis (EPTB). Eleven patients were consecutively recruited and evaluated. After the intravenous injection of 369 ± 153 MBq of FDG, all patients underwent FDG PET/CT imaging at two different time points: early scan at 57 ± 23 min and delayed scan at 136 ± 42 min. The maximum standardized uptake values (SUVmax) were recorded for both time points (early scan: SUVmax1 and delayed scan: SUVmax2). In total, 30 lesions were detected. The SUVmax2 in 22 of the lesions in confirmed EPTB patients were significantly higher than the SUVmax1 (7.9 ± 3.2 vs. 6.8 ± 2.5; P = 0.001). The SUVmax for another eight non-EPTB lesions also showed a significant increasing pattern of change (6.2 ± 2.6 vs. 6.5 ± 2.8; P = 0.044). However, there was insignificant difference between the mean percentage difference of SUVmax (%ΔSUVmax) of EPTB and non-EPTB lesions (P = 0.06). Our study demonstrates that early whole body PET/CT imaging may be sufficient for the detection of the EPTB lesions and DTPI of PET/CT may also not be a useful technique in differentiating between EPTB and non-EPTB lesions. However, our findings are based on a limited number of patients, and therefore, further investigations in larger series of patients are warranted. © 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.

  15. Comparative evaluation of IS6110 PCR via conventional methods in rapid diagnosis of new and previously treated cases of extrapulmonary tuberculosis.

    Science.gov (United States)

    Maurya, Anand Kumar; Kant, Surya; Nag, Vijaya Lakshmi; Kushwaha, Ram Awadh Singh; Kumar, Manoj; Dhole, Tapan N

    2011-01-01

    In developing countries the diagnosis of extrapulmonary tuberculosis (EPTB) is a major burning challenge. EPTB encounters many problems like pauci-bacillary nature, inadequate specimen volume. All the limitations reflect in the poor contribution of conventional bacteriological technique in the establishment of diagnosis of EPTB. Nucleic acid amplification methods are rapid and sensitive has modified strategies for the detection of mycobacterial DNA. A fragment of DNA of 123 bp belonging to insertion sequence IS6110 based on specific gene of Mycobacterium tuberculosis complex was amplified by polymerase chain reaction (PCR) for the rapid diagnosis of EPTB. The present study was to comparative evaluation of IS6110 PCR via conventional methods in the rapid diagnosis of new and Previously treated cases of extra pulmonary tuberculosis. Four hundred fifty specimens were collected from suspected cases of EPTB were processed for Mycobacteria by Zeihl Neelson (ZN) staining and BACTEC culture for M. tuberculosis. All the specimens were also processed for IS6110 based PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of M. tuberculosis complex. We found significant difference was seen in sensitivities of different tests. Of these 450 specimens, 60 (13.4%) were positive for AFB by ZN staining, 202 (45%) for BACTEC culture and IS6110 PCR were positive for M. tuberculosis complex in 283 (63%) specimens (pEPTB. It may facilitate therapeutic decisions for those with suspected of EPTB.

  16. IL12Rβ1ΔTM Is a Secreted Product of il12rb1 That Promotes Control of Extrapulmonary Tuberculosis

    Science.gov (United States)

    Ray, Aurelie A.; Fountain, Jeffrey J.; Miller, Halli E.; Cooper, Andrea M.

    2014-01-01

    IL12RB1 is a human gene that is important for resistance to Mycobacterium tuberculosis infection. IL12RB1 is expressed by multiple leukocyte lineages, and encodes a type I transmembrane protein (IL12Rβ1) that associates with IL12p40 and promotes the development of host-protective TH1cells. Recently, we observed that il12rb1—the mouse homolog of IL12RB1—is alternatively spliced by leukocytes to produce a second isoform (IL12Rβ1ΔTM) that has biological properties distinct from IL12Rβ1. Although the expression of IL12Rβ1ΔTM is elicited by M. tuberculosis in vivo, and its overexpression enhances IL12p40 responsiveness in vitro, the contribution of IL12Rβ1ΔTM to controlling M. tuberculosis infection has not been tested. Here, we demonstrate that IL12Rβ1ΔTM represents a secreted product of il12rb1 that, when absent from mice, compromises their ability to control M. tuberculosis infection in extrapulmonary organs. Furthermore, elevated M. tuberculosis burdens in IL12Rβ1ΔTM-deficient animals are associated with decreased lymph node cellularity and a decline in TH1 development. Collectively, these data support a model wherein IL12Rβ1ΔTM is a secreted product of il12rb1 that promotes resistance to M. tuberculosis infection by potentiating TH cells response to IL-12. PMID:25404030

  17. Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis

    National Research Council Canada - National Science Library

    Steingart, Karen R; Flores, Laura L; Dendukuri, Nandini; Schiller, Ian; Laal, Suman; Ramsay, Andrew; Hopewell, Philip C; Pai, Madhukar

    2011-01-01

    .... As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB...

  18. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need.

    Science.gov (United States)

    Purohit, Manju; Mustafa, Tehmina

    2015-04-01

    During the last decade, remarkable progress has been made in the diagnostics of pulmonary tuberculosis; however, diagnostic challenges in extra-pulmonary tuberculosis (EPTB) remain to be addressed. Diagnosis of EPTB is difficult due to the pauci-bacillary nature of disease, the variable clinical presentation, and need for invasive procedures to secure appropriate sample, and lack of laboratory facilities in the resource-limited settings. A more accurate test to diagnose various forms of EPTB, which can easily be incorporated in the routine TB control programme, would contribute significantly towards improving EPTB case-detection and thus reducing the morbidity and mortality. In this overview, we describe the status of current conventional and newer methods available for laboratory diagnosis of EPTB and discuss the challenges in their implementation in the resource-limited settings, and suggestion for better EPTB diagnostic algorithms, which can be incorporated in the routine TB control programmes.

  19. Enhanced control of Mycobacterium tuberculosis extrapulmonary dissemination in mice by an arabinomannan-protein conjugate vaccine.

    Directory of Open Access Journals (Sweden)

    Rafael Prados-Rosales

    2017-03-01

    Full Text Available Currently there are a dozen or so of new vaccine candidates in clinical trials for prevention of tuberculosis (TB and each formulation attempts to elicit protection by enhancement of cell-mediated immunity (CMI. In contrast, most approved vaccines against other bacterial pathogens are believed to mediate protection by eliciting antibody responses. However, it has been difficult to apply this formula to TB because of the difficulty in reliably eliciting protective antibodies. Here, we developed capsular polysaccharide conjugates by linking mycobacterial capsular arabinomannan (AM to either Mtb Ag85b or B. anthracis protective antigen (PA. Further, we studied their immunogenicity by ELISA and AM glycan microarrays and protection efficacy in mice. Immunization with either Abg85b-AM or PA-AM conjugates elicited an AM-specific antibody response in mice. AM binding antibodies stimulated transcriptional changes in Mtb. Sera from AM conjugate immunized mice reacted against a broad spectrum of AM structural variants and specifically recognized arabinan fragments. Conjugate vaccine immunized mice infected with Mtb had lower bacterial numbers in lungs and spleen, and lived longer than control mice. These findings provide additional evidence that humoral immunity can contribute to protection against Mtb.

  20. Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection.

    Science.gov (United States)

    Berg, Stefan; Schelling, Esther; Hailu, Elena; Firdessa, Rebuma; Gumi, Balako; Erenso, Girume; Gadisa, Endalamaw; Mengistu, Araya; Habtamu, Meseret; Hussein, Jemal; Kiros, Teklu; Bekele, Shiferaw; Mekonnen, Wondale; Derese, Yohannes; Zinsstag, Jakob; Ameni, Gobena; Gagneux, Sebastien; Robertson, Brian D; Tschopp, Rea; Hewinson, Glyn; Yamuah, Lawrence; Gordon, Stephen V; Aseffa, Abraham

    2015-03-03

    Ethiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia. Here we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia. Clinical characteristics were also correlated with genotypes of the causative agent, Mycobacterium tuberculosis. No major patient or bacterial strain factor could be identified as being responsible for the high rate of TBLN, and there was no association with HIV infection. However, analysis of the demographic data of involved patients showed that having regular and direct contact with live animals was more associated with TBLN than with PTB, although no M. bovis was isolated from patients with TBLN. Among PTB patients, those infected with Lineage 4 reported "contact with other TB patient" more often than patients infected with Lineage 3 did (OR = 1.6, CI 95% 1.0-2.7; p = 0.064). High fever, in contrast to low and moderate fever, was significantly associated with Lineage 4 (OR = 2.3; p = 0.024). On the other hand, TBLN cases infected with Lineage 4 tended to get milder symptoms overall for the constitutional symptoms than those infected with Lineage 3. The study suggests a complex role for multiple interacting factors in the epidemiology of extrapulmonary TB in Ethiopia, including factors that can only be derived from population-based studies, which may prove to be significant for TB control in Ethiopia.

  1. Xpert MTB/Rif for the diagnosis of extrapulmonary tuberculosis--an experience from a tertiary care centre in South India.

    Science.gov (United States)

    Suzana, Shirly; Ninan, Marilyn M; Gowri, Mahasampath; Venkatesh, Krishnan; Rupali, Priscilla; Michael, Joy S

    2016-03-01

    The Xpert MTB/Rif, with a detection limit of 131 CFU/ml, plays a valuable role in the diagnosis of extrapulmonary tuberculosis, both susceptible and resistant. This study aims at evaluating the Xpert MTB/Rif for the same, at a tertiary care centre in south India, assessing it against both culture and a composite gold standard (CGS). We tested consecutive samples from patients suspected of extrapulmonary tuberculosis with Xpert MTB/Rif, evaluated its sensitivity and specificity against solid and/or liquid culture and CGS. An individual analysis of different sample types (tissue biopsies, fluids, pus, lymph node biopsies and CSF) given an adequate sample size, against both culture and CGS, was also performed. In total, 494 samples were analysed against culture. Compared to culture, the sensitivity of Xpert MTB/Rif was 89% (95% CI 0.81-0.94) and its specificity was 74% (95% CI 0.70-0.78). When Xpert MTB/Rif was compared to the CGS, pooled sensitivity was 62% (95% CI 0.56-0.67) and specificity was 100% (95% CI 0.91-1.00). This assay performs better than the currently available conventional laboratory methods. The rapidity with which results are obtained is an added advantage, and its integration into a routine diagnostic protocol must be considered. © 2015 John Wiley & Sons Ltd.

  2. First-time detection and identification of the Mycobacterium tuberculosis Complex members in extrapulmonary tuberculosis clinical samples in south Tunisia by a single tube tetraplex real-time PCR assay.

    Science.gov (United States)

    Siala, Mariam; Smaoui, Salma; Taktak, Wafa; Hachicha, Salma; Ghorbel, Asma; Marouane, Chema; Kammoun, Sana; Gamara, Dhikrayet; Slim, Leila; Gdoura, Radhouane; Messadi-Akrout, Férièle

    2017-05-01

    Tunisia has one of the highest burdens of extrapulmonary tuberculosis (EPTB) among tuberculosis (TB) cases but the contribution of MTBC-mediated human EPTB is unknown. EPTB diagnosis is challenging due to the paucibacillary nature of clinical samples. Therefore, a need of a simplified molecular method for sensitive and specific TB detection and differentiation of MTBC members caused EPTB remains a priority to an early diagnosis, optimize successful anti-TB treatment and minimize transmission. We evaluated the performance of a single tube tetraplex Taq Man real time PCR for EPTB detection and differentiation between MTBC members directly on extrapulmonary samples. Extrapulmonary samples obtained from clinically suspected EPTB patients from 2013 to April 2015 were tested by Ziehl Neelsen Staining, mycobacterial culture and qPCR assay for RD1, RD9, RD12 and ext-RD9 targets (MTBC-RD qPCR). The performance of qPCR was compared to a reference standard based on MTBC culture and/or at least two criteria of a composite reference standard (CRS) including clinical, radiological, histopathological and therapeutic findings. EPTB was identified in 157/170 (92.4%) of included patients of whom 99 (63%) were confirmed by culture and 58 (36.9%) by CRS criteria. The sensitivity and specificity of qPCR, in comparison to the reference standard were 100% (157/157) and 92.3% (12/13), respectively. The sensitivity of qPCR was statistically significant as compared to culture and smear microscopy (P< 0.001). QPCR results showed M. bovis identification in 77.1% of extrapulmonary samples in occurrence to lymphadenitis infection. M. tuberculosis and M.bovis BCG were detected in 21.6% and 1.3% of cases, respectively. MTBC-RD qPCR proved to be a rapid and sensitive assay for simultaneously TB detection and MTBC members identification on extrapulmonary samples within 1.5 days after sample receipt. Its high sensitivity could make this method a useful tool in diagnosing TB in addition to routine

  3. First-time detection and identification of the Mycobacterium tuberculosis Complex members in extrapulmonary tuberculosis clinical samples in south Tunisia by a single tube tetraplex real-time PCR assay.

    Directory of Open Access Journals (Sweden)

    Mariam Siala

    2017-05-01

    Full Text Available Tunisia has one of the highest burdens of extrapulmonary tuberculosis (EPTB among tuberculosis (TB cases but the contribution of MTBC-mediated human EPTB is unknown. EPTB diagnosis is challenging due to the paucibacillary nature of clinical samples. Therefore, a need of a simplified molecular method for sensitive and specific TB detection and differentiation of MTBC members caused EPTB remains a priority to an early diagnosis, optimize successful anti-TB treatment and minimize transmission. We evaluated the performance of a single tube tetraplex Taq Man real time PCR for EPTB detection and differentiation between MTBC members directly on extrapulmonary samples.Extrapulmonary samples obtained from clinically suspected EPTB patients from 2013 to April 2015 were tested by Ziehl Neelsen Staining, mycobacterial culture and qPCR assay for RD1, RD9, RD12 and ext-RD9 targets (MTBC-RD qPCR. The performance of qPCR was compared to a reference standard based on MTBC culture and/or at least two criteria of a composite reference standard (CRS including clinical, radiological, histopathological and therapeutic findings.EPTB was identified in 157/170 (92.4% of included patients of whom 99 (63% were confirmed by culture and 58 (36.9% by CRS criteria. The sensitivity and specificity of qPCR, in comparison to the reference standard were 100% (157/157 and 92.3% (12/13, respectively. The sensitivity of qPCR was statistically significant as compared to culture and smear microscopy (P< 0.001. QPCR results showed M. bovis identification in 77.1% of extrapulmonary samples in occurrence to lymphadenitis infection. M. tuberculosis and M.bovis BCG were detected in 21.6% and 1.3% of cases, respectively.MTBC-RD qPCR proved to be a rapid and sensitive assay for simultaneously TB detection and MTBC members identification on extrapulmonary samples within 1.5 days after sample receipt. Its high sensitivity could make this method a useful tool in diagnosing TB in addition to

  4. Multicenter Evaluation of Anyplex Plus MTB/NTM MDR-TB Assay for Rapid Detection of Mycobacterium tuberculosis Complex and Multidrug-Resistant Isolates in Pulmonary and Extrapulmonary Specimens.

    Science.gov (United States)

    Sali, Michela; De Maio, Flavio; Caccuri, Francesca; Campilongo, Federica; Sanguinetti, Maurizio; Fiorentini, Simona; Delogu, Giovanni; Giagulli, Cinzia

    2016-01-01

    The rapid diagnosis of tuberculosis (TB) and the detection of drug-resistant Mycobacterium tuberculosis strains are critical for successful public health interventions. Therefore, TB diagnosis requires the availability of diagnostic tools that allow the rapid detection of M. tuberculosis and drug resistance in clinical samples. Here, we performed a multicenter study to evaluate the performance of the Seegene Anyplex MTB/NTM MDR-TB assay, a new molecular method based on a multiplex real-time PCR system, for detection of Mycobacterium tuberculosis complex (MTBC), nontuberculous mycobacteria (NTM), and genetic determinants of drug resistance. In total, the results for 755 samples (534 pulmonary and 221 extrapulmonary samples) were compared with the results of smears and cultures. For pulmonary specimens, the sensitivities of the Anyplex assay and acid-fast bacillus smear testing were 86.4% and 75.0%, respectively, and the specificities were 99% and 99.4%. For extrapulmonary specimens, the sensitivities of the Anyplex assay and acid-fast bacillus smear testing were 83.3% and 50.0%, respectively, and the specificities of both were 100%. The negative and positive predictive values of the Anyplex assay for pulmonary specimens were 97% and 100%, respectively, and those for extrapulmonary specimens were 84.6% and 100%. The sensitivities of the Anyplex assay for detecting isoniazid resistance in MTBC strains from pulmonary and extrapulmonary specimens were 83.3% and 50%, respectively, while the specificities were 100% for both specimen types. These results demonstrate that the Anyplex MTB/NTM MDR-TB assay is an efficient and rapid method for the diagnosis of pulmonary and extrapulmonary TB and the detection of isoniazid resistance. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  5. The utility of IS6110 sequence based polymerase chain reaction in comparison to conventional methods in the diagnosis of extra-pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Sekar B

    2008-01-01

    Full Text Available IS6110 sequence based polymerase chain reaction (PCR was compared with conventional bacteriological techniques in the laboratory diagnosis of extra-pulmonary tuberculosis (EPTB. One hundred and ninety one non-repeated clinical samples of EPTB and 17 samples from non-tuberculous cases as controls were included. All the samples were processed for Ziehl-Neelsen staining for acid fast bacilli (AFB and 143 samples were processed by culture for M. tuberculosis . All the samples were processed for PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of M. tuberculosis complex. Of the total 191 samples processed, 34 (18% were positive by smear for AFB. Culture for AFB was positive in 31(22% samples among the 143 samples processed. Either smear or culture for AFB was found positive in 51(27% samples. Of the total 191 samples processed 120 (63% were positive by PCR. In 140 samples, wherein both the conventional techniques were found negative, 74 (53% samples were positive by PCR alone. Among 51 samples positive by conventional techniques, 46 (90% were found positive by PCR. PCR assay targeting IS6110 is useful in establishing the diagnosis of EPTB, where there is strong clinical suspicion, especially when the conventional techniques are negative.

  6. Evaluation of whole blood IFNgamma test using PPD and recombinant antigen challenge for diagnosis of pulmonary and extra-pulmonary tuberculosis.

    Science.gov (United States)

    Kalantri, Yatiraj; Hemvani, Nanda; Chitnis, D S

    2009-06-01

    Quantiferon TB gold (QFT-G) with recombinant antigen cocktail is well evaluated for diagnosis of pulmonary tuberculosis (PTB). However, diagnosis of extra-pulmonary tuberculosis (EPTB) is more difficult due to limitations of conventional techniques. This study compares recombinant antigens based QFT-G and low cost PPD based interferon test for the diagnosis of PTB and EPTB. IFNgamma release, with recombinant antigens and PPD, was assayed by ELISA from 140 cases of EPTB, 100 cases of PTB along with acid fast bacillus (AFB) detection, AFB culture on LJ and MGIT BACTEC. Sensitivity and specificity for QFT-G recombinant antigens was 84.29% and 96%, while for PPD based interferon was 70% and 84% for EPTB group. The sensitivity was far superior to AFB smear and culture for both the antigens. Nine samples were identified as non-tubercular mycobacteria (NTM) in the EPTB group and all were negative for QFT-G, but six of them were positive for PPD based test. Results of the study show that QFT-G using recombinant antigen is sensitive and specific for both PTB and EPTB diagnosis. The PPD based test is economic and offers comparable performance for PTB and EPTB diagnosis and also useful for diagnosis of NTM.

  7. Accuracy of the Xpert® MTB/RIF assay for the diagnosis of extra-pulmonary tuberculosis in South Korea.

    Science.gov (United States)

    Kim, Y W; Kwak, N; Seong, M-W; Kim, E-C; Yoo, C-G; Kim, Y W; Han, S K; Yim, J-J

    2015-01-01

    The Xpert(®) MTB/RIF assay has been endorsed by the World Health Organization for the detection of pulmonary and extra-pulmonary tuberculosis (EPTB). To determine the accuracy of the Xpert assay in diagnosing EPTB in South Korea, a country with an intermediate TB burden. We retrospectively reviewed the medical records of 1429 patients in whom the Xpert assay using EPTB specimens was requested between 1 January 2011 and 31 October 2013 in a tertiary referral hospital in South Korea. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of EPTB and detection of rifampicin (RMP) resistance were calculated. Using culture as gold standard, the sensitivity, specificity, PPV and NPV of the assay were respectively 67.7%, 98.1%, 60% and 98.6%. Using a composite reference standard, the sensitivity, specificity, PPV and NPV were respectively 49.3%, 100%, 100% and 95.1%. The sensitivity, specificity, PPV and NPV for the detection of RMP resistance among specimens with positive results for Mycobacterium tuberculosis were respectively 80%, 100%, 100% and 97.7%. The Xpert assay showed acceptable sensitivity in certain groups and excellent specificity in diagnosing EPTB and detecting RMP resistance in an intermediate TB burden country.

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

    Directory of Open Access Journals (Sweden)

    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

  9. Clinical profile and diagnosis of extrapulmonary tb in HIV infected patients: routine abdominal ultrasonography increases detection of abdominal tuberculosis.

    Science.gov (United States)

    Spalgais, Sonam; Jaiswal, Anand; Puri, Manmohan; Sarin, Rohit; Agarwal, Upasna

    2013-07-01

    To study the clinical profile and assess the utility of the procedures performed for the diagnosis of extrapulmonary TB (EPTB) in HIV patients. Prospective observational study of HIV patients suspected to have EPTB. Two hundred and thirty HIV-infected patients were enrolled over 18 months. Of them, 87 cases had active TB, 60 (69%) of whom were of EPTB. Major presenting symptoms were fever (93.3%), weight loss (80%) and cough (61.6%). The most common site of active EPTB was the abdomen (70%), which could be detected due to routine use of abdominal ultrasonography, followed by CT scans in inconclusive cases. Peripheral lymph node (22%), pleura (15%), CNS involvement (3%) and one case each of psoas abscess and mediastinal lymphadeopathy were the other extra-pulmonary sites seen. Diagnosis of peripheral lymph node and pleural TB was based on cytological and mycobacterial examinations. Direct smear examinations were positive for AFB in 11 of 24 samples and mycobacterial cultures were positive in five of 18 samples. The median CD4 cell count in our HIV-EIPTB cases was 126 cells/micro1 (IQR=79.5-205.75). There was no statistical difference in the baseline CD4 cell counts in patients with PTB vs EPTB (p=0.70), single vs multiple extra-pulmonary site involvement (p=0.57), and AFB positive vs AFB negative EPTB cases (p=0.51). EPTB is the most common form of TB in HIV patients with low CD4 cell counts. Fever, weight loss and cough are common presenting symptoms of EPTB. Routine abdominal ultrasonography followed by an abdominal CT scan in inconclusive cases can significantly increase the detection of abdominal TB.

  10. Progression to active tuberculosis, but not transmission, varies by Mycobacterium tuberculosis lineage in The Gambia

    NARCIS (Netherlands)

    de Jong, Bouke C.; Hill, Philip C.; Aiken, Alex; Awine, Timothy; Antonio, Martin; Adetifa, Ifedayo M.; Jackson-Sillah, Dolly J.; Fox, Annette; Deriemer, Kathryn; Gagneux, Sebastien; Borgdorff, Martien W.; McAdam, Keith P. W. J.; Corrah, Tumani; Small, Peter M.; Adegbola, Richard A.

    2008-01-01

    BACKGROUND: There is considerable variability in the outcome of Mycobacterium tuberculosis infection. We hypothesized that Mycobacterium africanum was less likely than M. tuberculosis to transmit and progress to tuberculosis disease. METHODS: In a cohort study of patients with tuberculosis and their

  11. Renal tuberculosis

    OpenAIRE

    Džamić Zoran; Dimitrijević Vladan

    2016-01-01

    Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is charac...

  12. Peritoneal tuberculosis: radiographic diagnosis

    Directory of Open Access Journals (Sweden)

    Carolina Ospina-Moreno

    2014-12-01

    Full Text Available Peritoneal tuberculosis (TB is an extrapulmonary form of presentation of tuberculosis. HIV infection is a primary risk factor for this condition. Diagnosis requires microbiological or histopathological confirmation in addition to supporting radiological imaging studies. Abdominal ultrasonography and CT are useful to obtain a radiographic diagnosis, with typical findings including diffuse peritoneal thickening, presence of ascites in varying volumes, adenopathies, and caseating nodes. We report 2 cases of patients with ascites and nodular peritoneal thickening on diagnostic images, as well as high CA-125 levels in laboratory tests. In both patients, a diagnosis of peritoneal tuberculosis was reached following a US-guided peritoneal biopsy.

  13. Trends of anti-tuberculosis drug resistance pattern in new cases and previously treated cases of extrapulmonary tuberculosis cases in referral hospitals in northern India

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    A K Maurya

    2012-01-01

    Full Text Available Background: Drug-resistant tuberculosis is one of major current challenges to global public health. The transmission of resistant strains is increasing as a burden of multidrug-resistant tuberculosis (MDR-TB patients in extra pulmonary tuberculosis (EPTB cases in India. Aim and Objectives: The aim was to study trends of anti-tuberculosis drug resistance pattern in new cases and previously treated cases of EPTB in referral hospitals in northern India. Study Design and Setting: A prospectively observational study and referral medical institutions in northern India. Materials and Methods: All EPTB specimens were processed for Ziehl Neelsen staining, BACTEC culture and BACTEC NAP test for Mycobacterium tuberculosis complex. All M. tuberculosis complex isolates were performed for radiometric-based drug susceptibility pattern against streptomycin, isoniazid, rifampicin and ethambutol using the 1% proportion method. Results: We found that 165/756 (20.5% isolates were identified as M. tuberculosis complex by the NAP test. We observed that 39.9% were resistant to first-line antitubercular drugs. The resistance rate was higher in previously treated patients: H (30.3%, R (16.3%, E (15.7% and S (16.3%. MDR-TB was observed in 13.4%, but, in new cases, this was 11.4% and 19.1% of the previously treated patients (P<0.05. Conclusion: MDR-TB is gradually increased in EPTB cases and predominant resistance to previous treated cases of EPTB. The molecular drug sensitivity test (DST method can be an early decision for chemotherapy in MDR-TB patients. The International Standards of TB Care need to be used by the RNTCP and professional medical associations as a tool to improve TB care in the country.

  14. Incidence of and risk factors associated with pulmonary and extra-pulmonary tuberculosis in Saudi Arabia (2010-2011.

    Directory of Open Access Journals (Sweden)

    Ziad Ahmed Memish

    Full Text Available SETTING: National Tuberculosis Program, Department of Public Health, Ministry of Health, Kingdom of Saudi Arabia (KSA. OBJECTIVE: To summarize data on the incidence of tuberculosis and associated risk factors for cases reported during 2010-2011. DESIGN: Retrospective analysis of routinely collected data through an established national disease notification system of the Ministry of Health in KSA. RESULTS: The estimated incidence of all forms of tuberculosis fell from 15.8/100000 (95% CI: 15.3/100,000-16.3/100,000 in 2010 to 13.8/100,000 (95% CI: 13.4/100,000-14.2/100,000 in 2011. Saudis experienced a decrease from 11.8/100,000 (95% CI: 11.3/100,000 to 12.3/100,000 in 2010 to 9.9/100,000 (95% CI: 9.5/100,000-10.4/100,000 in 2011 while the incidence in non-Saudis declined from 24.7/100,000 (95% CI: 23.6/100,000 to 25.7/100,000 in 2010 to 22.5/100,000 (95% CI: 21.5/100,000 to 23.4/100,000 in 2011. The proportion of Extra Pulmonary TB (EPTB which increased minimally from 30% in 2010 to 32% in 2011 was higher than global figures and strongly associated with age, sex, nationality and occupation. CONCLUSION: The current estimated incidence of about 14/100,000 in 2011 is less than half its estimated value of 44/100000 in 1990. Without prejudice to any under-reporting, the KSA appeared to be on the course for TB elimination by 2050 having reached the first milestone set by WHO. The proportion of EPTB remains higher than global figure and age, sex, nationality and occupation were significant independent predictors of EPTB.

  15. P2X71513 A>C Polymorphism Confers Increased Risk of Extrapulmonary Tuberculosis: A Meta-analysis of Case-Control Studies.

    Science.gov (United States)

    Areeshi, Mohammed Y; Mandal, Raju K; Dar, Sajad; Wahid, Mohd; Khan, Md Ekhlaque A; Panda, Aditya K; Jawed, Arshad; Haque, Shafiul

    2015-10-01

    The association of A1513C (rs3751143) polymorphism of P2X7 gene with the risk of extrapulmonary tuberculosis (EPTB) has been extensively analyzed, but no consensus has been achieved. In this study, a meta-analysis was done to assess this precise association. Online web databases, like PubMed (MEDLINE) and EMBASE were searched for pertinent reports showing association of P2X7 A1513C polymorphism with EPTB risk. To assess the strength of this association, we calculated pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). A total of eight reports involving 2237controls and 594 EPTB cases were included in this study. Four genetic models, viz. allele (C vs. A: p=0.011; OR= 1.677, 95% CI = 1.125-2.501), homozygous (CC vs. AA: p = 0.053; OR= 2.362, 95% CI = 0.991-5.632), heterozygous (AC vs. AA: p = 0.003; OR= 1.775, 95% CI = 1.209-2.607) and dominant (CC + AC vs. AA: p = 0.005; OR= 1.890, 95% CI = 1.207-2.962) showed significant associations compared with wild type genotypes. Subgroup analysis stratified by ethnicity was also performed and the results suggested that homozygous and heterozygous genotypes were associated significantly with increased susceptibility of EPTB in Asian population. Similarly, heterozygous and dominant models showed increased EPTB risk in Caucasian population. The present meta-analysis suggests that P2X7 A1513C polymorphism may be an important risk factor for EPTB. Also, our sub-group analysis indicates that P2X7 A1513C polymorphism confers increased EPTB risk among Asians and Caucasians. However, future larger studies are needed to provide more precise conclusion and endorse the present results.

  16. Epidemiology, Diagnosis and Management of Extra-Pulmonary Tuberculosis in a Low-Prevalence Country: A Four Year Retrospective Study in an Australian Tertiary Infectious Diseases Unit.

    Directory of Open Access Journals (Sweden)

    Simon Pollett

    Full Text Available Extra-pulmonary tuberculosis (EPTB is relatively neglected and increasing in incidence, in comparison to pulmonary tuberculosis (PTB in low-burden settings. It poses particular diagnostic and management challenges. We aimed to determine the characteristics of EPTB in Western Sydney, Australia, and to conduct a quality assurance investigation of adherence to guidelines among Infectious Diseases (ID practitioners managing EPTB cases.All adult EPTB cases managed by a large ID service during 01/01/2008-31/12/2011 were eligible for inclusion in the retrospective review. Data were extracted from patient medical records on demographic, diagnostic, clinical and management details, and on clinician adherence to local and international TB guidelines.129 cases managed by the ID service were identified, with files available for 117. 98 cases were managed by the Respiratory service and were excluded. 98.2%(112/114 had been born in a country other than Australia. HIV status was tested or previously known in 97 people, and positive in 4 (4%. Microbiological confirmation was obtained in 68/117 (58.1%, an additional 24 had histopathological findings considered confirmatory (92/117, 78.6%, with the remainder diagnosed on clinical and/or radiological grounds. Median time to diagnosis post-migration from a high TB-burden country was 5 years (range 0-41. 95 cases were successfully treated, 11 cases defaulted, refused therapy or transferred, 2 cases relapsed and outcomes unknown or pending in 9 cases. No deaths occurred in the sample analysed. Clinician adherence to guidelines was high, but with scope for improvement in offering testing for co-infections, performing eye checks, monitoring blood glucose in patients receiving adjunctive corticosteroids, and considering drug interactions.Despite excellent TB outcomes in this setting, the low proportion of cases with susceptibility data is worrying in this era of increasing drug resistance, and illustrates the diagnostic

  17. Epidemiology, Diagnosis and Management of Extra-Pulmonary Tuberculosis in a Low-Prevalence Country: A Four Year Retrospective Study in an Australian Tertiary Infectious Diseases Unit.

    Science.gov (United States)

    Pollett, Simon; Banner, Pamela; O'Sullivan, Matthew V N; Ralph, Anna P

    2016-01-01

    Extra-pulmonary tuberculosis (EPTB) is relatively neglected and increasing in incidence, in comparison to pulmonary tuberculosis (PTB) in low-burden settings. It poses particular diagnostic and management challenges. We aimed to determine the characteristics of EPTB in Western Sydney, Australia, and to conduct a quality assurance investigation of adherence to guidelines among Infectious Diseases (ID) practitioners managing EPTB cases. All adult EPTB cases managed by a large ID service during 01/01/2008-31/12/2011 were eligible for inclusion in the retrospective review. Data were extracted from patient medical records on demographic, diagnostic, clinical and management details, and on clinician adherence to local and international TB guidelines. 129 cases managed by the ID service were identified, with files available for 117. 98 cases were managed by the Respiratory service and were excluded. 98.2%(112/114) had been born in a country other than Australia. HIV status was tested or previously known in 97 people, and positive in 4 (4%). Microbiological confirmation was obtained in 68/117 (58.1%), an additional 24 had histopathological findings considered confirmatory (92/117, 78.6%), with the remainder diagnosed on clinical and/or radiological grounds. Median time to diagnosis post-migration from a high TB-burden country was 5 years (range 0-41). 95 cases were successfully treated, 11 cases defaulted, refused therapy or transferred, 2 cases relapsed and outcomes unknown or pending in 9 cases. No deaths occurred in the sample analysed. Clinician adherence to guidelines was high, but with scope for improvement in offering testing for co-infections, performing eye checks, monitoring blood glucose in patients receiving adjunctive corticosteroids, and considering drug interactions. Despite excellent TB outcomes in this setting, the low proportion of cases with susceptibility data is worrying in this era of increasing drug resistance, and illustrates the diagnostic

  18. Identification ofMycobacterium tuberculosisin Clinical Specimens of Patients Suspected of Having Extrapulmonary Tuberculosis by Application of Nested PCR on Five Different Genes.

    Science.gov (United States)

    Khosravi, Azar D; Alami, Ameneh; Meghdadi, Hossein; Hosseini, Atta A

    2017-01-01

    Definitive and rapid diagnosis of extrapulmonary tuberculosis (EPTB) is challenging since conventional techniques have limitations due to the paucibacillary nature of the disease. To increase the sensitivity of detection of Mycobacterium tuberculosis (MTB) in EPTB specimens, we performed a nested PCR assay targeting several genes of MTB on EPTB specimens. A total of 100 clinical specimens from suspected cases of EPTB were processed. Standard staining for acid fast bacilli (AFB) was performed as the preliminary screening test. Extracted DNAs from specimens were subjected to Nested PCR technique for the detection of five different MTB target genes of IS6110, IS1081, hsp65kd, mbp64 , and mtp40 . On performing AFB staining, only 13% of specimens were positive, of which ascites fluid (33.3%), followed by pleural effusion (30.8%) showed the greatest AFB positivity rate. We demonstrated slight improvement in yields in lymph node which comprised the majority of specimens in this study, by employing PCR targeted to IS6110 - and hsp65-genes in comparison to AFB staining. However, the yields in ascites fluid and pleural effusion were not substantially improved by PCR, but those from bone and wound were, as in nested PCR employing either gene, the same positivity rate were obtained for ascites fluid (33.3%), while for pleural effusion specimens only IS1081 based PCR showed identical positivity rate with AFB stain (30.8%). The results for bone and wound specimens, however, demonstrated an improved yield mainly by employing IS1081 gene. Here, we report higher detection rate of EPTB in clinical specimens using five different targeted MTB genes. This nested PCR approach facilitates the comparison and the selection of the most frequently detected genes. Of course this study demonstrated the priority of IS1081 followed by mtp40 and IS6110 , among the five tested genes and indicates the effectiveness of any of the three genes in the design of an efficient nested-PCR test that

  19. Drug resistance patterns among extra-pulmonary tuberculosis cases in a tertiary care centre in North India.

    Science.gov (United States)

    Sharma, S K; Chaubey, J; Singh, B K; Sharma, R; Mittal, A; Sharma, A

    2017-10-01

    xtra-pulmonary tuberculosis (EPTB) is a growing public health concern, and data on drug resistance are limited. Specimens from 2468 clinically diagnosed EPTB patients received at the Intermediate Reference Laboratory (IRL) of a tertiary centre in India were subjected to Ziehl-Neelsen staining, Xpert® MTB/RIF testing, liquid culture and drug susceptibility testing (DST) using automated BACTEC MGIT™ 960™. Line-probe assay (LPA) was performed on all culture-positive isolates. Gene sequencing was performed on rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB) and phenotypic/genotypic discrepant isolates. The culture positivity rate was 18.9% (483/2553). The sensitivity and specificity of Xpert in diagnosing EPTB were respectively 70.8% (95%CI 66.5-74.8) and 97.7% (95%CI 96.9-98.3), with liquid culture as the reference standard. Prevalence of RR/MDR-TB was 10.1% (49/483). Prevalence of pre-extensively drug-resistant TB (pre-XDR-TB) was 18.4% (09/49), whereas the prevalence of XDR-TB among MDR-TB patients was 2% (01/49). The sensitivity of genotypic DST for the detection of rifampicin resistance was 92.7% (95%CI 81.1-98.5) and specificity was 99.3% (95%CI 97.5-99.9), with 100% concordance between Xpert and LPA. The burden of drug resistance, including M/XDR-TB, among EPTB patients is high. Novel molecular tests can help in early diagnosis and treatment to prevent disease progression and amplification of resistance.

  20. Real-time PCR followed by high-resolution melting curve analysis: A rapid and pragmatic approach for screening of multidrug-resistant extrapulmonary tuberculosis.

    Science.gov (United States)

    Sharma, Kusum; Sharma, Megha; Singh, Shreya; Modi, Manish; Sharma, Aman; Ray, Pallab; Varma, Subhash

    2017-09-01

    Multidrug resistance (MDR) in extrapulmonary tuberculosis (EPTB) is a diagnostic challenge in an endemic country like India. Timely detection of MDR-TB can contribute to a better patient outcome. To perform real-time PCR (qPCR) using rpoB, mpb64 and IS6110 gene on a variety of EPTB samples and to compare the performance of different gene targets. All qPCR positive samples were subjected to high resolution melt-curve analysis (HRM analysis) for rpoB and katG gene to evaluate its potential for MDR screening among different sample types. Real-time PCR using rpoB, mpb64 and IS6110 genes was carried out on 200 cases of study group and 100 cases of non-TB control group. The study group consisted of 100 culture-confirmed and 100 clinically suspected cases of EPTB. Phenotypic drug susceptibility testing (DST) for culture isolates was performed by the 1% indirect agar proportion method. DNA extracted from all qPCR positive samples was subjected to rpoB and katG HRM analysis for screening of MDR. Sequencing was used to confirm the results of HRM analysis and the results were also compared with phenotypic DST in all culture positive cases. The sensitivity of qPCR using rpoB, mpb64 and IS6110 was 86.5%, 86.5% and 76.5%, respectively. All isolates from the control group were negative by all the three targets, giving a specificity of 100%. HRM analysis detected MDR in 22/200 (11%) isolates. 3/200 (1.5%) had mono-rifampicin resistance while 8/200 (4%) had mono-isoniazid resistance. HRM analysis identified an additional 4 MDR cases directly from the samples which were negative by culture. On sequencing, mutations were observed at codon 531 (60%); 533 (16%); 516 (12%) and 526 (12%) of the rpoB gene and at codon 315 (100%) of the katG gene. There was 100% concordance in the results of phenotypic DST, HRM analysis and sequencing. The HRM analysis can play a promising role in the reliable and rapid screening of EPTB samples for detection of MDR. Copyright © 2017 Elsevier Ltd. All

  1. Evaluation of the Abbott RealTime MTB and RealTime MTB INH/RIF Assays for Direct Detection of Mycobacterium tuberculosis Complex and Resistance Markers in Respiratory and Extrapulmonary Specimens.

    Science.gov (United States)

    Hofmann-Thiel, Sabine; Molodtsov, Nikolay; Antonenka, Uladzimir; Hoffmann, Harald

    2016-12-01

    The Abbott RealTime MTB (RT MTB) assay is a new automated nucleic acid amplification test for the detection of Mycobacterium tuberculosis complex (MTBC) in clinical specimens. In combination with the RealTime MTB INH/RIF (RT MTB INH/RIF) resistance assay, which can be applied to RT MTB-positive specimens as an add-on assay, the tests also indicate the genetic markers of resistance to isoniazid (INH) and rifampin (RIF). We aimed to evaluate the diagnostic sensitivity and specificity of RT MTB using different types of respiratory and extrapulmonary specimens and to compare performance characteristics directly with those of the FluoroType MTB assay. The resistance results obtained by RT MTB INH/RIF were compared to those from the GenoType MTBDRplus and from phenotypic drug susceptibility testing. A total of 715 clinical specimens were analyzed. Compared to culture, the overall sensitivity of RT MTB was 92.1%; the sensitivity rates for smear-positive and smear-negative samples were 100% and 76.2%, respectively. The sensitivities of smear-negative specimens were almost identical for respiratory (76.3%) and extrapulmonary (76%) specimens. Specificity rates were 100% and 95.8% for culture-negative specimens and those that grew nontuberculous mycobacteria, respectively. RT MTB INH/RIF was applied to 233 RT MTB-positive samples and identified resistance markers in 7.7% of samples. Agreement with phenotypic and genotypic drug susceptibility testing was 99.5%. In conclusion, RT MTB and RT MTB INH/RIF allow for the rapid and accurate diagnosis of tuberculosis (TB) in different types of specimens and reliably indicate resistance markers. The strengths of this system are the comparably high sensitivity with paucibacillary specimens, its ability to detect INH and RIF resistance, and its high-throughput capacities. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  2. Dynamics of a stochastic tuberculosis model with constant recruitment and varying total population size

    Science.gov (United States)

    Liu, Qun; Jiang, Daqing; Shi, Ningzhong; Hayat, Tasawar; Alsaedi, Ahmed

    2017-03-01

    In this paper, we develop a mathematical model for a tuberculosis model with constant recruitment and varying total population size by incorporating stochastic perturbations. By constructing suitable stochastic Lyapunov functions, we establish sufficient conditions for the existence of an ergodic stationary distribution as well as extinction of the disease to the stochastic system.

  3. Drug resistance among extrapulmonary TB patients: Six years experience from a supranational reference laboratory

    Directory of Open Access Journals (Sweden)

    Azger Dusthackeer

    2015-01-01

    Full Text Available Background & objectives: There is limited information available about the drug resistance patterns in extrapulmonary tuberculosis (EPTB, especially from high burden countries. This may be due to difficulty in obtaining extrapulmonary specimens and limited facilities for drug susceptibility testing. This study was undertaken to review and report the first and second-line anti-TB drug susceptibility patterns in extrapulmonary specimens received at the National Institute for Research in Tuberculosis (NIRT, Chennai, India, between 2005 and 2012. Methods: Extrapulmonary specimens received from referring hospitals were decontaminated and cultured using standard procedures. Drug susceptibility testing (DST for Mycobacterium tuberculosis was done by absolute concentration or resistance ratio methods for the first and the second line anti-TB drugs. Results: Between 2005 and 2012, of the 1295 extrapulmonary specimens, 189 grew M. tuberculosis, 37 (19% cases were multidrug resistant (MDR while one was extensively drug resistant (XDR. Specimen-wise MDR prevalence was found to be: CSF-10 per cent, urine-6 per cent, fluids and aspirates-27 per cent, pus-23 per cent, lymph nodes-19 per cent. Resistance to isoniazid and ethionamide was found to be high (31 and 38%, respectively. Interpretation & conclusions: Drug resistance including MDR-TB was observed in a significant proportion of extrapulmonary specimens referred for DST. Access to culture and DST for extrapulmonary specimens should be expanded. Guidelines for MDR-TB management should have explicit sections on extra-pulmonary tuberculosis and training on laboratory techniques is urgently required.

  4. cervical spinal tuberculosis with tuberculous otitis media ...

    African Journals Online (AJOL)

    hi-tech

    CERVICAL SPINAL TUBERCULOSIS WITH TUBERCULOUS OTITIS MEDIA MASQUERADING AS OTITIS EXTERNA MALIGNANS IN AN ELDERLY. DIABETIC PATIENT: CASE REPORT. A. Aderibigbe, MBBS .... extrapulmonary tuberculosis, but in children it may occur in isolation(3,7). In Nigeria, cervical tuberculosis.

  5. Lymph node tuberculosis in patients from regions with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection.

    Science.gov (United States)

    Clevenbergh, Philippe; Maitrepierre, Isabelle; Simoneau, Guy; Raskine, Laurent; Magnier, Jean-Dominique; Sanson-Le-Pors, Marie-José; Bergmann, Jean-François; Sellier, Pierre

    2010-10-01

    Few large cohorts of patients with lymph node tuberculosis (LNTB) have been reported in developed countries. To describe the epidemiological and clinical characteristics of LNTB in patients living in France but born and raised in geographic areas with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection. A retrospective study of all patients with bacteriologically-proven LNTB assessed in a French hospital from March 1996 through April 2005. The analysis included 92 patients. HIV coinfected patients had a higher risk than those without HIV of presenting with disseminated TB and systemic symptoms and of hospitalization. Lymph node diagnostic procedures had a high yield when samples were cultured. About 25% of patients had an abnormal chest radiograph, and most of them were positive for acid-fast bacilli on sputum smears or for Mycobacterium tuberculosis culture. Treatment was generally prescribed for a longer duration than that recommended by international guidelines. One quarter of the patients developed a paradoxical reaction. A high proportion of our patients were classified as nonadherent and 20% defaulted or were lost to follow-up. Most of the differences in the clinical presentation among patients from various geographic areas were driven by the epidemiology of TB and HIV in the countries of origin. LNTB is frequently a clinical sign of disseminated disease, and culture for M. tuberculosis from LN or other sites is crucial for diagnosis. Adopting the strategy of Directly Observed Treatment, Short course (DOTS) might reduce the rates of nonadherence and default. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  6. Evaluation of GeneXpert MTB/RIF for the detection of Mycobacterium tuberculosis and resistance to rifampin in extra-pulmonary specimens

    Directory of Open Access Journals (Sweden)

    Chema Marouane

    2015-01-01

    Conclusion: The GX is a simple, rapid technique for real-time PCR and has increased the sensitivity of detection of Mycobacterium tuberculosis complex. It must be part of the diagnostic arsenal of tuberculosis without replacing conventional microbiological tools and allow early diagnosis and appropriate treatment.

  7. Tuberculosis verrucosa cutis

    Directory of Open Access Journals (Sweden)

    Krishnabharath S

    2017-08-01

    Full Text Available We report a case of 23-year-old male patient with tuberculosis verrucous cutis on the foot for a duration of six months without responding to routine treatment. Tuberculosis is a common disease worldwide. Extrapulmonary tuberculosis contributes to 10% of cases. Cutaneous tuberculosis occupies a small spectrum of extrapulmonary tuberculosis. Tuberculosis verrucosa cutis is an exogenous infection occurring in a previously sensitized patient by direct inoculation of the organism. It occurs in sensitized patients with a moderate to high immune response. The diagnosis in our patient was confirmed by history, clinical examination, histopathological examination and the patient’s response to anti-tuberculous therapy.

  8. Caecal Perforation from Primary Intestinal Tuberculosis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Soe Lwin

    2017-01-01

    Full Text Available The incidence of tuberculosis (TB is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of extrapulmonary TB (EPTB can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. We present a case of caecal TB in pregnancy, which resulted in caecal perforation, a right hemicolectomy, and severe preterm delivery. The aim of this case report is to discuss the diagnosis of extrapulmonary TB, as well as its subsequent management in pregnancy.

  9. Evaluation of a new automated Abbott RealTime MTB RIF/INH assay for qualitative detection of rifampicin/isoniazid resistance in pulmonary and extra-pulmonary clinical samples ofMycobacterium tuberculosis.

    Science.gov (United States)

    Ruiz, Pilar; Causse, Manuel; Vaquero, Manuel; Gutierrez, Juan Bautista; Casal, Manuel

    2017-01-01

    A new automated real-time PCR assay for the detection of rifampicin (RIF) and isoniazid (INH) resistance in Mycobacterium tuberculosis (MTB) was evaluated. A total of 163 clinical samples (128 pulmonary and 35 extra-pulmonary) were processed using four PCR assay kits: Abbott RealTime MTB RIF/INH, Genotype MTBDRplus, Xpert/MTB RIF, and Anyplex MTB/MDR. The results of phenotypic drug-susceptibility testing using BACTECMGIT 960 were used as reference. The sensitivity and specificity of the new Abbott RealTime MTB RIF/INH assay in comparison with phenotypic testing was 96.3% (95%CI 87.32%-100%) for RIF and 100% (95%CI 99.3%-100%) for INH; the sensitivity was 78.8% (95%CI 66.8%-90.9%) and the specificity was 100% (95%CI 98.9%-100%). The Abbott RealTime MTB RIF/INH test could be a valid method for detecting the most common mutations in strains resistant to RIF and INH.

  10. Detection of Mycobacterium tuberculosis in extrapulmonary biopsy samples using PCR targeting IS6110, rpoB and nested-rpoB PCR Cloning

    Directory of Open Access Journals (Sweden)

    Hossein eMeghdadi

    2015-07-01

    Full Text Available Present study was aimed to examine the diagnostic utility of PCR and nested PCR techniques for the detection of Mycobacterium tuberculosis (MTB DNA in samples from patients with extra pulmonary tuberculosis (EPTB. In total 80 formalin-fixed, paraffin-embedded (FFPE samples comprising 70 samples with definite diagnosis of EPTB and 10 samples from known non- EPTB on the basis of histopathology examination, were included in the study.PCR amplification targeting IS6110, rpoB gene and nested PCR targeting the rpoB gene were performed on the extracted DNAs from 80 FFPE samples. The strong positive samples were directly sequenced. For negative samples and those with weak band in nested-rpoB PCR, TA cloning was performed by cloning the products into the plasmid vector with subsequent sequencing. The 95% confidence intervals for the estimates of sensitivity and specificity were calculated for each method.Fourteen (20%, 34 (48.6% and 60 (85.7% of the 70 positive samples confirmed by histopathology, were positive by rpoB-PCR, IS6110- PCR and nested-rpoB PCR, respectively. By performing TA cloning on samples that yielded weak (no.=8 or negative results (no.=10 in the PCR methods, we were able to improve their quality for later sequencing. All samples with weak band and 7 out of 10 negative samples, showed strong positive results after cloning. So nested-rpoB PCR cloning revealed positivity in 67 out of 70 confirmed samples (95.7%. The sensitivity of these combination methods was calculated as 95.7% in comparison with histopathology examination. The confidence intervals for sensitivity of the PCR methods were calculated as 11.39-31.27% for rpoB-PCR, 36.44-60.83% for IS6110- PCR, 75.29-92.93% for nested-rpoB PCR and 87.98-99.11% for nested-rpoB PCR cloning. The 10 true EPTB negative samples by histopathology, were negative by all tested methods including cloning and were used to calculate the specificity of the applied methods. The confidence intervals for

  11. Detection of Mycobacterium tuberculosis in extrapulmonary biopsy samples using PCR targeting IS6110, rpoB, and nested-rpoB PCR Cloning.

    Science.gov (United States)

    Meghdadi, Hossein; Khosravi, Azar D; Ghadiri, Ata A; Sina, Amir H; Alami, Ameneh

    2015-01-01

    Present study was aimed to examine the diagnostic utility of polymerase chain reaction (PCR) and nested PCR techniques for the detection of Mycobacterium tuberculosis (MTB) DNA in samples from patients with extra pulmonary tuberculosis (EPTB). In total 80 formalin-fixed, paraffin-embedded (FFPE) samples comprising 70 samples with definite diagnosis of EPTB and 10 samples from known non- EPTB on the basis of histopathology examination, were included in the study. PCR amplification targeting IS6110, rpoB gene and nested PCR targeting the rpoB gene were performed on the extracted DNAs from 80 FFPE samples. The strong positive samples were directly sequenced. For negative samples and those with weak band in nested-rpoB PCR, TA cloning was performed by cloning the products into the plasmid vector with subsequent sequencing. The 95% confidence intervals (CI) for the estimates of sensitivity and specificity were calculated for each method. Fourteen (20%), 34 (48.6%), and 60 (85.7%) of the 70 positive samples confirmed by histopathology, were positive by rpoB-PCR, IS6110-PCR, and nested-rpoB PCR, respectively. By performing TA cloning on samples that yielded weak (n = 8) or negative results (n = 10) in the PCR methods, we were able to improve their quality for later sequencing. All samples with weak band and 7 out of 10 negative samples, showed strong positive results after cloning. So nested-rpoB PCR cloning revealed positivity in 67 out of 70 confirmed samples (95.7%). The sensitivity of these combination methods was calculated as 95.7% in comparison with histopathology examination. The CI for sensitivity of the PCR methods were calculated as 11.39-31.27% for rpoB-PCR, 36.44-60.83% for IS6110- PCR, 75.29-92.93% for nested-rpoB PCR, and 87.98-99.11% for nested-rpoB PCR cloning. The 10 true EPTB negative samples by histopathology, were negative by all tested methods including cloning and were used to calculate the specificity of the applied methods. The CI for 100

  12. Tuberculosis risk varies with the duration of HIV infection: a prospective study of European drug users with known date of HIV seroconversion

    NARCIS (Netherlands)

    van Asten, Liselotte; Langendam, Miranda; Zangerle, Robert; Hernández Aguado, Ildefonso; Boufassa, Faroudy; Schiffer, Veronique; Brettle, Raymond P.; Robertson, J. Roy; Fontanet, Arnaud; Coutinho, Roel A.; Prins, Maria

    2003-01-01

    Background: It is not known whether the risk of active tuberculosis disease varies with the length of time that individuals are infected with HIV. Objective: To study how, independently of CD4 T cell count, the risk of tuberculosis varies with the duration of HIV infection. Methods: Using Poisson

  13. Tuberculosis among HIV-positive patients across Europe

    DEFF Research Database (Denmark)

    Kruk, Alexey; Bannister, Wendy; Podlekareva, Daria

    2011-01-01

    To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe.......To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe....

  14. GENITAL TUBERCULOSIS PRESENTING AS PRIMARY AMENORRHEA

    Directory of Open Access Journals (Sweden)

    Supriya

    2015-06-01

    Full Text Available Incidence of Extrapulmonary TB (EPTB is increasing in young women throughout the world. We report a case of young woman apparently having no sings & symptoms of Tuberculosis. CASE REPORT: 18 years young female patient was referred to us as a case of Primary Amenorrhea. She had Normal secondary sexual characters & normal Breast Development (Tanner staging of Breast - IV. She had negative Progesterone Cha llenge Test (PCT. Estrogen & Progesterone Challenge Test was negative. Diagnosis of End Organ Problem was done. Diagnosis of Genital Tuberculosis was confirmed by hysterolaparoscopy. She was given AKT for six months. DISCUSSION: Hysterolaparoscopy is impo rtant investigation in a case of Primary Amenorrhea with negative Estrogen & Progesterone Challenge Test. Tuberculosis with its varied presentation can present as primary amenorrhea in young unmarried female.

  15. 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.

  16. Extrapulmonary tuberculosis among adults: Experience at Chris ...

    African Journals Online (AJOL)

    Adults (N=2 963) with culture-proven EPTB seen over 2 years at Chris Hani Baragwanath Academic Hospital, the main referral hospital serving Soweto, Johannesburg, South Africa, were retrospectively studied for pattern and incidence. Results. The commonest sites of EPTB were the pleura (39.1%), lymph nodes (31.0%), ...

  17. The within-host population dynamics of Mycobacterium tuberculosis vary with treatment efficacy.

    Science.gov (United States)

    Trauner, Andrej; Liu, Qingyun; Via, Laura E; Liu, Xin; Ruan, Xianglin; Liang, Lili; Shi, Huimin; Chen, Ying; Wang, Ziling; Liang, Ruixia; Zhang, Wei; Wei, Wang; Gao, Jingcai; Sun, Gang; Brites, Daniela; England, Kathleen; Zhang, Guolong; Gagneux, Sebastien; Barry, Clifton E; Gao, Qian

    2017-04-19

    Combination therapy is one of the most effective tools for limiting the emergence of drug resistance in pathogens. Despite the widespread adoption of combination therapy across diseases, drug resistance rates continue to rise, leading to failing treatment regimens. The mechanisms underlying treatment failure are well studied, but the processes governing successful combination therapy are poorly understood. We address this question by studying the population dynamics of Mycobacterium tuberculosis within tuberculosis patients undergoing treatment with different combinations of antibiotics. By combining very deep whole genome sequencing (~1000-fold genome-wide coverage) with sequential sputum sampling, we were able to detect transient genetic diversity driven by the apparently continuous turnover of minor alleles, which could serve as the source of drug-resistant bacteria. However, we report that treatment efficacy has a clear impact on the population dynamics: sufficient drug pressure bears a clear signature of purifying selection leading to apparent genetic stability. In contrast, M. tuberculosis populations subject to less drug pressure show markedly different dynamics, including cases of acquisition of additional drug resistance. Our findings show that for a pathogen like M. tuberculosis, which is well adapted to the human host, purifying selection constrains the evolutionary trajectory to resistance in effectively treated individuals. Nonetheless, we also report a continuous turnover of minor variants, which could give rise to the emergence of drug resistance in cases of drug pressure weakening. Monitoring bacterial population dynamics could therefore provide an informative metric for assessing the efficacy of novel drug combinations.

  18. [Parietal tuberculosis complicated by pulmonary embolism].

    Science.gov (United States)

    Bopaka, Regis Gothard; Bemba, Presley Lee Esthel; Janah, Hind; Okombi, Franck Hardain Okemba; Jabri, Hasna; Khattabi, Wiam El; Afif, Hicham

    2017-01-01

    Tuberculosis is a frequent infectious disease in developing countries. It can affect the lung or spread to other parts of the body. Extra-pulmonary tuberculosis poses a major diagnostic problem. We report the case of a patient with pulmonary embolism revealing parietal tuberculosis. This study emphasizes the importance of etiologic assessment in patients with pulmonary embolism.

  19. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran

    2016-01-01

    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  20. Extra-pulmonary primary multidrug-resistant tubercular lymphadenitis in an HIV negative patient

    Science.gov (United States)

    Kant, Surya; Saheer, S; Hassan, Ghulam; Parengal, Jabeed

    2012-01-01

    A 28-year-old woman without any history of prior antituberculosis treatment presented with cervical lymphadenopathy and a cold abscess near medial end of clavicle of 5 months duration. Pus culture and sensitivity revealed Mycobacterium tuberculosis resistant to rifampicin and isoniazid. Thus she was diagnosed as a case of primary multidrug-resistant tuberculosis and treated with second line drugs according to culture susceptibility pattern. On completion of therapy, patent showed good clinical response. This case highlights the observation that even extra-pulmonary primary multidrug-resistant tuberculosis can be successfully treated with currently available second line drugs. PMID:22605844

  1. [Extrapulmonary pneumocystosis: a case report].

    Science.gov (United States)

    Valdebenito, Carlos; Bonacic, Macarena; Matamala, Jennifer; Wolff, Marcelo

    2015-06-01

    We report a case of a middle-age male patient, with newly HIV infection in AIDS stage diagnosis, no comorbitidies, who was hospitalized for subacute malaise, fever, self-limited unproductive cough and no bloody chronic diarrea. The diagnosis of Pneumocystis jiroveci pneumonia was performed by imagenological suspicion and stains of cysts of this pathogen with bronchoalveolar lavage samples. Treatment was initiated with oral cotrimoxazole and starting HAART with good clinical outcome. Concomitantly, an etiologic study was conducted for chronic diarrhea and through histopathological examination of colonic mucosa, numerous extracellular cystic structures Pneumocystis characteristics were observed, performing the diagnosis of extrapulmonary pneumocystosis. Extrapulmonary pneumocystosis is a rare cause of P. jiroveci infection, requires a high index of suspicion and should be approached in HIV patients with severe AIDS which is common in co-infection of various infections and is peremptory to make an etiologic diagnosis and early treatment.

  2. Tuberculosis

    Directory of Open Access Journals (Sweden)

    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

  3. High prevalence of tuberculosis among adults with fever admitted at ...

    African Journals Online (AJOL)

    Tuberculosis is a leading cause of death in developing countries where HIV is endemic. This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis among febrile adults admitted at Bugando Medical Centre (BMC), Mwanza, ...

  4. High prevalence of tuberculosis among adults with fever admitted at ...

    African Journals Online (AJOL)

    Abstract: Tuberculosis is a leading cause of death in developing countries where HIV is endemic. This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis among febrile adults admitted at Bugando. Medical Centre (BMC) ...

  5. Abdominal Tuberculosis Mimicking Metastasis in a Patient with Carcinoma of the Oesophagus

    Directory of Open Access Journals (Sweden)

    Hester Yui Shan Cheung

    2006-01-01

    Full Text Available Oesophageal carcinoma typically manifests as ulcerative growth. Cases of oesophageal tuberculosis mimicking carcinoma of the oesophagus have been reported and create considerable diagnostic difficulty. Abdominal tuberculosis, however, is an uncommon extrapulmonary manifestation of tuberculosis. Here, we report a case of abdominal tuberculosis in a patient with squamous carcinoma of the oesophagus.

  6. Sinonasal tuberculosis: Report of three atypical cases.

    Science.gov (United States)

    Malik, Junaid N; Jan, Sabeena; Monga, Seema; Bahadur, Sudhir

    2016-10-01

    Primary sinonasal/nasal tuberculosis is rare amongst the commonly seen cases of extrapulmonary tuberculosis. We report three cases, two of primary sinonasal tuberculosis and one case of nasal tuberculosis in otherwise healthy patients. The diagnosis was based on radiological and histopathological findings. Treatment with antitubercular drug therapy was successful in all three of them. Sinonasal region tuberculosis, despite its rarity, should be added to differential diagnosis of nasal and paranasal sinus disorders particularly with intractable symptoms. Radiological imaging and nasal endoscopy with biopsy should be supplemented for confirmation. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  7. [Multifocal tuberculosis in immunocompetent patients].

    Science.gov (United States)

    Rezgui, Amel; Fredj, Fatma Ben; Mzabi, Anis; Karmani, Monia; Laouani, Chadia

    2016-01-01

    Multifocal tuberculosis is defined as the presence of lesions affecting at least two extrapulmonary sites, with or without pulmonary involvement. This retrospective study of 10 cases aims to investigate the clinical and evolutionary characteristics of multifocal tuberculosis. It included 41 cases with tuberculosis collected between 1999 and 2013. Ten patients had multifocal tuberculosis (24%): 9 women and 1 man, the average age was 50 years (30-68 years). Our patients were correctly BCG vaccinated. The evaluation of immunodepression was negative in all patients. 7 cases had lymph node tuberculosis, 3 cases digestive tuberculosis, 2 cases pericardial tuberculosis, 2 cases osteoarticular tuberculosis, 1 case brain tuberculosis, 2 cases urinary tuberculosis, 4 cases urogenital tuberculosis, 1 case adrenal tuberculosis, 1 case cutaneous and 1 case muscle tuberculosis. All patients received anti-tuberculosis treatment for a mean duration of 10 months, with good evolution. Multifocal tuberculosis is difficult to diagnose. It can affect immunocompetent patients but often has good prognosis. Anti-tuberculosis therapy must be initiated as soon as possible to avoid sequelae.

  8. Primary prostatic tuberculosis: A rare form of genitourinary tuberculosis

    African Journals Online (AJOL)

    J.M. Ratkal

    all extrapulmonary types of tuberculosis, with the prostate being involved in 70% of all cases. Amazingly, primary prostatic tuber- culosis in the absence of demonstrable disease elsewhere is rare with an autopsy incidence of only 1%, although the prostate is con- tiguous to the bladder and may be bathed in mycobacteria- ...

  9. Extrapulmonary sites of radiogallium accumulation in sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Sulavik, S.B.; Palestro, C.J.; Spencer, R.P.; Swyer, A.J.; Goldsmith, S.J.; Tierstein, A.S. (Univ. of Connecticut Health Center, Farmington (USA))

    1990-12-01

    In an effort to detect extrapulmonary sites of radiogallium accumulation in cases of sarcoidosis, 145 separate Ga-67 citrate studies of 114 patients with biopsy-proven sarcoidosis were examined. The most characteristic extrapulmonary radiogallium uptake pattern was the panda sign in 47 patients (41%). The most common site of prominent extrapulmonary radiogallium uptake was the lacrimal glands in 101 patients (88%). Second most common was activity in one or more superficial lymph node regions such as the cervical, axillary, femoral, or inguinal in 19 patients (17%). Other extrapulmonary sites included breast uptake in 6 out of 80 women (8%), prominent splenic and nasal uptake in 9 (8%) patients, periportal accumulation in 7 (6%), and cutaneous/subcutaneous activity in 4 (4%). Because many of these individuals were receiving corticosteroids, the natural (untreated) prevalence of extrapulmonary findings may be even higher. Although the sensitivity and specificity of extrapulmonary radiogallium accumulation has still to be determined, many of the sites may be accessible to biopsy both for diagnostic purposes and to follow the effects of medications. It is therefore suggested that whole-body imaging be performed when radiogallium is administered to patients with suspected or known sarcoidosis.

  10. Resurgence of tuberculosis: a rare case of primary orbitomaxillary tuberculoma.

    Science.gov (United States)

    Kar, Indu Bhusan; Panda, Sachchida Nanda; Mishra, Niranjan; Kar, Rosalin; Singh, Akhilesh Kumar

    2013-07-01

    Extrapulmonary sites of tuberculosis, which represent 15% of all sites, most commonly involve lymph nodes and bones. Facial bones and paranasal sinuses are rarely involved in the process. Tuberculosis of maxilla is an extremely rare condition, which usually presents with involvement of anterior wall of the maxillary sinus. Symptoms may include nasal discharge with partial nasal obstruction and mild pain. It still remains an underdiagnosed entity. We report a case of tuberculoma of the whole left maxilla extending into the orbit, with no previous history of pulmonary tuberculosis. Tuberculosis of paranasal sinus is a rare entity and is nearly always secondary to pulmonary or extrapulmonary tuberculosis, but this report describes the incidence of primary infection of extrapulmonary site. Any chronic granulomatous lesion present over the maxillofacial region which does not respond to initial antibiotic therapy may be suspected as tubercular infection and should be ruled out with priority. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Prophylactic Sublingual Immunization with Mycobacterium tuberculosis Subunit Vaccine Incorporating the Natural Killer T Cell Agonist Alpha-Galactosylceramide Enhances Protective Immunity to Limit Pulmonary and Extra-Pulmonary Bacterial Burden in Mice

    Directory of Open Access Journals (Sweden)

    Arshad Khan

    2017-12-01

    Full Text Available Infection by Mycobacterium tuberculosis (Mtb remains a major global concern and the available Bacillus Calmette-Guerin (BCG vaccine is poorly efficacious in adults. Therefore, alternative vaccines and delivery strategies focusing on Mtb antigens and appropriate immune stimulating adjuvants are needed to induce protective immunity targeted to the lungs, the primary sites of infections and pathology. We present here evidence in support of mucosal vaccination by the sublingual route in mice using the subunit Mtb antigens Ag85B and ESAT-6 adjuvanted with the glycolipid alpha-galactosylceramide (α-GalCer, a potent natural killer T (NKT cell agonist. Vaccinated animals exhibited strong antigen-specific CD4 and CD8 T cells responses in the spleen, cervical lymph nodes and lungs. In general, inclusion of the α-GalCer adjuvant significantly enhanced these responses that persisted over 50 days. Furthermore, aerosolized Mtb infection of vaccinated mice resulted in a significant reduction of bacterial load of the lungs and spleens as compared to levels seen in naïve controls or those vaccinated with subunit proteins, adjuvant , or BCG alone. The protection induced by the Mtb antigens and-GalCer vaccine through sublingual route correlated with a TH1-type immunity mediated by antigen-specific IFN-γ and IL-2 producing T cells.

  12. Extra-pulmonary manifestations of sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Vardhanabhuti, V. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Venkatanarasimha, N. [St Michael' s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8 (Canada); Bhatnagar, G.; Maviki, M.; Iyengar, S.; Adams, W.M. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Suresh, P., E-mail: sureshpriya2000@yahoo.com [Radiology Department, Derriford Hospital, Plymouth (United Kingdom)

    2012-03-15

    Although, the diagnosis and evaluation of sarcoidosis has traditionally remained confined to the chest, its multi-system nature has been widely recognized. Radiological features of pulmonary sarcoidosis are well known but extra-pulmonary manifestations can produce a plethora of non-specific imaging findings that can affect subcutaneous tissue, and the neurological, cardiac, gastrointestinal, urological, liver, spleen, and skeletal systems. In the literature, there are various case reports and specific system reviews but there are few reviews that encompass all the extra-pulmonary manifestations. In this paper, we comprehensively review the imaging features of extra-pulmonary sarcoidosis with characteristic features as well as atypical presentations. In addition, we discuss the emerging role of nuclear medicine in sarcoidosis.

  13. Axillary lymph node tuberculosis masquerading as inflammatory breast carcinoma in an immune-compromised patient.

    Science.gov (United States)

    Chikkannaiah, Panduranga; Vani, B R; Benachinmardi, Kirtilaxmi; Murthy, V Srinivasa

    2016-02-01

    While tuberculosis is still the leading opportunistic infection among human immunodeficiency virus-seropositive patients, extra-pulmonary tuberculosis is more common than pulmonary tuberculosis, with lymph nodes being a common site. Axillary lymph node pathology such as tuberculosis and lymphoma rarely mimics inflammatory breast carcinoma by producing lymphatic obstruction. We report a case of axillary lymph node tuberculosis in a 40-year-old immune-compromised woman, clinically presenting as inflammatory breast carcinoma. © The Author(s) 2015.

  14. Tuberculosis After Renal Transplant.

    Science.gov (United States)

    Barbouch, Samia; Hajji, Meriam; Helal, Imed; Ounissi, Mondher; Bacha, Mohammed Mongi; Ben Hamida, Fathi; Abderrahim, Ezzedine; Ben Abdallah, Taieb

    2017-02-01

    Tuberculosis is one of the leading infections after renal transplant, particularly in developing countries where the incidence and prevalence in the general population are high. Diagnosis requires bacteriologic and histologic confirmation. Interactions among the antitubercular drugs and the immunosuppressive agents have to be considered while prescribing, and surveillance for adverse effects is required. Although rare, case reports are available on extrapulmonary tuberculosis in allograft recipients. Here, we present a 25-year-old kidney transplant recipient who was diagnosed with lymph node tuberculosis under uncommon circumstances but who had a good outcome. This case report illustrates the difficulties in diagnosis of tuberculosis, changes in therapeutic protocols, and prognostic factors and highlights the effects of infectious complications with immunosuppressive therapy in this particular patient population.

  15. Central nervous system tuberculosis | Cherian | African Health ...

    African Journals Online (AJOL)

    Central nervous system (CNS) involvement, one of the most devastating clinical manifestations of tuberculosis (TB) is noted in 5 to 10% of extrapulmonary TB cases, and accounts for approximately 1% of all TB cases. Definitive diagnosis of tuberculous meningitis (TBM) depends upon the detection of the tubercle bacilli in ...

  16. Breast tuberculosis in outpatient practice: Case reports

    African Journals Online (AJOL)

    There has been a general increase in both pulmonary and extra-pulmonary tuberculosis. (TB) attributable to global spread of AIDS. The breast is rarely a focus whether primarily or contiguously. It is confused with cancer of the breast and confirmation by histology and/or demonstration of acid and alcohol fast bacilli.

  17. Primary nasal tuberculosis: A case report

    OpenAIRE

    Stojanović Jasmina; Belić Branislav; Mitrović Slobodanka; Stanković Predrag; Stojanović Stevan; Erdevički Ljiljana; Živić Ljubica; Arsenijević Snežana

    2013-01-01

    Introduction. During the past two decades, tuberculosis (TBC) both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. Case report. Thirty-yearold man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laborat...

  18. Prevalence and species spectrum of both pulmonary and extrapulmonary nontuberculous mycobacteria isolates at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Jyoti Umrao

    2016-01-01

    Full Text Available Objective/background: Nontuberculous mycobacteria (NTM infection associated with pulmonary and extrapulmonary disease has been increasing globally. Despite an increase in incidence rate of NTM infection, its prevalence, species diversity, and circulation pattern in India is largely unknown. This study sought to investigate the overall burden and diversity of NTM among both pulmonary and extrapulmonary clinical isolates from a Northern Indian population. Methods: The study was conducted in the Department of Microbiology, from January 2013 to December 2015. A total of 4620 clinical samples were collected from patients suspected to have pulmonary and extrapulmonary tuberculosis. Preliminary diagnosis was performed using Ziehl–Neelsen staining followed by liquid culture in BacT/ALERT three-dimensional system. A total of 906 positive cultures obtained were differentiated as either NTM or Mycobacterium tuberculosis complex using a biochemical and MPT64 antigen test. Further identification of NTM species was confirmed with a line probe assay. Results: Out of 906 cultures isolates, 263 (29.0% were confirmed as NTM and 643 (71.0% were identified as Mycobacterium tuberculosis complex. A total of 79.4% of the NTM were recovered from pulmonary and 18.2% from extrapulmonary specimens. The diversity of NTM species was high (13 species and predominated by Mycobacterium abscessus (31.3% followed by Mycobacterium fortuitum (22%, Mycobacterium intracellulare (13.6%, Mycobacterium chelonae (9.1%, however, M. abscessus and M. fortuitum were the predominant species in both types of clinical isolates. Men (60.4% and older patients aged greater than 55 years were the predominated risk group for NTM infection. Conclusion: The high prevalence and species diversity of NTM suggests the need for immediate and accurate characterization of NTM for proper treatment and management of patients.

  19. Prevalence and species spectrum of both pulmonary and extrapulmonary nontuberculous mycobacteria isolates at a tertiary care center.

    Science.gov (United States)

    Umrao, Jyoti; Singh, Dharamveer; Zia, Amreen; Saxena, Swati; Sarsaiya, Surendra; Singh, Shushma; Khatoon, Jahanarah; Dhole, Tapan N

    2016-09-01

    Nontuberculous mycobacteria (NTM) infection associated with pulmonary and extrapulmonary disease has been increasing globally. Despite an increase in incidence rate of NTM infection, its prevalence, species diversity, and circulation pattern in India is largely unknown. This study sought to investigate the overall burden and diversity of NTM among both pulmonary and extrapulmonary clinical isolates from a Northern Indian population. The study was conducted in the Department of Microbiology, from January 2013 to December 2015. A total of 4620 clinical samples were collected from patients suspected to have pulmonary and extrapulmonary tuberculosis. Preliminary diagnosis was performed using Ziehl-Neelsen staining followed by liquid culture in BacT/ALERT three-dimensional system. A total of 906 positive cultures obtained were differentiated as either NTM or Mycobacterium tuberculosis complex using a biochemical and MPT64 antigen test. Further identification of NTM species was confirmed with a line probe assay. Out of 906 cultures isolates, 263 (29.0%) were confirmed as NTM and 643 (71.0%) were identified as Mycobacterium tuberculosis complex. A total of 79.4% of the NTM were recovered from pulmonary and 18.2% from extrapulmonary specimens. The diversity of NTM species was high (13 species) and predominated by Mycobacterium abscessus (31.3%) followed by Mycobacterium fortuitum (22%), Mycobacterium intracellulare (13.6%), Mycobacterium chelonae (9.1%), however, M. abscessus and M. fortuitum were the predominant species in both types of clinical isolates. Men (60.4%) and older patients aged greater than 55years were the predominated risk group for NTM infection. The high prevalence and species diversity of NTM suggests the need for immediate and accurate characterization of NTM for proper treatment and management of patients. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  20. Functional imaging in extrapulmonary sarcoidosis: FDG-PET/CT and MR features.

    Science.gov (United States)

    Soussan, Michael; Augier, Alexandre; Brillet, Pierre-Yves; Weinmann, Pierre; Valeyre, Dominique

    2014-02-01

    Sarcoidosis is a multiorgan granulomatous disease of unknown etiology that primarily involves the lungs and the lymphatic system. Extrapulmonary sarcoidosis is common, occurring in 30 to 50% of patients. In this review, we describe and illustrate the role of F-FDG PET/CT and MR imaging in patients with extrapulmonary sarcoidosis. FDG-PET/CT and MR can improve the accuracy of the diagnosis of extrapulmonary involvement, specify the respective contributions of active and fibrotic components of lesions, guide the selection of the biopsy site, provide prognostic information, and guide therapeutic management. We focus on suggestive patterns that help to improve lesion characterization, especially when these lesions are clinically occult. In cardiac sarcoidosis, the combined use of FDG-PET/CT and cardiac MR may provide optimal detection of the disease by enabling the differentiation between patients with active granulomatous inflammation and those with fibrous lesions. In cases with central nervous system involvement, the T2 hypointensity of the dural and parenchymal lesions is helpful for identifying sarcoidosis. Granulomatous bone marrow infiltration in the axial skeleton can be sensitively detected by both FDG-PET/CT and MR. Muscular sarcoidosis can have a characteristic appearance with the "dark star" sign on MR and a thick linear FDG uptake that predominantly involves the lower legs, designated as the "tiger man" sign. Extrathoracic lymphadenopathy is commonly observed on FDG-PET/CT imaging; however, its features are not specific, and the differentiation of extrathoracic lymphadenopathy from metastatic disease, tuberculosis, or lymphoma may be difficult. Familiarity with the functional imaging features in extrapulmonary sarcoidosis in various anatomical locations plays a crucial role in the diagnosis and management of patients.

  1. Isolated axillary lymph node tuberculosis in ultrasonography. A case report.

    Science.gov (United States)

    Ścieszka, Joanna; Urbańska-Krawiec, Dagmara; Kajor, Maciej; Stefański, Leszek

    2012-09-01

    We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.8×1 cm of irregular outline with adjacent hypoechogenic lymph nodes was visualized. The diagnosis of tuberculosis was based on histopathologic examination of the excised tumor. In the latter years an increase in extrapulmonary type of tuberculosis has been observed. Extrapulmonary tuberculosis may appear in practically each organ, nevertheless it affects pleura most often. Lymph node tuberculosis is the second, when it comes to the prevalence rate, type of extrapulmonary tuberculosis. In the majority of cases of lymph node tuberculosis it affects superficial lymph nodes. In the ultrasound examination a packet of pathological, enlarged and hypoechogenic lymph nodes is stated. In 1/3 of cases the central part of the nodes is hyperechogenic which indicates its caseation necrosis. Lymph nodes have a tendency to be matted and they have blurred outline. We observed this type of lymph node image in the presented patient. This image may be a diagnostic hint. Nevertheless, in the differentiation diagnostics one should take many other disease entities into consideration, inter alia: sarcoidosis, lymphomas, fungal infections, neoplastic metastases; the latter ones have an image most similar to tuberculosis lymph nodes. Tuberculosis ought to be considered in differential diagnosis of atypical masses.

  2. Management of extrapulmonary sarcoidosis: challenges and solutions

    Science.gov (United States)

    Al-Kofahi, Khalid; Korsten, Peter; Ascoli, Christian; Virupannavar, Shanti; Mirsaeidi, Mehdi; Chang, Ian; Qaqish, Naim; Saketkoo, Lesley A; Baughman, Robert P; Sweiss, Nadera J

    2016-01-01

    Background Sarcoidosis is a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas that most often involves the lungs, but frequently has extrapulmonary manifestations, which might be difficult to treat in individual patients. Objective To review different disease manifestations, focusing on extrapulmonary organ systems, and to provide treatment options for refractory cases. Materials and methods We performed a literature search using Medline and Google Scholar for individual or combined keywords of “sarcoidosis, extrapulmonary, treatment, kidney, neurosarcoidosis, cardiovascular, gastrointestinal, transplantation, musculoskeletal, rheumatology, arthritis, and skin”. Peer-reviewed articles, including review articles, clinical trials, observational trials, and case reports that were published in English were included. References from retrieved articles were also manually searched for relevant articles. Results and conclusion Isolated involvement of a single organ or organ system is rare in sarcoidosis, and thus all patients must be thoroughly evaluated for additional disease manifestations. Cardiac sarcoidosis and neurosarcoidosis may be life-threatening. Clinicians need to assess patients comprehensively using clinical, laboratory, imaging, and histopathological data to recommend competently the best and least toxic treatment option for the individual patient. PMID:27853374

  3. Utility of Line Probe Assay for diagnosis of extrapulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Joveria Farooqi

    2015-01-01

    Conclusion: The study shows that LiPA has good overall sensitivity and specificity compared with culture. Although the number of samples was very small, the applicability appears to be most useful in urine and pus specimens and should be explored further as a diagnostic tool in these cases.

  4. [Smoking and adherence to anti-tuberculosis treatment].

    Science.gov (United States)

    Underner, M; Perriot, J; Peiffer, G; Meurice, J-C; Dautzenberg, B

    2016-02-01

    Smoking and tuberculosis are two major public health issues. Tobacco smoke increases the risk of Mycobacterium tuberculosis infection and the severity of pulmonary tuberculosis. Active smoking increases the risk of relapse of pulmonary and extra-pulmonary tuberculosis after treatment; smokers are less adherent to anti-tuberculosis treatment. Smoking cessation represent a means of controlling the tuberculosis epidemic in developing countries. This general review identified 17 studies in the international literature on the link between active smoking and the adherence to anti-tuberculosis treatment. It highlights a positive association between smoking and a lack of adherence to anti-tuberculosis treatment. This justifies the systematic application of aid to stopping smoking in smokers with tuberculosis. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  5. Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis

    Directory of Open Access Journals (Sweden)

    Sezgin Betul

    2008-01-01

    Full Text Available Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

  6. Atypical pleural tuberculosis presenting as an isolated pleural tuberculoma

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Sook Min; Rho, Ji Young; Yoo, Seung Min; Jung, Hae Kyoung (Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of)), Email: rhoji@naver.com; Cho, Sang Ho (Department of Pathology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of))

    2012-02-15

    Pleural tuberculosis is the most common extrapulmonary manifestation of tuberculosis, and is generally characterized by an effusion. The effusion is usually unilateral and residual pleural thickening or calcification is also observed in some cases. Manifestations of multiple pleural tuberculomas without associated effusion and history of tuberculosis or antituberculous therapy are rare and an isolated pleural tuberculoma is exceedingly rare. Herein, we report the first documented case of an isolated pleural tuberculoma, diagnosed by chest CT and pathological findings. Although rare, an isolated pleural tuberculoma should be added to the differential diagnosis of focal nodular pleural tumors, particularly in areas of high tuberculosis prevalence

  7. Is tuberculosis a lymphatic disease with a pulmonary portal

    Science.gov (United States)

    Tuberculosis (TB) is commonly viewed as a pulmonary disease, in which infection, persistence, induction of pathology and bacterial expulsion all occur in the lungs. In this model, enlarged lymph nodes represent reactive adenitis and spread of organisms to extrapulmonary sites results in a non-transm...

  8. Breast tuberculosis in outpatient practice: Case reports | Ndungu ...

    African Journals Online (AJOL)

    There has been a general increase in both pulmonary and extra-pulmonary tuberculosis (TB) attributable to global spread of AIDS. The breast is rarely a focus whether primarily or contiguously. It is confused with cancer of the breast and confirmation by histology and/or demonstration of acid and alcohol fast bacilli (AAFB) is ...

  9. Clinical presentation and diagnostic approach in cases of genitourinary tuberculosis

    Directory of Open Access Journals (Sweden)

    Rakesh Kapoor

    2008-01-01

    Full Text Available Objective: We herein describe the various modes of presentation in genitourinary tuberculosis (GUTB and a simple diagnostic approach to it. Materials and Methods: We made a literature search through Medline database and various other peer-reviewed online journals to study the various modes of presentation in GUTB. We reviewed over 100 articles published in the last 10 years (1998 -- 2007, which were tracked through the key words like GUTB and extrapulmonary tuberculosis. Results: GUTB has varied presentation and the most common way of presentation is in the form of irritative voiding symptoms, which are found in more than 50% of the patients. The usual frequency of organ involvement is: kidney, bladder, fallopian tube, and scrotum. The usual tests used to diagnose GUTB are the demonstration of mycobacterium in urine or body fluid and radiographic examination. Intravenous urography (IVU has been considered to be one of the most useful tests for the anatomical as well as the functional details of kidneys and ureters. In cases of renal failure, MRI can be used. Newer examinations such as radiometric liquid culture systems (i.e., BACTEC ® , Becton Dickinson,USA and polymerase chain reaction (PCR give rapid results and are highly sensitive in the identification of mycobacterium. Conclusion: GUTB can involve any part of the genitourinary system and presentation may vary from vague urinary symptoms to chronic kidney disease. Newer tests like radiometric liquid culture systems and polymerase chain reaction give rapid results and carry high diagnostic value.

  10. Treatment pathways of extrapulmonary patients diagnosed at a tertiary care hospital in Delhi, India

    Directory of Open Access Journals (Sweden)

    Manoj Grover

    2014-01-01

    Full Text Available Background: In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment. Materials and Methods: In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi. Results: Factors associated with longer paths included reason for going to first health facility (nearness and known provider, availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks. Conclusions: Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.

  11. Disseminated cutaneous Mycobacterium tuberculosis infection in a patient with AIDS.

    Science.gov (United States)

    Corbett, E L; Crossley, I; De Cock, K M; Miller, R F

    1995-01-01

    Individuals infected with the human immunodeficiency virus (HIV) are at an increased risk of both pulmonary and extrapulmonary tuberculosis. Disseminated cutaneous tuberculosis is rare, but has been reported in four HIV-positive patients, all of whom also had pulmonary infection. In this report we describe an HIV-infected patient with a febrile illness and an abnormal chest radiograph who developed widespread cutaneous tuberculous pustules following a lymph node biopsy on the previous day. Images PMID:7490048

  12. Rare extrapulmonary complications of Mycoplasma pneumoniae infection.

    Science.gov (United States)

    Dhaliwal, Kiran; Enright, Kevin

    2016-02-01

    Stevens-Johnsons syndrome (SJS) is a rare extra-pulmonary complication of Mycoplasma pneumoniae infection. We present the case of a 26-year-old man with fever, cough, extensive oral mucosal ulceration and a widespread truncal rash. He was diagnosed with M. pneumoniae-induced SJS. He responded well to antibiotics and steroids initially, but went on to develop pseudomembranous conjunctivitis requiring bilateral amniotic membrane grafting. SJS is most commonly drug-induced, however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis. It is also important to get specialist care involved early to minimise the long-term effects of any complications. 2016 BMJ Publishing Group Ltd.

  13. Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Amir Hossein Sarrami

    2010-12-01

    Full Text Available Abdominal tuberculosis (TB is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

  14. Expression profiling of lymph nodes in tuberculosis patients reveal inflammatory milieu at site of infection

    OpenAIRE

    Abhijit Maji; Richa Misra; Anupam Kumar Mondal; Dhirendra Kumar; Divya Bajaj; Anshika Singhal; Gunjan Arora; Asani Bhaduri; Andaleeb Sajid; Sugandha Bhatia; Sompal Singh; Harshvardhan Singh; Vivek Rao; Debasis Dash; Baby Shalini, E

    2015-01-01

    Extrapulmonary manifestations constitute 15 to 20% of tuberculosis cases, with lymph node tuberculosis (LNTB) as the most common form of infection. However, diagnosis and treatment advances are hindered by lack of understanding of LNTB biology. To identify host response, Mycobacterium tuberculosis infected lymph nodes from LNTB patients were studied by means of transcriptomics and quantitative proteomics analyses. The selected targets obtained by comparative analyses were validated by quantit...

  15. Tonsillar tuberculosis: a forgotten clinical entity

    Directory of Open Access Journals (Sweden)

    Anirban Das

    2015-01-01

    Full Text Available Tuberculosis of tonsils is an extremely rare variety of extra-pulmonary tuberculosis which frequently simulates the tonsillar malignancy, especially in elderly individuals. Secondary form is more common than primary one, and in present day, contact with the infected sputum or saliva in a case of sputum smear positive pulmonary tuberculosis is the main source of the disease. Chronic or recurrent tonsillitis with enlarged tonsils and sore throat is the main clinical presentation. As it is very difficult to differentiate it from tonsillar malignancy on clinical ground, histopathological examination of the tissue is must for the diagnosis of tonsillar TB. Antitubercular therapy is adequate for its successful resolution. Here, we report a primary form of tonsillar tuberculosis in a 76-year-old male, in whom, no pulmonary tuberculosis was documented.

  16. [CLINICAL INVESTIGATION OF TUBERCULOSIS PATIENTS IN A GENERAL HOSPITAL LACKING A TUBERCULOSIS WARD IN WESTERN AICHI PREFECTURE.

    Science.gov (United States)

    Nakao, Makoto; Muramatsu, Hideki; Sone, Kazuki; Suzuki, Yuto; Kagawa, Yusuke; Kurokawa, Ryota; Aoki, Sachiko; Okawa, Hironaga; Sato, Hidefumi

    2016-05-01

    With the recent decrease in the number of tuberculosis wards and increase in elderly tuber- culosis patients with comorbidities, the role of regional refer- ral hospitals has become more important in tuberculosis management. [Objective]. This study aimed to assess the current state of tuberculosis management and related issues in a general hospital lacking a tuberculosis ward. [Methods] We retrospectively evaluated the clinical char- acteristics and course of patients diagnosed with tuberculosis by culture testing from April 2008 to March 2015 at Kainan Hospital. [Results] A total of 146 patients (83 males and 63 females; mean age 76, range 18-94 years) were diagnosed with active tuberculosis. Of these, 129 were diagnosed with pulmonary tuberculosis (23 had pulmonary tuberculosis with pleurisy), and 17 patients were diagnosed with extrapulmonary tuber- culosis. The chief complains were cough/sputum in 40 cases, fever in 24, and no symptoms in 36. Associated major comorbidities included diabetes mellitus, chronic kidney disease, and malignancy. In 33 patients, over 30 days were required to diagnose tuberculosis after initial evaluation. Drug-resistant strains were detected in 14 patients. 57 were diagnosed with smear-positive pulmonary tuberculosis, and 66 were transferred to a tuberculosis hospital. Modify in anti- tuberculosis therapy due to adverse reactions were reported in 27 patients. [Conclusion] This study evaluated the current state of tuberculosis management in our hospital. Further educational guidance regarding tuberculosis is needed for the hospital staff, and is important for improvement of tuberculosis management in our hospital.

  17. [Tuberculosis within the laryngologic organs].

    Science.gov (United States)

    Polok, Aleksandra; Namysłowski, Grzegorz; Scierski, Wojciech; Czecior, Eugeniusz; Mrówka-Kata, Katarzyna; Gac, Bogusław

    2005-09-01

    Tuberculosis, considering entry of infection, most frequent concerns the lungs. Rarely we observed extrapulmonary cases of tuberculosis within the bones, joints, urogenital organs and lymph nodes as well as within the head and neck region--larynx, nose and paranasal sinuses, middle ear, pharynx, tonsils, tongue, parotid glands and central nervous system. The diagnosis of head and neck tuberculosis is based on patient's examination as well as on the bacteriologic and histologic study of the biopsy specimen. The aim of the study was to show our own, very rare cases of head and neck tuberculosis. We showed our own experience in the diagnosis and treatment of patients suffer from head and neck tuberculosis. 7 cases of head and neck tuberculosis (4 laryngeal, 2 sinonasal and 1 middle ear) were treated from 1986 to 2004 in the II ENT Department Silesian Medical University in Zabrze. In all the cases the diagnosis was based on the histological examination of the tissue specimen. All of the patients were suspected of the neoplastic disease. We assessed good long-term results after the conservative treatment (sometimes completed by surgery). Tuberculosis of the head and neck region should be taken into consideration during the differential diagnosis of neoplastic diseases.

  18. Mycobacterium tuberculosis complex detected by modified fluorescent in situ hybridization in lymph nodes of clinical samples.

    Science.gov (United States)

    Rodriguez-Nuñez, Juan; Avelar, Francisco J; Marquez, Francisco; Rivas-Santiago, Bruno; Quiñones, Cesar; Guerrero-Barrera, Alma L

    2012-01-12

    Lymph node tuberculosis (TB) is the leading cause of extrapulmonary tuberculosis and is the most frequently identified type in Aguascalientes, Mexico. Conventional diagnosis has serious limitations for rapid detection of extrapulmonary tuberculosis in clinical samples. Here PCR and modified FISH have been tested as complementary diagnosis methods for extrapulmonary tuberculosis. The specific insertion sequence IS6110 for Mycobacterium tuberculosis complex was used to perform PCR and build DNA and PNA FISH probes (20bp). PCR and modified DNA and PNA FISH assays were performed to evaluate 41 lymph node paraffin-embedded tissue samples, in comparison with the histopathology diagnosis, which was considered the gold standard (22 positive and 19 negative). In comparison with histopathology diagnosis PCR showed 62.5 % sensitivity and 77.8 % specificity (χ(2) = 4.583 p 0.05). Ziehl Neelsen stain was positive in only four cases of 22 lymph node samples positive to histopathology.  In contrast, PCR and modified DNA FISH were positive in 20 cases of the same group. The negative cases were coincident in all tests. PCR and DNA FISH showed a significant increase in the number of cases detected and also showed higher sensitivity and specificity compared with data reported by traditional methodology. In developing countries, these techniques could help to complement the early diagnosis and timely treatment of extrapulmonary tuberculosis.

  19. Pregnancy outcomes in women with tuberculosis: a 10-year experience from an Indian tertiary care hospital.

    Science.gov (United States)

    Chopra, Seema; Siwatch, Sujata; Aggarwal, Neelam; Sikka, Pooja; Suri, Vanita

    2017-04-01

    Our study sought to determine the characteristics of antenatal patients with tuberculosis (TB) and their pregnancy outcomes. Case records of 50 antenatal women with extra-pulmonary and pulmonary TB at a tertiary centre in India were compared to 150 antenatal women not suffering from TB, for adverse medical, obstetric and neonatal outcomes. The prevalence of TB was 1.16 per 1000 deliveries. Of these, 62% had extra-pulmonary TB. There were two maternal deaths. TB in pregnancy was associated with a five times higher risk of prematurity and three times higher risk of intrauterine growth restriction than the norm. Maternal prognosis depends on the complications of tuberculosis and treatment compliance.

  20. Clinical and epidemiological features of AIDS/tuberculosis comorbidity

    Directory of Open Access Journals (Sweden)

    Song Alice Tung Wan

    2003-01-01

    Full Text Available Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%, followed by intravenous drug use (29.3% and homosexual/bisexual contact (23.2%. Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

  1. Demographic and clinical characteristics in relation to patient and health system delays in a tuberculosis low-incidence country

    DEFF Research Database (Denmark)

    Leutscher, Peter; Madsen, Gitte; Erlandsen, Mogens

    2012-01-01

    Background: Delays in the diagnosis and treatment of tuberculosis (TB) are commonly encountered. Methods: A study was undertaken among pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) patients in a Danish university hospital to describe demographic and clinical characteristics...... of TB. Conclusions: This study confi rmed a typical delay of months in duration in the diagnosis and treatment of TB in the low endemic country of Denmark. Increased TB awareness is needed, in particular in communities with immigrants originating from high-endemic areas....

  2. Evaluation of Xpert MTB/RIF assay for rapid molecular diagnosis of tuberculosis in a two-year period in Croatia

    Directory of Open Access Journals (Sweden)

    Ljiljana Zmak

    2013-01-01

    Full Text Available Mycobacterium tuberculosis remains a major global health problem and is currently killing 1.5 million people every year. One of the most important steps in tuberculosis control is the rapid and accurate laboratory diagnosis. The Xpert MTB/RIF assay is a novel molecular, easy-to-use assay, which can lead to tuberculosis identification in less than 2 h. In this study, the Xpert MTB/RIF assay performance for rapid diagnosis of tuberculosis was evaluated in comparison with conventional culture methods; 361 pulmonary and extrapulmonary patient samples were collected between October 2010 and October 2012 and were analyzed at the National Reference laboratory for Mycobacteria, Zagreb, Croatia. For pulmonary samples the sensitivity and specificity were 86% and 100%, while for extrapulmonary samples the sensitivity and specificity were 75% and 99%, respectively. It was concluded that Xpert MTB/RIF assay has high sensitivity and specificity for both pulmonary and extrapulmonary specimens.

  3. Tuberculosis and nutrition

    Directory of Open Access Journals (Sweden)

    Gupta Krishna

    2009-01-01

    Full Text Available Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host′s susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.

  4. [Tuberculosis and immigration].

    Science.gov (United States)

    Salas-Coronas, Joaquín; Rogado-González, M Cruz; Lozano-Serrano, Ana Belén; Cabezas-Fernández, M Teresa

    2016-04-01

    The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  5. Tuberculosis (TB)

    Science.gov (United States)

    ... with facebook share with twitter share with linkedin Tuberculosis Go to Information for Researchers ► Tuberculosis (TB) is ... are drug resistant. Why Is the Study of Tuberculosis a Priority for NIAID? Tuberculosis is one of ...

  6. A modified scoring system to describe gross pathology in the rabbit model of tuberculosis

    Science.gov (United States)

    2011-01-01

    Background The rabbit model is an ideal means to study the pathogenesis of tuberculosis due to its semblance to the disease in humans. We have previously described the results using a bronchoscopic route of infection with live bacilli as a reliable means of generating lung cavities in sensitized rabbits. The role of sensitization in the development of disease outcomes has been well established in several animal models. We have described here the varying gross pathology that result from lack of sensitization with heat-killed M. bovis prior to high-dose bronchoscopic infection with live bacilli. Results Rabbits lacking sensitization did not generate lung cavities, but instead formed solely a tuberculoid pneumonia that replaced the normal lung parenchyma in the area of infection. Extrapulmonary dissemination was seen in approximately equal frequency and distribution in both rabbit populations. Notable differences include the lack of intestinal lesions in non-sensitized rabbits likely due to the lack of ingestion of expectorated bacilli from cavitary lesions. The experiment also employed a modified scoring system developed initially in the primate model of tuberculosis to allow for the quantification of findings observed at necropsy. Conclusions To date, no such scoring system has been employed in the rabbit model to describe gross pathology. The quantitative methodology would allow for rapid comparative analyses and standardization of thoracic and extrapulmonary pathology that could be evaluated for statistical significance. The aim is to use such a scoring system as the foundation for all future rabbit studies describing gross pathology at all stages in TB pathogenesis. PMID:21375756

  7. A modified scoring system to describe gross pathology in the rabbit model of tuberculosis

    Directory of Open Access Journals (Sweden)

    Osborne Jonathan

    2011-03-01

    Full Text Available Abstract Background The rabbit model is an ideal means to study the pathogenesis of tuberculosis due to its semblance to the disease in humans. We have previously described the results using a bronchoscopic route of infection with live bacilli as a reliable means of generating lung cavities in sensitized rabbits. The role of sensitization in the development of disease outcomes has been well established in several animal models. We have described here the varying gross pathology that result from lack of sensitization with heat-killed M. bovis prior to high-dose bronchoscopic infection with live bacilli. Results Rabbits lacking sensitization did not generate lung cavities, but instead formed solely a tuberculoid pneumonia that replaced the normal lung parenchyma in the area of infection. Extrapulmonary dissemination was seen in approximately equal frequency and distribution in both rabbit populations. Notable differences include the lack of intestinal lesions in non-sensitized rabbits likely due to the lack of ingestion of expectorated bacilli from cavitary lesions. The experiment also employed a modified scoring system developed initially in the primate model of tuberculosis to allow for the quantification of findings observed at necropsy. Conclusions To date, no such scoring system has been employed in the rabbit model to describe gross pathology. The quantitative methodology would allow for rapid comparative analyses and standardization of thoracic and extrapulmonary pathology that could be evaluated for statistical significance. The aim is to use such a scoring system as the foundation for all future rabbit studies describing gross pathology at all stages in TB pathogenesis.

  8. Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study.

    Science.gov (United States)

    Zhang, Xinyu; Andersen, Aase B; Lillebaek, Troels; Kamper-Jørgensen, Zaza; Thomsen, Vibeke Østergaard; Ladefoged, Karin; Marrs, Carl F; Zhang, Lixin; Yang, Zhenhua

    2011-08-01

    Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case-control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark and Greenland during 1992-2007 to gain insight to the role of host factors in EPTB pathogenesis. Among patients from Somalia and Asia, persons 25-44 and 45-64 years of age were more likely to have EPTB than persons 15-24 years of age. In contrast, among persons from Greenland, the two oldest age groups were significantly less likely to have EPTB than the youngest age group. For all the age groups, the odds for having EPTB was significantly higher among patients from Somalia and Asia and significantly lower among the patients from Greenland than among patients from Denmark. Furthermore, the occurrence of specific types of EPTB significantly varied among different age groups or origins.

  9. A review of tuberculosis research in malaysia.

    Science.gov (United States)

    Swarna Nantha, Y

    2014-08-01

    One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.

  10. Clinical and therapeutic aspects of extrapulmonary small cell carcinoma

    NARCIS (Netherlands)

    Walenkamp, Annemiek M. E.; Sonke, Gabe S.; Sleijfer, Dirk T.

    Extrapulmonary small cell carcinoma (EPSCC) is usually treated similarly to small cell lung cancer. Differences in aetiology, clinical course, frequency of brain metastases, and survival, however, warrant a differential therapeutic approach. In this review, we focus on the treatment of the most

  11. HIV and tuberculosis: Partners in crime

    Directory of Open Access Journals (Sweden)

    Maniar Janak

    2006-01-01

    Full Text Available Background: Tuberculosis is the commonest infection detected in HIV-infected individuals worldwide. Aim: The aim of this study is to describe the clinical, bacteriologic and radiological spectrum of tuberculosis (TB in the setting of human immunodeficiency virus (HIV infection in a tertiary care centre in Mumbai. Methods: A total of 8640 HIV-infected individuals were screened for tuberculosis routinely from January 1998 to December 2003, using clinical examination, chest X-ray and abdominal ultrasonography, sputum smears for acid-fast bacilli (AFB and culture on Lowenstein-Jensen medium. Results: TB was detected in 8078 (93.5% patients of whom 3393 (42% had pulmonary, 3514 (43.5% had extrapulmonary TB and 1171 (14.5% had disseminated disease. One thousand two hundred thirty eight patients (36.5% showed AFB in sputum, while 1154 (34% showed growth on culture medium and 4174 had radiographic involvement. In 781 (67% individuals disseminated disease coexisted with pulmonary involvement. All 8078 coinfected patients were treated with anti-TB therapy (ATT, of whom 6422 patients (79.5% showed one or more adverse events. Gastritis was the commonest complaint followed by hepatitis and skin rashes. ATT resistance was detected in 482 individuals. Conclusion: Tuberculosis is the commonest opportunistic infection (OI in HIV positive patients in India, showing a higher prevalence of extrapulmonary and disseminated TB and adverse events due to ATT. Early recognition of concurrent OIs and their adequate treatment and prophylaxis is essential.

  12. New tuberculosis diagnostics and rollout

    Directory of Open Access Journals (Sweden)

    Ruth McNerney

    2015-03-01

    Full Text Available Early detection and effective treatment are crucial for tuberculosis control, but global case detection rates remain low. The diagnosis of paediatric and extrapulmonary disease is problematic and there are, as yet, no rapid screening tests to assist active case finding in the community. Progress has been made in clinic-based detection tools with the introduction of Xpert MTB/RIF, a nucleic acid amplification test that combines sample processing and analysis in a single instrument to provide a diagnostic result and detection of resistance to rifampicin in under 2 h. Enthusiasm for Xpert MTB/RIF has been high and global rollout has been facilitated by donor agencies. However, concerns remain about access and sustainability due to the high cost and infrastructure requirements. Although more sensitive than smear microscopy, early studies suggest the impact of the new test on case detection rates and patient survival has been limited. Alternative technologies are being developed, including non-sputum-based tests to assist the detection of extrapulmonary disease. Evaluation studies are needed to provide evidence of the impact of the new technologies on patient outcomes. This will enable appropriate placement of new diagnostic products in the healthcare system to support the control and eventual eradication of tuberculosis disease.

  13. Post-delivery mycobacterium tuberculosis infection misdiagnosed as systemic lupus erythematosus.

    Science.gov (United States)

    Ting, Li Yu; Shrestha, Bikash; Lu, Yi Lu; Ping, Fu

    2016-12-30

    Tuberculosis is a common infectious mycobacterial disease having a wide range of clinical and serological manifestations that are similar to rheumatic disease. Differential diagnosis is a crucial aspect in any rheumatic disease as many other infectious diseases portray clinical similarities and autoantibody positivity. Our case report illustrates of a young woman just after the delivery of a child presented an unusual case of extrapulmonary tuberculosis infection initially misdiagnosed as systemic lupus erythematosus (SLE).

  14. Tuberculosis in ancient times

    Directory of Open Access Journals (Sweden)

    Louise Cilliers

    2008-09-01

    , tended to affect groups of people living close together, and young people in particular. Pregnancy exacerbated phthisis which was characterised by a chronic cough (worse at night, prominent sputum, often blood streaked and presumably arising from necrotic lung tissue. The face was typically flushed with sunken cheeks, sharp nose and very bright eyes. There was atrophy of all muscles with prominent (“winged” shoulder blades, fever and perspiration often associated with shivering. Symptoms were described which would fit in with complicating lung abscess and empyema. Hippocrates also mentions disease entities which would fit in with extra-pulmonary tuberculosis, like Pott’s disease of the spine and cervical lymphadenopathy (scrofula, although he did not associate this with phthisis. Minimal specific therapy was prescribed. Subsequent writers in the Hellenistic and Roman eras added little to the classic Hippocratic clinical picture of phthisis, but Celsus (1st century AD and Galen (2nd century first suggested that it was a contagious condition. From Themison (1st century BC onwards, therapeutic regimes became more drastic with the addition of inter alia strict dietary regimes, purges, enemas and venesection. Celsus suggested long sea voyages with ample relaxation and a change of climate. Aretaeus (1st century AD stressed the importance of not exacerbating the suffering of people with chronic disease by imposing aggressive therapy. Except for the introduction of more drastic therapy the concept of phthisis (tuberculosis had thus not progressed materially in the course of the millennium between Hippocrates and the end of the Roman era – and it would indeed remain virtually static for the next 1 000 years up to the Renaissance. There is, however, some evidence that the incidence of tuberculosis decreased during the major migration of nations which characterised the late Roman Empire.

  15. Childhood tuberculosis in Qatar

    Directory of Open Access Journals (Sweden)

    Jay P.N Singh

    2016-01-01

    Full Text Available Childhood tuberculosis (TB has been long neglected but has gained attention in recent years. In 2012, the World Health Organization annual report included an estimate for childhood TB for the first time, and in the following year, the TB Alliance received a grant from UNITAID (International Drug Purchase Facility to develop pediatric TB formulations. Qatar is a low-incidence country. In this observational study, laboratory-confirmed cases of TB were analyzed from 2013 to 2015 and included patients aged ≤14 years. Microscopy and GeneXpert MTB/RIF (Cepheid, USA and MGIT 960 (Becton, Dickinson and Company, USA automated culture systems were used to confirm cases at the National TB Reference Laboratory, Doha, Qatar. A total of 24 positive cases were identified in this pediatric population, 21 with Mycobacterium tuberculosis complex (MTBC and three with Mycobacterium other than tuberculosis (MOTT. Out of 21 MTBC cases, 19 were direct polymerase chain reaction (PCR positive and two were smear and PCR negative but culture positive were later confirmed by PCR. Most of the positive specimens were extrapulmonary from pus and tissues biopsies. While six were from pulmonary, out of that, five were sputum and one was from gastric aspirates. Niacin Strip Test (Becton, Dickinson and Company, USA was used to identify the Bacillus Calmette–Guérin (BCG vaccine strains from MTBC infections, and seven patients were infected with BCG. Keeping in mind that there were 500–600 laboratory-confirmed cases of TB in adults, childhood tuberculosis is not a major problem in Qatar. Lack of sensitivity of niacin test due to identification various niacin accumulating BCG strains is documented worldwide, further testing with more stringent molecular methods will certainly increase the number of BCG isolates in this study population.

  16. Bovine tuberculosis at the human-livestock-wildlife interface: Is it a public health problem in Tanzania? A review

    Directory of Open Access Journals (Sweden)

    Bugwesa Z. Katale

    2012-06-01

    Full Text Available Despite the apparent public health concern about Bovine tuberculosis (BTB in Tanzania, little has been done regarding the zoonotic importance of the disease and raising awareness of the community to prevent the disease. Bovine tuberculosis is a potential zoonotic disease that can infect a variety of hosts, including humans. The presence of multiple hosts including wild animals, inefficient diagnostic techniques, absence of defined national controls and eradication programs could impede the control of bovine TB. In Tanzania, the diagnosis of Mycobacterium bovis in animals is mostly carried out by tuberculin skin testing, meat inspection in abattoirs and only rarely using bacteriological techniques. The estimated prevalence of BTB in animals in Tanzania varies and ranges across regions from 0.2% to 13.3%, which is likely to be an underestimate if not confirmed by bacteriology or molecular techniques. Mycobacterium bovis has been detected and isolated from different animal species and has been recovered in 10% of apparently healthy wildebeest that did not show lesions at post-mortem. The transmission of the disease from animals to humans can occur directly through the aerosol route and indirectly by consumption of raw milk. This poses an emerging disease threat in the current era of HIV confection in Tanzania and elsewhere. Mycobacterium bovis is one of the causative agents of human extra pulmonary tuberculosis. In Tanzania there was a significant increase (116.6% of extrapulmonary cases reported between 1995 and 2009, suggesting the possibility of widespread M. bovis and Mycobacterium tuberculosis infection due to general rise of Human Immunodeficiency virus (HIV. This paper aims to review the potential health and economic impact of bovine tuberculosis and challenges to its control in order to safeguard human and animal population in Tanzania.

  17. Fast and efficient detection of tuberculosis antigens using liposome encapsulated secretory proteins of Mycobacterium tuberculosis.

    Science.gov (United States)

    Tiwari, Dileep; Haque, Shafiul; Tiwari, Ram P; Jawed, Arshad; Govender, Thavendran; Kruger, Hendrik G

    2017-04-01

    A rapid and efficient diagnostic test was developed for the detection of Mycobacterium tuberculosis antigens in serum samples of active tuberculosis (TB) and extrapulmonary TB patients via a liposomal agglutination-based method. A rapid card test has been developed to facilitate the recognition of high-affinity binding rabbit raised purified culture filtrate protein antibodies coupled on the surface of activated liposomal preparation. In the presence of TB antigens, the polyclonal antibodies bound to the liposomal particles demonstrate a visible agglutination reaction. The developed assay was simple, rapid, reliable, sensitive, and specific as a diagnostic test for the detection of antigens in serum samples of clinically confirmed cases of TB within 4-5 minutes' duration. The test was evaluated at different hospitals, medical colleges, and pathology centers, and involved 1483 participants. This investigation was conducted to detect the presence of these antigens during the period of active growth of the microorganism in serum samples for pulmonary TB and processed tissue biopsy for other extrapulmonary TB. Results obtained using this test were compared with acid-fast bacilli smear and culture results. Our study demonstrated that the newly developed liposome tuberculosis antigen card test detected antigens in our study population with approximately 97.48% sensitivity and 95.79% specificity. This is the first study to report the liposomal encapsulation of culture filtrate proteins from M. tuberculosis for diagnostic application. Copyright © 2015. Published by Elsevier B.V.

  18. Tuberculosis, advanced - chest x-rays (image)

    Science.gov (United States)

    Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, ... death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying ...

  19. Tuberculosis in HIV Patient

    Directory of Open Access Journals (Sweden)

    Bidhan Nidhi Paudel

    2013-09-01

    Full Text Available Introduction: Strict monitoring of anti tuberculosis therapy (ATT and antiretroviral therapy (ART is crucial for proper management of TB/HIV co-infected patients. Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS and its response was evaluated as per WHO guidelines. Results: Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB and 37.20% of the Extra-pulmonary Tuberculosis (EPTB cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default. Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting. Key words: antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response.

  20. Evaluation of the GeneXpert MTB/RIF assay on extrapulmonary and respiratory samples other than sputum: a low burden country experience.

    Science.gov (United States)

    Pandey, Sushil; Congdon, Jacob; McInnes, Bradley; Pop, Alina; Coulter, Christopher

    2017-01-01

    The aim of this study was to assess the performance of the GeneXpert MTB/RIF assay on extrapulmonary (EP) and respiratory (non-sputum) clinical samples of patients suspected of having tuberculosis (TB) from Queensland, Australia. A total of 269 EP and respiratory (non-sputum) clinical samples collected from Qld patients who were suspected of having TB were subjected to the GeneXpert MTB/RIF analysis, Ziehl-Neelsen (ZN) staining, Mycobacterium tuberculosis (MTB) culture and drug susceptibility testing. Phenotypic and genotypic data were compared. The overall performance analysis of the GeneXpert MTB/RIF assay for detection of MTB complex demonstrated sensitivity of 89%, specificity of 95%, PPV of 89% and NPV of 95% using culture as a reference standard. The GeneXpert MTB/RIF analysis of acid-fast bacilli (AFB) smear positive samples and AFB smear negative samples showed sensitivities of 100% and 77%, respectively. Looking at individual EP and respiratory (non-sputum) sample types, the sensitivity ranged from 60% to 100% although the specificity ranged from 33% to 100% with the specificity of lymph node tissue biopsy being the lowest. The GeneXpert MTB/RIF assay detected 11% more TB cases than culture and 27% more cases than ZN microscopy. Due to insufficient numbers of presenting rifampicin resistance cases, performance analysis of the GeneXpert MTB/RIF assay on rifampicin resistance could not be carried out. The GeneXpert MTB/RIF assay is potentially valuable for TB diagnosis in the majority of the EP and respiratory (other than sputum) samples in our setting. Although the GeneXpert MTB/RIF assay provides rapid diagnostic results, the overall sensitivity to rule out the disease is suboptimal for some specimen types. Performance varied according to specimen type and AFB smear status. The sensitivity and specificity of lymph node tissue was 63% and 33%. Care must be taken when using the GeneXpert MTB/RIF assay for detection of MTB in lymph node tissue samples. All

  1. Pulmonary tuberculosis

    Science.gov (United States)

    TB; Tuberculosis - pulmonary; Mycobacterium - pulmonary ... Pulmonary TB is caused by the bacterium Mycobacterium tuberculosis (M tuberculosis) . TB is contagious. This means the bacteria is easily spread from an infected person ...

  2. Ultrasound findings in cases of extrapulmonary TB in patients with HIV infection in Jeddah, Saudi Arabia

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    Samuel Goblirsch

    2014-02-01

    Full Text Available Objective: To report ultrasound (US, laboratory and chest radiograph (CXR findings of patients with extra-pulmonary tuberculosis (EPTB and discuss the diagnostic relevance of US in EPTB in high-risk individuals. Methods: In this retrospective study, we described a cohort of 39 patients with a primarily immigrant background diagnosed with HIV and EPTB in Saudi Arabia and evaluated the role of US in their clinical management. All inpatient files of those diagnosed with EPTB who were HIV positive and had at least one US exam and one CXR exam performed were identified; results and outcomes were extracted. Results: Thirty-nine patients were diagnosed with HIV-associated EPTB between January 2008 and March 2012 and fulfilled the search criteria. Disseminated TB was diagnosed in 32 patients, pleural TB in 15, TB meningitis in 9 and TB pericarditis in 5. Enlarged abdominal lymph nodes were the single most frequent US finding seen in 61%, followed by pleural effusions (38%, liver (36% and spleen (31% lesions. CXR were normal in 38% of the patients. Conclusions: As EPTB infections in HIV positive patients can be treated effectively if diagnosed early, we suggest that US should be integrated in diagnostic algorithms for EPTB.

  3. M. tuberculosis in Lymph Node Biopsy Paraffin-Embedded Sections

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    Abdurehman Eshete

    2011-01-01

    Full Text Available Background. Tuberculosis lymphadenitis is one of the most common forms of all extrapulmonary tuberculosis. Objective. To evaluate the magnitude of M. tuberculosis from lymph node biopsy paraffin-embedded sections among suspected patients visiting the Jimma University Specialized Hospital. Method. A cross-sectional study design of histological examination among lymph node biopsy paraffin-embedded sections by Ziehl-Neelsen and hematoxylin/eosin staining technique was conducted from December, 2009, to October, 2010, at the Department of Medical Laboratory Science and Pathology. Result. Histopathological examination of the specimens by hematoxylin and eosin staining technique revealed the presence of granulomas. But for the caseation and necrosis they were present in 85% cases of nodal tissue biopsies. From those, 56.7% were from females. The presence of acid-fast bacilli was microscopically confirmed by ZN staining in 37 (61.7% of the nodal tissue biopsies. Conclusion and Recommendation. Tuberculosis lymphadenitis is significantly more common in females. Hence, attention should be given for control and prevention of extrapulmonary tuberculosis.

  4. A CLINICAL AND HISTOPATHOLOGICAL PROFILE OF PATIENTS WITH CUTANEOUS TUBERCULOSIS

    Science.gov (United States)

    Puri, Neerja

    2011-01-01

    Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55%) had duration of cutaneous tuberculosis between 6–12 months followed by 35% between 13–24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients. PMID:22121276

  5. A clinical and histopathological profile of patients with cutaneous tuberculosis

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    Neerja Puri

    2011-01-01

    Full Text Available Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55% had duration of cutaneous tuberculosis between 6-12 months followed by 35% between 13-24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients.

  6. Access to Bacteriologic-Based Diagnosis in Smear Positive Retreatment Tuberculosis Patients in Rural China: A Cross-Sectional Study in Three Geographic Varied Provinces.

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    Changming Zhou

    Full Text Available To determine factors influencing the utilization and accessibility to bacteriologic-based tuberculosis (TB diagnosis among sputum smear positive (SS+ retreatment TB patients, and to develop strategies for improving the case detection rate of MDR-TB in rural China.A cross-sectional study of SS+ TB retreatment patients was conducted in eight counties from three provinces with different implementation period and strategy of MDR-TB program in China. Demographic and socioeconomic parameters were collected by self-reporting questionnaires. Sputum samples were collected and cultured by the laboratory of county-designated TB clinics and delivered to prefectural Centers for Disease Prevention and Control (CDC labs for DST with 4 first-line anti-TB drugs.Among the 196 SS+ retreatment patients, 61.22% received culture tests during current treatment. Patients from more developed regions (OR = 24.0 and 3.6, 95% CI: 8.6-67.3 and 1.1-11.6, with better socio-economic status (OR = 3. 8, 95% CI: 1.3-10.7, who had multiple previous anti-TB treatments (OR = 5.0, 95% CI: 1.6-15.9, and who failed in the most recent anti-TB treatment (OR = 2.6, 95% CI: 1.0-6.4 were more likely to receive culture tests. The percentage of isolates resistant to any of first-line anti-TB drugs and MDR-TB were 50.0% (95% CI: 39.8%-60.2% and 30.4% (95% CI: 21.0%-39.8% respectively.Retreatment SS+ TB patients, high risk MDR-TB population, had poor utilization of access to bacteriologic-based TB diagnosis, which is far from optimal. The next step of anti-TB strategy should be focused on how to make bacteriological-based diagnosis cheaper, safer and more maneuverable, and how to assure the DST-guided treatment for these high-risk TB patients.

  7. Pseudotumoral form of soft-tissue tuberculosis of the wrist.

    Science.gov (United States)

    Sbai, Mohamed Ali; Benzarti, Sofien; Msek, Hichem; Boussen, Monia; Khorbi, Adel

    2016-03-01

    Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  8. CCL2 responses to Mycobacterium tuberculosis are associated with disease severity in tuberculosis.

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    Zahra Hasan

    Full Text Available BACKGROUND: Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNgamma, TNFalpha and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity. METHODOLOGY: We investigated live M. tuberculosis- and M. bovis BCG-induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB and healthy endemic controls (ECs, n = 36. TB patients comprised pulmonary (PTB, n = 34 and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16 or severe disseminated ETB (D-ETB, n = 16. Secretion of CCL2, IFNgamma, IL10 and CCL3, and mRNA expression of CCL2, TNFalpha, CCL3 and CXCL8 were determined. RESULTS: M. tuberculosis- and BCG-induced CCL2 secretion was significantly increased in both PTB and D-ETB (p<0.05, p<0.01 as compared with L-ETB patients. CCL2 secretion in response to M. tuberculosis was significantly greater than to BCG in the PTB and D-ETB groups. M. tuberculosis-induced CCL2 mRNA transcription was greater in PTB than L-ETB (p = 0.023, while CCL2 was reduced in L-ETB as compared with D-ETB (p = 0.005 patients. M. tuberculosis-induced IFNgamma was greater in L-ETB than PTB (p = 0.04, while BCG-induced IFNgamma was greater in L-ETB as compared with D-ETB patients (p = 0.036. TNFalpha mRNA expression was raised in PTB as compared with L-ETB group in response to M. tuberculosis (p = 0.02 and BCG (p = 0.03. Mycobacterium-induced CCL3 and CXCL8 was comparable between TB groups. CONCLUSIONS: The increased CCL2 and TNFalpha in PTB patients may support effective leucocyte recruitment and M. tuberculosis localization. CCL2 alone is associated with severity of TB, possibly due to increased systemic inflammation found in severe disseminated TB or due to increased monocyte infiltration to lung parenchyma in pulmonary disease.

  9. [Tuberculosis in compromised hosts].

    Science.gov (United States)

    2003-11-01

    of the serum albumin of the dialysis patient has decreased. Many of them were thin when their BMI was examined. The size of the patients' erythema by the tuberculin test has become small. There were many patients receiving dialysis with erythema but no induration. It means that the delayed skin reaction specific to Mycobacterium tuberculosis has decreased among the dialysis patients. The morbidity rate, the mortality rate and the prevalence of tuberculosis was much higher than the general population. The anamnesis of tuberculosis was also high. Most of those tuberculosis patients appear the disease from the period immediately before the beginning of dialysis to one year after that. That is also the period that patients' number of peripheral blood lymphocyte decreased and the tuberculin reaction positivity rate fell sharply. During the dialysis patients, pulmonary tuberculosis with cavities was minority and extrapulmonary tuberculosis and miliary tuberculosis were remarkably many. People with large reaction against the tuberculin test were better prognosis than those with smaller reaction. It was thought that anorexia, weakening, and a weight decrease were seen when the immunity decreased. At the end stage of renal failure, kidney shrink, vitamin D activation becomes difficult, and the low calcium blood syndrome appears. The calcification of tuberculoma is absorbed, soft tuberculoma becomes baring, the caseation abscess melts, and the endogenous infection occurs. The cell immunity has decreased, and tuberculosis attacks. It might be such circumstances that tuberculosis happen frequently at the dialysis introduction period. There are a lot of cases that the caseation necrosis is a little, and the formation of tuberculoma is bad in the pathology opinion. Due to the decrease in the cell immunity, cavities are not formed easily. It is easy to stay in the leaching lesion so that anti-tuberculosis drugs are much effective, and the patients recover easily. However, if the

  10. The Evaluation of Patients with Tuberculosis Treated in Batman Tuberculosis Control Dispensary in 2003 Year

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    Tekin Yıldız

    2007-01-01

    Full Text Available Tuberculosis is a very important problem for public health all around the world. In this study, 168 patients with TB who were treated in Batman Tuberculosis Control Dispensary in 2003 were retrospectively assessed. Ninety six of our cases were male, 72 were female. Eighty one patients who underwent for the tuberculous treatment were with pulmonary tuberculosis and 87 cases were with extrapulmonary tuberculosis. Acid fast bacilli (AFB at sputum was positive in 66.17% of the cavitary pulmonary TB cases before treatment and only one patient’s sputum was positive in pulmonary tuberculosis without cavity. Results of the tuberculosis treatment of cases revealed that one case left the treatment, 3 patients were inharmonious, 3 patients were dead, 161 patients were cured. Success rate of treatment was 95,83% (5 of these cases were cured and 156 patients completed the treatment. These data suggest that in order to increase the rate of the cure, bacteriological examination of the sputum should be considered at the end of the treatment like as the beginning.

  11. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Percutaneous extrapulmonary radiofrequency ablation for tumors in the hepatic dome.

    Science.gov (United States)

    Wang, Zhen-Yuan; Sun, Wen-Bing; Li, Ming-Ying; Zhang, Xiao-Xia; Ding, Xue-Mei

    2008-01-01

    This study aims to assess the feasibility of one lung ventilation and computed tomography-guided extrapulmonary percutaneous radiofrequency ablation for tumors in the hepatic dome. Eleven patients (10 men, 1 women; age range, 34-84 years) with 12 tumors in the hepatic dome were enrolled in the study after institutional review board approval and informed consent had been obtained. A 35F or 37F left-sided double-lumen endotracheal tube was intubated after general anesthesia was induced. The right lung is permitted to collapse, with selective left lungs ventilation. With CT monitoring, the RF electrode was inserted through the empty pleural space to the targeted tumor and radiofrequency ablation procedures were performed. The median operative time was 122 minutes. The median one lung ventilation time was 134 minutes. The procedures of one lung ventilation and percutaneous radiofrequency ablation were successfully performed. There was no bronchial intubation, one lung ventilation and percutaneous radiofrequency ablation related complications, excluding minor pleural effusions recovering without thoracentesis in 2 patients. Complete tumor necrosis was achieved in 10 patients (90.9%). One lung ventilation and computed tomography guided percutaneous extrapulmonary radiofrequency ablation for tumors in the hepatic dome appears to be useful and safe.

  13. Tuberculose associada à AIDS: características demográficas, clínicas e laboratoriais de pacientes atendidos em um serviço de referência do sul do Brasil Tuberculosis associated to AIDS: demographic, clinical and laboratory characteristics of patients cared for at a reference center in the south of Brazil

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    Maria Marta Santos Boffo

    2004-04-01

    Full Text Available INTRODUÇÃO: A sinergia entre a tuberculose e o vírus da imunodeficiência humana é responsável pelo aumento da morbi-mortalidade dos pacientes com AIDS. OBJETIVO: Delinear o perfil de pacientes com tuberculose e AIDS na cidade de Rio Grande (RS relacionando dados demográficos, clínicos e laboratoriais. MÉTODO: A amostra foi constituída por todos os casos de tuberculose confirmados pelo isolamento de Mycobacterium tuberculosis ocorridos no Serviço de AIDS do Hospital Universitário/FURG entre setembro de 1997 e dezembro de 2000, em 31 pacientes reportados como casos definidos de AIDS. Foram examinados 33 materiais clínicos pulmonares e extrapulmonares através da cultura pelo método de Ogawa-Kudoh e da baciloscopia pelo Kinyoun. A identificação de M. tuberculosis foi feita pelos métodos fenotípicos usuais. Para determinação da resistência das cepas isoladas foi empregado o método das proporções. RESULTADOS: A média de idade foi de 33,8 ± 9,9 anos, com uma relação homem/mulher de 2,87:1. Eram brancos 80,7% dos pacientes. Todos os pacientes apresentavam manifestações clínicas gerais e/ou específicas de tuberculose no momento da suspeita diagnóstica. Em 20 deles foram constatados fatores de risco: uso de droga endovenosa, alcoolismo, desnutrição, encarceramento. A doença pulmonar ocorreu em 19 casos, a extrapulmonar em 10 e a associada em 2 deles. Entre aqueles com a forma extrapulmonar, predominou o comprometimento ganglionar. As 33 cepas isoladas foram identificadas como M. tuberculosis, e 28 mostraram sensibilidade à isoniazida e à rifampicina. CONCLUSÃO: A tuberculose nos pacientes com AIDS apresentou-se com manifestações clínicas variáveis, comprometendo homens e mulheres em condições sociais desfavoráveis, em plena fase produtiva de suas vidas.BACKGROUND: Synergism between tuberculosis and HIV is responsible for the increased morbidity-mortality rate in AIDS patients. OBJECTIVE: To delineate the

  14. Current status of multidrug resistant tuberculosis in a tertiary care hospital of East Delhi

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    T Sagar

    2013-01-01

    Full Text Available Background and Objective: Multidrug resistant tuberculosis (MDR-TB is caused by infection due to Mycobacterium tuberculosis which is resistant to both isoniazid (INH and rifampicin (RIF. It is caused by selection of resistant mutant strains due to inadequate treatment and poor compliance. MDR-TB is a major public health problem as the treatment is complicated, cure rates are well below those for drug susceptible tuberculosis and patient remains infectious for months despite receiving the best available therapy. The drug susceptibility pattern of M. tuberculosis is essential for proper control of MDR-TB in every health care setting, hence the study was initiated with the aim of studying the prevalence of MDR-TB in patients attending a tertiary care hospital in east Delhi. Materials and Methods: Five hundred and forty-three pulmonary and extrapulmonary samples from suspected cases of tuberculosis received in the mycobacteriology laboratory from November 2009 through October 2010 were investigated for M. tuberculosis. All the samples were subjected to direct microscopic examination for demonstration of acid fast bacilli followed by culture on Lowenstein-Jensen (LJ medium to isolate M. tuberculosis. Identification was done by conventional biochemical methods. Drug susceptibility of isolated M. tuberculosis strains was done by conventional 1% proportion method followed by sequencing of RIF resistant isolates to detect mutations to confirm resistance. Results and Conclusions: M. tuberculosis was isolated from 75 out of 543 suspected cases of pulmonary/extrapulmonary TB. Three of the total 75 M. tuberculosis isolates (4% showed resistance to any one of the first line drugs. Prevalence of MDR-TB was 1.3%. The sequencing of single MDR strain showed mutations at codons 516, 517, and 518. Amplification of rpoB and sequential analysis of the amplicon is a better way of detection of mutation and the evidence of new mutation in this study indicate that

  15. Extrapulmonary mycobacterial infections in a cohort of HIV-positive patients: ultrasound experience from Vicenza, Italy.

    Science.gov (United States)

    Giordani, Maria Teresa; Brunetti, Enrico; Binazzi, Raffaella; Benedetti, Paolo; Stecca, Clara; Goblirsch, Sam; Heller, Tom

    2013-04-01

    Extrapulmonary tuberculosis (EPTB) is frequently seen in human immunodeficiency virus (HIV)-infected individuals in Sub-Saharan Africa and recent work has shown point-of-care (POC) ultrasound to be a diagnostic aid in the resource-limited, highly endemic setting. Its role in industrialized countries, however, has rarely been studied. With international migration, EPTB is increasingly seen in European hospitals. This study reports ultrasound findings and discusses the diagnostic relevance of EPTB in an industrialized country setting. In this retrospective study, we describe a cohort of 27 patients with a predominantly immigrant background diagnosed with HIV and EPTB in Northern Italy and evaluate the role of ultrasound in their clinical management. All inpatient files of HIV-positive individuals admitted to our hospital with culture-proven diagnosis of EPTB were reviewed, along with chest X-rays and ultrasound studies. The outcome and results of long-term follow-up were extracted. A total of 243 HIV-positive inpatients were identified between January 2005 and November 2011. Twenty-seven of the patients [11.1 %, 95 % confidence interval (CI) 7.4-15.7] were diagnosed with EPTB. Ultrasound showed a typical pattern of enlarged abdominal lymph nodes and focal lesions in the spleen and liver in 22 patients (81.5 %, 95 % CI 7.4-15.7) and, thus, helped to raise the suspicion of mycobacterial infection. As disseminated mycobacterial infections in HIV-positive patients can be treated effectively if diagnosed early, and typical sonographic findings are seen in the majority of these patients, we suggest that POC ultrasound should be integrated in diagnostic and screening algorithms for EPTB in developed countries.

  16. Pediatric Tuberculosis at Moulay Youssef University Hopsital – Morocco.

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    Mohamed AHARMIM

    2014-06-01

    Full Text Available Background: There are few studies on presentations, treatment and outcomes of pediatric tuberculosis in Morocco.This study aimed to describe clinico-epidemiological profiles, laboratory findings, treatment and outcomes of pediatric tuberculosis (TB in a tertiary care hospital in Morocco.Materials and Methods: This is a prospective, descriptive study undertaken in children diagnosed with TB between June 2011 and May 2012. Clinico-pidemiologicalprofiles, laboratory findings, treatment and outcome of patients was recorded. Statistical significance of category variables was evaluated. Analysis was done on SPSS package. Results were expressed as rates and proportions. Chi square test was used to test for statistical significance.Results: 53 children aged 2 to 16 years (mean age of 9±3.2 with TB diagnosis were enrolled in our study. 33 (62% of patients were female. Common symptoms were fever, cough, chest pain, dyspnea, decreased appetite and weight loss. The types of TB were: pulmonary TB (32, 60%, and extrapulmonary TB (21, 39.6%. The sites of pediatric extrapulmonary tuberculosis (EPTB were: lymph nodes (7, 13.2%, peritoneal (6, 11.3%, meningeal (4, 7.5% and osteoarticular (4, 7.5%. 24 (45,3% of the patients had positive Calmette-Guérin vaccine scar, and 42(79.2% of the patients had a positive tuberculin skin test. An adult TB contact was identified in 19 (35.8% of the cases. On direct microscopy, acid-fast bacilli were found in 3 (5.6% patients and positive cul¬ture for Mycobacterium tuberculosis was found in 2 (3.7%. Drug mono- or multiresistance was not detected.Conclusion: Paediatric TB in both pulmonary and extrapulmonary forms is a challenging diagnosis, and is a common occurrence in our setting.Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations.

  17. Tuberculosis Fluoroscopy

    Science.gov (United States)

    Follow-up though Dec 31, 2002 has been completed for a study of site-specific cancer mortality among tuberculosis patients treated with artificial lung collapse therapy in Massachusetts tuberculosis sanatoria (1930-1950).

  18. [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.

  19. EFFECT OF SOME MEDICINAL PLANTS ON GROWTH OF MYCOBACTERIUM TUBERCULOSIS, MULTI DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS AND MYCOBACTERIUM OTHER THAN TUBERCULOSIS

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    Prashant Shukla

    2013-12-01

    Full Text Available Six plants of medicinal uses were tried for their inhibitory effect on Mycobacterium tuberculosis (MTB, multi drug resistant Mycobacterium tuberculosis (MDR MTB and Mycobacterium other than tuberculosis (MOTT. MTB, MDR MTB and MOTT were cultured in 12B medium vials for Bacterc 460 TB system and incubated at 37˚C. The vials were read in Bacterc 460 TB system. Garlic, Ocimum sanctum, onion and neem showed effectiveness towards Mycobacterium tuberculosis and multi drug resistant Mycobacterium tuberculosis to some extent but ginger showed no effect at all. None of the plants studied had any inhibitory effect on Mycobacterium other than tuberculosis. Aloe vera had opposite effect on the growth and it was found to be assisting the growth of Mycobacterium tuberculosis and multi drug resistant Mycobacterium tuberculosis. The tests performed were in-vitro and the authors conlude that in-vivo the results may vary.

  20. Bovine tuberculosis

    Science.gov (United States)

    Tuberculosis (TB) in animals and humans may result from exposure to bacilli within the Mycobacterium tuberculosis complex (i.e., M. tuberculosis, M. bovis, M. africanum, M. pinnipedii, M. microti, M. caprae, or M. canetti) . Mycobacterium bovis is the species most often isolated from tuberculous cat...

  1. Mycobacterium tuberculosis osteomyelitis in a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): a case report

    Science.gov (United States)

    2010-01-01

    The incidence of tuberculosis is increasing in the United States. Extra-pulmonary involvement is more common in patients with HIV/AIDS. The diagnosis of Tuberculosis osteomyelitis requires a high degree of suspicion for accurate and timely diagnosis. We present a case of a 49 year old Caucasian male with HIV/AIDS who presented with a four-month history of soft tissue swelling in the left proximal thigh unresponsive to various broad spectrum antibiotics who was eventually diagnosed with Mycobacterium tuberculosis osteomyelitis of the left proximal femur. PMID:20178567

  2. Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study.

    Science.gov (United States)

    Bates, Matthew; Mudenda, Victor; Shibemba, Aaron; Kaluwaji, Jonas; Tembo, John; Kabwe, Mwila; Chimoga, Charles; Chilukutu, Lophina; Chilufya, Moses; Kapata, Nathan; Hoelscher, Michael; Maeurer, Markus; Mwaba, Peter; Zumla, Alimuddin

    2015-05-01

    Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tuberculosis, multidrug-resistant tuberculosis, and asymptomatic tuberculosis are difficult to diagnose and may be missed at all points of health care. We did an autopsy study to ascertain the burden of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Lusaka, Zambia. Between April 5, 2012, and May 22, 2013, we did whole-body autopsies on inpatients aged at least 16 years who died in the adult inpatient wards at University Teaching Hospital, Lusaka, Zambia. We did gross pathological and histopathological analysis and processed lung tissues from patients with tuberculosis through the GeneXpert MTB/RIF assay to identify patients with multidrug-resistant tuberculosis. The primary outcome measure was specific disease or diseases stratified by HIV status. Secondary outcomes were missed tuberculosis, multidrug-resistant tuberculosis, and comorbidities with tuberculosis. Data were analysed using Pearson χ(2), the Mann-Whitney U test, and binary logistic regression. The median age of the 125 included patients was 35 years (IQR 29-43), 80 (64%) were men, and 101 (81%) were HIV positive. 78 (62%) patients had tuberculosis, of whom 66 (85%) were infected with HIV. 35 (45%) of these 78 patients had extrapulmonary tuberculosis. The risk of extrapulmonary tuberculosis was higher among HIV-infected patients than among uninfected patients (adjusted odds ratio 5·14, 95% CI 1·04-24·5; p=0·045). 20 (26%) of 78 patients with tuberculosis were not diagnosed during their life and 13 (17%) had undiagnosed multidrug-resistant tuberculosis. Common comorbidities with tuberculosis were pyogenic pneumonia in 26 patients (33%) and anaemia in 15 (19%). Increased clinical awareness and more proactive screening for tuberculosis and multidrug-resistant tuberculosis in inpatient settings is needed. Further autopsy studies are needed to ascertain the generalisability of the

  3. [Cerebromediastinal tuberculosis in a child with a probable Say-Barber-Miller syndrome: a causative link?].

    Science.gov (United States)

    Kechaou, I; Rouissi, A; Kraoua, I; Regayeg, A; Turki, I; Ben Hamouda, M; Gouider-Khouja, N

    2009-12-01

    Tuberculosis continues to be a public health problem in emerging countries with a recent evidence of increased incidence of extrapulmonary localization in developed countries probably linked to HIV. To our knowledge the occurrence of cerebro-mediastinal tuberculosis in an immuno-competent child has not been previously described; moreover the child we describe has a probable Say-Barber-Miller syndrome. We discuss a putative causative link between this syndrome and the occurrence of tuberculosis. A seven-year-old girl presented to our department with a history of infantile encephalopathy since birth characterized by a facial dysmorphy (evocative of a bird face), microcephaly, and mental retardation, and with recurrent infections. The child had complained of back pain for several months; the parents reported anorexia, loss of weight. Spinal and cerebral MRI showed a mediastinal mass involving the spine and cerebral lesions evocative of tuberculomas. The tuberculin interdermal reaction was positive. Culture of a vertebral biopsy was positive for Koch bacillus. Anti-tuberculosis treatment improved general and local status. An extensive immunological work-up was normal. [corrected] This observation is exceptional in many aspects: very early age of onset of extrapulmonary tuberculosis, no immune deficit, association with a rare congenital neurological syndrome. We discuss the possible link between this entity and the occurrence of tuberculosis.

  4. Up-to-date in pulmonary and extrapulmonary sarcoidosis.

    Science.gov (United States)

    Valeyre, D; Uzunhan, Y; Bouvry, D; Naccache, J-M; Nunes, H

    2008-01-01

    Sarcoidosis is a multisystemic immune disorder of unknown cause characterized by the formation of epithelioid granuloma in involved organs particularly the lung and the lymphatic system. Consistent recent advances have been made on the clinical, therapeutical and pathogenetic aspects. Various clinical phenotypes are better characterized and efforts to grade the severity could facilitate genetic studies and therapeutic trials. Pulmonary hypertension and some infrequent or atypical pulmonary manifestations as well as some rare extrapulmonary localizations have been thoroughly studied. Sarcoidosis-like granulomatosis due to identified causes constitute interesting models and have to be differentiated from sarcoidosis. THERAPEUTICAL ASPECTS: Anti-TNFalpha drugs have been investigated and infliximab has been proved efficient even though some limits to its efficiency have to be taken into account. PATHOGENETIC ASPECTS: Finally, advances concerning the pathogenesis, particularly genetic predisposing factors and phenotype/genotype correlations have been made.

  5. Risk factors for prolonged treatment of lymph node tuberculosis.

    Science.gov (United States)

    Lanoix, J-P; Guimard, T; Ettahar, N; Grannec, A; Flateau, C; Chapuzet, C; Bentayeb, H; Tattevin, P; Schmit, J-L

    2012-01-01

    Lymph node tuberculosis (LNTB) is the most frequent form of extra-pulmonary tuberculosis (TB). Randomised, controlled trials have convincingly demonstrated that 6 months of chemotherapy is sufficient for most drug-susceptible LNTB. We performed a retrospective, multicentric study from 1997 to 2010 to describe factors associated with prolonged anti-tuberculosis treatment in patients with LNTB. Of 126 patients diagnosed with LNTB, 22 (17.5%) were human immunodeficiency virus (HIV) infected. The median treatment duration was 9 months (interquartile range, 6-12). Treatment was significantly longer in patients with HIV (P < 0.01), additional sites of TB (P < 0.01) or weight loss (P = 0.04). Factors independently associated with excessively lengthy treatment were HIV co-infection and the presence of other TB foci.

  6. The Great Mimic Again? A Case of Tuberculosis Knee

    Directory of Open Access Journals (Sweden)

    Teo SH

    2011-11-01

    Full Text Available Tuberculosis (TB, once a disease confined to undeveloped or developing nations is currently in resurgence due to pandemic human immunodeficiency virus infection and immigration from endemic areas. TB is also known as the ‘great mimicker’. Extra-pulmonary tuberculosis affecting the knee is rare in all forms of TB (0.1-0.3%. Here, we report a case of isolated highly erosive TB knee in a previously fit Burmese migrant worker. He presented with after a history of fall into a drain. The patient also reported pain and swelling over his left knee for the previous three years. He had been treated for a bacterial infection of the knee in another hospital but defaulted due to financial constraints. Arthrotomy of the knee was performed including washout. Diagnosis of TB of the knee was made based on the synovial fluid and tissue culture. Treatment with anti- tuberculosis drugs was then initiated.

  7. Lymphatic endothelial cells are a replicative niche for Mycobacterium tuberculosis

    Science.gov (United States)

    Lerner, Thomas R.; de Souza Carvalho-Wodarz, Cristiane; Repnik, Urska; Russell, Matthew R.G.; Borel, Sophie; Diedrich, Collin R.; Rohde, Manfred; Wainwright, Helen; Collinson, Lucy M.; Wilkinson, Robert J.; Griffiths, Gareth; Gutierrez, Maximiliano G.

    2016-01-01

    In extrapulmonary tuberculosis, the most common site of infection is within the lymphatic system, and there is growing recognition that lymphatic endothelial cells (LECs) are involved in immune function. Here, we identified LECs, which line the lymphatic vessels, as a niche for Mycobacterium tuberculosis in the lymph nodes of patients with tuberculosis. In cultured primary human LECs (hLECs), we determined that M. tuberculosis replicates both in the cytosol and within autophagosomes, but the bacteria failed to replicate when the virulence locus RD1 was deleted. Activation by IFN-γ induced a cell-autonomous response in hLECs via autophagy and NO production that restricted M. tuberculosis growth. Thus, depending on the activation status of LECs, autophagy can both promote and restrict replication. Together, these findings reveal a previously unrecognized role for hLECs and autophagy in tuberculosis pathogenesis and suggest that hLECs are a potential niche for M. tuberculosis that allows establishment of persistent infection in lymph nodes. PMID:26901813

  8. Miliary tuberculosis: a severe opportunistic infection in juvenile systemic lupus erythematosus patients

    OpenAIRE

    Freire, Priscilla S.; Montoni, João D.; Ribeiro, Aline S.M.; Marques, Heloísa H.; Mauad, Thais; Silva, Clovis A.

    2016-01-01

    Abstract Introduction One of the main issues in juvenile systemic lupus erythematosus (JSLE) patients is infection, such as tuberculosis (TB). Of note, SLE patients are susceptible to pulmonary and extrapulmonary TB. However, to our knowledge, this contagious disease was rarely reported in pediatric lupus population, particularly diffuse or miliary TB. Therefore, from January 1983 to December 2011, 5,635 patients were followed-up at our Pediatric Rheumatology Unit and 285 (5%) of them met th...

  9. Tuberculosis (TB): Treatment

    Science.gov (United States)

    ... Education & Training Home Conditions Tuberculosis (TB) Tuberculosis: Treatment Tuberculosis: Treatment Make an Appointment Refer a Patient Ask ... or bones is treated longer. NEXT: Preventive Treatment Tuberculosis: Diagnosis Tuberculosis: History Clinical Trials For more than ...

  10. ASSESSMENT OF DIAGNOSTIC TECHNIQUES OF URINARY TUBERCULOSIS

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    Khaled Ismail Ghaleb

    2013-06-01

    Full Text Available Khalid Ghaleb a,* , Magdy Afifib, Mohamad El-Gohary c aDepartment of Medical Laboratories, Faculty of Applied Medical Science, King Khalid University, Bisha 551, Saudia Arabia bDepartment of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assuit 71524, Egypt cDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assuit, Egypt • The corresponding author e-mail: kh_ghaleb4@hotmail.com Current Tel: 00966595388496 Saudia,  00201119338055 Egypt The place of the study worked : Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assuit 71524, Egypt, e-mail: afifi_magdy@ymail.com  Tel: 00201006554961 Abstract Early diagnosis of active tuberculosis remains an elusive challenge. In addition, one third of the world's population is latently infected with Mycobacterium tuberculosis (Mtb and up to 10% of infected individuals develop tuberculosis (TB in their lifetime. In this investigation, the incidence of urinary tuberculosis among renal patients was studied. Three hundreds urine samples were processed for detection of Mtb by Ziehl-Neelson (ZN smear examination, Lowenstein Jensen (LJ medium, radiometric BACTEC460 system as well as polymerase chain reaction (PCR and DNA Enzyme Immunoassay (DEIA test.  Out of 300 urine samples, 2 were positive by both  ZN smears and LJ medium with incidence rate of 0.66 %, 3 positive samples by BACTEC460 culture system with incidence of 1%. PCR assay gave more positive results than smear and culture examination (i.e. 8 positive samples with incidence  rate of 2.6%.  The specificities were 25% for both ZN smears and LJ medium, 37.5% for BACTEC460 culture system, and 100% for PCR test, while  sensitivities of all assays were 100%. Thus PCR is a rapid and sensitive method for the early diagnosis of urinary tuberculosis.   Keywords: List of abbreviations:Acid Fast Bacilli (AFB-Base pair (bp-DNA Enzyme Immunoassay (DEIA  -Extrapulmonary Tuberculosis

  11. Tuberculosis of the temporomandibular joint.

    Science.gov (United States)

    Assouan, C; Anzouan, K; Nguessan, N D; Millogo, M; Horo, K; Konan, E; Zwetyenga, N

    2014-04-01

    Extrapulmonary and extra-spinal tuberculosis (TB) is rare, even in countries where the disease is endemic. Ten percent of these localizations are cervico-facial. Involvement of the temporomandibular joint (TMJ) is very unusual. We present the features of such a case. We looked for patients managed for TMJ TB in 2 Maxillofacial Surgery departments and in 1 Pneumology & Phthisiology Department since 1992. The second part of the study was a literature review. One case was found in our departments and 15 other cases were found in published data. Most patients were women with mean age of 39.9 years (5 to 68). Pre-auricular swelling was the predominant functional sign, often without fever or change in the health status. The biological and radiological abnormalities were non-specific (osteolysis, joint pinching, etc.). No lung involvement was observed. The joint recovered its normal function after appropriate management. Tuberculosis of the TMJ is difficult to diagnose given its rarity and the non-specific nature of clinical and paraclinical signs. It must be considered in the differential diagnosis for common diseases of the TMJ whether TB is endemic or not. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Comparison of the conventional diagnostic modalities, bactec culture and polymerase chain reaction test for diagnosis of tuberculosis

    Directory of Open Access Journals (Sweden)

    Negi S

    2005-01-01

    Full Text Available PURPOSE: To evaluate the performance of 65 kDa antigen based PCR assay in clinical samples obtained from pulmonary and extrapulmonary cases of tuberculosis. METHODS: One hundred and fifty six samples were processed for detection of Mycobacterium tuberculosis by ZN smear examination, LJ medium culture, BACTEC radiometric culture and PCR tests. RESULTS: A significant difference was seen in the sensitivities of different tests, the figures being 74.4% for PCR test, 33.79% for ZN smear examination, 48.9% for LJ culture and 55.8% for BACTEC culture (P0.05 as far as specificity of different tests was concerned. PCR test sensitivity in pulmonary and extrapulmonary clinical samples were 72.7% and 75.9% respectively and found to be significantly higher (PM.tuberculosis was 24.03 days by LJ medium culture, 12.89 days by BACTEC culture and less than one day by PCR test. CONCLUSIONS: PCR is a rapid and sensitive method for the early diagnosis of pulmonary and extrapulmonary tuberculosis.

  13. [OCCUPATIONAL PREVALENCE OF MYCOBACTERIUM TUBERCULOSIS INFECTION AMONG HEALTHCARE WORKERS].

    Science.gov (United States)

    Pasechnik, O A; Plotnikova, O V

    2015-01-01

    Professional prevalence of tuberculosis of workers of health care is the important medico-social problem. The study is based on the observation of the epidemic process of tuberculosis in the Omsk region for 2000-2014. Material for the study was the data of the forms of Federal statistical observation. There were used observational descriptive and evaluative research methods of the study. In the Omsk region on the background of the downtrend of tuberculosis incidence there were observed qualitative changes in the nature of bacterioexcretion, characterized by the widespread occurrence of multidrug-resistant Mycobacterium. Over the study period 154 cases of occupational diseases in workers of medical institutions were registered Tuberculosis accounted for 80.5% of cases; at that 77.4% are employees of phthisiatric institutions, out of them nursing staff--48.3%, medical attendants--20.2%, doctors--18.5%, employees of the bacteriological laboratory--6.4%, workers of other support units--6.4%. Among diseased patients 41.1% were persons with the experience of working in harmful conditions from 1 to 5 years, 20%--experience of 5-10 years, 8.8%--working experience of 10 to 15 years, 29%--more than 15 years. In patients there was prevailed tuberculosis of respiratory organs--85.4% of cases, extrapulmonary forms of tuberculosis (tuberculosis of the genitourinary system, peripheral lymph nodes, eyes, central nervous system) accounted for 14.6%. About 30% of cases of tuberculosis among health care workers were accompanied by bacterioexcretion. In conditions of the wide spread of drug-resistant Mycobacterium tuberculosis it is necessary to optimize the approaches to the prevention of tuberculosis among health care workers.

  14. Patterns, trends and treatment outcomes of extra-pulmonary tuberculosis in Sohag, Upper Egypt

    Directory of Open Access Journals (Sweden)

    Hamdy Mohammadien

    2017-04-01

    Conclusions: Sohag has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

  15. Lupus vulgaris with endopthalmitis--a rare manifestation of extrapulmonary tuberculosis in India.

    Science.gov (United States)

    Bhandare, Chirag A; Barad, Prachi S

    2010-04-01

    We report a case of 17-year-old girl who presented with gradual destruction of the nose along with endopthalmitis and loss of vision of the left eye. On nasal examination, left alae nasi and nasal cartilage was destroyed. Left eye showed signs of endopthalmitis with pthisis bulbi with complete loss of vision. Skin biopsy, FNAC of the lymph nodes were suggestive of tubercular etiology. However, patient did not have any evidence of pulmonary TB. We report this case due to the rare clinical features. The importance of a high index of suspicion and prompt treatment in such atypical forms to prevent morbidity cannot be over-emphasised.

  16. 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

    and it was investigated whether mortality was associated with family-related risk factors. METHODS: A NATIONWIDE COHORT STUDY WAS CONDUCTED INCLUDING: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult...... increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared...... patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug abuse as well as immune suppression, and family-related factors....

  17. Abdominal Tuberculosis: A Diagnostic Dilemma.

    Science.gov (United States)

    Awasthi, Seema; Saxena, Manoj; Ahmad, Faiyaz; Kumar, Ashutosh; Dutta, Shyamoli

    2015-05-01

    Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment. A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases. Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put

  18. Tuberculosis in Spain: epidemiological pattern and clinical practice.

    Science.gov (United States)

    Diez, M; Huerta, C; Moreno, T; Caloto, T; Guerra, D; Pozo, F; Alcaide, J; Castells, C; Cardenal, J I; Domínguez, A; Gayoso, P; Gutiérrez, G; López, M J; Muñoz, F; Navarro, C; Picó, M; Quirós, J R; Robles, F; Sánchez, J M; Vanaclocha, H; Vega, T

    2002-04-01

    Thirteen Autonomous Regions in Spain. To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB. Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians. The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs. The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.

  19. Human tuberculosis caused by Mycobacterium bovis: a retrospective comparison with Mycobacterium tuberculosis in a Mexican tertiary care centre, 2000-2015.

    Science.gov (United States)

    Torres-Gonzalez, Pedro; Cervera-Hernandez, Miguel E; Martinez-Gamboa, Areli; Garcia-Garcia, Lourdes; Cruz-Hervert, Luis P; Bobadilla-Del Valle, Miriam; Ponce-de Leon, Alfredo; Sifuentes-Osornio, Jose

    2016-11-08

    Human tuberculosis caused by Mycobacterium bovis is believed to be frequent in developing countries. Transmission is usually through ingestion of unpasteurized dairy products, although airborne contagion is possible. Disease caused by M. tuberculosis or M. bovis is clinically indistinguishable from each other. The aim of this study was to determine the factors associated with M. bovis disease. Retrospective analysis of all culture-positive cases of M. bovis and M. tuberculosis from 2000 to 2015, in a Mexican tertiary-care centre. Sociodemographic, clinical, and radiographic data from medical records were compared. Disease site was classified as pulmonary, extrapulmonary, or pulmonary and extrapulmonary, based on cultures. We evaluated 533 cases, 372 (69.7 %) of which were caused by M. tuberculosis and 161 (30.2 %) by M. bovis. Characteristics associated with M. bovis disease were: younger age (aOR 0.97, 95 % CI 0.95-0.98), glucocorticoid use (aOR 2.27, 95 % CI 1.42-3.63), and extrapulmonary disease (aOR 1.80, 95 % CI 1.21-2.69). M. tuberculosis was associated with lower socioeconomic status (aOR 0.52, 95 % CI 0.28-0.97). When we analysed only pulmonary cases, younger age (aOR 0.97, 95 % CI 0.96-0.99), glucocorticoid use (aOR 2.41, 95 % CI 1.30-4.46), and smoking (aOR 1.94, CI 95 % 1.15-3.27) were associated with M. bovis. Both groups showed similar proportions of direct microscopy smear results (respiratory samples) and chest X-ray cavitations. Younger age, glucocorticoid use, and extrapulmonary disease were associated with M. bovis as the causative agent of tuberculosis in a group of patients from a tertiary care centre in a country where bovine tuberculosis is endemic. Further studies must be conducted in the general population to determine pathogen-specific associated factors and outcomes.

  20. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality

    OpenAIRE

    Nathália Mota de Faria Gomes; Meire Cardoso da Mota Bastos; Renata Magliano Marins; Aline Alves Barbosa; Luiz Clóvis Parente Soares; Annelise Maria de Oliveira Wilken de Abreu; João Tadeu Damian Souto Filho

    2015-01-01

    Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with ab...

  1. Análise comparativa entre tuberculides e tuberculose extrapulmonar – Uma outra face do Mycobacterium tuberculosis

    Directory of Open Access Journals (Sweden)

    João Cláudio Barroso Pereira

    2008-05-01

    Full Text Available Resumo: O autor propõe uma comparação entre tuberculides e tuberculose extrapulmonar ressaltando diferenças, quanto ao conceito, patogénese, quadro clínico, diagnóstico e tratamento e provando de uma maneira definitiva que são situações distintas do Mycobacterium tuberculosis. Informações actualizadas sobre etiopatogenia e diagnóstico das tuberculides serão discutidas. É também feita uma revisão sobre as diferentes apresentações da tuberculose extrapulmonar.Rev Port Pneumol 2008; XIV (3: 391-407 Abstract: The author proposes a comparison of tuberculids and extrapulmonary tuberculosis, highlighting the differences in definition, pathogenesis, clinical manifestations, diagnosis and treatment, proving that they are different expressions of Mycobacterium tuberculosis. The article further discusses updated information on tuberculids pathogenesis and diagnosis. A review of different presentations of extrapulmonary tuberculosis is also presented.Rev Port Pneumol 2008; XIV (3: 391-407 Palavras-chave: Tuberculides, tuberculose extrapulmonar, diferenças, patogénese, quadro clínico, diagnóstico, Key-words: Tuberculids, extrapulmonary tuberculosis, differences, pathogenesis, clinical manifestations, diagnosis

  2. Oral manifestation of tuberculosis: a case-report

    Directory of Open Access Journals (Sweden)

    Bárbara Capitanio de Souza

    Full Text Available Abstract The present case-report describes tuberculosis on the oral mucosa, in a rare manifestation of the disease. The importance of appropriate diagnosis and awareness of the clinical manifestations is highlighted. Oral lesions seem to occur as chronic ulcers, nodular or granular areas, and rare, firm leukoplakia regions. Most extra-pulmonary lesions represent secondary infections of a primary lung infectious focus; therefore, early and accurate diagnosis is required for planning of the best treatment and strategies to control the disease.

  3. [Lymph node tuberculosis treatment: from recommendations to practice].

    Science.gov (United States)

    Lanoix, J-P; Douadi, Y; Borel, A; Andrejak, C; El Samad, Y; Ducroix, J-P; Schmit, J-L

    2011-02-01

    Lymph node infection is the most frequent localization of extrapulmonary tuberculosis. However, there is still no consensus on the length of antimicrobial treatment. We conducted a retrospective study in the Department of infectious diseases and internal medicine in the Amiens Teaching Hospital, France. All patients diagnosed with lymph node tuberculosis between 1998 and 2007 were included; some patients presented with bi- or multifocal tuberculosis. The aim of the study was a practice analysis. We studied 48 medical records, 16 were excluded for lack of more than 40% of data or because lymph node tuberculosis was non-active. The mean age of the 32 patients included was 49 years. The mean duration of treatment was 10.9 months (standard deviation 2.6, median 11, range 6-18). There was no statistical age difference between subgroups (lymph node tuberculosis versus multifocal tuberculosis). There was no significant difference between the 6-month treatment group and the 9-month treatment group in term of clinical response. One relapse was diagnosed, eight patients (25%) were lost to follow-up at 1 year after treatment. DISCUSSION AND REVIEW: No reliable published data was found as to the optimal duration of treatment. A high quality clinical trial should be carried out to suggest a consensus. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  4. Genital Tuberculosis as the Cause of Tuboovarian Abscess in an Immunosuppressed Patient

    Directory of Open Access Journals (Sweden)

    M. Ilmer

    2009-01-01

    Full Text Available Background. Although tuberculosis (TB is a major health problem worldwide, primary extrapulmonary tuberculosis (EPTB, and in particular female genital tract infection, remains a rare event. Case Report. A 35-year-old human immunodeficiency virus (HIV seropositive woman of African descent with lower abdominal pain and fever of two days duration underwent surgery due to left adnexal mass suggesting pelvic inflammatory disease. The surgical situs showed a four quadrant peritonitis, consistent with the clinical symptoms of the patient, provoked by a tuboovarian abscess (TOA on the left side. All routine diagnostic procedures failed to determine the causative organism/pathogen of the infection. Histopathological evaluation identified a necrotic granulomatous salpingitis and specific PCR analysis corroborated Mycobacterium tuberculosis (M. Tb. Consequently, antituberculotic therapy was provided. Conclusion. In the differential diagnosis of pelvic inflammatory disease, internal genital tuberculosis should be considered. Moreover, physicians should consider tuberculous infections early in the work-up of patients when immunosuppressive conditions are present.

  5. [Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007].

    Science.gov (United States)

    Giménez Duran, Jaume; Galmés Truyols, Antonia M; Herrera Guibert, Dionisio; Bonilla Vargas, Luis A; Luque Fernández, Miguel A; Bosch Isabel, Catalina; Nicolau Riutort, Antoni; Caylà Buqueras, Joan

    2011-01-01

    We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  6. [Endobronchial tuberculosis].

    Science.gov (United States)

    Manal, E; Nahid, Z; Hanane, B; Najiba, Y

    2017-04-01

    The endobronchial tuberculosis (EBTB) is an uncommon type of tuberculosis. The respiratory symptoms in EBTB are usually nonspecific and misleading. The aim of the study is to determine the clinical features and diagnostic aspects of EBTB. Twenty-eight cases of endobronchial tuberculosis collected from January 2009 to October 2015. EBTB was found in 16 females and 12 males. The mean age was 48 years. The history of tuberculosis and tuberculosis contagion were not found in any case. The respiratory symptoms were dominated by cough and dyspnea. Hemoptysis was found in 7 cases. The chest X-ray showed associated pulmonary lesions in 26 cases. Bronchoscopy finded an endobronchial granular lesion in 15 cases, a tumorous pattern in 7 cases; a thickening spurs in 4 cases and ganglio-bronchial fistula in two cases. Bronchial biopsies had found a caseo-follicular tuberculosis in 27 cases. Pleural biopsy confirmed associated pleural tuberculosis in one case. The research of Koch bacillus in the sputum was positive in 13 cases and culture in 6 cases. The antituberculosis treatment was started in all patients and an oral corticosteroids treatment was associated in 5 cases. The evolution was good in 26 cases. This study showed clinical, radiological and endoscopic bronchial tuberculosis polymorphism making its diagnosis difficult and the importance of a bacteriological and/or histological confirmation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. [Therapeutic outcomes of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection: Cohort of Kabinda Center in Kinshasa, Democratic Republic of Congo].

    Science.gov (United States)

    Akilimali, P Z; Tshilumbu, J M K; Mavila, A K; Kaba, D K

    2015-12-01

    The study aimed to determine the clinical forms of tuberculosis and therapeutic outcome of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection. A retrospective cohort of 120 HIV-positive patients with tuberculosis and 297 HIV-negative patients with tuberculosis attending the Kabinda Center was followed from 2010 to June, 30th 2013. The logistic regression model identified the determinants of a defavorable outcome after initiation of tuberculostatics. The proportion of female patients was higher in the co-infected group compared with the non-co-infected group (60.8% versus 42.7%, P<0.001). HIV-seropositive patients had more forms of pulmonary smear-negative (39.2% versus 25.3%, P<0.002) and extra-pulmonary (38% versus 35%, P<0.002) tuberculosis than HIV-negative patients. HIV-positive serology (OR: 3.13, 95%CI: 1.72-5.69) and age of patients more than 41 years (OR: 3.15, 95%CI: 1.36-7.29) were associated with an unfavorable outcome. This study highlights the usefulness of a systematically determining immunological status in co-infected patients and a timely and systematic ARV treatment, together with early diagnosis of tuberculosis. It also emphasizes the importance of adherence to support measures in order to improve tuberculosis treatment outcomes in co-infected patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Characteristics of tuberculosis patients at intake in Cambodia, two provinces in China, and Viet Nam

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    Lauritsen Jens M

    2011-05-01

    Full Text Available Abstract Background The tuberculosis register is a critical data source for the information system of national tuberculosis control programs. From the information in the tuberculosis case register, it is possible to extend the standard analysis of age and sex characteristics among sputum smear-positive cases to all tuberculosis case categories. National tuberculosis programs might utilize such information to identify problems related to referral and access to diagnosis and treatment. Objectives Based on the electronic database we created, our objectives were to provide a detailed description of age and sex characteristics of tuberculosis patients at registration and to provide a comparison of age-specific sex characteristics among incident and prevalent sputum smear-positive cases. Methods A representative sample of tuberculosis case registers from 1 January 2003 to 31 December 2005 was selected in Cambodia, two provinces in China and Viet Nam. Age and sex characteristics of cases in the three separate prevalence surveys in the three jurisdictions (Cambodia: year 2002; China: year 2000; and Viet Nam: year 2006-2007 were obtained for comparison. Results A total 37,635 patients had been registered during the period in the selected units in the three countries. Cases were more frequently male in all three countries with 53%, 71%, and 69% in Cambodia, China, and Viet Nam, respectively. The ratios of the female-to-male odds in the notification system to that in the prevalence survey in smear-positive cases in Cambodia, China and Viet Nam were 2.1, 0.9, and 1.8, respectively. Because of the small proportion of extrapulmonary tuberculosis registered in China, we limited the analysis on age and sex distribution for extrapulmonary cases to Cambodia and Viet Nam. The proportion with extrapulmonary tuberculosis among all cases was 18.5% in Cambodia and 15.7% in Viet Nam, decreasing in frequency with increasing age. Conclusions Characteristics of patients

  9. Tuberculosis in children undergoing hemodialysis

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    Gargah Tahar

    2010-04-01

    Full Text Available Gargah Tahar1, Goucha-Louzir Rim2, Lakhoua Mohamed Rachid11Department of Pediatric Nephrology, 2Department of Nephrology, Charles Nicolle Hospital, Tunis, TunisiaAbstract: Tuberculosis (TB remains a public health problem in Tunisia. Its incidence is higher in immunocompromised hosts than in the general population. In children and during hemodialysis, TB is characterized by the frequency of extrapulmonary localizations and diagnostic difficulties. The aim of this retrospective study is to evaluate the incidence of TB in Tunisian children undergoing hemodialysis and to determine its clinical features as well as the results of chemotherapy.Method: This retrospective study includes seven TB children among 112 children on hemodialysis at the pediatric nephrology department in Charles Nicolle Hospital from 2002 to 2008. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological, and histological examinations. Treatment with anti-TB drugs, the results of therapy, and the outcome of patients were noted.Results: There were four girls and three boys aged 10 to 16 years (mean, 13 years. They had been on hemodialysis for 2 to 5 years (mean, 3 years. Noted clinical features were weight loss and fever in five cases, chest pain in one case, cervical lymph node in one case, and spinal pain in one case. The organ systems involved were pleural in two cases, pulmonary in one case, peritoneal in one case, cervical lymphatic in one case, and spinal in one case. One patient was treated empirically with a good response. Diagnosis was made by isolation of mycobacterium TB in three cases, by specific histological signs observed in a lymph node biopsy in one case, in peritoneal biopsy in one case, and in discovertebral biopsy in one case. In the remaining patient, the clinical and radiological presentations were compatible with pulmonary TB. All patients received four anti-TB drugs: isoniazid, rifampicin, pyrazinamide

  10. Microscopic Observation Drug Susceptibility Assay for Rapid Diagnosis of Lymph Node Tuberculosis and Detection of Drug Resistance.

    Science.gov (United States)

    Kirwan, Daniela E; Ugarte-Gil, Cesar; Gilman, Robert H; Caviedes, Luz; Rizvi, Hasan; Ticona, Eduardo; Chavez, Gonzalo; Cabrera, José Luis; Matos, Eduardo D; Evans, Carlton A; Moore, David A J; Friedland, Jon S

    2016-01-01

    In this study, 132 patients with lymphadenopathy were investigated. Fifty-two (39.4%) were diagnosed with tuberculosis (TB). The microscopic observation drug susceptibility (MODS) assay provided rapid (13 days), accurate diagnosis (sensitivity, 65.4%) and reliable drug susceptibility testing (DST). Despite its lower sensitivity than that of other methods, its faster results and simultaneous DST are advantageous in resource-poor settings, supporting the incorporation of MODS into diagnostic algorithms for extrapulmonary TB. Copyright © 2015 Kirwan et al.

  11. Obstructive Jaundice Due to Tuberculosis of Distal CBD and ...

    African Journals Online (AJOL)

    Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis ...

  12. Base of Tongue Tuberculosis: A Case Report

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    Carlos Chiesa Estomba

    2015-05-01

    Full Text Available Introduction: Tuberculosis is an infectious disease that has displayed increasing incidence in the last decades. It is estimated that up to 20% of tuberculosis cases affect extra-pulmonary organs. In the ENT area, soft palate and tongue are the least probable locations.   Case Report A 62-year-old female with a history of rheumatoid arthritis and treatment with corticosteroids and Adalimumab, developed a foreign body sensation in the pharynx accompanied by a sore throat and halitosis. The laryngoscopy with a 70 degree rigid telescope showed an ulcerated hypertrophic lesion in the right vallecula of about 2-3 cm in the base of the tongue. Acid-alcohol resistant bacilli were found positive for M. tuberculosis, through the Ziehl Neelsen method and Löwenstein culture the patient was treated with tuberculostatic medication. Conclusion:  TB is a possible diagnosis when in the presence of an ulcerated lesion at the base of the tongue, accompanied by sore throat, dysphagia, or foreign body sensation.

  13. Pulmonary clearance kinetics and extrapulmonary translocation of seven titanium dioxide nano- and submicron materials following intratracheal administration in rats.

    Science.gov (United States)

    Shinohara, Naohide; Oshima, Yutaka; Kobayashi, Toshio; Imatanaka, Nobuya; Nakai, Makoto; Ichinose, Takayuki; Sasaki, Takeshi; Kawaguchi, Kenji; Zhang, Guihua; Gamo, Masashi

    2015-01-01

    We evaluated and compared the pulmonary clearance kinetics and extrapulmonary translocations of seven titanium dioxide (TiO2) nano- and submicron particles with different characteristics, including size, shape and surface coating. Varying doses of TiO2 nano- and submicron particles dispersed in 0.2% disodium phosphate solution were intratracheally administered to male F344 rats. The rats were euthanized under anesthesia for 3, 28 and 91 days after administration. Ti levels in pulmonary and various extrapulmonary organs were determined using inductively coupled plasma-sector field mass spectrometry (ICP-SFMS). The lungs, including bronchoalveolar lavage fluid (BALF), contained 55-89% of the administered TiO2 dose at 3 days after administration. The pulmonary clearance rate constants, estimated using a one-compartment model, were higher after administration of 0.375-2.0 mg/kg body weight (bw) (0.016-0.020/day) than after administration of 3.0-6.0 mg/kg bw (0.0073-0.013/day) for six uncoated TiO2. In contrast, the clearance rate constant was 0.011, 0.0046 and 0.00018/day following administration of 0.67, 2.0 and 6.0 mg/kg bw TiO2 nanoparticle with Al(OH)3 coating, respectively. Translocation of TiO2 from the lungs to the thoracic lymph nodes increased in a time- and dose-dependent manner. Furthermore, the translocation of TiO2 from the lungs to the thoracic lymph nodes after 91 days was higher when Al(OH)3 coated TiO2 was administered (0.93-6.4%), as compared to uncoated TiO2 (0.016-1.8%). Slight liver translocation was observed (kidney, spleen and brain.

  14. Tuberculosis: a study of 111 cases in an area of high prevalence in the extreme south of Brazil

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    Ivo Gomes de Mattos

    Full Text Available Tuberculosis is an increasingly important public health problem in developing countries. We studied 111 tuberculosis patients confirmed by mycobacteria isolation between 1998 and 2000 in Rio Grande, in south Brazil. One-hundred-thirteen pulmonary and extrapulmonary clinical materials were examined through culture by the Ogawa-Kudoh method and through smear examination by the Ziehl-Nielsen or Kinyoun methods. The identification of Mycobacterium tuberculosis was done through the usual phenotypical methods. The proportion method (indirect technique was used to determine the resistance of isolates. The man/woman ratio was 2.6:1, 75% were white, and the group had a mean age of 39.7±12.7. Risk factors were present in 38.7% (34 men and 9 women, p=0.2, with a mean age of 35 (p=0.002; infection by HIV was the most frequent (28.8%, followed by alcoholism (16.2% and injected drug use (15.3%. The frequency of M. tuberculosis isolates was 99.1%. Pulmonary disease occurred in 88.3% of the cases, extrapulmonary in 9.9% and 1.8% in both. There was an association between extrapulmonary tuberculosis and the presence of risk factors (p=0.0001. Resistance to isoniazid was found in 4% of the isolates and to isoniazid and rifampin in 2%, all being patients with some risk factors. The profile of tuberculosis in the population of this study followed the pattern described for developing regions of the world.

  15. SEVA TB ELISA - Multi antigen and antibody assays for serodiagnosis of suspected cases of pulmonary and extra pulmonary tuberculosis in tertiary care hospital -A retrospective study

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    Pranita J Waghmare

    2012-10-01

    Full Text Available Objective: To assess the usefulness of in-house developed multiantigen and antibody assays, in diagnosis of both pulmonary and extra-pulmonary tuberculosis. Method: Clinically suspected cases of 31 pulmonary and 171 extra-pulmonary tuberculosis (TB were screened by ELISA using cocktail (ES-31 + EST-6 antigen and their specific antibodies (anti ES-31 + anti EST-6 IgG for detection of antibody and and antigen (circulating antigen and immune complexed antigen respectively and correlated with antituberculosis therapy in retrospective study. Results: Out of 31 cases of pulmonary TB screened, 15 patients showed ELISA positivity out of which five cases were given antituberculosis therapy. Out of 171 cases of EPTB screened, 76 cases showed ELISA positivity out of which 18 were given antituberculosis therapy. Further 4 EPTB cases which showed AFB negativity were given ATT. The data was further analyzed based on PTB & EPTB, adults and children, OPD and IPD patients to understand false positivity in clinically suspected PTB and EPTB cases. There was significant correlation (108/202 cases with ELISA negativity and no ATT advised in clinically suspected PTB and EPTB patients. Conclusions: In house developed multi antigen and antibody assays have been observed to be quite useful as adjunct test in serodiagnosis of suspected cases of tuberculosis in particular extrapulmonary tuberculosis.

  16. Abdominal tuberculosis: utility of laparoscopy in the correct diagnosis.

    Science.gov (United States)

    Muroni, Mirko; Rouet, Audrey; Brocheriou, Isabelle; Houry, Sidney

    2015-05-01

    Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features. We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli. Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment. In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.

  17. Rapid Detection of Cell-Free Mycobacterium tuberculosis DNA in Tuberculous Pleural Effusion.

    Science.gov (United States)

    Che, Nanying; Yang, Xinting; Liu, Zichen; Li, Kun; Chen, Xiaoyou

    2017-05-01

    Tuberculous pleurisy is one of the most common types of extrapulmonary tuberculosis, but its diagnosis remains difficult. In this study, we report for the first time on the detection of cell-free Mycobacterium tuberculosis DNA in pleural effusion and an evaluation of a newly developed molecular assay for the detection of cell-free Mycobacterium tuberculosis DNA. A total of 78 patients with pleural effusion, 60 patients with tuberculous pleurisy, and 18 patients with alternative diseases were included in this study. Mycobacterial culture, the Xpert MTB/RIF assay, the adenosine deaminase assay, the T-SPOT.TB assay, and the cell-free Mycobacterium tuberculosis DNA assay were performed on all the pleural effusion samples. The cell-free Mycobacterium tuberculosis DNA assay and adenosine deaminase assay showed significantly higher sensitivities of 75.0% and 68.3%, respectively, than mycobacterial culture and the Xpert MTB/RIF assay, which had sensitivities of 26.7% and 20.0%, respectively (P Mycobacterium tuberculosis DNA assay detected as few as 1.25 copies of IS6110 per ml of pleural effusion and showed good accordance of the results between repeated tests (r = 0.978, P = 2.84 × 10-10). These data suggest that the cell-free Mycobacterium tuberculosis DNA assay is a rapid and accurate molecular test which provides direct evidence of Mycobacterium tuberculosis etiology. Copyright © 2017 American Society for Microbiology.

  18. Tuberculosis among older adults – time to take notice

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    Joel Negin

    2015-03-01

    Full Text Available Knowledge that older people are vulnerable to develop tuberculosis is rarely considered in developing country settings. According to 2010 Global Burden of Disease estimates, the majority of tuberculosis-related deaths occurred among people older than 50; most in those aged 65 and above. Older people also contribute a large proportion of Disability-Adjusted Life Years (DALYs; 51% of tuberculosis DALYs occurred in patients aged 50 years and older in East Asia. Tuberculosis age distributions in Africa have been severely skewed by the human immunodeficiency virus (HIV epidemic, but emerging data suggest increasing disease burdens among older people. Older adults are more likely to develop extra-pulmonary and atypical forms of disease that are often harder to diagnose than conventional sputum smear-positive pulmonary tuberculosis. Their care is complicated by more frequent drug-related adverse events and increased co-morbidity, which may prove difficult to manage in regions where health resources are already constrained. Health systems will have to confront the challenge of an ageing global population and the integrated services required to address their health needs.

  19. Firstly diagnosed HIV/AIDS-associated tuberculosis: clinical peculiarities and causes of patients` deaths

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    A. S. Shalmin

    2013-06-01

    Full Text Available Introduction. According to the literature, HIV infection increases the risk of tuberculosis, and tuberculosis causes an adverse effect on the course of HIV infection. Tuberculosis is the direct cause of death of patients up to 30.0% with HIV infection and in 90.0% of cases at AIDS. That’s why studying the clinical course of HIV/AIDS-associated tuberculosis and analysis of causes of death in these patients is highly actual today. The aim of the study. To determine the clinical course and causes of death in patients with primarily diagnosed HIV/AIDS-associated tuberculosis. Materials and methods. 22 patients cards who died of primarily diagnosed HIV/AIDS-associated tuberculosis were analyzed in this article. The results of research. Among patients with primarily diagnosed HIV/AIDS-associated tuberculosis there were 12 men (54.6%, and 10 (45.4% women. The average age was 39.5 ± 1.5 years. There were 90.9% of unemployed patients (20 patients, 4 patients (18.2% were former prisoners, 1(4.5% – shelterless person, 5 patients (22.7% suffered from drug addiction and alcoholism. 9 (40.9% patients lived antisocial life. HIV-infection had started after tuberculosis in 1 patient (4.5%, before tuberculosis - in 15 (68.2%, the simultaneous detection of co-infection was found in 6 cases (27.3%. Prevailed disseminated (60 % and infiltrative forms of lung tuberculosis (33,3 % were significantly (P <0.05 more often registered among patients with co-infection of primarily diagnosed HIV/AIDS-associated tuberculosis. 5 (33.3% patients had pulmonary tuberculosis combined with extrapulmonary, that significantly complicated the course of co-infection. There were 3 patients (13.6%, who interrupted treatment, 1 patient refused treatment completely. 6 patients had received antiretroviral therapy (27.3%, 5 patients (22.7% renounced, in 11 (50.0% - antiretroviral therapy was not intended. The autopsy determined that 14 (63.6% patients died from progressive worsening of

  20. Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia.

    Science.gov (United States)

    Walls, Genevieve; Bulifon, Sophie; Breysse, Serge; Daneth, Thol; Bonnet, Maryline; Hurtado, Northan; Molfino, Lucas

    2015-01-01

    There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB) in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV) co-infection in a national referral hospital in Phnom Penh, Cambodia. Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures. M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB). The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (pCambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

  1. Imaging of extraspinal musculoskeletal tuberculosis

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    De Backer, A.I. [Department of Radiology, General Hospital Sint-Lucas, Groenebriel 1, B-9000 Ghent (Belgium)]. E-mail: adelard.debacker@azstlucas.be; Mortele, K.J. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States); Vanhoenacker, F.M. [Department of Radiology, Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, B-2650, Edegem (Belgium); Parizel, P.M. [Department of Radiology, Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, B-2650, Edegem (Belgium)

    2006-01-15

    Tuberculosis (TB) is still a major cause of significant morbidity and mortality despite universal availability of effective chemotherapy. The emergence of multidrug-resistant mycobacteria along with a worldwide increase in HIV infection has led to a recent surge in the number of patients with TB. TB involves both pulmonary and extrapulmonary sites. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB is among the least common manifestations of TB. It shows a predilection for joints and para-articular areas while isolated soft tissue TB occurs extremely rare. A non-specific, often indolent clinical presentation in conjunction with its low prevalence constitutes obstacles for diagnosis. The differential diagnosis of extraspinal musculoskeletal TB consists of degenerative processes, inflammatory and infectious conditions, primary neoplasms, and metastatic lesions. Early diagnosis and treatment is of utmost importance to prevent serious joint and bone destruction. Radiological assessment of patients with musculoskeletal TB is often the key to adequate diagnosis and early treatment. The purpose of this manuscript is to review the imaging features of extraspinal musculoskeletal TB and to focus on the magnetic resonance imaging (MRI) characteristics of this pathology.

  2. Patient and health care system delays in the start of tuberculosis treatment in Norway

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    Rygh Jens

    2006-02-01

    Full Text Available Abstract Background Delay in start of tuberculosis (TB treatment has an impact at both the individual level, by increasing the risk of morbidity and mortality, and at the community level, by increasing the risk of transmission. The aims of this study were to assess the delays in the start of treatment for TB patients in Oslo/Akershus region, Norway and to analyze risk factors for the delays. Methods This study was based on information from the National TB Registry, clinical case notes from hospitals and referral case notes from primary health care providers. Delays were divided into patient, health care system and total delays. The association with sex, birthplace, site of the disease and age group was analyzed by multiple linear regression. Results Among the 83 TB patients included in this study, 71 (86% were born abroad. The median patient, health care system and total delays were 28, 33 and 63 days respectively, with a range of 1–434 days. In unadjusted analysis, patient delay and health care system delay did not vary significantly between men and women, according to birthplace or age group. Patients with extra-pulmonary TB had a significantly longer patient, health care system and total delay compared to patients with pulmonary TB. Median total delay was 81 and 56 days in the two groups of TB patients respectively. The health care system delay exceeded the patient delay for those born in Norway. The age group 60+ years had significantly shorter patient delay than the reference group aged 15–29 years when adjusted for multiple covariates. Also, in the multivariate analysis patients born in Norway had significantly longer health care system delay than patients born abroad. Conclusion A high proportion of patients had total delays in start of TB treatment exceeding two months. This study emphasizes the need of awareness of TB in the general population and among health personnel. Extra-pulmonary TB should be considered as a differential

  3. Should patients with extrapulmonary small-cell carcinoma receive prophylactic cranial irradiation?

    LENUS (Irish Health Repository)

    Naidoo, Jarushka

    2013-09-01

    Extrapulmonary small-cell carcinoma (EPSCC) is a rare disease. Management is based on small-cell lung carcinoma. Prophylactic cranial irradiation (PCI) is not routinely administered in EPSCC. This study investigates the role of PCI in EPSCC, by analyzing the incidence, treatment, and survival of patients with brain metastases in a national cohort. Disease biology and epidemiology are also investigated.

  4. Extrapulmonary colony formation after intravenous injection of tumour cells into heparin treated animals

    NARCIS (Netherlands)

    Maat, B.

    1978-01-01

    Recent data on extrapulmonary colony formation after heparin administration are inconclusive. A systemic study of this topic was undertaken with 4 experimental tumour systems and 2 distinct periods of reduced clotting capacity in rats and mice. I.v. injection of various numbers of tumour cells into

  5. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality

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    Nathália Mota de Faria Gomes

    2015-01-01

    Full Text Available Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65 and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96. In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76. The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85, coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56, illiteracy (OR = 1.88, 95% CI = 1.27–2.75, the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38, and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75. Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.

  6. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality.

    Science.gov (United States)

    de Faria Gomes, Nathália Mota; da Mota Bastos, Meire Cardoso; Marins, Renata Magliano; Barbosa, Aline Alves; Soares, Luiz Clóvis Parente; de Oliveira Wilken de Abreu, Annelise Maria; Souto Filho, João Tadeu Damian

    2015-01-01

    To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR=2.05; 95% CI=1.15-3.65) and nonadherence to previous treatment (OR=3.14; 95% CI=1.96-5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR=0.33, 95% CI=0.14-0.76). The following risk factors were associated with mortality: age over 40 years (OR=2.61, 95% CI=1.76-3.85), coinfection with HIV (OR=6.01, 95% CI=3.78-9.56), illiteracy (OR=1.88, 95% CI=1.27-2.75), the presence of severe extrapulmonary TB (OR=2.33, 95% CI=1.24-4.38), and retreatment after relapse (OR=1.95, 95% CI=1.01-3.75). Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.

  7. [Tuberculosis treatment for children: An update].

    Science.gov (United States)

    Mellado Peña, María José; Santiago García, Begoña; Baquero-Artigao, Fernando; Moreno Pérez, David; Piñeiro Pérez, Roi; Méndez Echevarría, Ana; Ramos Amador, José Tomás; Gómez-Pastrana Durán, David; Noguera Julian, Antoni

    2018-01-01

    Tuberculosis (TB) is the most important infectious disease all over the world, with a high morbidity and mortality. Pediatric tuberculosis has been a neglected epidemic, due to the difficulties in assessing its global impact, reduced incidence and lower infectivity compared to adults. In 2015, the WHO reported 1 million cases of paediatric TB and 169,000 deaths. In Europe, the emergence of MDR TB is a major concern, representing 16% of the new diagnosis in Eastern Europe. In 2014, it was estimated that about 219,000 children were infected by MDR-TB-strains in Europe, and 2,120 developed the disease. Spain is the Western European country with more paediatric cases, with an incidence 4.3/100,000 inhabitants in 2014. Paediatric tuberculosis mortality in Spain is rare, but extra-pulmonary disease is associated with significant complications. The prevalence of paediatric drug resistant TB in Spain is over 4%, higher than the estimated incidence in adult population, representing mayor difficulties for therapeutic intervention. These data reveal that paediatric TB is still a Public Health priority in our country. The difficulties in diagnosis and the lack of optimal paediatric drug formulations are the major challenges for controlling the childhood's tuberculosis epidemic. A group of national paeditric TB experts has reviewed the international guidelines and the most recent evidences, and has established new recommendations for the management of paediatric TB contacts, latent infection and active TB disease, especially focused in drug resistant cases. This document replaces the former national guidelines from the Spanish Society for Pediatric Infectios Diseases, although the prior recommendations on the diagnosis remain valid. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia

    Directory of Open Access Journals (Sweden)

    Genevieve Walls

    2015-01-01

    Full Text Available Background and objective: There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV co-infection in a national referral hospital in Phnom Penh, Cambodia. Design: Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures. Results: M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB. The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (p<0.001. The diagnosis of MDR TB was made after death in 15.8% of patients; in total 26.3% of patients with MDR TB died. The diagnosis of TB was established by culture of extra-pulmonary specimens in 23.6% of cases. Conclusions: There is significant resistance to first-line TB drugs amongst new and previously treated TB–HIV co-infected patients in Phnom Penh. These data suggest that the prevalence of DR TB in Cambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

  9. Extra-pulmonary manifestations of paracoccidioidomycosis; Manifestacoes extrapulmonares da paracoccidioidomicose

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Marlos Augusto Bittencourt; Carvalho, Tarcisio Nunes; Araujo Junior, Cyrillo Rodrigues de; Borba, Ana Olivia Cardoso; Veloso, Gerson Augusto; Teixeira, Kim-Ir-Sem Santos [Goias Univ., Goiania, GO (Brazil). Hospital das Clinicas. Dept. de Diagnostico por Imagem]. E-mail: radiologia@brturbo.com

    2001-02-01

    The authors present a review and iconographic study of patients with disseminated paracoccidioidomycosis, including the main radiographic findings seen in the central nervous system, adrenal glands, osteoarticular system, lymph nodes and digestive tract. Imaging diagnostic methods have allowed a more precise approach of these patients due to their high sensitivity in detecting lesions, even in asymptomatic patients. In most cases these abnormalities are unspecific, simulating either neoplasic or chronic infectious lesions, and sometimes difficult to distinguish from tuberculosis. Although these findings are nonspecific and only the mycologic and histologic fungus demonstration can confirm the diagnosis, they may suggest a presumptive one, when these imaging findings are considered in an appropriate clinical and epidemiological setting. (author)

  10. Active tuberculosis in psoriasis patients treated with TNF antagonists: a French nationwide retrospective study.

    Science.gov (United States)

    Guinard, E; Bulai Livideanu, C; Barthélémy, H; Viguier, M; Reguiai, Z; Richard, M A; Jullien, D; Beneton, N; Bara, C; Vabres, P; Grandvuillemin, A; Marguery, M C; Amelot, F; Konstantinou, M P; Bagheri, H; Paul, C

    2016-08-01

    There is limited information about active tuberculosis (TB) occurring in psoriasis patients treated with Tumor necrosis factor (TNF) antagonists. To describe the clinical characteristics of TB in psoriasis patients treated with TNF antagonists. Nationwide retrospective study of psoriasis patients having experienced TB. Cases of TB were collected via three methods: search in the national pharmacosurveillance database, questionnaire to members of the French psoriasis research group, the college of French dermatology professors. We collected demographic data, TNF antagonist used, screening for latent tuberculosis infection, median time between TNF antagonists introduction and first symptoms, tests used for diagnosing TB infection, clinical features of tuberculosis and outcome. Eight centres reported 12 cases of TB between 2006 and 2014. They were nine men and three women with mean age of 49 years. All patients had adequate screening for latent tuberculosis. Three patients had stayed in endemic areas, three reported contact with a patient with TB. Tuberculosis presentation was extrapulmonary in 10 patients. Seven patients were treated with infliximab, four with adalimumab and one with certolizumab. The median time between TNF antagonist introduction and first symptoms of tuberculosis was 23.4 weeks (2-176). Six of the 12 patients had a positive direct examination and/or positive culture for Mycobacterium tuberculosis. Histological samples of affected organs taken from seven patients showed granulomatous inflammation in six, with caseating necrosis in five. Two of the 12 patients died of disseminated TB. This study shows tuberculosis in patients treated with TNF antagonists still occurs despite adherence to tuberculosis prevention guidelines. Prophylactic measures do not fully prevent the occurrence of tuberculosis. Rapid initiation of effective anti-tuberculosis treatment is important even in patients with negative mycobacteriological examination presenting with

  11. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings

    Directory of Open Access Journals (Sweden)

    Eduardo Lima da Rocha

    2015-06-01

    Full Text Available Abstract Tuberculosis is a disease whose incidence has increased principally as a consequence of HIV infection and use of immunosuppressive drugs. The abdomen is the most common site of extrapulmonary tuberculosis. It may be confused with several different conditions such as inflammatory bowel disease, cancer and other infectious diseases. Delay in the diagnosis may result in significantly increased morbidity, and therefore an early recognition of the condition is essential for proper treatment. In the present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed by means of computed tomography and magnetic resonance imaging, demonstrating the involvement of different organs and systems, and presentations which frequently lead radiologists to a diagnostic dilemma. A brief literature review was focused on imaging findings and their respective prevalence.

  12. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Rocha, Eduardo Lima da; Pedrassa, Bruno Cheregati; Bormann, Renata Lilian; Kierszenbaum, Marcelo Longo; Torres, Lucas Rios; D' Ippolito, Giuseppe, E-mail: giuseppe_dr@uol.com.br [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina

    2015-05-15

    Tuberculosis is a disease whose incidence has increased principally as a consequence of HIV infection and use of immunosuppressive drugs. The abdomen is the most common site of extrapulmonary tuberculosis. It may be confused with several different conditions such as inflammatory bowel disease, cancer and other infectious diseases. Delay in the diagnosis may result in significantly increased morbidity, and therefore an early recognition of the condition is essential for proper treatment. In the present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed by means of computed tomography and magnetic resonance imaging, demonstrating the involvement of different organs and systems, and presentations which frequently lead radiologists to a diagnostic dilemma. A brief literature review was focused on imaging findings and their respective prevalence. (author)

  13. Cutaneous squamous cell carcinoma in lupus vulgaris caused by drug resistant Mycobacterium tuberculosis

    Directory of Open Access Journals (Sweden)

    Muthu S Kumaran

    2017-01-01

    Full Text Available Tuberculosis (TB is still a major public health problem in the world, with many factors contributing to this burden, including poor living conditions, overcrowding, poverty, malnutrition, illiteracy, and rapid spread of human immunodeficiency virus infection. Cutaneous tuberculosis is a less common form of extrapulmonary tuberculosis, and in this paucibacillary form the diagnosis depends on histopathology, tuberculin positivity, and response to treatment. The diagnosis is even more difficult in cases with drug resistant Mycobacterium tuberculosis due to lack of awareness and lack of facilities to diagnose drug resistant tuberculosis. In this article, we describe an unusual case of multidrug resistant lupus vulgaris (LV, in a 34-year-old male who responded to anti-tubercular treatment (ATT initially, but developed recurrent disease which failed to respond to standard four-drug ATT; subsequently, tissue culture showed growth of multidrug resistant M. tuberculosis. Subsequently, he also developed cutaneous squamous cell carcinoma. This article aims to exemplify a grave complication that can occur in long-standing case of LV, the limitations faced by clinicians in developing countries where tuberculosis is endemic, and classical methods of proving drug resistance are generally unavailable or fail.

  14. Undiagnosed tuberculosis as clinical, epidemiological and medicolegal problem: Report of two cases

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    Savić Slobodan

    2006-01-01

    Full Text Available The authors present two cases of undiagnosed tuberculosis in order to point out clinical, epidemiological and medicolegal importance of such cases. The first patient was a 29- year old woman, who died after 10-day hospital treatment, but true nature of her disease remained undiscovered. Due to her known marital problems, as well as numerous bruises developed as a consequence of hemorrhagic syndrome, violent death caused by injuries inflicted by her husband was suspected. Medicolegal autopsy and microscopic examination revealed fatal tuberculosis of the lungs, and small and large intestines. In another case, a 35-year old male died suddenly and unexpectedly, being found dead in his flat where numerous blood traces were noticed during the scene investigation. Therefore, possible homicide was suspected. Medicolegal investigation proved pulmonary tuberculosis as a cause of natural death. Presented cases point out the fact that even nowadays both pulmonary and extrapulmonary tuberculosis may remain clinically undiscovered, even when this disease is a cause of death. Hence, physicians should always keep in mind possible tuberculosis, especially in patients with long-lasting typical symptoms and signs. In both reported cases, the individuals suffered from cavernous pulmonary tuberculosis being thus a permanent source of infection. From medicolegal point of view, described cases represent examples of so called suspicious natural death. On the other hand, the fact that fatal tuberculosis remained clinically undiagnosed may make physicians be accused of medical negligence and malpractice.

  15. Cutaneous Squamous Cell Carcinoma in Lupus Vulgaris Caused by Drug Resistant Mycobacterium Tuberculosis.

    Science.gov (United States)

    Kumaran, Muthu S; Narang, Tarun; Jitendriya, Madhukara; Tirumale, Rajalakshmi; Manjunath, Suraj; Savio, Jayanthi

    2017-01-01

    Tuberculosis (TB) is still a major public health problem in the world, with many factors contributing to this burden, including poor living conditions, overcrowding, poverty, malnutrition, illiteracy, and rapid spread of human immunodeficiency virus infection. Cutaneous tuberculosis is a less common form of extrapulmonary tuberculosis, and in this paucibacillary form the diagnosis depends on histopathology, tuberculin positivity, and response to treatment. The diagnosis is even more difficult in cases with drug resistant Mycobacterium tuberculosis due to lack of awareness and lack of facilities to diagnose drug resistant tuberculosis. In this article, we describe an unusual case of multidrug resistant lupus vulgaris (LV), in a 34-year-old male who responded to anti-tubercular treatment (ATT) initially, but developed recurrent disease which failed to respond to standard four-drug ATT; subsequently, tissue culture showed growth of multidrug resistant M. tuberculosis. Subsequently, he also developed cutaneous squamous cell carcinoma. This article aims to exemplify a grave complication that can occur in long-standing case of LV, the limitations faced by clinicians in developing countries where tuberculosis is endemic, and classical methods of proving drug resistance are generally unavailable or fail.

  16. Tuberculosis Multidrogoresistente

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    German A Acevedo

    2013-12-01

    Full Text Available La tuberculosis es una enfermedad infecciosa causada por el Mycobacterium tuberculosis. En el año 2010 se registraron 8.8 millones de casos incidentes en el mundo y en los últimos años han aparecido poblaciones bacterianas de micobacterias con resistencia a los fármacos de primera línea. Se ha definido la presencia de resistencia a rifampicina e isoniacida como multidrogoresistencia, estimándose una incidencia mundial aproximada de 3.6%. Esta revisión de tema se centrará en la situación de la tuberculosis multidrogoresistente en el mundo, incluyendo un análisis regional de la casuística Colombiana. Se comentarán los principales mecanismos de resistencia del microorganismo, los genes implicados en la misma y los factores de riesgo asociados a la generación de resistencia en algunas comunidades.

  17. Primary nasal tuberculosis: a case report.

    Science.gov (United States)

    Stojanović, Jasmina; Belić, Branislav; Mitrović, Slobodanka; Stanković, Predrag; Stojanović, Stevan; Erdevicki, Ljiljana; Zivić, Ljubica; Arsenijević, Snezana

    2013-08-01

    During the past two decades, tuberculosis (TBC) both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. Thirty-year-old man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laboratory analyses were within the reference ranges. Nasal and throat swabs for bacteria and fungi were normal. Skin allergy testing to standard inhalatory allergens was positive. Computer rhinomanometry showed increased nasal resistance at medium difficulty level, on the right. Radiography of paranasal sinuses indicated chronic polysinusitis on the right. Anti-allergy therapy was prescribed. The patient came for checkup after a month with subjective deterioration and a neck tumefact on the right. Nasal endoscopy revealed the presence of dark red infiltrates with the 3 mm diameter on nasal septal mucosa, dominantly on the right, with small greyish nodules. This findings indicated a potential specific nasal inflammatory process. In the upper jugulodigastric area, on the left, painless tumefact 3 x 5 cm in size was palpated, it was mobile comparing to supra- and infrastructure, with unaltered skin above. The definite diagnosis was established on the basis of the results of nasal mucosa biopsy. After histopathological diagnosis was obtained, we started with antituberculosis therapy at once. Due to actual trends of TBC incidences, otolaryngologist should have in mind nasal TBC, when granulomatose lesions are found in nose.

  18. Mycobacterium tuberculosis Infection following Kidney Transplantation

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    Karima Boubaker

    2013-01-01

    Full Text Available Introduction and Aims. Post-transplant tuberculosis (TB is a problem in successful long-term outcome of renal transplantation recipients. Our objective was to describe the pattern and risk factors of TB infection and the prognosis in our transplant recipients. Patients and Methods. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. Results. 16 patients (3,2% developed post-transplant TB with a mean age of 32,5 ± 12,7 (range: 13–60 years and a mean post-transplant period of 36,6months (range: 12,3 months–15,9 years. The forms of the diseases were pulmonary in 10/16 (62,6%, disseminated in 3/16 (18,7%, and extrapulmonary in 3/16 (18,7%. Graft dysfunction was observed in 7 cases (43,7% with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18,7% during treatment. Recurrences were observed in 4 cases after early stop of treatment. Two patients (12.5% died. Conclusion. Extra pulmonary and disseminated tuberculosis were observed in third of our patients. More than 9months of treatment may be necessary to prevent recurrence.

  19. Genetic association study suggests a role for SP110 variants in lymph node tuberculosis but not pulmonary tuberculosis in north Indians.

    Science.gov (United States)

    Abhimanyu; Jha, Pankaj; Jain, Ashima; Arora, Komal; Bose, Mridula

    2011-07-01

    Ethnic specificity is a key determinant in understanding the association of genetic variants with outcome of disease susceptibility. SP110, a component of the nuclear body, has been subjected to association studies with conflicting results. In this study we probed SP110 variants in pulmonary (PTB) and lymph node tuberculosis (LNTB) cases to explore their role in controlling susceptibility to Mycobacterium tuberculosis infection in north Indians. We genotyped 24 SP110 variants in over 140 north Indian tuberculosis cases and 78 ethnicity-matched controls. The SP110 gene variants were available from public databases. The cases and controls were free of any population stratification when subjected to Eigenstrat principal component analysis. Genotyping was carried out using the Sequenom MassARRAY platform. Applying exclusion criteria, 11 single nucleotide polymorphisms (SNPs) of the LNTB panel and 13 SNPs of the PTB panel passed all filters and were analyzed further. No significant association was observed between SP110 variants and PTB. Surprisingly, we discovered evidence of an association of SP110 variants with LNTB, a form of extrapulmonary tuberculosis, at 3 loci, namely, rs6436915, rs1427294, and rs1346311. When permutations analysis (n = 10,000) of allelic p values was undertaken, only rs1427294 passed the test with its p value remaining statistically significant. The C allele of rs1427294 exhibited a 5-fold risk of developing LNTB. No significant haplotypes were observed. In the pilot study presented here, our results provide evidence for the first time that SP110 may be a risk determinant locus in LNTB while confirming a doubtful role of SP110 in PTB in north Indians. In general, the results might indicate a role of SP110 variants in extrapulmonary tuberculosis rather than PTB. Copyright © 2011 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  20. Learn About Tuberculosis

    Science.gov (United States)

    ... Health and Diseases > Lung Disease Lookup > Tuberculosis (TB) Learn About Tuberculosis Tuberculosis (TB) is an airborne bacterial ... against the resistant TB germs in the body. Learn more about the types of drug resistant TB . ...

  1. Tuberculosis: General Information

    Science.gov (United States)

    TB Elimination Tuberculosis: General Information What is TB? Tuberculosis (TB) is a disease caused by germs that are spread from person ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CS227840_A What Does a Positive Test ...

  2. Tuberculosis; Eye

    African Journals Online (AJOL)

    muscle could present as a painful swelling over the corresponding part of the eye with associated restriction of ocular motility involving the muscle. TUBERCULOSIS OF THE EYE. CORNEA: Primary infection of the cornea is very rare. Corneal involvement is usually due to a hypersentitivity or cross-reaction whereby the.

  3. Tuberculosis perinatal

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    Jessica Sáenz-Gómez

    2015-01-01

    Conclusiones: La infección perinatal debe sospecharse en niños con sepsis o neumonía sin respuesta a antibióticos. En este caso, el antecedente de la madre con tuberculosis orientó al diagnóstico.

  4. Increased severity of tuberculosis in Guinea pigs with type 2 diabetes: a model of diabetes-tuberculosis comorbidity.

    Science.gov (United States)

    Podell, Brendan K; Ackart, David F; Obregon-Henao, Andres; Eck, Sarah P; Henao-Tamayo, Marcela; Richardson, Michael; Orme, Ian M; Ordway, Diane J; Basaraba, Randall J

    2014-04-01

    Impaired glucose tolerance and type 2 diabetes were induced in guinea pigs to model the emerging comorbidity of Mycobacterium tuberculosis infection in diabetic patients. Type 2 diabetes mellitus was induced by low-dose streptozotocin in guinea pigs rendered glucose intolerant by first feeding a high-fat, high-carbohydrate diet before M. tuberculosis exposure. M. tuberculosis infection of diabetic guinea pigs resulted in severe and rapidly progressive tuberculosis (TB) with a shortened survival interval, more severe pulmonary and extrapulmonary pathology, and a higher bacterial burden compared with glucose-intolerant and nondiabetic controls. Compared with nondiabetics, diabetic guinea pigs with TB had an exacerbated proinflammatory response with more severe granulocytic inflammation and higher gene expression for the cytokines/chemokines interferon-γ, IL-17A, IL-8, and IL-10 in the lung and for interferon-γ, tumor necrosis factor-α, IL-8, and monocyte chemoattractant protein-1 in the spleen. TB disease progression in guinea pigs with impaired glucose tolerance was similar to that of nondiabetic controls in the early stages of infection but was more severe by day 90. The guinea pig model of type 2 diabetes-TB comorbidity mimics important features of the naturally occurring disease in humans. This model will be beneficial in understanding the complex pathogenesis of TB in diabetic patients and to test new strategies to improve TB and diabetes control when the two diseases occur together. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  5. Sociodemographic, clinical and epidemiological aspects of Tuberculosis treatment abandonment in Pernambuco, Brazil, 2001-2014.

    Science.gov (United States)

    Soares, Marcelo Luiz Medeiros; Amaral, Nathália Alves Castro do; Zacarias, Amanda Correia Paes; Ribeiro, Leila Karina de Novaes Pires

    2017-01-01

    to describe abandonment rates according to sociodemographic, clinical and epidemiological characteristics of new tuberculosis cases being treated in Pernambuco State, Brazil. this is a descriptive ecological study using data from the Information System for Notifiable Diseases from 2001 to 2014; the abandonment rate was calculated by the Regional Administration on Health (GERES). of the 57,015 new cases, 6,474 (11.3%) abandoned treatment, although abandonment decreased from 16.4% (2001) to 9.3% (2014); the abandonment rate in GERES I Recife, III Palmares, IV Caruaru, VIII Petrolina and IX Ouricuri was still >5% in 2014; the rate was higher in males (11.9%), people aged 20-39 (12.7%), people with incomplete elementary school (12.1%), black-skinned people (13.7%), institutionalized people (12.5%) and those with pulmonary + extrapulmonary tuberculosis (14.1%). despite the decrease, the abandonment rate remained high; males, adults with low education level, black-skinned people, institutionalized patients and patients with pulmonary + extrapulmonary tuberculosis seemed more prone to abandoning treatment.

  6. Mannose-binding lectin exon 1 and promoter polymorphisms in tuberculosis disease in a Mediterranean area.

    Science.gov (United States)

    García-Gasalla, M; Milá Llambí, J; Losada-López, I; Cifuentes-Luna, C; Fernández-Baca, V; Pareja-Bezares, A; Mir-Villadrich, I; Payeras-Cifré, A

    2014-08-01

    Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found. © 2014 John Wiley & Sons Ltd.

  7. Frequency of Mycobacterium Tuberculosis Infection among Iranian Patients with HIV/AIDS by PPD Test

    Directory of Open Access Journals (Sweden)

    Fatemeh Fattahi

    2010-02-01

    Full Text Available Persons infected with the Human Immunodeficiency Virus (HIV are particularly susceptible to tuberculosis, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24% were shown to have the tuberculosis infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35% had pulmonary Tuberculosis, 2 (3.2% had extrapulmonary tuberculosis, and 39 (53% had no evidence of M. tuberculosis infection (latent infection. Also 8 (12.7% had history of long term residence in a foreign country, 32 (50.8% were exposed to an index case, and 9 (14.3% had past history of pulmonary tuberculosis, while only 33.3% had clinical manifestations of TB (active disease. There was no resistant case of tuberculosis. Our study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.

  8. Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - Report from a developing country.

    Science.gov (United States)

    Iram, Shagufta; Zeenat, Asyia; Hussain, Shahida; Wasim Yusuf, Noshin; Aslam, Maleeha

    2015-01-01

    To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extrapulmonary specimens and to compare it with conventional techniques. During a period of 10 months from December 2012 through September 2013, two hundred and forty five clinically TB suspects were enrolled for Xpert MTB\\RIF assay. The cohort comprised of 205 suspects of pulmonary TB and 40 of extrapulmonary TB (EPTB). The 40 EPTB samples included pus aspirated from different sites of the body (n=19), pleural fluid (n=11), ascitic fluid (n=7), pericardial fluid, CSF and urine one each. Ziehl-Neelsen (ZN) Stained smear microscopy, culture on LJ media and Xpert MTB/RIF assay was performed on samples from these patients. M. tuberculosis (MTB) were detected by Xpert MTB/RIF test in 111 (45.3%) out of 245 samples. Of these, 85 (34.7%) were smear positive on ZN staining and 102 (41.6%) were positive on LJ cultures. Rifampicin resistance was detected in 16 (6.5%) patients. Nine out of 19 pus samples (47.3%) were positive for MTB by Gene Xpert, 03 (15.8%) on ZN staining and 04 (21%) on LJ culture. MTB could not be detected in any other extrapulmonary sample. Xpert MTB/RIF is a sensitive method for rapid diagnosis of Tuberculosis, especially in smear negative cases and in EPTB as compared to the conventional ZN staining. Among EPTB cases the highest yield of positivity was shown in Pus samples. For countries endemic for TB GeneXpert can serve as a sensitive and time saving diagnostic modality for pulmonary and EPTB.

  9. É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais? Differentiating between tuberculosis-related and lymphoma-related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible?

    Directory of Open Access Journals (Sweden)

    Leila Antonangelo

    2012-04-01

    Full Text Available OBJETIVO: Descrever características clínicas e laboratoriais em pacientes com derrames pleurais linfocíticos secundários a tuberculose ou linfoma, a fim de identificar as variáveis que possam contribuir no diagnóstico diferencial dessas doenças. MÉTODOS: Estudo retrospectivo com 159 pacientes adultos HIV negativos com derrame pleural linfocítico secundário a tuberculose ou linfoma (130 e 29 pacientes, respectivamente tratados no Ambulatório da Pleura, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP, entre outubro de 2008 e março de 2010. RESULTADOS: A média de idade e de duração dos sintomas foi menor no grupo tuberculose que no grupo linfoma. Os níveis pleurais de proteínas, albumina, colesterol, amilase e adenosina desaminase (ADA, assim como os níveis séricos de proteínas, albumina e amilase, foram maiores no grupo tuberculose, enquanto os níveis séricos de colesterol e triglicérides foram maiores no grupo linfoma. As contagens de leucócitos e linfócitos no líquido pleural foram maiores no grupo tuberculose. Células malignas estavam ausentes no grupo tuberculose, entretanto, linfócitos atípicos foram observados em 4 desses pacientes. No grupo linfoma, a citologia para células neoplásicas foi positiva, suspeita e negativa em 51,8%, 24,1% e 24,1% dos pacientes, respectivamente. A imunofenotipagem do líquido pleural foi conclusiva na maioria dos pacientes com linfoma. CONCLUSÕES: Nossos resultados demonstram semelhanças clínicas e laboratoriais entre os pacientes com tuberculose ou linfoma. Embora os níveis de proteínas e ADA no líquido pleural tendam a ser mais elevados no grupo tuberculose que no grupo linfoma, mesmo essas variáveis mostraram uma sobreposição. Entretanto, nenhum paciente com tuberculose apresentou níveis de ADA no líquido pleural inferiores ao ponto de corte (40 U/L.OBJECTIVE: To describe clinical and laboratory

  10. Tuberculosis and AIDS co-morbidity in Brazil: linkage of the tuberculosis and AIDS databases

    Directory of Open Access Journals (Sweden)

    Angelica Espinosa Miranda

    Full Text Available This study evaluated differences in AIDS patients with and without tuberculosis (TB in Espírito Santo State, Brazil. Standard regional AIDS (SINAN, SISCEL, SICLOM and SIM and tuberculosis (SINAN databases were used. TB and AIDS databases were linked using Reclink software, version 3, with SPSS software support to identify co-infected cases. Data from July 2000 to June 2006 in Espírito Santo State were linked. The results showed 3,523 adult AIDS cases and 9,958 adult TB cases resulted in 430 co-infected patients, who were compared to 1,290 AIDS patients who never developed TB. Among 430 co-infected patients, TB was diagnosed first in 223 (51.9%, AIDS was first in 44 (10.2%, and AIDS and TB were diagnosed concurrently in 163 (37.9%. Median age did not differ between co-infected cases (36 years (interquartile range [IQR] 29-43 and non-co-infected cases (34 years; IQR 28-42. Pulmonary tuberculosis was diagnosed in 239 (55.6%; 109 (25.3% had extra-pulmonary TB and 82 (19.1% had both presentations. In the final logistic regression model, living in a metropolitan area [Odds Ratio (OR=1.43 (95% Confidence Interval (CI 1.05-1.95], education < 3 years [OR=3.03 (95%CI 1.56-5.88] and CD4 counts < 200/mm³ [OR=1.14 (95%CI 1.09-1.18] were associated with co-infection. This report emphasizes the significance of tuberculosis among AIDS cases in Brazil, and highlights the importance of evaluating secondary data for purposes of improving data quality and developing public health interventions.

  11. Tuberculosis and AIDS Co-Morbidity in Brazil: Linkage of the Tuberculosis and AIDS Databases

    Science.gov (United States)

    Miranda, Angelica Espinosa; Golub, Jonathan E.; Lucena, Francisca de Fátima; Maciel, Ethel Noia; Gurgel, Maria de Fátima; Dietze, Reynaldo

    2013-01-01

    This study evaluated differences in AIDS patients with and without tuberculosis (TB) in Espírito Santo State, Brazil. Standard regional AIDS (SINAN, SISCEL, SICLOM and SIM) and tuberculosis (SINAN) databases were used. TB and AIDS databases were linked using Reclink software, version 3, with SPSS software support to identify co-infected cases. Data from July 2000 to June 2006 in Espírito Santo State were linked. The results showed 3,523 adult AIDS cases and 9,958 adult TB cases resulted in 430 co-infected patients, who were compared to 1,290 AIDS patients who never developed TB. Among 430 co-infected patients, TB was diagnosed first in 223 (51.9%), AIDS was first in 44 (10.2%), and AIDS and TB were diagnosed concurrently in 163 (37.9%). Median age did not differ between co-infected cases (36 years (interquartile range [IQR] 29–43) and non-co-infected cases (34 years; IQR 28–42). Pulmonary tuberculosis was diagnosed in 239 (55.6%); 109 (25.3%) had extra-pulmonary TB and 82 (19.1%) had both presentations. In the final logistic regression model, living in a metropolitan area [Odds Ratio (OR)=1.43 (95% Confidence Interval (CI) 1.05–1.95)], education ≤3 years [OR=3.03 (95%CI 1.56–5.88)] and CD4 counts ≤200/mm3 [OR=1.14 (95%CI 1.09–1.18)] were associated with co-infection. This report emphasizes the significance of tuberculosis among AIDS cases in Brazil, and highlights the importance of evaluating secondary data for purposes of improving data quality and developing public health interventions. PMID:20140359

  12. [Tuberculosis in 7 general hospitals in Andalusia. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas].

    Science.gov (United States)

    Gómez Camacho, E; Cuello, J A; Muñoz Lucena, F; Pérez Pérez, M; Causse, M; Torres, M; Kindelan, J M

    1992-05-01

    To know the clinical features of tuberculosis in our environment, to evaluate its diagnostic techniques and therapeutic options as well as the evolution of patients. Multicenter retrospective study of 1115 patients with tuberculosis, diagnosed between 1984 and 1988 in the population based areas of 7 Hospitals from Andalusia (Spain). The mean age was less than 40 ages, the exponential growing of the number of cases a year in which the influence of drug addicts could be an important factor, an elevated proportion (45%) of extrapulmonary tuberculosis and disseminated forms, and a social environment of 20% of cases being alcoholics or drug addicts. A good use of diagnostic techniques is recorded, although the use of culture as diagnostic tools is lacking. The usual treatment was three drugs for nine months. The global evolution seems good. However a global mortality of 6.4% is recorded, mainly in disseminated forms and among patients with risk factors for developing tuberculosis. We have seen an increment among tuberculosis cases, as well as a change in the clinical spectrum of the disease, linked to social illness and drug addiction. The diagnostic approach to tuberculosis seems to be appropriate. The follow up of patients is somewhat confusing.

  13. RADIOLOGICAL FEATURES OF GENITO-URINARY TUBERCULOSIS-A PICTORIAL ESSAY

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    Sujata Patnaik

    2017-08-01

    Full Text Available BACKGROUND Genitourinary tuberculosis (GUTB is the most common extra-pulmonary TB accounting for 14-41% of all tubercular affections. Caseation, parenchymal loss, intra-renal scars and strictures at calyceal neck, pelvi-ureteral junction and ureterovesical junction are hall-marks of GUTB. Radiological diagnosis of GUTB is often a challenge due to the variable imaging features it can cause. Varying degrees of calcifications in KUB region is seen 21-44% of cases. High dose IVU is the gold standard for its evaluation. Loss of calyceal sharpness, fuzzy margin, calyceal dilatation, papillary necrosis, cavitation and moth eaten calyces due to erosion are common findings on IVP. There may be stricture at calyceal neck, in pelvis resulting in hydrocalycosis and hydronephrosis or contracted pelvis. Ureteric involvement (typically a beaded, saw tooth or pipe stem appearance mays seen in 50% of patients. One third of GUTB there is affection of the urinary bladder. ‘Thimble bladder’ may be a late manifestation. Our own observation of 25 proven cases, showed thimble bladder (n=16 followed by hydronephrosis (n=16, vesico-ureteric reflux (n=5, beaded ureter (n=7, scarred pelvis (n=8, infundibular stenosis (n=9 and non-functioning kidneys (n=4. Though uncommon, putty kidney (3, ghost calyx, granuloma/abscess and urethral diverticula were also observed. The most diagnostic radiological features of GUTB are lobar calcification, diffuse uneven caliectasis without pelvis dilatation, contracted pelvis with or without calcification, urothelial thickening and thimble bladder. Multiplicity of abnormal features in the same patient is very characteristic presentation. Knowledge of IVU features is important as CT Urography depicts the same features as IVU.

  14. Transcriptional Profiling Mycobacterium tuberculosis from Patient Sputa.

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    Wildner, Leticia Muraro; Gould, Katherine A; Waddell, Simon J

    2018-01-01

    The emergence of drug resistance threatens to destroy tuberculosis control programs worldwide, with resistance to all first-line drugs and most second-line drugs detected. Drug tolerance (or phenotypic drug resistance) is also likely to be clinically relevant over the 6-month long standard treatment for drug-sensitive tuberculosis. Transcriptional profiling the response of Mycobacterium tuberculosis to antimicrobial drugs offers a novel interpretation of drug efficacy and mycobacterial drug-susceptibility that likely varies in dynamic microenvironments, such as the lung. This chapter describes the noninvasive sampling of tuberculous sputa and techniques for mRNA profiling M. tb bacilli during patient therapy to characterize real-world drug actions.

  15. Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia

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    Yohannes Zenebe

    2016-08-01

    Full Text Available Abstract Background Tuberculosis (TB is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital. Methods We analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients’ socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant. Results The proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %, 548 (31.1 % and 1008 (57.2 %, respectively. The overall treatment success rate accounts 542(80.8 % with unsuccessful treatment of 129(19.2 %. The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 % of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20–8.37 P = 0.001, retreatment (AOR = 5.32, 95 % CI, 1.92–14.3, P = 0.001, rural residency (AOR = 18.0, 95 % CI, 9.06–37.82, P = 0.001 and the age group of 15–24 years (AOR = 2.91, 95%CI, 1.00–8.45, P = 0.04 showed statistical significant association for poor treatment outcome. Conclusions In the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional

  16. Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014

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    Sotgiu, Giovanni; Falzon, Dennis; Hollo, Vahur; Lefebvre, Nicolas; Dadu, Andrei

    2017-01-01

    Background We explored host-related factors associated with the site of tuberculosis (TB) disease using variables routinely collected by the 31 EU/EEA countries for national surveillance. Methods Logistic regression models were fitted to case-based surveillance data reported to the European Centre for Disease Prevention and Control for TB cases notified from 2003 to 2014. Missing data on HIV infection and on susceptibility to isoniazid and rifampicin for many patients precluded the inclusion of these variables in the analysis. Records from Finland, Lithuania, Spain and the United Kingdom were excluded for lack of exact details of disease localisation; other records without one or more variable (e.g. previous treatment history, geographical origin) or who had mixed pulmonary and extrapulmonary disease or more than one form of extrapulmonary disease were also removed (total exclusion = 38% of 913,637 notifications). Results 564,916 TB cases reported by 27 EU/EEA countries had exclusive pulmonary (PTB; 83%) or extrapulmonary (EPTB; 17%) disease. EPTB was associated with age 3.7), and age EPTB among patients originating from countries outside Europe may reflect strain preferences for disease localization, geographic/ethnic differences in disease manifestation and other factors, like HIV. PMID:29155819

  17. Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014.

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    Giovanni Sotgiu

    Full Text Available We explored host-related factors associated with the site of tuberculosis (TB disease using variables routinely collected by the 31 EU/EEA countries for national surveillance.Logistic regression models were fitted to case-based surveillance data reported to the European Centre for Disease Prevention and Control for TB cases notified from 2003 to 2014. Missing data on HIV infection and on susceptibility to isoniazid and rifampicin for many patients precluded the inclusion of these variables in the analysis. Records from Finland, Lithuania, Spain and the United Kingdom were excluded for lack of exact details of disease localisation; other records without one or more variable (e.g. previous treatment history, geographical origin or who had mixed pulmonary and extrapulmonary disease or more than one form of extrapulmonary disease were also removed (total exclusion = 38% of 913,637 notifications.564,916 TB cases reported by 27 EU/EEA countries had exclusive pulmonary (PTB; 83% or extrapulmonary (EPTB; 17% disease. EPTB was associated with age 3.7, and age <15 years with lymphatic (aOR: 17.96 and central nervous system disease (aOR: 11.41.Awareness of host-related determinants of site of TB is useful for diagnosis. The predilection for EPTB among patients originating from countries outside Europe may reflect strain preferences for disease localization, geographic/ethnic differences in disease manifestation and other factors, like HIV.

  18. PET CT Identifies Reactivation Risk in Cynomolgus Macaques with Latent M. tuberculosis.

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    Philana Ling Lin

    2016-07-01

    Full Text Available Mycobacterium tuberculosis infection presents across a spectrum in humans, from latent infection to active tuberculosis. Among those with latent tuberculosis, it is now recognized that there is also a spectrum of infection and this likely contributes to the variable risk of reactivation tuberculosis. Here, functional imaging with 18F-fluorodeoxygluose positron emission tomography and computed tomography (PET CT of cynomolgus macaques with latent M. tuberculosis infection was used to characterize the features of reactivation after tumor necrosis factor (TNF neutralization and determine which imaging characteristics before TNF neutralization distinguish reactivation risk. PET CT was performed on latently infected macaques (n = 26 before and during the course of TNF neutralization and a separate set of latently infected controls (n = 25. Reactivation occurred in 50% of the latently infected animals receiving TNF neutralizing antibody defined as development of at least one new granuloma in adjacent or distant locations including extrapulmonary sites. Increased lung inflammation measured by PET and the presence of extrapulmonary involvement before TNF neutralization predicted reactivation with 92% sensitivity and specificity. To define the biologic features associated with risk of reactivation, we used these PET CT parameters to identify latently infected animals at high risk for reactivation. High risk animals had higher cumulative lung bacterial burden and higher maximum lesional bacterial burdens, and more T cells producing IL-2, IL-10 and IL-17 in lung granulomas as compared to low risk macaques. In total, these data support that risk of reactivation is associated with lung inflammation and higher bacterial burden in macaques with latent Mtb infection.

  19. A rare case of concomitant tuberculosis of the nose, paranasal sinuses and larynx: clinical, histological and immunohistochemical aspects. A case report.

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    Budu, Vlad Andrei; Bulescu, Ioan Alexandru; Schnaider, Alexandra; Popp, Cristiana Gabriela; Toma, Claudia Lucia; Mogoantă, Carmen Aurelia; Mühlfay, Gheorghe

    2015-01-01

    Extrapulmonary tuberculosis is a rare condition determined by Mycobacterium tuberculosis. It can affect any organ, and has a higher incidence with the increase of HIV infection, or in countries with high pulmonary tuberculosis. Diagnosis is difficult, mostly because of non-specific symptoms and a low rate of presentation for medical consult when symptoms do occur. Complete diagnosis is usually set by histological, immunohistochemical examinations, and also with Polymerase Chain Reaction (PCR) in selected cases. The authors present a case of concomitant tuberculosis of the nose, paranasal sinuses and subglottic larynx, without primary involvement of the lungs. The diagnosis was imposed by histological examination and immunostaining of probes obtained in surgery. The treatment was surgical debridement followed by specific antituberculosis medication.

  20. Influence of HIV and other risk factors on tuberculosis.

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    Mahtab, Sana; Coetzee, David

    2017-04-25

    Tuberculosis (TB) notification in South Africa has increased six-fold over the past two decades, mainly because of the HIV epidemic. To describe the sociodemographic and outcome characteristics of TB patients, and to identify risk factors associated with TB treatment outcomes stratified by HIV status. A cross-sectional study was used to analyse data from the Cape Town Metro East geographical service area (GSA) electronic TB register (ETR.Net), including adult patients aged ≥15 years who initiated TB treatment between 1 July 2011 and 30 June 2012. TB case notification in the GSA was 922 per 100 000 population. Of the 12 672 TB patients registered, 50.5% were co-infected with HIV. The death rate in co-infected patients was 5.4% v. 2.8% in HIV-negative patients, the rate of treatment success 66.6% v. 73.5%, and the rate of unfavourable treatment outcome 28.1% v. 23.7%. The Khayelitsha subdistrict had the highest proportion of TB burden (37.0%) and co-infection (47.6%). Fourteen percent of patients had extrapulmonary TB, 65.9% of whom were co-infected with HIV. In the multivariate analysis, HIV infection (relative risk (RR) 1.2), retreatment (RR 1.4) and sputum smear microscopy not done (RR 1.4) were significantly associated with unfavourable treatment outcome. The Eastern (RR 0.9) and Northern (RR 0.7) subdistricts were less likely to have unfavourable outcomes compared with Khayelitsha. In the stratified analysis, retreatment and smear not done were significant risk factors for an unfavourable treatment outcome in both co-infected and HIV-negative patients. The burdens of both TB and co-infection were high in this community, although HIV prevalence varied. Mortality was higher and treatment completion lower in co-infected patients than in those who were HIV-negative. Co-infection, previous TB treatment and smear not done were significant risk factors for an unfavourable outcome in all patients.

  1. Influence of HIV and other risk factors on tuberculosis

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    Sana Mahtab

    2017-05-01

    Full Text Available Background. Tuberculosis (TB notification in South Africa has increased six-fold over the past two decades, mainly because of the HIV epidemic. Objectives. To describe the sociodemographic and outcome characteristics of TB patients, and to identify risk factors associated with TB treatment outcomes stratified by HIV status. Methods. A cross-sectional study was used to analyse data from the Cape Town Metro East geographical service area (GSA electronic TB register (ETR.Net, including adult patients aged ≥15 years who initiated TB treatment between 1 July 2011 and 30 June 2012. Results. TB case notification in the GSA was 922 per 100 000 population. Of the 12 672 TB patients registered, 50.5% were co-infected with HIV. The death rate in co-infected patients was 5.4% v. 2.8% in HIV-negative patients, the rate of treatment success 66.6% v. 73.5%, and the rate of unfavourable treatment outcome 28.1% v. 23.7%. The Khayelitsha subdistrict had the highest proportion of TB burden (37.0% and co-infection (47.6%. Fourteen percent of patients had extrapulmonary TB, 65.9% of whom were co-infected with HIV. In the multivariate analysis, HIV infection (relative risk (RR 1.2, retreatment (RR 1.4 and sputum smear microscopy not done (RR 1.4 were significantly associated with unfavourable treatment outcome. The Eastern (RR 0.9 and Northern (RR 0.7 subdistricts were less likely to have unfavourable outcomes compared with Khayelitsha. In the stratified analysis, retreatment and smear not done were significant risk factors for an unfavourable treatment outcome in both co-infected and HIV-negative patients. Conclusions. The burdens of both TB and co-infection were high in this community, although HIV prevalence varied. Mortality was higher and treatment completion lower in co-infected patients than in those who were HIV-negative. Co-infection, previous TB treatment and smear not done were significant risk factors for an unfavourable outcome in all patients.

  2. TREATMENT OUTCOMES OF CHILDHOOD TUBERCULOSIS WITH DOTS STRATEGY IN KOTTAYAM, KERALA.

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    Ramesh Hanumantappa

    2013-01-01

    Full Text Available Background: Childhood tuberculosis is a reflection of sputum-positive pulmonary tuberculosis and extent of transmission of tuberculosis in the community. Children suffer from serious form of tuberculosis and are more likely to die if not treated at proper time. Paediatricians are reluctant to refer them to Directly Observed Treatment- Short course (DOTS centres. Present study is conducted to know the clinical profile and treatment outcomes of childhood tuberculosis patients registered under Revised National Tuberculosis Control Program (RNTCP in Kottayam, Kerala. Methods: It was a record based cross-sectional study. Data was collected from RNTCP records from January to December 2009. Data was analysed using SPSS 16.0 and results were presented as proportions with 95% confidence limits. Chi-square test was used to find out the association. Results: The total number of paediatric tuberculosis cases was 155. There were 84 (55.6% males and 67(44.4% females. 66 (43.7% were less than 5 years of age. Out of 117 (77.5% pulmonary tuberculosis cases, 8 (0.06% were sputum smear-positive. Among extra-pulmonary TB cases, peripheral lymph node disease [25 (73.5%] was most common. The treatment completion rate was 90.7% with cure rate of 100% among sputum smear positive cases. Chi-square test showed significant association between age and treatment outcome (p-value <0.0001. Conclusions: Study showed that the RNTCP-DOTS is still the most effective strategy in treating childhood tuberculosis patients. Further studies are needed to assess the reasons for low proportion of smear positive and low TB meningitis cases.

  3. Evaluation of disease patterns, treatment and prognosis of tuberculosis in AIDS patient

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    Atomiya Angela Naomi

    2002-01-01

    Full Text Available Patterns of disease, diagnosis, treatment and prognosis of tuberculosis in 100 patients co-infected with AIDS at Casa da AIDS clinic was studied. Demographic characteristics were as follows: 76 male patients, 24 female patients, 67 caucasian, average 35.8 years-old (SD ± 8.5. Sexual transmission of HIV was reported in 68 patients. Pulmonary tuberculosis was seen in 40 patients, extrapulmonary in 11, and combined in 49 patients. In 63 patients, TCD4+ counts were below 200/mm³ when tuberculosis was diagnosed. Fifty-five patients had their diagnoses confirmed by bacteriological identification of Mycobacterium; either through direct observation and/or culture. Tuberculosis was treated with rifampin, isoniazid and pyrazinamide in 60 patients, reinforced treatment in 14 and alternative treatment in the other 13 patients. Tuberculosis therapy lasted up to 9 months in 66% of the patients. Fifty-four patients were treated with a two-drug antiretroviral regimen and the remaining 46 patients received a triple regimen, which included a protease inhibitor. Among the latter, 35 patients were co-treated with rifampin. The occurrence of hepatic liver enzyme abnormalities was statistically related to alternative antiretroviral regimens (p = 0.01 and to the co-administration of rifampin and protease inhibitor (p = 0.019. Clinical resolution of tuberculosis was obtained in 74 patients. Twelve patients died during tuberculosis treatment. Resolution of tuberculosis was statistically significant related to antituberculosis treatment adherence (p = 0.001. The risk of no response to the treatment was 1.84 times more frequent among patients treated with alternative regimens regardless of the duration of the therapy. We conclude that the characteristics of tuberculosis in HIV infected patients requires that special attention be directed to the types and duration of both antiretroviral and anti-TB therapy in order to achieve the highest level of care.

  4. Evaluation of disease patterns, treatment and prognosis of tuberculosis in AIDS patient

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    Angela Naomi Atomiya

    Full Text Available Patterns of disease, diagnosis, treatment and prognosis of tuberculosis in 100 patients co-infected with AIDS at Casa da AIDS clinic was studied. Demographic characteristics were as follows: 76 male patients, 24 female patients, 67 caucasian, average 35.8 years-old (SD ± 8.5. Sexual transmission of HIV was reported in 68 patients. Pulmonary tuberculosis was seen in 40 patients, extrapulmonary in 11, and combined in 49 patients. In 63 patients, TCD4+ counts were below 200/mm³ when tuberculosis was diagnosed. Fifty-five patients had their diagnoses confirmed by bacteriological identification of Mycobacterium; either through direct observation and/or culture. Tuberculosis was treated with rifampin, isoniazid and pyrazinamide in 60 patients, reinforced treatment in 14 and alternative treatment in the other 13 patients. Tuberculosis therapy lasted up to 9 months in 66% of the patients. Fifty-four patients were treated with a two-drug antiretroviral regimen and the remaining 46 patients received a triple regimen, which included a protease inhibitor. Among the latter, 35 patients were co-treated with rifampin. The occurrence of hepatic liver enzyme abnormalities was statistically related to alternative antiretroviral regimens (p = 0.01 and to the co-administration of rifampin and protease inhibitor (p = 0.019. Clinical resolution of tuberculosis was obtained in 74 patients. Twelve patients died during tuberculosis treatment. Resolution of tuberculosis was statistically significant related to antituberculosis treatment adherence (p = 0.001. The risk of no response to the treatment was 1.84 times more frequent among patients treated with alternative regimens regardless of the duration of the therapy. We conclude that the characteristics of tuberculosis in HIV infected patients requires that special attention be directed to the types and duration of both antiretroviral and anti-TB therapy in order to achieve the highest level of care.

  5. Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five--year retrospective study.

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    Tessema, Belay; Muche, Abebe; Bekele, Assegedech; Reissig, Dieter; Emmrich, Frank; Sack, Ulrich

    2009-10-04

    In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia. We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables. From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate. The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.

  6. Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

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    Tessema, Belay; Muche, Abebe; Bekele, Assegedech; Reissig, Dieter; Emmrich, Frank; Sack, Ulrich

    2009-01-01

    Background In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia. Methods We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables. Results From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate. Conclusion The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently. PMID:19799801

  7. Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

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    Bekele Assegedech

    2009-10-01

    Full Text Available Abstract Background In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS started in 2000. According to the proposal of World Health Organization (WHO, treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia. Methods We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables. Results From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%, smear negative pulmonary tuberculosis in 2196 (54.9% and smear positive pulmonary tuberculosis in 671 (16.8% cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%, defaulted in 730 (18.3%, died in 403 (10.1%, treatment failed in six (0.2% and transferred out in 1680 (42.0% patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2% to 228(42.9%. Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate. Conclusion The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%. A high proportion of patients died (10.1% or defaulted (18.3%, which is a serious public health concern that needs to be addressed urgently.

  8. Lymph node tuberculosis mimicking malignancy on18F-FDG PET/CT in two patients: A case report.

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    Ding, Rui-Lin; Cao, Hong-Ying; Hu, Yue; Shang, Chang-Ling; Xie, Fang; Zhang, Zhen-Hua; Wen, Qing-Lian

    2017-06-01

    18 F-fluorodeoxyglucose positron emission/computed tomography ( 18 F-FDG PET/CT) imaging, an established procedure for evaluation of malignancy, reports an increased 18 F-FDG uptake in acute or chronic inflammatory condition. Lymph node tuberculosis (LNTB) is the most common form of extrapulmonary tuberculosis. However, the absence of clinical symptoms and bacteriological basis makes it difficult to diagnose. In the current case report, two patients with LNTB mimicking malignant lymphoma are presented by 18 F-FDG PET/CT. The objective of the present report is to emphasize that LNTB should be considered as a noteworthy differential diagnosis in patients with enlarged lymph nodes, particularly in tuberculosis-endemic countries, and that lymph node biopsy serves a vital role in diagnosing LNTB.

  9. Genitourinary Tuberculosis: A Rare Cause of Obstructive Uropathy in Pregnancy

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    Emily H. Adhikari

    2014-01-01

    Full Text Available Background. A rare but morbid form of extrapulmonary tuberculosis (TB, genitourinary TB is an important cause of obstructive uropathy and is likely underdiagnosed in pregnancy. Case. A 30-year-old primigravida undergoing treatment for active pulmonary TB presented with anuria at 13-14-weeks gestation. Bilateral ureteral strictures above the level of the ureterovesicular junctions were seen on imaging studies. Given her pulmonary disease, her obstructive uropathy was attributed to genitourinary TB. Bilateral percutaneous nephrostomy tubes were placed during pregnancy with successful ureteral reimplantation postpartum. Conclusion. Genitourinary TB should be considered as an etiology of urinary tract pathology during pregnancy, especially in foreign-born and immunocompromised persons. Early recognition resulting in prompt treatment can prevent further deterioration of maternal renal function and optimize pregnancy outcomes.

  10. Pediatric tuberculosis at Beijing Children's Hospital: 2002-2010.

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    Wu, Xi-Rong; Yin, Qing-Qin; Jiao, An-Xia; Xu, Bao-Ping; Sun, Lin; Jiao, Wei-Wei; Xiao, Jing; Miao, Qing; Shen, Chen; Liu, Fang; Shen, Dan; Shen, Adong

    2012-12-01

    Our aim was to describe the patient characteristics, clinical-epidemiological profile, and treatment outcome of childhood tuberculosis (TB). A retrospective, descriptive study was undertaken of 1212 children aged 0 to 18 years admitted to Beijing Children's Hospital for the treatment of TB from January 2002 to December 2010. Statistical significance of category variables was evaluated by using Fisher's exact test. Fifty-four percent of patients had extrapulmonary tuberculosis (EPTB), 38.8% had tuberculous meningitis, and 31.3% had disseminated TB. The last 2 types were defined as severe TB. Most patients with TB (81.6%) were cured or completed treatment. There were more patients aged EPTB than with pulmonary tuberculosis. More severe cases of TB were found in patients aged EPTB, only 61.3% and 61.1% had positive results on the purified protein derivative tuberculin skin test and chest radiograph, respectively. In this referral hospital setting, more pediatric EPTB and severe TB patients were found among children aged EPTB and severe TB.

  11. Renal tuberculosis presenting as acute pyelonephritis - A rarity.

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    Verma, Ajay Kumar; Mishra, Ashwini Kumar; Kumar, Manoj; Kant, Surya; Singh, Anubhuti; Singh, Ajay

    2016-07-01

    One of the major health problems faced particularly by the developing world since ages is that of tuberculosis (TB). Genito-urinary tuberculosis (GUTB) is the second most common extrapulmonary TB, with kidney being the most frequent site of infection. Due to the diverse and atypical clinical manifestations of urinary TB, the disease is easy to misdiagnose. The diagnosis of renal TB should be suspected in a nonspecific bacterial cystitis associated with a therapeutic failure or a sterile pyuria and a past history of pulmonary TB with important radiologic findings, particularly with the help of CT scan. Here, we describe a case of renal TB where no clinical or radiological features suggestive of renal TB were present. The diagnosis was only evident after the histopathological examination of the excised kidney. This case highlights the importance of suspecting renal TB as an important cause of kidney disease, which can lead to irreversible renal function loss particularly in an endemic area, and also the diversity that this disease may acquire in its presentation leading to misdiagnosis. In such a case, particularly in a high endemic area for TB, therapeutic trial of ATT may also be considered to avoid unnecessary surgical intervention and end-stage renal disease. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  12. Is adipose tissue a place for Mycobacterium tuberculosis persistence?

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    Olivier Neyrolles

    Full Text Available BACKGROUND: Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB, has the ability to persist in its human host for exceptionally long periods of time. However, little is known about the location of the bacilli in latently infected individuals. Long-term mycobacterial persistence in the lungs has been reported, but this may not sufficiently account for strictly extra-pulmonary TB, which represents 10-15% of the reactivation cases. METHODOLOGY/PRINCIPAL FINDINGS: We applied in situ and conventional PCR to sections of adipose tissue samples of various anatomical origins from 19 individuals from Mexico and 20 from France who had died from causes other than TB. M. tuberculosis DNA could be detected by either or both techniques in fat tissue surrounding the kidneys, the stomach, the lymph nodes, the heart and the skin in 9/57 Mexican samples (6/19 individuals, and in 8/26 French samples (6/20 individuals. In addition, mycobacteria could be immuno-detected in perinodal adipose tissue of 1 out of 3 biopsy samples from individuals with active TB. In vitro, using a combination of adipose cell models, including the widely used murine adipose cell line 3T3-L1, as well as primary human adipocytes, we show that after binding to scavenger receptors, M. tuberculosis can enter within adipocytes, where it accumulates intracytoplasmic lipid inclusions and survives in a non-replicating state that is insensitive to the major anti-mycobacterial drug isoniazid. CONCLUSIONS/SIGNIFICANCE: Given the abundance and the wide distribution of the adipose tissue throughout the body, our results suggest that this tissue, among others, might constitute a vast reservoir where the tubercle bacillus could persist for long periods of time, and avoid both killing by antimicrobials and recognition by the host immune system. In addition, M. tuberculosis-infected adipocytes might provide a new model to investigate dormancy and to evaluate new drugs for the treatment of

  13. Differential in vivo expression of mycobacterial antigens in Mycobacterium tuberculosis infected lungs and lymph node tissues.

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    Mustafa, Tehmina; Leversen, Nils Anders; Sviland, Lisbet; Wiker, Harald Gotten

    2014-10-03

    The clinical course of tuberculosis (TB) infection, bacterial load and the morphology of lesions vary between pulmonary and extrapulmonary TB. Antigens expressed in abundance during infection could represent relevant antigens in the development of diagnostic tools, but little is known about the in vivo expression of various M. tuberculosis antigens in different clinical manifestations. The aim of this study was to study the differences in the presence of major secreted as well as somatic mycobacterial antigens in host tissues during advanced rapidly progressing and fatal pulmonary disease with mainly pneumonic infiltrates and high bacterial load, and to compare this to the presence of the same antigens in TB lymphadenitis cases, which is mainly chronic and self-limiting disease with organised granulomas and lower bacterial load. Human pulmonary (n = 3) and lymph node (n = 17) TB biopsies, and non-TB controls (n = 12) were studied. Ziehl-Neelsen stain, nested PCR 1S6110 and immunohistochemistry were performed. Major secreted (MPT32, MPT44, MPT46, MPT51, MPT53, MPT59, MPT63, and MPT64) and somatic mycobacterial antigens (Mce1A, Hsp65, and MPT57) were detected by using rabbit polyclonal antibodies. Plenty of bacilli were detectable with Ziehl-Neelsen stain in the lung biopsies while no bacilli were detected in the lymph node biopsies. All the cases were shown to be positive by PCR. Both secretory and somatic antigens were expressed in abundance in pulmonary infiltrates, while primarily somatic antigens were detected in the lymphadenitis cases. Of the secreted antigens, only MPT64 was consistently detected in both cases, indicating a preferential accumulation of this antigen within the inflammatory cells, even if the cells of the granuloma can efficiently restrict bacterial growth and clear away the secreted antigens. This study shows that major secreted mycobacterial antigens were found in high amounts in advanced pulmonary lesions without proper granuloma

  14. Implementation of the national tuberculosis guidelines on culture and drug sensitivity testing in Guatemala, 2013.

    Science.gov (United States)

    Samayoa-Peláez, Maritza; Ayala, Nancy; Yadon, Zaida E; Heldal, Einar

    2016-01-01

    Objective To assess whether the National Tuberculosis Program (NTP) guidelines for culture and drug sensitivity testing (DST) in Guatemala were successfully implemented, particularly in cases of smear-negative pulmonary tuberculosis (TB) or previously treated TB, by documenting notification rates by department (geographic area), disease type and category, and culture and DST results. Methods This was a cross-sectional, operational research study that merged and linked all patients registered by the NTP and the National Reference Laboratory in 2013, eliminating duplicates. The proportions with culture (for new smear negative pulmonary cases) and culture combined with DST (for previously treated patients) were estimated and analyzed by department. Data were analyzed using EpiData Analysis version 2.2. Results There were 3 074 patients registered with TB (all forms), for a case notification rate of 20/100 000 population. Of these, 2 842 had new TB, of which 2 167 (76%) were smear-positive pulmonary TB (PTB), 385 (14%) were smear-negative PTB, and 290 (10%) were extrapulmonary TB. There were 232 (8%) previously treated cases. Case notification rates (all forms) varied by department from 2-68 per 100 000 population, with the highest rates seen in the southwest and northeast part of Guatemala. Of new TB patients, 136 had a culture performed and 55 had DST of which the results were 33 fully sensitive, 9 monoresistant, 3 polyresistant, and 10 multidrug resistant TB (MDR-TB). Only 21 (5%) of new smear-negative PTB patients had cultures. Of 232 previously treated patients, 54 (23%) had a culture and 47 (20%) had DST, of which 29 were fully sensitive, 7 monoresistant, 2 polyresistant, and 9 MDR-TB. Of 22 departments (including the capital), culture and DST was performed in new smear-negative PTB in 7 departments (32%) and in previously treated TB in 13 departments (59%). Conclusions Despite national guidelines, only 5% of smear-negative PTB cases had a culture and only 20% of

  15. HIV prevalence in the Israeli tuberculosis cohort, 1999-2011.

    Science.gov (United States)

    Zohar, Mor; Moshe, Lidji; Daniel, Chemtob; Noa, Cedar; Itamar, Grotto

    2014-10-21

    Tuberculosis (TB) patients who are co-infected with HIV are at greater risk of mortality. Nevertheless, not all countries achieved sustainable and TB and HIV collaboration to describe the burden of both diseases at a national scale. This study aims to describe HIV prevalence among TB-patients in Israel and identify variable associated with TB/HIV co-infection. This retrospective study was conducted by cross-matching the National HIV and TB Registries to describe TB/HIV epidemiology during the last 13-years and define variables predicting TB/HIV co-infection. Between 1999 and 2011, 5,502 TB-patients were reported: 779 (14.2%) were Israeli-born and 4,723 (85.8%) non-Israeli born. Of all TB patients, 254 (4.6%) were HIV-infected. The trend of HIV/TB co-infection among non-Israeli born has generally decreased since 2003 (trend analysis p tuberculosis patient. In a multivariate analysis, short time after arrival in Israel, older age, being born in Ethiopia, having positive sputum, positive culture and multi-drug resistant TB predicted TB/HIV co-infection.TB/HIV co-infected patients with extra-pulmonary TB had a higher proportion of infection in lymphatic, miliary and abdominal sites than those with extra-pulmonary TB who were HIV-negative. Most TB/HIV co-infected patients were migrants originating in high-burden countries. Despite the moderate 4.6% TB/HIV co-infection rate in Israel, these patients had worse treatment outcomes and higher mortality rates. This study illustrates the importance of integrating TB with HIV in surveillance and treatment components, which should be employed in other countries, as it has a positive impact on disease control.

  16. Validity of serum Adenosine deaminase in diagnosis of tuberculosis ...

    African Journals Online (AJOL)

    Introduction: Tuberculosis is one of the most important infectious causes of death worldwide. Ziehl-Neelsen staining of sputum has high specificity in tuberculosis endemic countries, but modest sensitivity which varies among laboratories. This study was set up to investigate the diagnostic value of serum Adenosine ...

  17. Risk Assessment of Tuberculosis in Immunocompromised Patients. A TBNET Study

    NARCIS (Netherlands)

    Sester, Martina; van Leth, Frank; Bruchfeld, Judith; Bumbacea, Dragos; Cirillo, Daniela M.; Dilektasli, Asli Gorek; Domínguez, José; Duarte, Raquel; Ernst, Martin; Eyuboglu, Fusun Oner; Gerogianni, Irini; Girardi, Enrico; Goletti, Delia; Janssens, Jean-Paul; Julander, Inger; Lange, Berit; Latorre, Irene; Losi, Monica; Markova, Roumiana; Matteelli, Alberto; Milburn, Heather; Ravn, Pernille; Scholman, Theresia; Soccal, Paola M.; Straub, Marina; Wagner, Dirk; Wolf, Timo; Yalcin, Aslihan; Lange, Christoph

    2014-01-01

    In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency. This study compared the performance of TST and IGRAs in

  18. The profile of tuberculosis infection at the Babcock University ...

    African Journals Online (AJOL)

    2016-01-23

    Jan 23, 2016 ... open pulmonary tuberculosis via coughing, sneezing, talking or expectorating.[1]. The pathogen is found in ... absence of a BCG scar, cigarette smoking, alcohol use, chronic anaemia, HIV co-infection, and previous ... Tuberculosis can affect any organ system.[5]. Clinical manifestations vary accordingly but.

  19. Obstructive jaundice due to tuberculosis of distal CBD and periampullary region mimickcholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Sumantra Ray

    2012-01-01

    Full Text Available Abdominal tuberculosis (TB commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.

  20. Factors associated with patient's delay in tuberculosis treatment in Bahir Dar City administration, Northwest Ethiopia.

    Science.gov (United States)

    Gebeyehu, Endalew; Azage, Muluken; Abeje, Gedefaw

    2014-01-01

    Unknown proportions of tuberculosis cases remain undiagnosed and untreated as result of several factors which further increases the number of tuberculosis cases per index case. To identify factors associated with patient's delay in initiating treatment of tuberculosis. Methods. Cross-sectional study was employed from January to April, 2013, in Bahir Dar Ethiopia. A total of 360 patients were included. Data were collected from tuberculosis patients using a semistructured questionnaire. Data were entered and analyzed using SPSS version 16 windows. Multivariate logistic regression analysis was used to identify factors associated with patient delay. Of all patients, 211 (62%) sought medical care after the WHO recommended period (21 days). The median patient delays of smear positive, smear negative, and extrapulmonary patients were 27 (IQR: 10-59), 30 (IQR: 9-65), and 31 (IQR: 10-150) days, respectively, with statistically significant variations among them (ANOVA: F = 5.96; P tuberculosis patients were delayed in seeking medical care within the recommended period. Provision of DOTS service in the vicinity and health education on TB may reduce patient delay and its consequences.

  1. Factors Associated with Patient's Delay in Tuberculosis Treatment in Bahir Dar City Administration, Northwest Ethiopia

    Science.gov (United States)

    Gebeyehu, Endalew; Abeje, Gedefaw

    2014-01-01

    Background. Unknown proportions of tuberculosis cases remain undiagnosed and untreated as result of several factors which further increases the number of tuberculosis cases per index case. Objective. To identify factors associated with patient's delay in initiating treatment of tuberculosis. Methods. Cross-sectional study was employed from January to April, 2013, in Bahir Dar Ethiopia. A total of 360 patients were included. Data were collected from tuberculosis patients using a semistructured questionnaire. Data were entered and analyzed using SPSS version 16 windows. Multivariate logistic regression analysis was used to identify factors associated with patient delay. Results. Of all patients, 211 (62%) sought medical care after the WHO recommended period (21 days). The median patient delays of smear positive, smear negative, and extrapulmonary patients were 27 (IQR: 10–59), 30 (IQR: 9–65), and 31 (IQR: 10–150) days, respectively, with statistically significant variations among them (ANOVA: F = 5.96; P .003). Place of residence and educational status were the predictors of patient delay. Conclusion. Around two-thirds of all patients and more than half of smear positive tuberculosis patients were delayed in seeking medical care within the recommended period. Provision of DOTS service in the vicinity and health education on TB may reduce patient delay and its consequences. PMID:24982901

  2. [Drug resistance of Mycobacterium tuberculosis in the North-West of Russia].

    Science.gov (United States)

    Vishnevskiĭ, B I; Vishnevskaia, E B

    2003-01-01

    The morbidity of primary and secondary drug resistance (DR) of Mycobacterium tuberculosis (MBT) was studied in the North-West of Russia during 1991-2001. The frequency rate and structure of, mainly, secondary DR MBT was investigated in tuberculosis of different localizations on the basis of data provided by clinics of Saint-Petersburg Research Institute for Phthisiopulmonology (PRIP) during 1990-2000. A sharp increase of primary DR MBT (in the North-West of Russia) up to 35-45.5% was detected in the Murmansk, Arkhangelsk and Saint-Petersburg Regions as well as in the Republic of Karelia, an increase of up to 61% was registered in the Kaliningrad Region. The frequency rate of secondary DR MBT went up by 1.5-2 times reaching 80-86% in the Murmansk, Arkhangelsk and Kaliningrad Regions. According to the PRIP clinics, there is also an essential growth of DR MBT in all tuberculosis localizations with a trend of the stability structure shifting towards poly-resistance, which accounts for 65.2% in pulmonary tuberculosis and for 33.6% in extra-pulmonary tuberculosis.

  3. Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count

    Directory of Open Access Journals (Sweden)

    Ajay Jaryal

    2011-01-01

    Full Text Available Background: HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse. Objective: The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB in HIV-seropositive patients and their relationship to CD4 counts. Materials and Methods: It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB. Results: Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC examination. All patients with AFB-positive lymph node had CD4 count below 200/cum. Conclusions: The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore

  4. A novel terminology and dissemination theory for a subgroup of intrathoracic extrapulmonary hydatid cysts.

    Science.gov (United States)

    Isitmangil, Turgut; Toker, Alper; Sebit, Saban; Erdik, Oryal; Tunc, Habil; Gorur, Rauf

    2003-07-01

    Chest wall, mediastinal, pericardial, myocardial, lobar fissure and pleural locations of the hydatid cysts are referred to be intrathoracic extrapulmonary cysts. In this report a 20-year-old male patient had a liver dome cyst, which was opened into the diaphragm and caused diaphragmatic hydatid cysts. The scoleces have probably been transported by diaphragmatic lymphatics into the subpleural location and then hydatid disease has been disseminated via parasternal lymph nodes anteriorly and intercostal lymph nodes posteriorly towards cupola of the thorax. With regard to this localization, we propose a novel terminology as 'intrathoracic extrapleural hydatid cyst' and we hypothesize a novel dissemination theory for the hydatid cysts via diaphragmatic lymphatic drainage.

  5. Risk assessment of tuberculosis in immunocompromised patients

    DEFF Research Database (Denmark)

    Sester, Martina; van Leth, Frank; Bruchfeld, Judith

    2014-01-01

    RATIONALE: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency. OBJECTIVES: This study compared the performance...... of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis. METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation......, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. MEASUREMENTS AND MAIN RESULTS: Frequencies of positive...

  6. Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town.

    Science.gov (United States)

    Bekker, Adrie; Schaaf, Hendrik S; Draper, Heather R; Kriel, Magdalena; Hesseling, Anneke C

    2016-01-01

    Tuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings. A prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa, from January 2011 through December 2011. Maternal tuberculosis disease spectrum and tuberculosis-exposed newborns were characterized by maternal HIV status. Maternal tuberculosis treatment outcomes were documented and a multivariable regression model identified predictors of unfavourable tuberculosis treatment outcomes. Infant outcomes were also described. Seventy-four women with tuberculosis, 53 (72%) HIV-infected, were consecutively enrolled; 35 (47%) were diagnosed at delivery or postpartum and 22 (30%) of women reported previous antituberculosis treatment. HIV-infected women were 5.67 times more likely to have extrapulmonary tuberculosis (95% CI 1.18-27.25, p = 0.03). All 5 maternal deaths were amongst HIV-infected women. Birth outcomes were available for 75 newborns (2 sets of twins, missing data for 1 stillbirth). Of the 75 newborns, 49 (65%) were premature and 44 (59%) were low birth weight (LBW; <2500 grams). All 6 infants who died and the 4 stillbirths were born to HIV-infected women. Unfavourable tuberculosis treatment outcomes were documented in 33/74 (45%) women. Unfavourable maternal tuberculosis outcome was associated with delivery of LBW infants (OR 3.83; 95% CI 1.40-10.53, p = 0.009). A large number of pregnant women with tuberculosis presented at a provincial referral hospital. All maternal and infant deaths occurred in HIV-infected women and their newborns. Maternal tuberculosis treatment outcomes were poor.

  7. Utility of QuantiFERON-TB Gold In-Tube assay in adult, pulmonary and extrapulmonary, active tuberculosis diagnosis

    Directory of Open Access Journals (Sweden)

    Mohammed Azghay

    2016-03-01

    Conclusion: On its own, QFT-GIT is an insufficient tool to confirm the diagnosis of TB disease. However, it may form part of an ensemble of tools in combination with clinical, biological, and radiological assessments.

  8. Effect of Sex, Age, and Race on the Clinical Presentation of Tuberculosis: A 15-Year Population-Based Study

    OpenAIRE

    Zhang, Xinyu; Andersen, Aase B.; Lillebaek, Troels; Kamper-Jørgensen, Zaza; Thomsen, Vibeke Østergaard; Ladefoged, Karin; Marrs, Carl F.; Zhang, Lixin; Yang, Zhenhua

    2011-01-01

    Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case–control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark and Greenland during 1992–2007 to gain insight to the role of host factors in EPTB pathogenesis. Among patients from Somalia and Asia, persons 25–44 and 45–64 years of age were more likely to have EPTB than pe...

  9. Natural History and Factors Associated with Early and Delayed Mortality in HIV-Infected Patients Treated of Tuberculosis under Directly Observed Treatment Short-Course Strategy: A Prospective Cohort Study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2012-01-01

    Full Text Available Despite the impressive global results of DOTS in India, the effectiveness of DOTS for the treatment of tuberculosis in HIV-infected patients is not well known. This is an observational prospective cohort study performed in Anantapur District, Andhra Pradesh, India. The study included 1000 DOTS antituberculosis treatment (ATT episodes and 840 person-years. CD4 lymphocyte count was below 200 cells/mm3 in 77% of the cases, and 21% were retreatments. Two thirds were presented with extrapulmonary tuberculosis, and the most common form of extrapulmonary tuberculosis was tuberculous meningitis followed by pleuritis, abdominal tuberculosis, and lymphadenitis. Cumulative incidence of mortality was 16%, 26%, 39%, and 46% at 1, 3, 12, and 24 months, respectively. Factors associated with three-month (early mortality were being homeless, having low CD4+ lymphocyte count, having tuberculous meningitis, belonging to a socially disadvantaged community, having more than 35 years, and being on an antiretroviral therapy at the moment of initiating the ATT. Factors associated with delayed mortality were having low CD4+ lymphocyte count, belonging to a socially disadvantaged community, receiving a category II ATT because of a previous episode of ATT and having acid fast bacilli in sputum before the ATT initiation. These findings indicate that there is an urgent need to improve the treatment of tuberculosis in HIV-infected patients in India.

  10. Primary nasal tuberculosis: A case report

    Directory of Open Access Journals (Sweden)

    Stojanović Jasmina

    2013-01-01

    Full Text Available Introduction. During the past two decades, tuberculosis (TBC both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. Case report. Thirty-yearold man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laboratory analyses were within the reference ranges. Nasal and throat swabs for bacteria and fungi were normal. Skin allergy testing to standard inhalatory allergens was positive. Computer rhinomanometry showed increased nasal resistance at medium difficulty level, on the right. Radiography of paranasal sinuses indicated chronic polysinusitis on the right. Anti-allergy therapy was prescribed. The patient came for checkup after a month with subjective deterioration and a neck tumefact on the right. Nasal endoscopy revealed the presence of dark red infiltrates with the 3 mm diameter on nasal septal mucosa, dominantly on the right, with small greyish nodules. This findings indicated a potential specific nasal inflammatory process. In the upper jugulodigastric area, on the left, painless tumefact 3 x 5 cm in size was palpated, it was mobile comparing to supra- and infrastructure, with unaltered skin above. The definite diagnosis was established on the basis of the results of nasal mucosa biopsy. After histopathological diagnosis was obtained, we started with antituberculosis therapy at once. Conclusion. Due to actual trends of TBC incidences, otolaryngologist should have in mind nasal TBC, when granulomatose lesions are found in nose.

  11. Tuberculosis Data and Statistics

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search The CDC Tuberculosis (TB) Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Tuberculosis Basic TB Facts How TB Spreads Latent TB ...

  12. Tuberculosis and Diabetes

    Science.gov (United States)

    TUBERCULOSIS www.who.int/tb & DIABETES THE DUAL EPIDEMIC OF TB AND DIABETES DEADLY LINKAGES  People with ... higher risk of progressing from latent to active tuberculosis.  Diabetes triples a person’s risk of developing TB. ...

  13. Tuberculosis Treatment and Pregnancy

    Science.gov (United States)

    ... Search The CDC Cancel Submit Search The CDC Tuberculosis (TB) Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Tuberculosis Basic TB Facts How TB Spreads Latent TB ...

  14. Potential for chlorine gas-induced injury in the extrapulmonary vasculature.

    Science.gov (United States)

    Samal, Andrey; Honovar, Jaideep; White, C Roger; Patel, Rakesh P

    2010-07-01

    Exposure to chlorine gas (Cl(2)) primarily causes injury to the lung and is characterized by inflammation and oxidative stress mediated by reactive chlorine species. Reducing lung injury and improving respiratory function are the principal therapeutic goals in treating individuals exposed to Cl(2) gas. Less is known on the potential for Cl(2) gas exposure to cause injury to extrapulmonary tissues and specifically to mediate endothelial dysfunction. This concept is forwarded in this article on the basis that (1) many irritant gases whose reactivity is limited to the lung have now been shown to have effects that promote endothelial dysfunction in the systemic vasculature, and as such lead to the acute and chronic cardiovascular disease events (e.g., myocardial infarctions and atherosclerosis); and (2) that endogenously produced reactive chlorine species are now considered to be central in the development of cardiovascular diseases. This article discusses these two areas with the view of providing a framework in which potential extrapulmonary toxic effects of Cl(2) gas exposure may be considered.

  15. Potential for Chlorine Gas–induced Injury in the Extrapulmonary Vasculature

    Science.gov (United States)

    Samal, Andrey; Honovar, Jaideep; White, C. Roger; Patel, Rakesh P.

    2010-01-01

    Exposure to chlorine gas (Cl2) primarily causes injury to the lung and is characterized by inflammation and oxidative stress mediated by reactive chlorine species. Reducing lung injury and improving respiratory function are the principal therapeutic goals in treating individuals exposed to Cl2 gas. Less is known on the potential for Cl2 gas exposure to cause injury to extrapulmonary tissues and specifically to mediate endothelial dysfunction. This concept is forwarded in this article on the basis that (1) many irritant gases whose reactivity is limited to the lung have now been shown to have effects that promote endothelial dysfunction in the systemic vasculature, and as such lead to the acute and chronic cardiovascular disease events (e.g., myocardial infarctions and atherosclerosis); and (2) that endogenously produced reactive chlorine species are now considered to be central in the development of cardiovascular diseases. This article discusses these two areas with the view of providing a framework in which potential extrapulmonary toxic effects of Cl2 gas exposure may be considered. PMID:20601634

  16. [Diagnostic means for tuberculosis].

    Science.gov (United States)

    Jabri, H; Lakhdar, N; El Khattabi, W; Afif, H

    2016-10-01

    Tuberculosis is a public health problem. In recent years, there is a change in the epidemiological profile of tuberculosis. The diagnosis of tuberculosis is based on clinical and radiological arguments but confirmation is bacteriological and/or histological. Culture remains the gold standard. Technological progress especially in molecular biology provides the clinician now new means of tuberculosis diagnostics. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Global Tuberculosis Report 2016

    Science.gov (United States)

    ... Русский Español Tuberculosis (TB) Menu Tuberculosis The End TB Strategy Areas ... data News, events and features About us Global tuberculosis report 2017 WHO has published a global TB ...

  18. Abdominal tuberculosis in children

    Directory of Open Access Journals (Sweden)

    Heda Melinda Nataprawira

    2001-06-01

    supported the diagnosis. There was no positive results of acid fast bacilli and culture done for Mycobacterium tuberculosis in gastric aspirate as well as ascitic fuid. Peritonitis tuberculosis was most commonly diagnosed (80.0%, followed by mesenterial/nodal tuberculosis (20.0%. All of the children followed (60.0% responded well to the drugs therapy.

  19. Tuberculosis in Blacks

    Science.gov (United States)

    ... Journal Articles Tuberculosis Laboratory Aggregate Reports Slide Sets Epidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United ... Facilitator Guide Introduction to TB Genotyping Core Curriculum Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2014 Prevention ...

  20. of Mycobacterium tuberculosis

    African Journals Online (AJOL)

    STORAGESEVER

    2009-08-18

    Aug 18, 2009 ... Tuberculosis is a well-known infectious disease in human beings and domestic animals since ancient times. Tuberculin skin test as the only indicator of latent infection with Mycobacterium tuberculosis has a low specificity and sensitivity value. This test also cannot distinguish between tuberculosis infection.

  1. Cutaneous tuberculosis, tuberculosis verrucosa cutis

    Directory of Open Access Journals (Sweden)

    Nilamani Mohanty

    2014-01-01

    Full Text Available Cutaneous tuberculosis because of its variability in presentation, wider differential diagnosis, and difficulty in obtaining microbiological confirmation continues to be the most challenging to diagnose for dermatologists in developing countries. Despite the evolution of sophisticated techniques such as polymerase chain reaction (PCR and enzyme-linked-immunosorbent serologic assay (ELISA, the sensitivity of new methods are not better than the isolation of Mycobacterium tuberculosum in culture. Even in the 21 st century, we rely on methods as old as the intradermal reaction purified protein derivative standard test and therapeutic trials, as diagnostic tools. We describe a case which has been diagnosed and treated as eczema by renowned physicians for 2 years. Incisional biopsy showed the presence of well-defined granulomas and ZN staining of the biopsy specimen showed the presence of acid fast bacilli; a trial of ATT (antitubercular therapy for 6 months lead to permanent cure of the lesion.

  2. [Evaluation of the diagnostic performance of Xpert MTB/RIF test for the detection of Mycobacterium tuberculosis and rifampin resistance in clinical samples].

    Science.gov (United States)

    Gürsoy, Nafia Canan; Yakupoğulları, Yusuf; Tekerekoğlu, Mehmet Sait; Otlu, Barış

    2016-04-01

    Rapid and accurate detection of active tuberculosis (TB) cases is one of the most important goal of tuberculosis control programme. For this purpose, new methods are being developed to isolate, serotype and determine the drug resistance of the agent. Xpert MTB/RIF test (CepheidGeneXpert® System, USA) that has been recently developed, is a real-time polymerase chain reaction-based method which detects Mycobacterium tuberculosis complex and resistance of the strain to rifampicin (RIF) from the clinical sample directly within a couple of hours. However, there are not sufficient data about the performance of that test for extrapulmonary samples and pulmonary samples other than sputum. The aims of this study were to investigate the sensitivity, specificity, positive and negative predictive values of Xpert MTB/RIF test in detection of M. tuberculosis and the performance in the determination of rifampicin resistance of the isolates from pulmonary and extrapulmonary clinical samples. A total of 2160 clinical samples, in which 1141 (52.8%) were pulmonary and 1019 (47.2%) were extrapulmonary samples, sent to our laboratory between July 2013 to December 2014, were included in the study. Sixty seven of the evaluated samples (3.1%) were positive with microscopy (acid-fast stain; AFS), 116 samples (5.1%) were positive with culture and 98 samples (4.5%) were positive with Xpert MTB/RIF test. When the culture was considered as the reference method, the sensitivity and specificity of Xpert MTB/RIF test were determined as 73.3% and 99.3%, respectively for all samples; 77.5% and 99.5%, respectively for pulmonary samples and 63.9% and 99.2%, respectively for extrapulmonary samples. Among AFS positive samples, the sensitivity was 100% and specificity was 66.7%; whereas among AFS negative samples those values were 40.4% and 99.4%, respectively. Among all the samples involved in the study, RIF resistance was determined only in three samples with Xpert MTB/ RIF test and that was also

  3. [Tuberculosis among chronic hemodialysis patients in Togo: Report of 10 cases].

    Science.gov (United States)

    Tsevi, Mawufemo Yawovi; Sabi, Akomola Kossi; Lawson-Ananissoh, Laté Mawuli; Noto-Kadou-Kaza, Befa; Amekoudi, Eyram Yoan

    2017-02-01

    To determine the frequency of tuberculosis among hemodialysis patients in Togo, specify its different localizations and identify its diagnostic and therapeutic difficulties. This was a retrospective study over a period of 5 years (2010-2015). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Sylvanus-Olympio University Teaching Hospital in Lomé. The diagnosis of tuberculosis was selected on the basis of clinical and laboratory data. The specific treatment has involved the association of 4 antituberculosis, which was adapted to the renal function. Of 91 chronic hemodialysis patients treated in Hospital Sylvanus-Olympio hemodialysis center, 10 cases (10.9%) of tuberculosis were diagnosed. The mean age was 37.3±12.8 years, and the sex ratio was 1.5. The median time to onset of tuberculosis after initiation of hemodialysis was 16.8±9 months. Extrapulmonary sites are found in 100% of cases (5 had both peritoneal and pleural localization, only 5 had pleural localization). The tuberculin skin test was positive in 4 patients (40%). The search for Mycobacterium tuberculosis was unsuccessful in all types of samples. Tuberculosis treatment was generally tolerated. Two patients (20%) had died during treatment. Tuberculosis is relatively common in hemodialysis patients. Diagnosis is difficult and may be based on the therapeutic trial. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  4. Lung Functional and Biologic Responses to Variable Ventilation in Experimental Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Samary, Cynthia S; Moraes, Lillian; Santos, Cintia L; Huhle, Robert; Santos, Raquel S; Ornellas, Debora S; Felix, Nathane S; Capelozzi, Vera L; Schanaider, Alberto; Pelosi, Paolo; de Abreu, Marcelo Gama; Rocco, Patricia R M; Silva, Pedro L

    2016-07-01

    The biologic effects of variable ventilation may depend on the etiology of acute respiratory distress syndrome. We compared variable and conventional ventilation in experimental pulmonary and extrapulmonary acute respiratory distress syndrome. Prospective, randomized, controlled experimental study. University research laboratory. Twenty-four Wistar rats. Acute respiratory distress syndrome was induced by Escherichia coli lipopolysaccharide administered intratracheally (pulmonary acute respiratory distress syndrome, n = 12) or intraperitoneally (extrapulmonary acute respiratory distress syndrome, n = 12). After 24 hours, animals were randomly assigned to receive conventional (volume-controlled ventilation, n = 6) or variable ventilation (n = 6). Nonventilated animals (n = 4 per etiology) were used for comparison of diffuse alveolar damage, E-cadherin, and molecular biology variables. Variable ventilation was applied on a breath-to-breath basis as a sequence of randomly generated tidal volume values (n = 600; mean tidal volume = 6 mL/kg), with a 30% coefficient of variation (normal distribution). After randomization, animals were ventilated for 1 hour and lungs were removed for histology and molecular biology analysis. Variable ventilation improved oxygenation and reduced lung elastance compared with volume-controlled ventilation in both acute respiratory distress syndrome etiologies. In pulmonary acute respiratory distress syndrome, but not in extrapulmonary acute respiratory distress syndrome, variable ventilation 1) decreased total diffuse alveolar damage (median [interquartile range]: volume-controlled ventilation, 12 [11-17] vs variable ventilation, 9 [8-10]; p ventilation, 21.5 [18.3-23.3] vs variable ventilation, 5.6 [4.6-12.1]; p ventilation, 2.0 [1.3-2.1] vs variable ventilation, 0.7 [0.6-1.4]; p ventilation, 0.3 [0.2-0.5] vs variable ventilation, 0.8 [0.5-1.3]; p ventilation increased vascular cell adhesion molecule-1 messenger RNA expression (volume

  5. Matrix Degradation in Human Immunodeficiency Virus Type 1-Associated Tuberculosis and Tuberculosis Immune Reconstitution Inflammatory Syndrome: A Prospective Observational Study.

    Science.gov (United States)

    Walker, Naomi F; Wilkinson, Katalin A; Meintjes, Graeme; Tezera, Liku B; Goliath, Rene; Peyper, Janique M; Tadokera, Rebecca; Opondo, Charles; Coussens, Anna K; Wilkinson, Robert J; Friedland, Jon S; Elkington, Paul T

    2017-07-01

    Extensive immunopathology occurs in human immunodeficiency virus (HIV)/tuberculosis (TB) coinfection, but the underlying molecular mechanisms are not well-defined. Excessive matrix metalloproteinase (MMP) activity is emerging as a key process but has not been systematically studied in HIV-associated TB. We performed a cross-sectional study of matrix turnover in HIV type 1 (HIV-1)-infected and -uninfected TB patients and controls, and a prospective cohort study of HIV-1-infected TB patients at risk of TB immune reconstitution inflammatory syndrome (TB-IRIS), in Cape Town, South Africa. Sputum and plasma MMP concentrations were quantified by Luminex, plasma procollagen III N-terminal propeptide (PIIINP) by enzyme-linked immunosorbent assay, and urinary lipoarabinomannan (LAM) by Alere Determine TB LAM assay. Peripheral blood mononuclear cells from healthy donors were cultured with Mycobacterium tuberculosis and extracellular matrix in a 3D model of TB granuloma formation. MMP activity differed between HIV-1-infected and -uninfected TB patients and corresponded with specific TB clinical phenotypes. HIV-1-infected TB patients had reduced pulmonary MMP concentrations, associated with reduced cavitation, but increased plasma PIIINP, compared to HIV-1-uninfected TB patients. Elevated extrapulmonary extracellular matrix turnover was associated with TB-IRIS, both before and during TB-IRIS onset. The predominant collagenase was MMP-8, which was likely neutrophil derived and M. tuberculosis-antigen driven. Mycobacterium tuberculosis-induced matrix degradation was suppressed by the MMP inhibitor doxycycline in vitro. MMP activity in TB differs by HIV-1 status and compartment, and releases matrix degradation products. Matrix turnover in HIV-1-infected patients is increased before and during TB-IRIS, informing novel diagnostic strategies. MMP inhibition is a potential host-directed therapy strategy for prevention and treatment of TB-IRIS.

  6. The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

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    Jonnalagada Subbanna

    2011-12-01

    Full Text Available Abstract Background India has 2.0 million estimated tuberculosis (TB cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i treatment outcomes including the number who died while on treatment, ii the month of death and iii characteristics associated with "early" death, occurring in the initial 8 weeks of treatment. Methods This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results There were 8,240 TB patients (5183 males of whom 492 (6% were known to have died during treatment. Case-fatality was higher in those previously treated (12% and lower in those with extra-pulmonary TB (2%. There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death". Conclusion In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.

  7. [Semeiotics of abdominal tuberculosis].

    Science.gov (United States)

    Guseĭnov, G K; Ramazanova, A M; Guseĭnov, A G

    1984-01-01

    Examination of 119 patients with abdominal tuberculosis permitted the description of the characteristic semiotics of the illness. Today the patients with abdominal tuberculosis are mainly women of child-bearing age with a long-term tuberculosis catamnesis and intoxication, with a history of tuberculosis of different sites, those suffering from tuberculosis or its sequels at present (64%), those with pains (94%), discomfort or swelling of the abdomen (79%), malfunction of the gastrointestinal tract (65%), weight loss (86%), malnutrition (72%), anemia (63%), not infrequently with inflammatory induration (43%) or ascites in the abdominal cavity (39%). In addition to this characteristic semiotics, the patients with abdominal tuberculosis may demonstrate the most different and unexpected symptoms up to acute abdomen (23%). To make differential diagnosis of abdominal tuberculosis, one has often to resort to diagnostic laparotomy, laparoscopy, Koch's test and to trial therapy.

  8. [Tuberculosis in ancient Egypt].

    Science.gov (United States)

    Ziskind, B; Halioua, B

    2007-12-01

    Did Tuberculosis plague Ancient Egypt five millennia ago? Some medical papyri appear to evoke tuberculosis. Egyptian physicians did not individualize it, but they seem to have noticed some of its clinical expressions, such as cough, cervical adenitis, and cold abscesses. In Egyptian iconography, some cases of hump-backs were probably due to Pott's disease of the spine Descriptive paleopathology, born with the 20th century, has identified pulmonary and especially spinal lesions compatible with tuberculosis. Progress of molecular biology has made a decisive contribution with the diagnosis of tuberculosis on ancient samples. Tuberculosis has been identified using PCR in nearly a third of the Egyptian mummies recently examined. Spoligotyping has made it possible to re-evaluate the phylogenic tree of the Mycobacterium tuberculosis complex in Ancient Egypt. Tuberculosis certainly plagued the Nile Valley and appears to have been an important cause of mortality in Ancient Egypt.

  9. Increased Severity of Tuberculosis in Guinea Pigs with Type 2 Diabetes

    Science.gov (United States)

    Podell, Brendan K.; Ackart, David F.; Obregon-Henao, Andres; Eck, Sarah P.; Henao-Tamayo, Marcela; Richardson, Michael; Orme, Ian M.; Ordway, Diane J.; Basaraba, Randall J.

    2015-01-01

    Impaired glucose tolerance and type 2 diabetes were induced in guinea pigs to model the emerging comorbidity of Mycobacterium tuberculosis infection in diabetic patients. Type 2 diabetes mellitus was induced by low-dose streptozotocin in guinea pigs rendered glucose intolerant by first feeding a high-fat, high-carbohydrate diet before M. tuberculosis exposure. M. tuberculosis infection of diabetic guinea pigs resulted in severe and rapidly progressive tuberculosis (TB) with a shortened survival interval, more severe pulmonary and extrapulmonary pathology, and a higher bacterial burden compared with glucose-intolerant and nondiabetic controls. Compared with nondiabetics, diabetic guinea pigs with TB had an exacerbated proinflammatory response with more severe granulocytic inflammation and higher gene expression for the cytokines/chemokines interferon-γ, IL-17A, IL-8, and IL-10 in the lung and for interferon-γ, tumor necrosis factor-α, IL-8, and monocyte chemoattractant protein-1 in the spleen. TB disease progression in guinea pigs with impaired glucose tolerance was similar to that of nondiabetic controls in the early stages of infection but was more severe by day 90. The guinea pig model of type 2 diabetes–TB comorbidity mimics important features of the naturally occurring disease in humans. This model will be beneficial in understanding the complex pathogenesis of TB in diabetic patients and to test new strategies to improve TB and diabetes control when the two diseases occur together. PMID:24492198

  10. International standards for tuberculosis care: Relevance and implications for laboratory professionals

    Directory of Open Access Journals (Sweden)

    Pai M

    2007-01-01

    Full Text Available On World Tuberculosis (TB Day 2006, the International Standards for Tuberculosis Care (ISTC was officially released and widely endorsed by several agencies and organizations. The ISTC release was the culmination of a year long global effort to develop and set internationally acceptable, evidence-based standards for tuberculosis care. The ISTC describes a widely endorsed level of care that all practitioners, public and private, should seek to achieve in managing individuals who have or are suspected of having, TB and is intended to facilitate the effective engagement of all healthcare providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative and extra-pulmonary TB, TB caused by drug-resistant Mycobacterium tuberculosis and TB/HIV coinfection. In this article, we present the ISTC, with a special focus on the diagnostic standards and describe their implications and relevance for laboratory professionals in India and worldwide. Laboratory professionals play a critical role in ensuring that all the standards are actually met by providing high quality laboratory services for smear microscopy, culture and drug susceptibility testing and other services such as testing for HIV infection. In fact, if the ISTC is widely followed, it can be expected that there will be a greater need and demand for quality assured laboratory services and this will have obvious implications for all laboratories in terms of work load, requirement for resources and trained personnel and organization of quality assurance systems.

  11. Spoligotyping of Mycobacterium tuberculosis isolates at a tertiary care hospital in India.

    Science.gov (United States)

    Suzana, Shirly; Shanmugam, Sivakumar; Uma Devi, K R; Swarna Latha, P N; Michael, Joy S

    2017-06-01

    Spoligotyping is a valuable genotyping tool to study the genetic diversity and molecular epidemiology of Mycobacterium tuberculosis (M. tb). The aim of this study was to analyse different spoligotype patterns of M. tb strains isolated from patients with tuberculosis from different parts of India. A total of 163 M. tb isolates were spoligotyped between January 2014 and January 2015. About 47% (n = 77) were from patients with extrapulmonary tuberculosis; of these, 10 were MDR, and seven were Pre-XDR. Of the 86 M. tb isolates from patients with pulmonary tuberculosis, 25 were MDR, and 25 were Pre-XDR. We found 61 spoligo patterns, 128 clusters in the spoligotype data base (spoldb4 data base) with spoligo international type (SIT) number and 35 true unique isolates. The most pre-dominant spoligotype was EAI lineage (56), followed by Beijing (28), CAS (20), T(9), U(7), X(3), H(3), BOVIS_1 BCG(1) and LAM(1). Although our study identified EAI, CAS and Beijing strain lineages as pre-dominant, we also found a large number of orphan strains (20%) in our study. Beijing strains were more significantly associated with MDR TB than CAS and EAI lineages. Further studies on large sample sizes would help to clearly describe the epidemiology of M. tb in India. © 2017 John Wiley & Sons Ltd.

  12. Incidental diagnosis of renal tuberculosis in an adolescent submitted to videolaparoscopic nefrectomy

    Directory of Open Access Journals (Sweden)

    Letícia Alves Antunes

    2016-09-01

    Full Text Available Genitourinary tuberculosis is rare in children. The aim of this study is to describe an unusual case of renal tuberculosis in a 16 years old girl, diagnosed with Hinman Syndrome and chronic renal failure. During a hematuria investigation the cystourethrogram revealed grade V right vesicoureteral reflux and small bladder. Ultrasonography demonstrated various cysts in left kidney with irregular content, suggesting dysplastic multicystic kidney. Scintigraphy showed functional exclusion of the left kidney. Total laparoscopic nephrectomy was proposed. Gregoir right ureteral reimplantation and Mitrofanoff mechanism using the distal left ureter were also indicated. During surgery presence of multiple cysts in the left kidney with caseous aspect, left ureter obstruction with caseous content in the lumen and bladder mucosa with friable and thickened wall were found. Histopathological study revealed chronic necrotizing granulomatous inflammation. Mantoux tuberculin skin test was strongly reactive, and family history was positive for pulmonary tuberculosis 10 years earlier. This paper shows the importance of bringing extrapulmonary tuberculosis to the roll of differential diagnosis of hematuria. Early treatment is important to avoid disease progression with functional loss of the organs as happened in this case.

  13. Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma.

    Science.gov (United States)

    Ganesan, Vithiya; Mandal, Jharna

    2016-03-01

    Pulmonary tuberculosis (TB) is the most common form of TB. Primary infection can also affect the pharynx, cervical lymph node, intestine, or oral mucosa. Historically, the observed incidence of concomitant infection with leprosy and TB is high. However, reports of concomitant infection in modern literature remain scarce. Most cases reported in the literature had borderline/lepromatous leprosy and pulmonary tuberculosis. Extrapulmonary tuberculosis is reported in only 3.2% of leprosy cases. To the best of our knowledge, this is the first case report of primary oral tuberculosis of the tongue in a patient with lepromatous leprosy with Type 2 lepra reaction. The patient was referred to Directly Observed Treatment, Short-Course clinic and started on Category I treatment. She received oral prednisolone for lepra reaction, which was subsequently tapered and stopped, however, she continued to receive other antileprotic drugs (thalidomide and clofazimine). The patient's general condition improved and she is on regular follow up. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  14. SLE and Tuberculosis: A Case Series and Review of Literature.

    Science.gov (United States)

    Bhattacharya, Prasanta Kumar; Jamil, Md; Roy, Aakash; Talukdar, Kishore Kumar

    2017-02-01

    Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

  15. Inherited and acquired immunodeficiencies underlying tuberculosis in childhood

    Science.gov (United States)

    Boisson-Dupuis, Stéphanie; Bustamante, Jacinta; El-Baghdadi, Jamila; Camcioglu, Yildiz; Parvaneh, Nima; Azbaoui, Safaa El; Agader, Aomar; Hassani, Amal; Hafidi, Naima El; Mrani, Nidal Alaoui; Jouhadi, Zineb; Ailal, Fatima; Najib, Jilali; Reisli, Ismail; Zamani, Adil; Yosunkaya, Sebnem; Gulle-Girit, Saniye; Yildiran, Alisan; Cipe, Funda Erol; Torun, Selda Hancerli; Metin, Ayse; Atikan, Basak Yildiz; Hatipoglu, Nevin; Aydogmus, Cigdem; Kilic, Sara Sebnem; Dogu, Figen; Karaca, Neslihan; Aksu, Guzide; Kutukculer, Necil; Keser-Emiroglu, Melike; Somer, Ayper; Tanir, Gonul; Aytekin, Caner; Adimi, Parisa; Mahdaviani, Seyed Alireza; Mamishi, Setareh; Bousfiha, Aziz; Sanal, Ozden; Mansouri, Davood; Casanova, Jean-Laurent; Abel, Laurent

    2015-01-01

    Summary Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN-γ immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey. PMID:25703555

  16. Tuberculosis in immigrants in Finland, 1995-2013.

    Science.gov (United States)

    Räisänen, P E; Soini, H; Vasankari, T; Smit, P W; Nuorti, J P; Ollgren, J; Ruutu, P; Lyytikäinen, O

    2016-01-01

    Increasing immigration from high tuberculosis (TB) incidence countries is a challenge for surveillance and control in Finland. Here, we describe the epidemiology of TB in immigrants by using national surveillance data. During 1995-2013, 7030 (84·7%) native and 1199 (14·4%) immigrant cases were identified. The proportion of immigrant cases increased from 5·8% in 1995 to 32·1% in 2013, consistent with increasing immigrant population (2·1-5·6%) and decreasing incidence of TB in the native population (from 12·1 to 3·5/100 000). TB cases in immigrants were significantly younger, more often female, and had extrapulmonary TB more often than native cases (P immigrants than natives (P Immigrant cases were born in 82 different countries; most commonly in Somalia and the former Soviet Union/Russia. During 2008-2013, 433 Mycobacterium tuberculosis isolates from immigrants were submitted for spoligotyping; 10 different clades were identified. Clades were similar to those found in the case's country of birth. Screening immigrants from high-incidence countries and raising awareness of common characteristics and symptoms of TB is important to ensure early diagnosis and to prevent transmission.

  17. [Childhood tuberculosis].

    Science.gov (United States)

    Hamzaoui, A

    2015-01-01

    Childhood TB is an indication of failing TB control in the community. It allows disease persistence in the population. Mortality and morbidity due to TB is high in children. Moreover, HIV co-infection and multidrug-resistant diseases are as frequent in children as in adults. Infection is more frequent in younger children. Disease risk after primary infection is greatest in infants younger than 2 years. In case of exposure, evidence of infection can be obtained using the tuberculin skin test (TST) or an interferon-gamma assay (IGRA). There is no evidence to support the use of IGRA over TST in young children. TB suspicion should be confirmed whenever possible, using new available tools, particularly in case of pulmonary and lymph node TB. Induced sputum, nasopharyngeal aspiration and fine needle aspiration biopsy provide a rapid and definitive diagnosis of mycobacterial infection in a large proportion of patients. Analysis of paediatric samples revealed higher sensitivity and specificity values of molecular techniques in comparison with the ones originated from adults. Children require higher drugs dosages than adults. Short courses of steroids are associated with TB treatment in case of respiratory distress, bronchoscopic desobstruction is proposed for severe airways involvement and antiretroviral therapy is mandatory in case of HIV infection. Post-exposure prophylaxis in children is a highly effective strategy to reduce the risk of TB disease. The optimal therapy for treatment of latent infection with a presumably multidrug-resistant Mycobacterium tuberculosis strain is currently not known. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Diagnosis of smear-negative tuberculosis is greatly improved by Xpert MTB/RIF.

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    Giulia Lombardi

    Full Text Available Diagnosis of pulmonary (PTB and extra-pulmonary tuberculosis (EPTB in smear-negative patients can be difficult. We assessed retrospectively the performance of Xpert MTB/RIF system (Xpert, Cepheid in diagnosing smear-negative tuberculosis (TB, which represents the most common form of TB in a low incidence setting.Performance of Xpert was compared to acid-fast microscopic examination using Ziehl-Neelsen (ZN stain in patients with culture-confirmed TB.386 Mycobacterium tuberculosis (MTB culture-positive samples were detected out of 5170 specimens tested with smear microscopy, Xpert and culture: 323 were both culture- and Xpert-positive, and 63 culture-positive only. Of these, 234 (60.6% were smear-negative. In addition Xpert detected 40 probable TB cases, based on clinical findings, which were culture-negative. Compared to culture, Xpert showed an overall sensitivity of 83.7% and a specificity of 99.1%; sensitivity was higher for respiratory samples (86.5% than for non-respiratory samples (76.8%. Xpert sensitivity for smear-negative culture-confirmed TB was 73.1% and was not influenced by TB localization. As sensitivity of microscopy alone was poor (39.4%, Xpert improved both diagnosis of pulmonary TB (Δ = 36.5% and extra-pulmonary TB (Δ = 63.4%.Xpert MTB/RIF is a sensitive method for rapid diagnosis of TB compared to the conventional ZN staining. Xpert can serve as a sensitive and time-saving diagnostic method for microbiological diagnosis of smear-negative TB in countries with a low TB prevalence.

  19. Tuberculosis Facts - Testing for TB

    Science.gov (United States)

    Tuberculosis (TB) Facts Testing for TB What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  20. Tuberculosis in the lung (image)

    Science.gov (United States)

    Tuberculosis is caused by a group of organisms: Mycobacterium tuberculosis, M bovis , M africanum and a few other rarer subtypes. Tuberculosis usually appears as a lung (pulmonary) infection. However, ...

  1. Tuberculosis Facts - Exposure to TB

    Science.gov (United States)

    Tuberculosis (TB) Facts Exposure to TB What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  2. Drivers of Tuberculosis Transmission.

    Science.gov (United States)

    Mathema, Barun; Andrews, Jason R; Cohen, Ted; Borgdorff, Martien W; Behr, Marcel; Glynn, Judith R; Rustomjee, Roxana; Silk, Benjamin J; Wood, Robin

    2017-11-03

    Measuring tuberculosis transmission is exceedingly difficult, given the remarkable variability in the timing of clinical disease after Mycobacterium tuberculosis infection; incident disease can result from either a recent (ie, weeks to months) or a remote (ie, several years to decades) infection event. Although we cannot identify with certainty the timing and location of tuberculosis transmission for individuals, approaches for estimating the individual probability of recent transmission and for estimating the fraction of tuberculosis cases due to recent transmission in populations have been developed. Data used to estimate the probable burden of recent transmission include tuberculosis case notifications in young children and trends in tuberculin skin test and interferon γ-release assays. More recently, M. tuberculosis whole-genome sequencing has been used to estimate population levels of recent transmission, identify the distribution of specific strains within communities, and decipher chains of transmission among culture-positive tuberculosis cases. The factors that drive the transmission of tuberculosis in communities depend on the burden of prevalent tuberculosis; the ways in which individuals live, work, and interact (eg, congregate settings); and the capacity of healthcare and public health systems to identify and effectively treat individuals with infectious forms of tuberculosis. Here we provide an overview of these factors, describe tools for measurement of ongoing transmission, and highlight knowledge gaps that must be addressed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  3. Immunologic evaluation and validation of methods using synthetic peptides derived from Mycobacterium tuberculosis for the diagnosis of tuberculosis infection.

    Science.gov (United States)

    Araujo, Zaida; Giampietro, Francesca; Bochichio, María de los Angeles; Palacios, Andrea; Dinis, Jenifer; Isern, Jaime; Waard, Jacobus Henry de; Rada, Elsa; Borges, Rafael; Fernández de Larrea, Carlos; Villasmil, Angel; Vanegas, Magnolia; Enciso-Moreno, Jose Antonio; Patarroyo, Manuel Alfonso

    2013-04-01

    The goal of this study was to demonstrate the usefulness of an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of pulmonary tuberculosis (PTB) and extrapulmonary TB (EPTB). This assay used 20 amino acid-long, non-overlapped synthetic peptides that spanned the complete Mycobacterium tuberculosis ESAT-6 and Ag85A sequences. The validation cohort consisted of 1,102 individuals who were grouped into the following five diagnostic groups: 455 patients with PTB, 60 patients with EPTB, 40 individuals with non-EPTB, 33 individuals with leprosy and 514 healthy controls. For the PTB group, two ESAT-6 peptides (12033 and 12034) had the highest sensitivity levels of 96.9% and 96.2%, respectively, and an Ag85A-peptide (29878) was the most specific (97.4%) in the PTB groups. For the EPTB group, two Ag85A peptides (11005 and 11006) were observed to have a sensitivity of 98.3% and an Ag85A-peptide (29878) was also the most specific (96.4%). When combinations of peptides were used, such as 12033 and 12034 or 11005 and 11006, 99.5% and 100% sensitivities in the PTB and EPTB groups were observed, respectively. In conclusion, for a cohort that consists entirely of individuals from Venezuela, a multi-antigen immunoassay using highly sensitive ESAT-6 and Ag85A peptides alone and in combination could be used to more rapidly diagnose PTB and EPTB infection.

  4. High Grade Infective Spondylolisthesis of Cervical Spine Secondary to Tuberculosis.

    Science.gov (United States)

    Hadgaonkar, Shailesh; Shah, Kunal; Shyam, Ashok; Sancheti, Parag

    2015-12-01

    Spondylolisthesis coexisting with tuberculosis is rarely reported. There is a controversy whether spondylolisthesis coexists or precedes tuberculosis. Few cases of pathological spondylolisthesis secondary to tuberculous spondylodiscitis have been reported in the lumbar and lumbosacral spine. All cases in the literature presented as anterolisthesis, except one which presented as posterolisthesis of lumbar spine. Spondylolisthesis in the cervical spine is mainly degenerative and traumatic. Spondylolisthesis due to tuberculosis is not reported in the lower cervical spine. The exact mechanism of such an occurrence of spondylolisthesis with tuberculosis is sparsely reported in the literature and inadequately understood. We report a rare case of high grade pathological posterolisthesis of the lower cervical spine due to tubercular spondylodiscitis in a 67-year-old woman managed surgically with a three-year follow-up period. This case highlights the varied and complex presentation of tuberculosis of the lower cervical spine and gives insight into its pathogenesis, diagnosis, and management.

  5. Prevalence, incidence, and associated risk factors of tuberculosis in children with HIV living in the UK and Ireland (CHIPS): a cohort study.

    Science.gov (United States)

    Turkova, Anna; Chappell, Elizabeth; Judd, Ali; Goodall, Ruth L; Welch, Steven B; Foster, Caroline; Riordan, Andrew; Shingadia, Delane; Shackley, Fiona; Doerholt, Katja; Gibb, Diana M; Collins, Intira J

    2015-12-01

    Tuberculosis is the most common serious co-infection in people living with HIV worldwide, but little is known about its incidence in HIV-infected children living in high-resource settings with low tuberculosis prevalence. We aimed to assess the incidence and prevalence of tuberculosis in children with HIV living in the UK and Ireland to understand rates, risk factors, and outcomes of the disease in this group. We did an analysis of children enrolled in CHIPS, an observational multicentre cohort of children receiving HIV care in the UK and Ireland. We assessed characteristics and prevalence of tuberculosis at baseline, measured incidence of disease through the follow-up period using the CHIPS database, and calculated associated risk factors in these children with multivariable logistic and Cox regression models. Between Jan 1, 1996, to Sept 18, 2014, data for 1848 children with 14 761 years of follow-up were reported to CHIPS. 57 (3%) children were diagnosed with tuberculosis: 29 children had tuberculosis at presentation (prevalent tuberculosis) and 29 had the disease diagnosed during follow-up (incident tuberculosis), including one child with recurrent tuberculosis events. Median age at diagnosis was 9 years (IQR 5-12). 25 (43%) children had pulmonary tuberculosis, 24 (41%) had extrapulmonary tuberculosis with or without pulmonary involvement, and the remainder (n=9; 16%) had unspecified-site tuberculosis. The overall incidence rate for the follow-up period was 196 cases per 100 000 person-years (95% CI 137-283). In our multivariable model, tuberculosis at presentation was associated with more severe WHO immunological stage at baseline (odds ratio 0·25, 95% CI 0·08-0·74; p=0·0331; for none vs severe) and being born abroad (odds ratio 0·28, 0·10-0·73; p=0·0036; for UK and Ireland vs abroad). Incident tuberculosis was associated with time-updated more severe WHO immunological stage (hazard ratio 0·15, 95% CI 0·06-0·41; p=0·0056; for none vs severe

  6. Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study

    DEFF Research Database (Denmark)

    Zhang, Xinyu; Bengård Andersen, Åse; Lillebaek, Troels

    2011-01-01

    Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case-control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark and Green......Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case-control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark...... and Greenland during 1992-2007 to gain insight to the role of host factors in EPTB pathogenesis. Among patients from Somalia and Asia, persons 25-44 and 45-64 years of age were more likely to have EPTB than persons 15-24 years of age. In contrast, among persons from Greenland, the two oldest age groups were...... significantly less likely to have EPTB than the youngest age group. For all the age groups, the odds for having EPTB was significantly higher among patients from Somalia and Asia and significantly lower among the patients from Greenland than among patients from Denmark. Furthermore, the occurrence of specific...

  7. [Evaluation of Xpert® MTB/RIF technique for Mycobacterium tuberculosis complex detection in extra-respiratory specimens].

    Science.gov (United States)

    García, Patricia; Balcells, M Elvira; Castillo, Claudia; Miranda, Carolina; Geoffroy, Enrique; Román, Juan C; Wozniak, Aniela

    2017-08-01

    Extra-pulmonary tuberculosis (TB) represents the 26.2% of total TB cases in Chile. Culture is the gold standard method, but the process is extremely slow. Xpert®MTB/RIF technique detects Mycobacterium tuberculosis complex (MTBc) through real time PCR in less than 3 h. However, it has been validated only for respiratory specimens. We aimed to determine the performance of Xpert®MTB/RIF test in detecting MTBc in extra-respiratory specimens compared with a combined gold standard consisting in a positive (liquid and solid) mycobacterial culture and/or a positive validated molecular method (q-RPC, Cobas®TaqMan®-MTB). Fifty extra-respiratory specimens were analyzed, from which 25 were positive and 25 negative for MTBc based on the combined gold standard. The 25 positive specimens had a positive result by Xpert®MTB/RIF; from the 25 negative specimens, 24 had a negative result and one had a positive result. We obtained an overall concordance of 98% between Xpert®MTB/RIF and the combined gold standard. Xpert®MTB/RIF test was able to detect 12 smear-negative specimens and 3 culture-negative specimens, all of them corresponding to extra-pulmonary TB cases. Xpert®MTB/RIF showed similar sensitivity to q-RPC in detecting MTBc in extra-respiratory specimens. This procedure allowed a substantial reduction in the time of diagnosis.

  8. [Clinical analysis of 44 cases of leukemia complicated with active tuberculosis-a single-center report].

    Science.gov (United States)

    Li, Jun; Jiang, Meng; Yang, Yi-ming; Liu, Ting; Niu, Ting

    2013-07-01

    To analyze the prevalence, clinical features, diagnosis, potential risk factors, anti-tuberculosis treatment efficacy and prognosis of the patients with leukemia complicated with active tuberculosis (TB). A retrospective study was performed to analyze the clinical characteristics, relevant examination data, diagnosis methods and follow-up data about 44 leukemia cases complicated with active TB from January 2006 to December 2011 in our single center. The prevalence of leukemia complicated with active TB was 1.70% (pulmonary TB 1.35%, extra-pulmonary TB 0.35%) and no statistically significant difference was found between each subgroup of acute and chronic leukemia groups (P>0.05). Most of the patients were men, with a male to female ratio of 2.14:1, the median age of 40 years old (range 16 to 78), presenting as atypical clinical manifestations, such as high fever, cough, and so on. Eighteen patients (40.9%) were diagnosed with definitely etiological evidence while the other 26 patients (59.1%) were diagnosed clinically. The extra-pulmonary TB group had a higher purified protein derivative (PPD) test positive rate than that of the pulmonary TB group (88.9% vs 42.9%, P=0.020). The chest CT and T-cell spot of tuberculosis test (T-SPOT.TB) were helpful tools for diagnosis. The potential risk factors included age, sex, nutritional status, neutropenia, decreased cellular immunity, type and course of leukemia, etc. The significant differences in age, gender, administration route of immunosuppressive drugs were found between neutropenic and non-neutropenic groups (Pleukemia complicated with active TB is higher than the general population in our single center. The main characteristics including various potential risk factors, atypical clinical features, diagnoses mainly made by clinical features were found in our patients with leukemia complicated with active TB. However, it showed that these patients demonstrated good responses to the first-line anti-tuberculosis therapy and

  9. SIV Infection Facilitates Mycobacterium tuberculosis Infection of Rhesus Macaques

    Science.gov (United States)

    Guo, Ming; Xian, Qiao-Yang; Rao, Yan; Zhang, Jing; Wang, Yong; Huang, Zhi-Xiang; Wang, Xin; Bao, Rong; Zhou, Li; Liu, Jin-Biao; Tang, Zhi-Jiao; Guo, De-yin; Qin, Chuan; Li, Jie-Liang; Ho, Wen-Zhe

    2017-01-01

    Tuberculosis (TB) is a common opportunistic infection and the leading cause of death for human immunodeficiency virus (HIV)-infected patients. Thus, it is necessary to understand the pathogenetic interactions between M.tb and HIV infection. In this study, we examined M.tb and/or simian immunodeficiency virus (SIV) infection of Chinese rhesus macaques. While there was little evidence that M.tb enhanced SIV infection of macaques, SIV could facilitate M.tb infection as demonstrated by X-rays, pathological and microbiological findings. Chest X-rays showed that co-infected animals had disseminated lesions in both left and right lungs, while M.tb mono-infected animals displayed the lesions only in right lungs. Necropsy of co-infected animals revealed a disseminated M.tb infection not only in the lungs but also in the extrapulmonary organs including spleen, pancreas, liver, kidney, and heart. The bacterial counts in the lungs, the bronchial lymph nodes, and the extrapulmonary organs of co-infected animals were significantly higher than those of M.tb mono-infected animals. The mechanistic studies demonstrated that two of three co-infected animals had lower levels of M.tb specific IFN-γ and IL-22 in PBMCs than M.tb mono-infected animals. These findings suggest that Chinese rhesus macaque is a suitable and alternative non-human primate model for SIV/M.tb coinfection studies. The impairment of the specific anti-TB immunity is likely to be a contributor of SIV-mediated enhancement M.tb infection. PMID:28133458

  10. Tuberculosis of paranasal sinuses

    OpenAIRE

    Sanehi, S.; Dravid, Chandrashekhar; Chaudhary, Neena; Venkatachalam, V. P.

    2008-01-01

    Nasal tuberculosis is very rare but much rarer is tuberculosis of paranasal sinuses. It involves especially the maxillary sinus and is usually unilateral. We report an unusual case of tuberculosis of frontal and maxillary sinus in a 68 years old male, who presented with a swelling above left medial canthus, with no other eye or nasal complaints. Clinical and radiological findings on our initial evaluation suggested that the patient had left frontal mucocoele with bilateral maxillary haziness....

  11. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    Science.gov (United States)

    Mendoza-Ticona, Alberto

    2014-01-01

    Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Perú están normados y reglamentados los derechos laborales inherentes a la tuberculosis como enfermedad ocupacional, como la cobertura por discapacidad temporal o permanente. Sin embargo, estos derechos aún no han sido suficientemente socializados. En este trabajo se presenta información sobre el riesgo de adquirir tuberculosis en el lugar de trabajo, se revisan las evidencias para declarar a la tuberculosis como enfermedad ocupacional en trabajadores de salud y se presenta la legislación peruana vigente al respecto. PMID:22858771

  12. Primary isolated gingival tuberculosis

    Directory of Open Access Journals (Sweden)

    Gabriel Rodrigues

    Full Text Available Tuberculosis of the oral cavity is a rare event and when present is usually secondary to pulmonary tuberculosis. We present a case of a 33-year-old male patient who presented with symptoms of gingivitis. Local examination revealed multiple ulcers and a few nodules over the gingiva. A nodule biopsy was consistent with the diagnosis of gingival tuberculosis. The patient had no evidence of tuberculosis any where else in the body. Medical treatment was curative. As this condition is very rare, it is often over looked as it is never thought as a common clinical diagnosis. A biopsy is mandatory to establish diagnosis. The relevant literature is reviewed.

  13. Tuberculosis in AIDS Patients

    OpenAIRE

    Nissapatorn, Veeranoot; Lee, Christopher; Ithoi, Init; Yik, Fong Mun; Abdullah, Khairul Anuar

    2003-01-01

    Tuberculosis is the top agenda among opportunistic diseases and the most leading cause of death in HIV/AIDS patients. A total of 406 AIDS patients were recruited in this retrospective and descriptive study. 123/406 (30.3%) were diagnosed as AIDS-related tuberculosis (TB). Their age range from 17 to 69 years with a mean (±SD) of 37.2 (±9.51. There were significant association between occupation, or mode of HIV transmission and tuberculosis infection (p< 0.05). Pulmonary tuberculosis 104/123 (8...

  14. Initial experience with GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program.

    Science.gov (United States)

    Patil, Naveen; Saba, Hamida; Marco, Asween; Samant, Rohan; Mukasa, Leonard

    2014-01-01

    Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. Rapid and accurate diagnosis of pulmonary and extra-pulmonary tuberculosis (TB) is still a great challenge. The GeneXpert MTB/RIF assay is a novel integrated diagnostic system for the diagnosis of tuberculosis and rapid detection of Rifampin (RIF) resistance in clinical specimens. In 2012, the Arkansas Tuberculosis Control Program introduced GeneXpert MTB/RIF assay to replace the labour-intensive Mycobacterium Tuberculosis Direct (MTD) assay. To rapidly diagnose TB within two hours and to simultaneously detect RIF resistance. Describe the procedure used to introduce GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program.Characterise the current gap in rapid M. tuberculosis diagnosis in Arkansas.Assess factors that predict acid fast bacilli (AFB) smearnegative but culture-positive cases in Arkansas.Illustrate, with two case reports, the role of GeneXpert MTB/RIF assay in reduction of time to confirmation of M. tuberculosis diagnosis in the first year of implementation. Between June 2012 and June 2013, all AFB sputum smearpositive cases and any others, on request by the physician, had GeneXpert MTB/RIF assay performed as well as traditional M. tuberculosis culture and susceptibilities using Mycobacteria Growth Indicator Tube (MGIT) 960 and Löwenstein-Jensen (LJ) slants. Surveillance data for January 2009-June 2013 was analysed to characterise sputum smear-negative but culture-positive cases. Seventy-one TB cases were reported from June 2012- June 2013. GeneXpert MTB/RIF assay identified all culture-positive cases as well as three cases that were negative on culture. Also, this rapid assay identified all six smear-negative but M. tuberculosis culture-positive cases; two of these cases are described as case reports. GeneXpert MTB/RIF assay has made rapid TB diagnosis possible, with tremendous potential in determining isolation of TB suspects on one

  15. Treatment outcomes of childhood tuberculosis in Addis Ababa: a five-year retrospective analysis

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    Genene Tilahun

    2016-07-01

    Full Text Available Abstract Background Tuberculosis (TB kills one child every 5 min. Childhood TB is given low priority in most national health programmes particularly in TB-endemic areas. TB among children is an indicator of a recent transmission of the disease in the community. Treatment outcome results serve as a proxy of the quality of treatment provided by a health care system. In Ethiopia, data on treatment outcomes of childhood TB are limited. The aim of the study was to determine the treatment outcomes of childhood TB in a hospital setting in Addis Ababa. Methods The study was conducted during June to August 2014. The data of 491 children treated for TB in Zewditu Memorial Hospital during a 5 year (2009–2013 was analysed. TB was diagnosed using standard methods. Demographic and clinical data including type of TB, TB-HIV co-infection and treatment outcomes were collected from registry of the TB clinic. Treatment outcome definitions are used according to the World Health Organization. Results Of the 491 children, 272(55.4 % were females, 107(21.8 % were under 5 year old, 454(92.5 % of them were new cases. The types of TB were extra-pulmonary tuberculosis (EPTB 243(49.5 % and 248(50.5 % pulmonary tuberculosis (PTB. Of the PTB cases, 42(16.9 % were sputum smear positive. Of the 291 children tested for HIV, 82(28.2 % were positive. The overall treatment success rate was 420(85.5 % and the poor treatment outcome was 71(14.5 %. Of the children with poor treatment outcome, 9(1.8 % died, 3(0.6 % defaulted from treatment, 2(0.4 % were treatment failure and 55(11.2 % were transferred out. Males and females had similar treatment success rates of 85.8 % and 85.3 %, respectively. Infants under one year had significantly lower treatment success rate of 72.7 % compared to those above 1 years of age of 86.5 % (P < 0.001. Treatment success rate ranged from 78.0 to 92.6 % during the study period. Associated factors for treatment outcome were age above

  16. [Management of multidrug-resistant tuberculosis].

    Science.gov (United States)

    Tritar, F; Daghfous, H; Ben Saad, S; Slim-Saidi, L

    2015-01-01

    The emergence of drug-resistant TB in many countries has become a major public health problem and an obstacle to effective tuberculosis control. Multidrug-resistant tuberculosis (MDR-TB), which is most often the result of poor adherence, is a particularly dangerous form of tuberculosis because it is caused by bacilli resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs. Techniques for rapid diagnosis of resistance have greatly improved the care of patients by allowing early treatment which remains complex and costly establishment, and requires skills and resources. The treatment is not standardized but it includes in all cases attack phase with five drugs (there must be an injectable agent and a fluoroquinolone that form the basis of the regimen) for eight months and a maintenance phase (without injectable agent) with a total duration of 20 months on average. Surgery may be beneficial as long as the lesions are localized and the patient has a good cardiorespiratory function. Evolution of MDR-TB treated is less favorable than tuberculosis with germ sensitive. The cure rate varies from 60 to 75% for MDR-TB, and drops to 30 to 40% for XDR-TB. Mortality remains high, ranging from 20 to 40% even up to 70-90% in people co-infected with HIV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  17. Ocular Tuberculosis I: Epidemiology, Pathogenesis and Clinical Features

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    Sumru Önal

    2011-06-01

    Full Text Available The World Health Organization has declared tuberculosis (TB to be a global emergency, as it remains the most common single cause of morbidity and mortality worldwide. TB is caused by the acid-fast bacillus Mycobacterium tuberculosis and primarily affects the lungs [pulmonary TB (PTB]. It can also affect any other part of the body [extrapulmonary TB (EPTB]. It is estimated that 1.4% of patients with PTB will eventually develop ocular disease; however, in the majority of cases of ocular TB, PTB may not be documented. Ocular TB infection is usually a result of hematogenous spread during PTB or EPTB. Symptomatic disease most commonly develops after reactivation of dormant foci in the ocular tissue rather than being the manifestation of the initial infection. Immune-mediated ocular TB can occur due to hypersensitivity to M. tuberculosis antigens from a distant focus (such as lungs, despite the absence of the bacterium in the eye. The most common clinical presentation of intraocular inflammation (uveitis due to TB appears to be posterior uveitis, followed by anterior uveitis, panuveitis and intermediate uveitis. The absence of uniform diagnostic criteria for intraocular TB has led to confusion regarding its diagnosis and management. Recent studies on the clinical importance of purified protein derivative (PPD skin test, interferon-gamma release assays, chest computed tomography and polymerase chain reaction have provided a new approach to diagnosing ocular TB. This review series focuses on the clinical features, diagnostic techniques, diagnostic criteria, and treatment modalities in the light of recent literature. (Turk J Ophthalmol 2011; 41: 171-81

  18. Extrapulmonary effects of continuous airway pressure on patients with obstructive sleep apnoea: protocol for an overview of systematic reviews.

    Science.gov (United States)

    Labarca, Gonzalo; Ortega, Francisco; Arenas, Alex; Reyes, Tomas; Rada, Gabriel; Jorquera, Jorge

    2017-06-30

    Obstructive sleep apnoea (OSA) is associated with both pulmonary and extrapulmonary consequences. Continuous positive airway pressure (CPAP) is an effective treatment for pulmonary symptoms. However, it is not clear if CPAP modifies extrapulmonary symptoms, especially in the long term. To date, several studies addressing this issue have been performed, but the evidence is scattered across different reviews that address each outcome separately. Therefore, we will conduct an overview to assess and summarise all systematic reviews on the extrapulmonary effects of this intervention in patients with OSA. This is a protocol for a systematic overview of reviews that will follow the guidelines from the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA-P. We will conduct comprehensive literature searches using MEDLINE, EMBASE, Cochrane, CINAHL, DARE and Epistemonikos. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the extrapulmonary effects of CPAP on OSA. Two reviewers will independently screen articles for inclusion using criteria that are determined a priori, assessing the quality of included reviews and extracting relevant information. We will create matrices of evidence in the Epistemonikos database, including all systematic reviews addressing a similar question and all studies addressing the question in those reviews. We will try to explain why studies are not included in individual reviews using the inclusion criteria, and we will estimate the overlap between different reviews in the same matrix of evidence. This review will be published in a peer-reviewed journal. CRD42014013036. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Diagnostic accuracy and effectiveness of the Xpert MTB/RIF assay for the diagnosis of HIV-associated lymph node tuberculosis.

    Science.gov (United States)

    Van Rie, A; Page-Shipp, L; Mellet, K; Scott, L; Mkhwnazi, M; Jong, E; Omar, T; Beylis, N; Stevens, W; Sanne, I; Menezes, C N

    2013-11-01

    Xpert MTB/RIF (Xpert) is recommended for human immunodeficiency virus (HIV)-associated pulmonary tuberculosis but not extrapulmonary tuberculosis. We assessed the performance of Xpert for HIV-associated lymph node tuberculosis (LNTB), the most common type of extrapulmonary tuberculosis. Among HIV-infected adults suspected of LNTB presenting for fine needle aspirate (FNA) at a South African hospital, we assessed the diagnostic accuracy of Xpert using either FNA culture or a composite of microscopy, culture, and cytology as the reference standard, and evaluated the impact of different diagnostics on patient management. Among 344 adults with valid FNA culture and Xpert results, 84 (24 %) were positive on microscopy, 149 (43 %) on culture, 152 (53 %) on Xpert, and 181 (57 %) had a cytology result suggestive of tuberculosis. Using liquid culture as the reference standard, the specificity of a single Xpert was suboptimal (88.2 %) but the sensitivity was high [93.3 %, 95 % confidence interval (CI) 87.6-96.6] and increased with decreasing CD4 count (from 87.0 % for CD4 >250 to 98.6 % for CD4 <100 cells/mm(3)). Using a composite reference standard reduced the sensitivity to 79.2 % but increased the specificity to 98.6 %. All Xpert-positive patients initiated treatment within one day, compared to 70 % of culture-positive but Xpert-negative and 13 % of culture- and Xpert-negative but cytology-positive patients. Xpert is accurate and effective and could be endorsed as the initial diagnostic for HIV-associated LNTB.

  20. Mycobacterium bovis (Bovine Tuberculosis) in Humans

    Science.gov (United States)

    Mycobacterium bovis (Bovine Tuberculosis) in Humans What is Mycobacterium bovis ? In the United States, the majority of tuberculosis (TB) cases in people are caused by Mycobacterium tuberculosis ( ...

  1. Seasonal variations in notification of active tuberculosis cases in China, 2005-2012.

    Directory of Open Access Journals (Sweden)

    Xin-Xu Li

    Full Text Available BACKGROUND: Although seasonal variation in tuberculosis (TB incidence has been described in many countries, it remains unknown in China. METHODS: A time series decomposition analysis (X-12-ARIMA was performed to examine the seasonal variation in active TB cases nationwide from 2005 through 2012 in China. Seasonal amplitude was calculated for the evaluation of TB seasonal variation. RESULTS: A total of 7.78 million active TB cases were reported over a period of 8 years. A spring peak (April was observed with seasonal amplitude of 46.3%, compared with the winter trough (February. Most cases in provinces with subtropical and tropical monsoon climate showed lower amplitudes than those in temperate continental, plateau and mountain climate regions. The magnitude of seasonality varied inversely with annual average temperature, r (95% CI = -0.71 (-0.79, -0.61. The seasonal amplitudes were 56.7, 60.5, 40.6, 46.4 and 50.9% for patients aged ≤14, 15-24, 25-44, 45-64, and ≥65 years, respectively. Students demonstrated greater seasonal amplitude than peasants, migrant workers and workers (115.3% vs. 43.5, 41.6 and 48.1%. Patients with pulmonary TB had lower amplitude compared to patients with pleural and other extra-pulmonary TB (EPTB (45.9% vs. 52.0 and 56.3%. Relapse cases with sputum smear positive TB (SS+ TB had significantly higher seasonal amplitude compared to new cases with sputum smear positive TB (52.2% vs. 41.6%. CONCLUSIONS: TB is a seasonal disease in China. The peak and trough of TB transmission actually are in winter and in autumn respectively after factors of delay are removed. Higher amplitudes of TB seasonality are more likely to happen in temperate continental, plateau and mountain climate regions and regions with lower annual average temperature, and young person, students, patients with EPTB and relapse cases with SS+ TB are more likely to be affected by TB seasonality.

  2. TUBERCULOSIS IN ORTHOPAEDICS

    African Journals Online (AJOL)

    Tuberculosis death rates have fallen by 47% from 1990 to 2015 with 43 million lives saved between 2000 and. 2014 by TB diagnosis and treatment2. Tuberculosis dates back to antiquity. Signs of skeletal TB (Pott's disease) have been reported from as early as 8000 BC in Europe from Neolithic remains,. 1000 BC in ancient ...

  3. Drivers of Tuberculosis Transmission

    NARCIS (Netherlands)

    Mathema, Barun; Andrews, Jason R.; Cohen, Ted; Borgdorff, Martien W.; Behr, Marcel; Glynn, Judith R.; Rustomjee, Roxana; Silk, Benjamin J.; Wood, Robin

    2017-01-01

    Measuring tuberculosis transmission is exceedingly difficult, given the remarkable variability in the timing of clinical disease after Mycobacterium tuberculosis infection; incident disease can result from either a recent (ie, weeks to months) or a remote (ie, several years to decades) infection

  4. Seasonality of tuberculosis

    Directory of Open Access Journals (Sweden)

    Auda Fares

    2011-01-01

    Full Text Available Objectives: This study was designed to review previous studies and analyse the current knowledge and controversies related to seasonal variability of tuberculosis (TB to examine whether TB has an annual seasonal pattern. Study Design and Methods: Systematic review of peer reviewed studies identified through literature searches using online databases belonging to PubMed and the Cochrane library with key words "Tuberculosis, Seasonal influence" and " Tuberculosis, Seasonal variation". The search was restricted to articles published in English. The references of the identified papers for further relevant publications were also reviewed. Results: Twelve studies conducted between the period 1971 and 2006 from 11 countries/regions around the world (South Western Cameroon, South Africa, India, Hong Kong, Japan, Kuwait, Spain, UK, Ireland, Russia, and Mongolia were reviewed. A seasonal pattern of tuberculosis with a mostly predominant peak is seen during the spring and summer seasons in all of the countries (except South Western Cameroon and Russia. Conclusions: The observation of seasonality leads to assume that the risk of transmission of M. tuberculosis does appear to be the greatest during winter months. Vitamin D level variability, indoor activities, seasonal change in immune function, and delays in the diagnosis and treatment of tuberculosis are potential stimuli of seasonal tuberculosis disease. Additionally, seasonal variation in food availability and food intake, age, and sex are important factors which can play a role in the tuberculosis notification variability. Prospective studies regarding this topic and other related subjects are highly recommended.

  5. Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Beng Kwang Ng

    2017-01-01

    Full Text Available Tuberculosis (TB remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

  6. Tuberculosis in Aboriginal Canadians

    Directory of Open Access Journals (Sweden)

    Vernon H Hoeppner

    2000-01-01

    Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

  7. Abdominal tuberculosis: Imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Jose M. [Department of Radiology, Hospital de S. Joao, Porto (Portugal)]. E-mail: jmpjesus@yahoo.com; Madureira, Antonio J. [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Vieira, Alberto [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Ramos, Isabel [Department of Radiology, Hospital de S. Joao, Porto (Portugal)

    2005-08-01

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis.

  8. La tuberculosis, otra vez un problema de salud

    Directory of Open Access Journals (Sweden)

    Everardo Valdés Pacheco

    1999-01-01

    Full Text Available Se realiza una revisión bibliográfica sobre el tema de la Tuberculosis, con el objetivo de llamar la atención sobre su importancia hoy y para actualizar algunas concepciones modernas. Desde 1986, se comienza a detectar una elevación en la presentación de casos de Tuberculosis en todo el mundo, principalmente en los países en desarrollo. La infección respiratoria continúa siendo la forma principal, pero la presencia de la infección VIH/ SIDA, tiene una especial susceptibilidad a la infección tuberculosa, al estar afectados los linfocitos t4 presentándose en estos casos con frecuencia las formas extrapulmonares. Se necesitan técnicas de diagnóstico más efectivas, rápidas y sencillas. El tratamiento se recomienda que sea con 3 o más medicamentos simultáneamente y realizarse de forma completa, y es imprescindible el apoyo financiero gubernamental para este propósito. La prevención es vital en cualquier programa de control y debe ser dirigido tanto al individuo susceptible, como al personal de salud que trabaja en contacto con estos pacientes.A bibliographic review is made on the topic of tuberculosis aimed at calling the attention on its importance at present and at updating some modern conceptions. Since 1986, the number of cases with tuberculosis has increased all over the world, mainly in the developing countries. The respiratory infection is still the principal form, but the presence of HIV/AIDS infection has a special susceptibility to tuberculosis, since the 14 lymphocytes are affected. The extrapulmonary forms appear frequently in these cases. More effective, faster and easier diagnostic techniques are necessary. It is a recommended a complete treatment with 3 or more drugs used simultaneously. It is essential the governmental financial support fo this purpose. Prevention is vital in any program of control and it should be directed not only to the susceptible individual, but also to the health personnel working with these

  9. Tuberculosis genitourinaria: Reporte de 9 casos en el Hospital Universitario de Santander, Colombia, 2003-2008 Genitourinary tuberculosis: A report of 9 cases in Santander University Hospital, Colombia, 2003-2008

    Directory of Open Access Journals (Sweden)

    Julio Cesar Mantilla Hernández

    2009-08-01

    Full Text Available Introducción: La tuberculosis constituye aún un problema de salud pública en el mundo, el cual se agrava por la pandemia del SIDA. La tuberculosis extrapulmonar puede comprometer cualquier órgano, siendo el sistema genitourinario uno de los más afectados, por lo cual es importante conocer su magnitud en cada institución. Objetivos: Caracterizar la tuberculosis genitourinaria desde el punto de vista epidemiológico, clínico y paraclínico de los pacientes en los cuales la enfermedad constituyó la causa básica de muerte y su compromiso genitourinario fue un hallazgo principal de autopsia. Metodología: Estudio descriptivo retrospectivo realizado entre el 2003 y el 2008 mediante revisión de los protocolos de autopsias efectuadas en el Departamento de Patología de la Universidad Industrial de Santander, de los pacientes que fallecieron a causa de tuberculosis en el Hospital Universitario de Santander, Colombia. Resultados: Se encontraron 9 casos, con rango de edad entre 20 y 66 años, de los cuales 8 correspondían a hombres y 5 se asociaron con síndrome de inmunodeficiencia adquirida. Las manifestaciones clínicas más frecuentes fueron los síntomas constitucionales, seguido de los respiratorios, los urinarios, el dolor lumbar y los testiculares. El diagnóstico se realizó a través de los hallazgos anatomopatológicos durante la autopsia. Conclusiones: La tuberculosis genitourinaria es una forma severa de tuberculosis extra pulmonar, que por la poca especificidad del cuadro clínico, tiene un índice de sospecha bajo, lo que resulta inconveniente, ya que no permite diagnóstico oportuno, ni tratamiento adecuado para prevenir daños severos irreversibles. Salud UIS 2009; 41: 181-196Introduction: Tuberculosis continues to be a serious public health problem worldwide, which increases with AIDS pandemic. Extra-pulmonary tuberculosis can compromise any organ, genitourinary system being one of the most affected therefore it is important to

  10. Successful treatment of cranial metastases of extrapulmonary small cell carcinoma with chemotherapy alone.

    Science.gov (United States)

    Orhan, B; Yalçin, S; Evrensel, T; Yerci, O; Manavoğlu, O

    1998-04-01

    Extrapulmonary small cell carcinoma (EPSCC) is a distinct clinical and pathological entity other than small cell carcinoma of the lung. We present a case with EPSCC, with neurologic impairment due to brain metastases at initial diagnosis, which showed a complete response to combination chemotherapy. A 55-year-old male patient was first admitted with a mass of 6 x 6 cm in diameter in the right cervical region. The diagnosis of small cell carcinoma was entertained with immunohistopathologic and light microscopic findings. During the period of investigation the tumor showed rapid progression and the patient had neurologic dysfunction with right hemiparesia, and papilla oedema in fundoscopy. Cranial CT showed supratentorial multiple cranial metastases and peritumoral oedema. Since the patient refused radiotherapy, combination chemotherapy was started (Etoposide 100 mg/sq m i.v., days 1,3,5 and cisplatin 80 mg/sq m i.v., day 1). A fast response to the chemotherapy was observed with rapid disappearance of the cervical mass. Following six cycles of the chemotherapy the patient recovered fully and all the lesions disappeared with CT.

  11. High prevalence of TB disease in contacts of adults with extrapulmonary TB.

    Science.gov (United States)

    Wingfield, Tom; MacPherson, Peter; Cleary, Paul; Ormerod, L Peter

    2017-11-16

    UK guidelines no longer recommend routine screening of household contacts of adult patients with extrapulmonary TB (EPTB). From 27 March 2012 to 28 June 2016, we investigated the prevalence of active TB disease in household contacts of 1023 EPTB index cases in North West England, and compared estimates with: published new entrant migrant screening programme prevalence (~147/100 000 person-years); London-based contact screening data (700/100 000 contacts screened); and National Institute for Health and Care Excellence (NICE) new entrant TB screening thresholds (TB prevalence >40/100 000 people). Active TB disease prevalence in EPTB contacts was 440/100 000 contacts screened, similar to UK new entrant screening programmes, London EPTB contact prevalence and >10 times NICE's threshold for new entrant screening. The decision to no longer recommend routine screening of EPTB contacts should be re-evaluated and cost-effectiveness analyses of screening strategies for EPTB contacts should be performed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Multidrug-resistant tuberculosis.

    Science.gov (United States)

    Zager, Ellen M; McNerney, Ruth

    2008-01-25

    With almost 9 million new cases each year, tuberculosis remains one of the most feared diseases on the planet. Led by the STOP-TB Partnership and WHO, recent efforts to combat the disease have made considerable progress in a number of countries. However, the emergence of mutated strains of Mycobacterium tuberculosis that are resistant to the major anti-tuberculosis drugs poses a deadly threat to control efforts. Multidrug-resistant tuberculosis (MDR-TB) has been reported in all regions of the world. More recently, extensively drug resistant-tuberculosis (XDR-TB) that is also resistant to second line drugs has emerged in a number of countries. To ensure that adequate resources are allocated to prevent the emergence and spread of drug resistance it is important to understand the scale of the problem. In this article we propose that current methods of describing the epidemiology of drug resistant tuberculosis are not adequate for this purpose and argue for the inclusion of population based statistics in global surveillance data. Whereas the prevalence of tuberculosis is presented as the proportion of individuals within a defined population having disease, the prevalence of drug resistant tuberculosis is usually presented as the proportion of tuberculosis cases exhibiting resistance to anti-tuberculosis drugs. Global surveillance activities have identified countries in Eastern Europe, the former Soviet Union and regions of China as having a high proportion of MDR-TB cases and international commentary has focused primarily on the urgent need to improve control in these settings. Other regions, such as sub-Saharan Africa have been observed as having a low proportion of drug resistant cases. However, if one considers the incidence of new tuberculosis cases with drug resistant disease in terms of the population then countries of sub-Saharan Africa have amongst the highest rates of transmitted MDR-TB in the world. We propose that inclusion of population based statistics in

  13. Multidrug-resistant tuberculosis

    Directory of Open Access Journals (Sweden)

    McNerney Ruth

    2008-01-01

    Full Text Available Abstract Background With almost 9 million new cases each year, tuberculosis remains one of the most feared diseases on the planet. Led by the STOP-TB Partnership and WHO, recent efforts to combat the disease have made considerable progress in a number of countries. However, the emergence of mutated strains of Mycobacterium tuberculosis that are resistant to the major anti-tuberculosis drugs poses a deadly threat to control efforts. Multidrug-resistant tuberculosis (MDR-TB has been reported in all regions of the world. More recently, extensively drug resistant-tuberculosis (XDR-TB that is also resistant to second line drugs has emerged in a number of countries. To ensure that adequate resources are allocated to prevent the emergence and spread of drug resistance it is important to understand the scale of the problem. In this article we propose that current methods of describing the epidemiology of drug resistant tuberculosis are not adequate for this purpose and argue for the inclusion of population based statistics in global surveillance data. Discussion Whereas the prevalence of tuberculosis is presented as the proportion of individuals within a defined population having disease, the prevalence of drug resistant tuberculosis is usually presented as the proportion of tuberculosis cases exhibiting resistance to anti-tuberculosis drugs. Global surveillance activities have identified countries in Eastern Europe, the former Soviet Union and regions of China as having a high proportion of MDR-TB cases and international commentary has focused primarily on the urgent need to improve control in these settings. Other regions, such as sub-Saharan Africa have been observed as having a low proportion of drug resistant cases. However, if one considers the incidence of new tuberculosis cases with drug resistant disease in terms of the population then countries of sub-Saharan Africa have amongst the highest rates of transmitted MDR-TB in the world. We propose

  14. Epidemiological and cost analysis of multidrug-resistant tuberculosis in Oman.

    Science.gov (United States)

    Mohammadi, A; Nassor, Z S; Behlim, T; Mohammadi, E; Govindarajan, R; Al Maniri, A; Smego, R A

    2008-01-01

    We conducted an epidemiological and cost analysis for all 13 patients diagnosed with multaidrug-resistant tuberculosis (11 pulmonary, 2 extrapulmonary) in Oman from January 2000 to October 2005. The disease was secondary, or acquired, in 12 of 13 patients. A total of 140 contacts were screened (mean 10.8 persons per patient), but contact tracing revealed no secondary cases. The mean number of drugs that TB isolates were resistant to was 2.8 (range 2-5). A mean of 4.7 drugs were given to patients, the mean length of therapy was 8 months and all patients were cured. The cost of medications for these multidrug-resistant cases was 14 to 29 times higher than that for the standard drug-sensitive TB regimen.

  15. Poor response to tuberculosis treatment with regimens without rifampicin in immunosuppressed AIDS patients

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    O'Donnel M.M.

    2002-01-01

    Full Text Available A prospective study was conducted on 79 advanced immunosuppressed AIDS patients from 1997 to 1999, during which nine cases of tuberculosis (TB were diagnosed. The main clinical and laboratory characteristics and the response to TB treatment were reviewed. The clinical manifestations of TB were: pulmonary (six cases, extrapulmonary (two cases and disseminated (one case. These patients were being treated with highly active antiretroviral treatment (HAART and were not responding. In three cases an optional regimen without rifampicin (RMP was indicated to maintain HAART during TB treatment. A clinical response to TB treatment (disappearance of fever was observed in 6/9 patients during a mean of 73 days (SD = 96. The three unresponsive patients were those treated without RMP. A switch to TB regimens containing RMP was proposed and successful. In our study, though it was limited by a small sample size, the response to TB regimens without rifampin was poor in immunossupressed patients failing HAART.

  16. Poor response to tuberculosis treatment with regimens without rifampicin in immunosuppressed AIDS patients

    Directory of Open Access Journals (Sweden)

    M.M. O'Donnel

    Full Text Available A prospective study was conducted on 79 advanced immunosuppressed AIDS patients from 1997 to 1999, during which nine cases of tuberculosis (TB were diagnosed. The main clinical and laboratory characteristics and the response to TB treatment were reviewed. The clinical manifestations of TB were: pulmonary (six cases, extrapulmonary (two cases and disseminated (one case. These patients were being treated with highly active antiretroviral treatment (HAART and were not responding. In three cases an optional regimen without rifampicin (RMP was indicated to maintain HAART during TB treatment. A clinical response to TB treatment (disappearance of fever was observed in 6/9 patients during a mean of 73 days (SD = 96. The three unresponsive patients were those treated without RMP. A switch to TB regimens containing RMP was proposed and successful. In our study, though it was limited by a small sample size, the response to TB regimens without rifampin was poor in immunossupressed patients failing HAART.

  17. Ten-year experiences of the tuberculosis control programme in the southern region of Ethiopia.

    Science.gov (United States)

    Yassin, M A; Datiko, D G; Shargie, E B

    2006-10-01

    The tuberculosis control programme, southern region of Ethiopia. To assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. Of 136,572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear-positive case notification rate increased from 45 to 143 per 100,000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26% to 6% and from 7% to 1%, respectively. There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms.

  18. Expression profiling of lymph nodes in tuberculosis patients reveal inflammatory milieu at site of infection

    Science.gov (United States)

    Maji, Abhijit; Misra, Richa; Kumar Mondal, Anupam; Kumar, Dhirendra; Bajaj, Divya; Singhal, Anshika; Arora, Gunjan; Bhaduri, Asani; Sajid, Andaleeb; Bhatia, Sugandha; Singh, Sompal; Singh, Harshvardhan; Rao, Vivek; Dash, Debasis; Baby Shalini, E; Sarojini Michael, Joy; Chaudhary, Anil; Gokhale, Rajesh S.; Singh, Yogendra

    2015-01-01

    Extrapulmonary manifestations constitute 15 to 20% of tuberculosis cases, with lymph node tuberculosis (LNTB) as the most common form of infection. However, diagnosis and treatment advances are hindered by lack of understanding of LNTB biology. To identify host response, Mycobacterium tuberculosis infected lymph nodes from LNTB patients were studied by means of transcriptomics and quantitative proteomics analyses. The selected targets obtained by comparative analyses were validated by quantitative PCR and immunohistochemistry. This approach provided expression data for 8,728 transcripts and 102 proteins, differentially regulated in the infected human lymph node. Enhanced inflammation with upregulation of T-helper1-related genes, combined with marked dysregulation of matrix metalloproteinases, indicates tissue damage due to high immunoactivity at infected niche. This expression signature was accompanied by significant upregulation of an immunoregulatory gene, leukotriene A4 hydrolase, at both transcript and protein levels. Comparative transcriptional analyses revealed LNTB-specific perturbations. In contrast to pulmonary TB-associated increase in lipid metabolism, genes involved in fatty-acid metabolism were found to be downregulated in LNTB suggesting differential lipid metabolic signature. This study investigates the tissue molecular signature of LNTB patients for the first time and presents findings that indicate the possible mechanism of disease pathology through dysregulation of inflammatory and tissue-repair processes. PMID:26469538

  19. Outcome of multidrug-resistant tuberculosis in human immunodeficiency virus-infected patients.

    Science.gov (United States)

    Franzetti, F; Gori, A; Iemoli, E; Meraviglia, P; Mainini, F; Quirino, T; degli Esposti, A; degl'Innocenti, M; Grassini, A; Nardi, G; Cargnel, A

    1999-09-01

    Among 324 cases of culture-proven tuberculosis from 1988 to 1996 in a hospital in Milan, Italy, 90 (27.8%) were due to Mycobacterium tuberculosis strains resistant to isoniazid and rifampin. Sixty-one of 69 isolates tested had identical restriction fragment length polymorphism patterns. The prevalent strain tested susceptible only to ethionamide and was also resistant to ethambutol, streptomycin, cycloserine, amikacin, kanamycin, terizodone, ofloxacin, rifabutin, rifapentin, and KRM 1648. The median survival time was 94 days. Multivariate analysis showed a trend toward better outcome in the period 1994-1996 (hazard ratio, 4.16; P<.001), and extrapulmonary localization of tuberculosis was the only other independent predictor of a negative outcome (hazard ratio, 2.1; P = .019). The delay from symptoms to beginning of therapy did not seem to be a determining factor in survival time. Standard antituberculosis therapy with four drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) had a higher efficacy than did other regimens with fewer drugs but without a statistically significant difference.

  20. Tuberculose Pélvica Simulando Tumor Ovariano: a Case Report Pelvic Tuberculosis Simulating Ovarian Tumor

    Directory of Open Access Journals (Sweden)

    Marcelo Ivo Campagnolo

    2000-09-01

    Full Text Available A tuberculose pélvica é uma forma de tuberculose extrapulmonar cuja incidência vem aumentando no mundo ocidental. Esta entidade freqüentemente é acompanhada de achados clínicos e laboratoriais que podem ser inespecíficos e mimetizar outras doenças, inclusive neoplasias ginecológicas. Os autores apresentam um caso de tuberculose pélvica associada à tuberculose peritoneal do abdome em uma mulher de 53 anos, que foi submetida a avaliação laboratorial extensa, incluindo laparoscopia diagnóstica, dosagem de CA-125 e reação de Mantoux. Os aspectos clinicopatológicos e os meios propedêuticos para elucidar o caso são discutidos.Pelvic tuberculosis is an extrapulmonary form of tuberculosis with increasing incidence in the western world. Clinical and laboratory findings of this disease are often unspecific and mimic a variety of other disorders, including gynecologic malignant tumors. The authors report a case of a 53-year-old woman with pelvic tuberculosis and associated abdominal tuberculous peritonitis. Laboratory investigation included laparoscopy, CA-125 levels and tuberculin test, among others. Discussion on the clinicopathological aspects and diagnostic methods used to elucidate this case is presented.

  1. FEATURES OF ADOLESCENTS TUBERCULOSIS AT A REFERRAL TB'S HOSPITAL IN TEHRAN, IRAN

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    Ferial Lotfian

    2016-01-01

    Full Text Available Abstract OBJECTIVE: To identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow -up of the diagnosed cases of active tuberculosis (TB adolescents. METHODS: This study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD in Tehran, Iran, between March 2006 and March2011. RESULTS: Of the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%.The most common presenting symptom was cough (86%.Isolated pulmonary TB (PTB was detected in 113 patients (79%, 21 patients (14.7% had extrapulmonary TB(EPTB, and 9 patients (6.3% had PTB and EP TB .The most common site of  EPTB was pleural (14% .The most common radiographic finding was infiltration (61%.Positive acid fast smears were seen in 67.8%.Positive cultures for Mycobacterium tuberculosis(M. TB were seen in 31.6%. Positive PCR results were seen in 60%.The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001, smear positive (p=0.002and have positive PCR results (p=0.009. The type of TB (p=0.017 was a significant factor influencing loss to follow-up. CONCLUSIONS: Adolescents with the high rate of positive sputum smear results and the high treatment default rate are more likely to increase risk for TB transmission to the community. The TB control programs should pay more attention to prevention and treatment of TB in adolescents.     Key words: adolescents, tuberculosis, Lost to follow-up, prevention

  2. Outcome of tuberculosis patients under directly observed short course treatment in western Ethiopia.

    Science.gov (United States)

    Ejeta, Eyasu; Chala, Muda; Arega, Gebeyaw; Ayalsew, Kassahu; Tesfaye, Lensa; Birhanu, Tadesse; Disassa, Haimanot

    2015-07-30

    Treatment outcome is an important indicator of tuberculosis control programs, as suggested by the World Health Organization. However, this has not been well documented in the study area. This work contributes to a better understanding this issue. A five-year (2009-2013) retrospective cohort study was conducted between April and May 2014, in six randomly selected health institutions providing tuberculosis treatment in western Ethiopia. Bivariate and multivariate logistic regression analyses were used to assess the association between treatment outcomes and predictor variables. A total of 1,175 tuberculosis patients with a mean (standard deviation) age of 29.91 (13.99) were involved in the study. The majority of the study participants had smear-negative pulmonary tuberculosis (39.7%) and extrapulmonary tuberculosis (39.7%). Of all the study participants, 14.5% were cured, 56.3% completed treatment, 0.2% had treatment failure, 8.1% died during follow-up, 7.1% were reported as defaulters, and 13.8% were transferred out to another health institution. The overall treatment success rate was 70.8% and show progressive increases over the course of the study. The associated predictors were enrollment years, HIV co-infection, and sputum smear follow-up in the second, fifth, and seven months. The treatment success rate was unsatisfactory in spite of improvement seen over the study period. Thus, continued follow-up of patients, with frequent supportive supervision during the course of treatment, and provision of early detection and follow-up for HIV infection need to be strengthened to achieve an effective treatment outcome.

  3. Antibacterial Activity of Medicinal Aqueous Plant Extracts against Mycobacterium tuberculosis

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    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 in homeless persons in Poland.

    Science.gov (United States)

    Korzeniewska-Koseła, Maria; Kuś, Jan; Lewandowska, Katarzyna; Siemion-Szcześniak, Izabela

    2015-01-01

    The fall in rates of tuberculosis (TB) in many countries has been accompanied by the concentration of cases in the social risk groups including homeless persons. Comparison of TB features in homeless persons and in non-homeless patients. TB cases reported to National TB Register in Poland in whom information about the social status was available (the data about the social status were collected obligatorily in the years 2004-2013 only) were analysed. The results of DSTs were obtained from laboratory records and were available for the cases reported since 2010. Treatment outcome after 12 months was analysed for the cases registered between 2004-2012. The significance (Si) of the differences in proportions was assessed with chi-square test. Phomeless persons (HP) and 72,989 other patients (OP) with TB were included. In the group of HP, there was a greater proportion of males in comparison with OP (90.5% vs. 66.3%) (Si). The mean age of HP was 49.8 years (SD±10.9); of OP-52.9 years (SD±17.5) (Si). 16.6% of HP and 10.4% of OP were previously treated for TB (Si). The previous treatment was adequate in 62.2% of HP and in 85.8% of OP (Si). Pulmonary TB was in 98.0%, extrapulmonary TB in 2.0% of HP and, respectively, in 92.5% and 7.5% of OP (Si). Pulmonary TB was confirmed by culture in 76.3% of HP and in 64.5% of OP (Si). Sputum smears were positive in 70.7% of HP and in 62.5% of OP (Si). Caseous pneumonia occurred in 2.7% of homeless subjects and in 1.1% of OP (Si); infiltrative TB in 95.5% of HP and in 97.5% of OP (Si). Resistance to isoniazid was observed in 2.9% of HP and in 3.1% of OP; to rifampicin in 0.0% of HP and in 0.2% of OP; to isoniazid and rifampicin in 0.4% of HP and in 0.8% of OP. These differences were not Si. Treatment success rate among HP was 44.1%; default rate 24.8%; 4.0% of HP died from tuberculosis; 3.2% died from other causes; 5.2% were transferred and their outcomes were unknown; 0.4% were still on treatment; 0.4% had treatment failure; in 17

  5. Seasonal variation among tuberculosis suspects in four countries

    DEFF Research Database (Denmark)

    Mabaera, Biggie; Naranbat, Nymadawa; Katamba, Achilles

    2009-01-01

    The objective of the study was to analyze monthly trends across a calendar year in tuberculosis suspects and sputum smear-positive cases based on nationally representative samples of tuberculosis laboratory registers from Moldova, Mongolia, Uganda and Zimbabwe. Out of the 47 140 suspects registered...... in the tuberculosis laboratory registers, 13.4% (6312) were cases. The proportion varied from country to country, Moldova having the lowest (9%) and Uganda the highest (21%). From the monthly proportion of suspects and cases among total suspects and cases, seasonal variations were most marked in Mongolia which, among...... attendance to diagnostic laboratory services, evidenced by the contrasting findings of Mongolia (extreme continental northern climate) compared to Uganda (equatorial climate). A combination of external and possibly endogenous factors seems to determine whether tuberculosis suspects and cases present...

  6. Preclinical testing of new drugs for tuberculosis: current challenges.

    Science.gov (United States)

    Lenaerts, Anne J; Degroote, Mary Ann; Orme, Ian M

    2008-02-01

    The continuing global epidemic of tuberculosis, the increasing rate of multidrug resistant (MDR) tuberculosis and the more recent emergence of extensively drug resistant (XDR) tuberculosis are great causes for concern. A major international effort is currently underway to optimize current drug therapies and to discover new drugs that are active against these organisms. This effort has created a pipeline of new candidate drugs at various stages of preclinical and early clinical evaluations. Major challenges still exist, however, varying from the standardization and application of current animal models and their application to drug discovery and characterization to the fact that our knowledge about the basic biology of the MDR and XDR strains of Mycobacterium tuberculosis is minimal at best.

  7. NNDSS - Table III. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table III. Tuberculosis - 2017.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  8. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2014.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  9. Tuberculosis of paranasal sinuses.

    Science.gov (United States)

    Sanehi, S; Dravid, Chandrashekhar; Chaudhary, Neena; Venkatachalam, V P

    2008-03-01

    Nasal tuberculosis is very rare but much rarer is tuberculosis of paranasal sinuses. It involves especially the maxillary sinus and is usually unilateral. We report an unusual case of tuberculosis of frontal and maxillary sinus in a 68 years old male, who presented with a swelling above left medial canthus, with no other eye or nasal complaints. Clinical and radiological findings on our initial evaluation suggested that the patient had left frontal mucocoele with bilateral maxillary haziness. Diagnosis was established on FNAC report and subsequent Ziehl - Neelsen staining of nasal swabs and tuberculin skin test. Later chest x-ray examination was suggestive of pulmonary tuberculosis, which was the primary cause. Patient responded well to antituberculosis drug therapy.

  10. Mycobacterium tuberculosis Metabolism

    Science.gov (United States)

    Warner, Digby F.

    2015-01-01

    Metabolism underpins the physiology and pathogenesis of Mycobacterium tuberculosis. However, although experimental mycobacteriology has provided key insights into the metabolic pathways that are essential for survival and pathogenesis, determining the metabolic status of bacilli during different stages of infection and in different cellular compartments remains challenging. Recent advances—in particular, the development of systems biology tools such as metabolomics—have enabled key insights into the biochemical state of M. tuberculosis in experimental models of infection. In addition, their use to elucidate mechanisms of action of new and existing antituberculosis drugs is critical for the development of improved interventions to counter tuberculosis. This review provides a broad summary of mycobacterial metabolism, highlighting the adaptation of M. tuberculosis as specialist human pathogen, and discusses recent insights into the strategies used by the host and infecting bacillus to influence the outcomes of the host–pathogen interaction through modulation of metabolic functions. PMID:25502746

  11. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2015.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  12. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2016.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  13. HIV and Tuberculosis (TB)

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV and Opportunistic Infections, Coinfections, and Conditions Home Understanding ... 4 p.m. ET) Send us an email HIV and Tuberculosis (TB) Last Reviewed: July 26, 2017 ...

  14. Tuberculosis (For Parents)

    Science.gov (United States)

    ... vaccine called BCG (Bacille Calmette-Guérin) is considered controversial because it isn't very effective in countries ... Teens For Kids For Parents MORE ON THIS TOPIC Pneumonia HIV and AIDS Fevers Immunizations Tuberculosis Contact ...

  15. Tuberculosis concomitant with diabetes

    Directory of Open Access Journals (Sweden)

    S. Rodríguez-Rodríguez

    2015-10-01

    The aim of this study is to analyse the different factors involved in this phenomenon and to give a clear, comprehensive picture of the problem of tuberculosis resurgence and its correlation with diabetes and metabolic syndrome.

  16. Tuberculosis in AIDS Patients

    Science.gov (United States)

    Nissapatorn, Veeranoot; Lee, Christopher; Ithoi, Init; Yik, Fong Mun; Abdullah, Khairul Anuar

    2003-01-01

    Tuberculosis is the top agenda among opportunistic diseases and the most leading cause of death in HIV/AIDS patients. A total of 406 AIDS patients were recruited in this retrospective and descriptive study. 123/406 (30.3%) were diagnosed as AIDS-related tuberculosis (TB). Their age range from 17 to 69 years with a mean (±SD) of 37.2 (±9.51. There were significant association between occupation, or mode of HIV transmission and tuberculosis infection (p< 0.05). Pulmonary tuberculosis 104/123 (84.6%) was the most common disease location among TB patients. We found the significant association between the clinical presentations i.e. fever, cough, sputum or hemoptysis and TB patients (p<0.05), moreover, the level of CD4 cell count plays a significant role in association with the disease (p<0.05) in this study. PMID:23365502

  17. Regulatory T Cells and Pro-inflammatory Responses Predominate in Children with Tuberculosis

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    Elizabeth Whittaker

    2017-04-01

    Full Text Available BackgroundFollowing infection with Mycobacterium tuberculosis (M.tb, children are more susceptible to develop disease particularly extrapulmonary disease than adults. The exact mechanisms required for containment of M.tb are not known, but would be important to identify correlates of protection.ObjectiveTo comprehensively analyze key immune responses to mycobacteria between HIV-negative children with extrapulmonary TB (EPTB compared to children with pulmonary TB (PTB or healthy controls.MethodsWhole blood was stimulated in vitro with mycobacteria for 24 h or 6 days to induce effector and memory responses. CD4, CD8, γδ, regulatory T cells, and their related cytokines were measured. Samples of children with tuberculosis (TB disease were analyzed both at time of diagnosis and at the end of TB treatment to determine if any differences were due to TB disease or an underlying host phenotype.ResultsSeventy-six children with TB disease (48 with PTB and 28 with EPTB and 83 healthy controls were recruited to the study. The frequency of CD4+CD25+CD39+FOXP3+ regulatory T cells and secreted IL10 were significantly higher in children with TB compared to healthy controls. IFNγ-, IL17-, and IL22-producing γδ T cells, IL22-producing CD4+ T cells and secreted pro-inflammatory cytokines (IFNγ, IL1β, and TNFα were significantly lower in children with TB disease compared to healthy controls. IFNγ-producing CD4+ T cells and Ki67+-proliferating CD4+ T cells, however, were present in equal numbers in both groups. Following treatment, these immune parameters recovered to “healthy” levels or greater in children with PTB, but not those with extrapulmonary TB.ConclusionIn children with TB disease, a predominantly immune regulatory state is present. These immune findings do not distinguish between children with PTB and EPTB at the time of diagnosis. Following treatment, these inflammatory responses recover in PTB, suggesting that the effect is disease

  18. Low-Density Granulocytes Are Elevated in Mycobacterial Infection and Associated with the Severity of Tuberculosis.

    Science.gov (United States)

    Deng, Yating; Ye, Jianqing; Luo, Qing; Huang, Zhikun; Peng, Yiping; Xiong, Guoliang; Guo, Yang; Jiang, Hong; Li, Junming

    2016-01-01

    Tuberculosis remains a global health problem caused by infection with Mycobacterium tuberculosis. Numerous studies have established a close correlation between the development of tuberculosis and the roles of neutrophils. Recently, a distinct population of CD15+ granulocytes was found to be present in the peripheral blood mononuclear cell (PBMC) fraction in humans. This population of granulocytes, termed low-density granulocytes (LDGs), was reported to be elevated and associated with disease activity or severity in a number of different conditions including SLE, asthma and HIV infection. However, both the frequency and clinical significance of LDGs associated with tuberculosis are unclear. Here we determined LDG levels and made comparisons between subjects with active pulmonary tuberculosis (PTB) and healthy controls, between PTB patients with mild-to-moderate disease and patients with advanced disease, and among PTB patients following anti-tuberculous therapy of varying durations. The direct correlation between M. tuberculosis infection and LDG levels was confirmed by in vitro infection of whole peripheral blood and isolated granulocytes with mycobacteria. Our results demonstrated that PBMCs in PTB patients contained significantly elevated percentages of LDGs compared with control subjects. LDGs in tuberculosis expressed higher levels of activation markers compared to normal-density granulocytes (NDGs). M. tuberculosis induced the generation of LDGs in both whole blood and isolated NDGs from control subjects, which suggests that LDGs associated with M. tuberculosis infection are likely to originate from in situ activation. Furthermore, our results revealed that the frequency of LDGs is associated with the severity of tuberculosis.

  19. Low-Density Granulocytes Are Elevated in Mycobacterial Infection and Associated with the Severity of Tuberculosis.

    Directory of Open Access Journals (Sweden)

    Yating Deng

    Full Text Available Tuberculosis remains a global health problem caused by infection with Mycobacterium tuberculosis. Numerous studies have established a close correlation between the development of tuberculosis and the roles of neutrophils. Recently, a distinct population of CD15+ granulocytes was found to be present in the peripheral blood mononuclear cell (PBMC fraction in humans. This population of granulocytes, termed low-density granulocytes (LDGs, was reported to be elevated and associated with disease activity or severity in a number of different conditions including SLE, asthma and HIV infection. However, both the frequency and clinical significance of LDGs associated with tuberculosis are unclear. Here we determined LDG levels and made comparisons between subjects with active pulmonary tuberculosis (PTB and healthy controls, between PTB patients with mild-to-moderate disease and patients with advanced disease, and among PTB patients following anti-tuberculous therapy of varying durations. The direct correlation between M. tuberculosis infection and LDG levels was confirmed by in vitro infection of whole peripheral blood and isolated granulocytes with mycobacteria. Our results demonstrated that PBMCs in PTB patients contained significantly elevated percentages of LDGs compared with control subjects. LDGs in tuberculosis expressed higher levels of activation markers compared to normal-density granulocytes (NDGs. M. tuberculosis induced the generation of LDGs in both whole blood and isolated NDGs from control subjects, which suggests that LDGs associated with M. tuberculosis infection are likely to originate from in situ activation. Furthermore, our results revealed that the frequency of LDGs is associated with the severity of tuberculosis.

  20. Nebulized cyclosporine in the rat: assessment of regional lung and extrapulmonary deposition.

    Science.gov (United States)

    Blot, F; Faurisson, F; Bernard, N; Sellam, S; Friard, S; Tavakoli, R; Carbon, C; Stern, M; Bisson, A; Pocidalo, J J; Caubarrere, I

    1999-07-27

    Nebulized cyclosporine (CsA) has been shown to limit lung allograft rejection as well as intramuscular (IM) CsA, with limited blood diffusion. The present study determined the pharmacokinetic parameters of nebulized CsA, by the assessment of regional lung deposition and extrapulmonary diffusion of CsA. CsA was given either by IM injection (10 mg/kg) or by aerosol (at 10 and 25 mg/kg doses); 70 rats were killed at 25 and 50 min, and at 2, 4, 6, 8, 12, 24, or 48 hr after CsA administration. CsA levels were measured in the whole lung, in central and peripheral parts of the lung, in whole blood, kidney, and heart. The areas under the concentration time curves (AUCs) were determined. In blood, kidney, and heart, CsA levels were significantly higher for IM than for aerosol administrations at 10 and 25 mg/kg doses. In the whole lung, the AUC was greater for the aerosol route at 25 mg/kg doses (588 ng x hr/mg) than for the low-dose (200 ng x hr/mg) or IM administration (200 ng x hr/mg). The central to peripheral index of CsA (ratio of AUC central/peripheral part of the lung) was not significantly different for both aerosol administrations (0.63 and 0.69, respectively) and for the IM route (0.81). Nebulized CsA allows better pulmonary concentration than IM administration, with equivalent central and peripheral deposition whatever the mode of administration, and results in lower levels in blood, kidney, and heart.

  1. Lung deposition and extrapulmonary translocation of nano-ceria after intratracheal instillation

    Energy Technology Data Exchange (ETDEWEB)

    He Xiao; Zhang Haifeng; Ma Yuhui; Bai Wei; Zhang Zhiyong; Ding Yayun; Zhao Yuliang; Chai Zhifang [CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, CAS Key Laboratory of Nuclear Analytical Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049 (China); Lu Kai, E-mail: hx421@ihep.ac.cn, E-mail: zhanghf@ihep.ac.cn, E-mail: mayh@ihep.ac.cn, E-mail: baiw@ihep.ac.cn, E-mail: zhangzhy@ihep.ac.cn, E-mail: jkliiii4@163.com, E-mail: dingyy@ihep.ac.cn, E-mail: zhaoyuliang@ihep.ac.cn, E-mail: chaizf@ihep.ac.cn [School of Biological Science and Engineering, South China University of Technology, Guangzhou 510641 (China)

    2010-07-16

    The broad potential applications of manufactured nanomaterials call for urgent assessment of their environmental and biological safety. However, most of the previous work focused on the cell level performance; little was known about the consequences of nanomaterial exposure at the whole-body and organ levels. In the present paper, the radiotracer technique was employed to study the pulmonary deposition and the translocation to secondary target organs after ceria nanoparticles (nano-ceria) were intratracheally instilled into Wistar rats. It was found that 63.9 {+-} 8.2% of the instilled nano-ceria remained in the lung by 28 d postexposure and the elimination half-life was 103 d. At the end of the test period, only 1/8-1/3 of the daily elimination of nano-ceria from the lung was cleared via the gastrointestinal tract, suggesting that phagocytosis by alveolar macrophages (AMs) with subsequent removal towards the larynx was no longer the predominant route for the elimination of nano-ceria from the lung. The whole-body redistribution of nano-ceria demonstrated that the deposited nano-ceria could penetrate through the alveolar wall into the systemic circulation and accumulate in the extrapulmonary organs. In vitro study suggested that nano-ceria would agglomerate and form sediments in the bronchoalveolar aqueous surrounding while binding to protein would be conducive to the redispersion of nano-ceria. The decrease in the size of agglomerates might enhance the penetration of nano-ceria into the systemic circulation. Our findings suggested that the effect of nanomaterial exposure, even at low concentration, should be assessed because of the potential lung and systemic cumulative toxicity of the nanomaterials.

  2. Pulmonary and extrapulmonary complications of human rhinovirus infection in critically ill patients.

    Science.gov (United States)

    To, Kelvin K W; Lau, Susanna K P; Chan, Kwok-Hei; Mok, Ka-Yi; Luk, Hayes K H; Yip, Cyril C Y; Ma, Yat-Kwan; Sinn, Lorraine H Y; Lam, Sonia H Y; Ngai, Chun-Wai; Hung, Ivan F N; Chan, Kwok-Hung; Yuen, Kwok-Yung

    2016-04-01

    Human rhinovirus (HRV) is frequently detected in patients with respiratory tract infection. However, the full clinical spectrum of HRV infection in critically ill patients is not well characterized. To evaluate the clinical and virological characteristics of critically ill patients with HRV infection. HRV-specific reverse transcription-polymerase chain reaction (RT-PCR) was performed on nasopharyngeal aspirate (NPA) specimens from 294 adult patients who required admission into the intensive care unit (ICU). Clinical characteristics were analyzed. HRV genotyping using the 5'UTR-VP4-VP2 region was performed. HRV was detected in NPA specimens of 22 patients (7.5%) by RT-PCR. Dyspnea was the most common presenting symptom (16/22; 72.7%), but seizure also occurred in 5 (22.7%) patients. Exacerbation of underlying disease occurred in 12 (54.5%) patients. Four (18.2%) patients died, and HRV was considered to play a role as the cause of death in 3 patients. Thirteen (59.1%) patients had pneumonia, and the most common radiological finding was consolidation (6/1