المؤلفون: Eletreby, Rasha¹ (AUTHOR), Elsharkawy, Aisha¹ (AUTHOR), Mohamed, Rahma¹ (AUTHOR) rahma-mohamed@kasralainy.edu.eg, Hamed, Mai² (AUTHOR), Kamal Ibrahim, Eman³ (AUTHOR), Fouad, Rabab¹ (AUTHOR)

المصدر: BMC Infectious Diseases. 7/9/2024, Vol. 24 Issue 1, p1-13. 13p.

مصطلحات موضوعية: *EXTRAPULMONARY tuberculosis, *VITAMIN D deficiency, *CHOLECALCIFEROL, *DIETARY supplements, *END of treatment, *TUBERCULOUS meningitis

مستخلص: Background: We aimed to assess serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in extrapulmonary tuberculosis (EPTB) patients and to evaluate the effect of vitamin D3 supplementation on their treatment course. Methods: Serum 25(OH)D3concentrations were measured in 47 newly diagnosed EPTB patients and 42 controls. Vitamin D-deficient EPTB patients were randomly assigned to receive 50,000 IU of vitamin D3 (cholecalciferol) orally once a week for 6 weeks (total 300,000 IU), followed by maintenance doses of 1000 IU a day besides anti-TB drugs or the first line anti-TB treatment only. Follow up serum 25(OH)D3 concentrations were measured after 3 months of starting vitamin D3 supplementation. Both groups were evaluated for clinical, laboratory, and radiological outcomes after treatment. Results: Serum 25(OH)D3 concentrations were significantly lower among TB cases (17.1 ± 5.5 nmol/L) compared to healthy controls (51.8 ± 27.3 nmol/L), and vitamin D deficiency was observed in all EPTB patients (n = 47). Patients in VD3 supplementation group had significantly higher weight gain and serum albumin level at 2 months and end of treatment, higher hemoglobin concentration at the end of treatment, significantly lower CRP and ESR at 2 months and at the end of treatment. In cases with TB pleurisy, a significant higher rate of full resolution of pleural fluid after 6 months of anti-TB treatment and shorter treatment duration were noted compared to the other group. Conclusions: Vitamin D deficiency is prevalent in EPTB patients, in whom, vitamin D supplementation is a useful adjunctive therapy to anti-TB drugs and improves treatment course. [ABSTRACT FROM AUTHOR]

المؤلفون: Sohail, Marium¹ (AUTHOR), Maniar, Arpita² (AUTHOR), Winn, Bryan J.³ (AUTHOR), Patel, Shreya⁴ (AUTHOR), Famuyide, Akinrinola⁴ (AUTHOR), Dagi Glass, Lora R.² (AUTHOR) ld2514@cumc.columbia.edu

المصدر: Orbit. Jun2024, Vol. 43 Issue 3, p344-349. 6p.

مصطلحات موضوعية: *EXTRAPULMONARY tuberculosis, *TUBERCULOSIS, *COMPUTED tomography, *EDEMA

مستخلص: Orbital tuberculosis is a manifestation of extra-pulmonary tuberculosis that is challenging to diagnose and treat. Here, we describe the pivotal role of serial imaging in the diagnosis and treatment of orbital tuberculosis. A 28-year-old male presented with recurrent right upper eyelid swelling and a supraduction deficit associated with a firm painless orbital mass, seen on initial computed tomography to be an extensive superomedial lesion producing mass effect. Biopsy revealed a tuberculosis-like granulomatous inflammation, which, coupled with a positive QuantiFERON gold test, led to empiric anti-tuberculin treatment. Serial radiologic imaging following initiation of treatment showed progressive reduction in mass size, supporting the diagnosis and determining the length of treatment. This rare case demonstrates the utility of serial radiologic exams in the diagnosis and treatment of orbital tuberculosis. [ABSTRACT FROM AUTHOR]

المؤلفون: Hayre, Kedija¹ (AUTHOR), Takele, Mihiretu Kumie¹ (AUTHOR), Birri, Dagim Jirata² (AUTHOR) dagimj@yahoo.com

المصدر: PLoS ONE. 5/21/2024, Vol. 19 Issue 5, p1-10. 10p.

مصطلحات موضوعية: *TUBERCULOSIS, *EXTRAPULMONARY tuberculosis, *TREATMENT effectiveness, *MEDICAL centers, *HEALTH facilities, *LOGISTIC regression analysis, *ARACHNOID cysts

مصطلحات جغرافية: ETHIOPIA

مستخلص: Background: Tuberculosis (TB) is a global public health problem. Evaluation of TB treatment outcome enables health institutions to measure and improve the effectiveness of TB control programs. This study aimed to assess treatment outcomes of tuberculosis and identify associated factors among TB patients registered at Alemgena Health Center, Oromia, Ethiopia. Method: A retrospective study was conducted; Secondary data were collected from medical records of 1010 TB patients treated at Alemgena Health Center between September 2012 and August 2018, inclusively. Logistic regression was used to identify factors associated with TB treatment outcomes. P-value less than 0.05 was considered statistically significant. Results: The proportion of males and females was almost equal. Among the patients 64.7% were in the age group 15–34, 98% were new cases, 31.2% were smear positive, 13% were HIV positive and 40.3% had extra-pulmonary tuberculosis. 94.2% of the patients had successful treatment outcome, with 26.9% cured and 67.3% treatment completed, whereas 5.8% had unsuccessful treatment outcomes, of whom 4.2% died and 1.5% defaulted. Death rate was higher among patients older than 44 years (10.4%) than among children (0%). In bivariate logistic regression analysis, treatment success rate was 3.582 (95% CI 1.958–6.554, p-value =.000) times higher in the age group 44 and below compared to the age group 45 and above. Conclusion: Treatment success rate exceeded the one targeted by WHO. Age was found to be associated with treatment outcome. Success rate has to be improved for TB patients in the age group greater than 45 years of age. [ABSTRACT FROM AUTHOR]

المؤلفون: Zang, Xinxin¹ (AUTHOR), Zhang, Jiajun¹ (AUTHOR), Jiang, Yanyan¹ (AUTHOR), Feng, Tingting¹ (AUTHOR), Cui, Yingying¹ (AUTHOR), Wang, Hui¹ (AUTHOR), Cui, Ziyin¹ (AUTHOR), Dang, Guanghui¹ (AUTHOR) dangguanghui@caas.cn, Liu, Siguo¹ (AUTHOR) dangguanghui@caas.cn

المصدر: PLoS Pathogens. 5/9/2024, Vol. 20 Issue 5, p1-23. 23p.

مصطلحات موضوعية: *MYCOBACTERIUM tuberculosis, *EXTRAPULMONARY tuberculosis, *TIGHT junctions, *SERINE, *ADHERENS junctions, *CADHERINS, *CLAUDINS

مستخلص: Epithelial cells function as the primary line of defense against invading pathogens. However, bacterial pathogens possess the ability to compromise this barrier and facilitate the transmigration of bacteria. Nonetheless, the specific molecular mechanism employed by Mycobacterium tuberculosis (M.tb) in this process is not fully understood. Here, we investigated the role of Rv2569c in M.tb translocation by assessing its ability to cleave E-cadherin, a crucial component of cell-cell adhesion junctions that are disrupted during bacterial invasion. By utilizing recombinant Rv2569c expressed in Escherichia coli and subsequently purified through affinity chromatography, we demonstrated that Rv2569c exhibited cell wall–associated serine protease activity. Furthermore, Rv2569c was capable of degrading a range of protein substrates, including casein, fibrinogen, fibronectin, and E-cadherin. We also determined that the optimal conditions for the protease activity of Rv2569c occurred at a temperature of 37°C and a pH of 9.0, in the presence of MgCl2. To investigate the function of Rv2569c in M.tb, a deletion mutant of Rv2569c and its complemented strains were generated and used to infect A549 cells and mice. The results of the A549-cell infection experiments revealed that Rv2569c had the ability to cleave E-cadherin and facilitate the transmigration of M.tb through polarized A549 epithelial cell layers. Furthermore, in vivo infection assays demonstrated that Rv2569c could disrupt E-cadherin, enhance the colonization of M.tb, and induce pathological damage in the lungs of C57BL/6 mice. Collectively, these results strongly suggest that M.tb employs the serine protease Rv2569c to disrupt epithelial defenses and facilitate its systemic dissemination by crossing the epithelial barrier. Author summary: Mycobacterium tuberculosis (M.tb) causes tuberculosis (TB), a highly contagious respiratory disease and a leading cause of death worldwide. Following the inhalation of aerosol particles, the bacteria often establish a persistent infection within the lungs, leading to the development of the characteristic pulmonary TB syndrome. Additionally, M.tb can breach alveolar barrier, thereby initiating extrapulmonary TB. The pathogenesis of M.tb heavily relies on systemic dissemination, although the precise underlying mechanism remains incompletely elucidated. The alveolar epithelial barrier, composed of tight junctions and adherens junctions, plays a crucial role in safeguarding against invading pathogens. In this study, we present groundbreaking discoveries pertaining to the extracellular serine protease Rv2569c of M.tb, which facilitates bacterial transmigration through the cleavage of E-cadherin. Furthermore, we ascertain that Rv2569c elicits profound pathological harm and enhances M.tb colonization within murine pulmonary tissues. These findings contribute to a deeper comprehension of the pathogenic mechanisms employed by M.tb and hold potential for informing future strategies aimed at controlling TB infections. [ABSTRACT FROM AUTHOR]

المؤلفون: Lalanda, Raquel¹ (AUTHOR) raquellalanda@gmail.com, Barão, Andreia¹ (AUTHOR), Draiblate, Beatriz¹ (AUTHOR), Malcato, Ester¹ (AUTHOR), Matos, Hélder¹ (AUTHOR), Girão, José¹ (AUTHOR), Rosa, Rosário¹ (AUTHOR), Freire, José Paulo¹ (AUTHOR), Miranda, Luís¹ (AUTHOR)

المصدر: Clinical Case Reports. May2024, Vol. 12 Issue 5, p1-7. 7p.

مصطلحات موضوعية: *FOURNIER gangrene, *EXTRAPULMONARY tuberculosis, *TUBERCULOSIS, *SYMPTOMS, *ADULT respiratory distress syndrome, *NECROTIZING fasciitis

مستخلص: Key Clinical Message: In the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as a potential underlying cause. Tuberculosis cutis orificialis is a rare form of extrapulmonary tuberculosis that affects the perianal region. Fournier's gangrene is an aggressive necrotizing fasciitis that primarily involves the perianal area and external genitalia. A previously healthy 38‐year‐old man presented with a left perianal abscess. His condition deteriorated, leading to septic shock and multiorgan dysfunction syndrome. A CT scan displayed extensive necrotizing fasciitis. Treatment included broad‐spectrum antibiotics, numerous surgical perineal debridements, a transverse loop colostomy, and hyperbaric oxygen therapy. We believe the patient had pre‐existing asymptomatic, non‐diagnosed perianal tuberculosis, and a subsequent bacterial superinfection resulted in a perineal local abscess that progressed to severe Fournier's gangrene. The diagnosis of tuberculosis was confirmed through positive cultures and molecular identification in perineal biopsies. The patient experienced a complex clinical course with complications such as myocardial necrosis, acute respiratory distress syndrome, rhabdomyolysis with severe critical illness polyneuromyopathy and internal jugular thrombosis. Fournier's gangrene resulted in air dissection throughout the perineal fasciae, extending to the abdominal wall muscles resulting in an infected extraperitoneal spontaneous hematoma, probably caused by therapeutic anticoagulation. An extraperitoneal surgical drainage was performed. This case emphasizes the complexities in diagnosing and managing both perianal tuberculosis and Fournier's gangrene. [ABSTRACT FROM AUTHOR]

المؤلفون: Basnet, Preeti¹ (AUTHOR), Joshi, Anish¹ (AUTHOR), Karki, Saurab² (AUTHOR), Thapa, Anil Jung² (AUTHOR), Poudel, Prayash³ (AUTHOR), Sapkota, Anugya¹ (AUTHOR), Shrestha, Manoj¹ (AUTHOR), Pande, Shreebridhi⁴ (AUTHOR)

المصدر: Case Reports in Infectious Diseases. 4/27/2024, Vol. 2024, p1-5. 5p.

مصطلحات موضوعية: *PARAPLEGIA, *EXTRAPULMONARY tuberculosis, *SPINAL tuberculosis, *ANTITUBERCULAR agents, *DISEASE complications, *SPINE abnormalities

مستخلص: Introduction. Potts disease is extrapulmonary skeletal tuberculosis mostly affecting the thoracolumbar spine. It destroys the disc space, adjacent vertebral bodies, and spinal elements, leading to cord compression and paraplegia. Methods. This is a case report study of a 29-month-old toddler who presented to our hospital with bilateral lower limb weakness. Results. On clinical, laboratory, and radiological examination, she was diagnosed with Pott's spine, started on antitubercular therapy, and planned for surgery in her follow-up. Conclusion. Tuberculosis of the spine is still prevalent in developing countries, mainly in children. Complications of the disease can be devastating because of its ability to cause bone destruction, spinal deformity, and paraplegia. So, in a tuberculosis-endemic region, clinical suspicion should be there for Potts disease when a child presents with paraplegia of the lower limbs. Children can develop tuberculosis which can spread to the spine despite vaccination. The prognosis of spinal tuberculosis is improved by early diagnosis and rapid intervention. [ABSTRACT FROM AUTHOR]

المؤلفون: G. S., Praveen¹, Kambar, Sanjay S.², M. V., Sajna³ mvsajna@yahoo.com, Areekal, Binu⁴

المصدر: International Journal of Medicine & Public Health. Apr-Jun2024, Vol. 14 Issue 2, p22-25. 4p.

مصطلحات موضوعية: *EXTRAPULMONARY tuberculosis, *DIABETES, *TUBERCULOSIS, *TUBERCULOSIS patients, *CASE-control method

مصطلحات جغرافية: INDIA

مستخلص: Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd's ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. [ABSTRACT FROM AUTHOR]

المؤلفون: Kurver, Lisa¹ (AUTHOR), Seers, Timothy² (AUTHOR), Dorp, Suzanne van³ (AUTHOR), Crevel, Reinout van¹ (AUTHOR), Pollara, Gabriele^2,4 (AUTHOR) g.pollara@ucl.ac.uk, Laarhoven, Arjan van¹ (AUTHOR) g.pollara@ucl.ac.uk

المصدر: Open Forum Infectious Diseases. Apr2024, Vol. 11 Issue 4, p1-9. 9p.

مصطلحات موضوعية: *HEMOPHAGOCYTIC lymphohistiocytosis, *EXTRAPULMONARY tuberculosis, *MYCOBACTERIUM tuberculosis, *IMMUNE reconstitution inflammatory syndrome, *LUNG diseases, *TUBERCULIN test

مستخلص: Background Tuberculosis (TB) can induce secondary hemophagocytic lymphohistiocytosis (HLH), a severe inflammatory syndrome with high mortality. We integrated all published reports of adult HIV-negative TB-associated HLH (TB-HLH) to define clinical characteristics, diagnostic strategies, and therapeutic approaches associated with improved survival. Methods PubMed, Embase, and Global Index Medicus were searched for eligible records. TB-HLH cases were categorized into (1) patients with a confirmed TB diagnosis receiving antituberculosis treatment while developing HLH and (2) patients presenting with HLH of unknown cause later diagnosed with TB. We used a logistic regression model to define clinical and diagnostic parameters associated with survival. Results We identified 115 individual cases, 45 (39.1%) from countries with low TB incidence (<10/100 000 per year). When compared with patients with HLH and known TB (n = 21), patients with HLH of unknown cause (n = 94) more often had extrapulmonary TB (66.7% vs 88.3%), while the opposite was true for pulmonary disease (91.5% vs 59.6%). Overall, Mycobacterium tuberculosis was identified in the bone marrow in 78.4% of patients for whom examination was reported (n = 74). Only 10.5% (4/38) of patients tested had a positive result upon a tuberculin skin test or interferon-γ release assay. In-hospital mortality was 28.1% (27/96) in those treated for TB and 100% (18/18) in those who did not receive antituberculosis treatment (P <.001). Conclusions Tuberculosis should be considered a cause of unexplained HLH. TB-HLH is likely underreported, and the diagnostic workup of patients with HLH should include bone marrow investigations for evidence of Mycobacerium tuberculosis. Prompt initiation of antituberculosis treatment likely improves survival in TB-HLH. [ABSTRACT FROM AUTHOR]

المؤلفون: Bejja, Fadia¹, Dahou, Badreddine¹ badreddine.dahou@gmail.com, Aboulhoda, Fatiha¹, Mokhtari, Abdelrhani¹, Soulaymani, Abdelmajid¹

المصدر: Bangladesh Journal of Medical Science. Apr2024, Vol. 23 Issue 2, p521-526. 6p.

مصطلحات موضوعية: *EXTRAPULMONARY tuberculosis, *TUBERCULOSIS, *THERAPEUTICS, *TUBERCULOSIS patients, *RESPIRATORY diseases, *SPINAL tuberculosis

مصطلحات جغرافية: MOROCCO

مستخلص: In countries like Morocco, drug-sensitive tuberculosis remains a major public health burden. Effective management of this condition is crucial, not only to achieve positive therapeutic outcomes for patients but also to curb its emergence and transmission. This study presents a detailed analysis of the therapeutic approach to drug-sensitive tuberculosis in Morocco. This retrospective study provides an overview of the therapeutic protocol used to treat drug-sensitive tuberculosis. The study examined all tuberculosis patients registered at the Tuberculosis and Respiratory Diseases Diagnostic Center in Kenitra from 2014 to 2017. A total of 5207 tuberculosis cases were recorded, with men comprising the majority of patients (63%) in this group, with a sex ratio of 1.7. The most affected age groups were 15 to 24 years and 25 to 34 years. Urban areas had a representation of 53%. The study revealed that 54% of cases were pulmonary, and extrapulmonary tuberculosis accounted for 46%. There were two main stages to the treatment regimens recommended by the WHO. During the initial phase, 96% of patients received a two-month quadritherapy (for new cases), 3% received a three-month regimen (for retreatment cases), and 2% received a three-drug therapy (for those under 15 years). This phase was followed by a continuation phase (bitherapy) lasting four to ten months. 82% of cases showed positive progression, 13% of patients experienced loss to follow-up, 1% had transfers out, and 2% of patients died. The study emphasizes the importance of integrating patient support, education on treatment, and the use of new technologies to enhance the monitoring and follow-up of tuberculosis patients. These measures could help reduce the morbidity and mortality associated with tuberculosis, contributing to overall health improvement. [ABSTRACT FROM AUTHOR]

المؤلفون: Möller, Kathleen¹ (AUTHOR) k.moeller@live.de, Löwe, Axel² (AUTHOR) axel.loewe@hirslanden.ch, Jenssen, Christian^3,4 (AUTHOR) c.jenssen@khmol.de, Chaubal, Nitin^5,6 (AUTHOR) thaneultrasound@gmail.com, Gottschall, Heike¹ (AUTHOR) heike.gottschall@sana.de, Misselwitz, Benjamin⁷ (AUTHOR) benjamin.misselwitz@insel.ch, Kurapati, Meghana Reddy³ (AUTHOR) anoopreddy27@gmail.com, Puritipati, Anoop Reddy³ (AUTHOR), Dong, Yi⁸ (AUTHOR) drdaisydong@hotmail.com, Faiss, Siegbert¹ (AUTHOR) siegbert.faiss@sana.de, Dietrich, Christoph F.² (AUTHOR) c.f.dietrich@googlemail.com

المصدر: Diagnostics (2075-4418). Apr2024, Vol. 14 Issue 7, p706. 35p.

مصطلحات موضوعية: *EXTRAPULMONARY tuberculosis, *ULTRASONIC imaging, *POINT-of-care testing, *CONTRAST-enhanced ultrasound, *TUBERCULOSIS

مستخلص: This review describes the appearance of extrapulmonary tuberculosis manifestations in comprehensive and multiparametric ultrasound imaging. The aim is to increase awareness of typical ultrasound findings regarding extrapulmonary tuberculosis, correlate those with pathological features, and facilitate differential diagnosis. Point of care ultrasound protocols can be used as a screening method in high-risk populations, although the negative findings do not exclude tuberculosis. Conversely, the diagnosis of extrapulmonary tuberculosis can never be made using ultrasound alone, as many ultrasound findings in extrapulmonary tuberculosis are non-specific. However, ultrasound-based sampling techniques can significantly facilitate the collection of samples for microbiological or molecular proof of tuberculosis, as well as facilitating the establishment of alternative diagnoses. [ABSTRACT FROM AUTHOR]