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Clinical Medicine (London, England) Mar 2023We describe an active and latent tuberculosis (TB) screening programme undertaken in Manchester, UK in response to the arrival of a cohort of refugees from Afghanistan....
We describe an active and latent tuberculosis (TB) screening programme undertaken in Manchester, UK in response to the arrival of a cohort of refugees from Afghanistan. In total, 217 adults and 347 children were offered screening, which involved a symptom questionnaire, Mantoux test or interferon gamma release assay, blood-borne virus screening and a chest X-ray in participants over the age of 11. We found a latent TB infection (LTBI) rate of 15% in adults and 1.5% in children, which is lower than global LTBI estimates. One case of active TB was detected. Screening was undertaken in the hotels where participants were temporarily housed, leading to high participant engagement levels. Attendance rates were almost doubled compared with a previous hospital-based screening programme. Hotel-based screening for TB presented several challenges, including transfer of information and results to secondary care. Understanding these challenges and learning from the programme has helped us refine our screening protocol to optimise migrant TB screening in Manchester in the future.
Topics: Child; Adult; Humans; Latent Tuberculosis; Afghanistan; Feasibility Studies; Tuberculosis; Interferon-gamma Release Tests; Mass Screening
PubMed: 36958840
DOI: 10.7861/clinmed.2022-0327 -
The American Journal of Case Reports Mar 2023BACKGROUND Tuberculosis (TB), a global public health problem, is a disease with a high incidence and prevalence worldwide. The risk of developing TB increases after...
BACKGROUND Tuberculosis (TB), a global public health problem, is a disease with a high incidence and prevalence worldwide. The risk of developing TB increases after starting anti-tumor necrosis factor (TNF) therapy in the management of ulcerative colitis (UC). Isolated neurotuberculosis (NTB) without other manifestations is a rare form of infection in these patients. This article reports a case of a severe UC patient with isolated NTB following long-term therapy with adalimumab and discusses the clinical aspects, diagnosis, management, and prognosis. CASE REPORT A 34-year-old female patient with severe UC with pancolitis reported continuous and progressive holocranial headaches associated with a daily fever of 38°C and night sweats after 4 years of using adalimumab and after being in deep remission. Annually, she was screened for latent TB with chest X-rays and a Mantoux tuberculin skin test, and she always had negative results for TB. On cerebral magnetic resonance imaging with post-contrast sequences, small cortical lesions in the left frontal lobe and 2 larger lesions were visualized and were suggestive of tuberculomas. The initial management consisted of the suspension of immunosuppressive therapy and treatment with rifampicin, isoniazid, ethambutol, pyrazinamide, and prednisone. The patient showed clinical and neurological improvement and was clinically asymptomatic, with no changes in laboratory tests. Also, she had no neurological sequelae and was taking maintenance therapy with prednisone as indicated by the neurologist. CONCLUSIONS Early recognition of symptoms of neurological involvement of TB, suspension of anti-TNF and adequate treatment are fundamental steps to prevent complications.
Topics: Female; Humans; Adult; Adalimumab; Colitis, Ulcerative; Prednisone; Tumor Necrosis Factor Inhibitors; Tuberculosis; Tumor Necrosis Factor-alpha
PubMed: 36918754
DOI: 10.12659/AJCR.938353 -
Journal of Medicine and Life Dec 2022Prison inmates are a high-risk group for tuberculosis (TB) infection and disease due to the increasing number of vulnerable fringe groups, risk factors (., alcohol and...
Diagnostic accuracy of screening algorithms to identify persons with active pulmonary tuberculosis at prison entry: protocol of a systematic review and network meta-analysis.
Prison inmates are a high-risk group for tuberculosis (TB) infection and disease due to the increasing number of vulnerable fringe groups, risk factors (., alcohol and drug addictions), contagious diseases (HIV, hepatitis), and their high-risk behavior. Compared to the general population, TB incidence and prevalence rates are significantly higher among prison inmates. Early identification of potentially infectious pulmonary TB (PTB) and targeted care of sick inmates are essential to effectively control TB within the prison system. The WHO recommends combining active and passive case-finding in prisons. No study has been published comparing the broad spectrum of screening tools using a diagnostic accuracy network meta-analysis (NMA). We aim to identify the most accurate TB case-finding algorithm at prison entry that is feasible in resource-limited prisons of high-burden TB countries and ensures continuous comprehensive TB detection services in such settings. Evidence generated by this NMA can provide important decision support in selecting the most (cost-) effective algorithms for screening methods for resource-limited settings in the short, medium, and long terms.
Topics: Humans; Prisons; Network Meta-Analysis; Tuberculosis; Tuberculosis, Pulmonary; Latent Tuberculosis; Meta-Analysis as Topic; Systematic Reviews as Topic
PubMed: 36762336
DOI: 10.25122/jml-2022-0164 -
Journal of Family Medicine and Primary... Oct 2022Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old...
Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old female presented with painful swelling in the volar aspect of the left wrist and incomplete flexion of the little finger. The laboratory tests revealed ESR 10 mm/1 hr and C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide tests were negative. Thickened and distended ulnar bursa with rice bodies was seen on magnetic resonance imaging (MRI). Thorough drainage, debridement, and synovectomy were done. Epithelioid cell granulomas with multinucleated giant cells on microscopy and the strongly positive Mantoux test prompted us to start anti-tubercular treatment. The wound healed uneventfully with good recovery of range of motion of the little finger at one-year follow up. Rice bodies can be a diagnostic dilemma in the absence of classical signs of their rheumatoid or tubercular origin.
PubMed: 36618161
DOI: 10.4103/jfmpc.jfmpc_786_22 -
Journal of Obstetrics and Gynaecology... Oct 2022Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis...
BACKGROUND
Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis difficult. No single test has been able to accurately diagnose genital tuberculosis. In this study we aim to compare conventional diagnostic tests for tuberculosis like Acid Fast Bacilli (AFB) Staining, Lowenstein Jensen (LJ) Culture and Histopathology with newer tests like PCR, MGIT 960, GeneXpert.
METHODS
This study included 67 infertile women from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. They were subjected to detailed history and routine investigations, namely Haemogram, ESR, Mantoux test, Chest X-ray and pelvic ultrasound to look for the findings of tuberculosis. A premenstrual endometrial aspirate was taken and was subjected to the AFB Staining, LJ Culture, Histopathology, PCR, MGIT 960, Gene Xpert, and the test results were compared.
RESULT AND CONCLUSION
35.8% (24/67) of women were diagnosed with genital tuberculosis using the diagnostic criteria. With culture as the gold standard, the positivity of genital TB was 19.4% (13/67). Majority of infertile patients with low index of suspicion clinically were positive for genital tuberculosis. Therefore, all the patients of infertility should be routinely evaluated for genital tuberculosis. PCR and MGIT 960 have shown promising results in the newer methods. LJ culture and histopathology are still the most reliable and available diagnostic methods. The usefulness of AFB Staining and GeneXpert remains questionable.
PubMed: 36458068
DOI: 10.1007/s13224-022-01629-8 -
Cureus Oct 2022Female genital tuberculosis is a significant cause of female infertility. It has been noted that about 10% of females having infertility were due to genital tuberculosis...
Female genital tuberculosis is a significant cause of female infertility. It has been noted that about 10% of females having infertility were due to genital tuberculosis (TB). It is an accidental finding while one is investigating infertility. Laparoscopy is the investigation of choice. A histopathologic examination is done to confirm the diagnosis. A 34-year-old primigravida with 35 weeks + four days gestation with IVF conception and decreased fetal movements with ultrasonography suggestive of a double loop of cord around the neck came for safe confinement. She was operated on July 6, 2022, as an emergency lower segment cesarean section procedure with bilateral fimbriectomy. The indication was that this was an IVF baby, and the mother noticed diminished fetal movements. She was discharged on July 11, 2022. A color doppler was done on the day of discharge which showed normal findings. The patient was asked to come for a follow-up after 15 days in the outpatient department or so in case of an emergency. A high protein and iron diet, plenty of fluids, and adequate rest were recommended. Symptoms differ depending on the severity and spread of the disease. Typical symptoms of TB include fever, night sweats, and weight loss. Other presentations include menstrual dysfunction, and chronic abdominal pain, with or without general symptoms like weight loss. Genital TB can cause abdominal adhesions and tubal blockage. It even causes infertility and menstrual abnormalities like amenorrhea and menorrhagia in females. The investigations to be done are the Mantoux test, chest X-ray, and cartridge-based nucleic acid amplification test (CBNAAT) to detect the presence of . Hysterosalpingography is done to check for infertility. A laparoscopy is to be performed. Symptomatic management of the patient can lead to a successful pregnancy.
PubMed: 36415409
DOI: 10.7759/cureus.30548 -
International Journal of Surgery Case... Sep 2022The prevalence of osteoarticular tuberculosis is increasing. Tuberculous infection in midfoot is rare. Establishing the diagnosis is difficult, leading to delay in...
INTRODUCTION
The prevalence of osteoarticular tuberculosis is increasing. Tuberculous infection in midfoot is rare. Establishing the diagnosis is difficult, leading to delay in management and leave many complications.
CASE PRESENTATION
An 18-year-old man presents to our clinic with pain on his foot for the last 1 year. No other remarkable signs and symptoms. X-ray of his foot shown destruction of the 1st tarsometatarsal joint, later confirmed with MRI that shown synovitis and bone edema. Mantoux test and biopsy were done and established the diagnosis of tuberculous infection.
CLINICAL DISCUSSION
Intensive phase of anti-tuberculosis chemotherapy was given for 2 months, followed by continuation phase for 7 months. Surgical management of debridement and arthrodesis were performed as adjunctive treatment. At 10 months follow-up patient was pain free, fully weight-bearing and no signs of further destruction.
CONCLUSION
Osteoarticular tuberculosis is difficult to diagnose, a high index of suspicion is required to avoid delay treatment and complications. Anti-TB chemotherapy is still the treatment of choice, with surgical management is reserved for advance case.
PubMed: 36380541
DOI: 10.1016/j.ijscr.2022.107582 -
Annals of Maxillofacial Surgery 2022Primary orofacial tuberculosis (TB) accounts for <3% of all cases of TB. TB of the mandibular condyle is often misdiagnosed owing to its rarity.
RATIONALE
Primary orofacial tuberculosis (TB) accounts for <3% of all cases of TB. TB of the mandibular condyle is often misdiagnosed owing to its rarity.
PATIENT CONCERNS
This report presents a 19-year-old female who presented with a painful swelling over the right preauricular region. The radiographic evaluation suggested a diagnosis of suppurative osteomyelitis of the condyle.
DIAGNOSIS
Clinically, the aetiology of the swelling was considered as infective. The histopathological examination of the resected specimen showed tuberculous granuloma and the polymerase chain reaction came positive.This confirms the diagnosis of tubercular osteomyelitis. Mantoux test and sputum acid-fast bacilli were found to be negative.
TREATMENT
The patient was subjected to sequestrectomy with high condylectomy and systemic multidrug antitubercular regimen for 6 months.
OUTCOMES
There was a resolution of infection postoperatively with subsequent regeneration of healthy bone.
TAKE-AWAY LESSONS
Early identification and prompt diagnosis is imperative for better treatment outcomes.
PubMed: 36199466
DOI: 10.4103/ams.ams_301_21 -
Therapeutic Advances in Ophthalmology 2022The definitive diagnosing of ocular tuberculosis (TB) is difficult; therefore, there is a need of better understanding of investigating TB DNA in presumed ocular TB...
BACKGROUND
The definitive diagnosing of ocular tuberculosis (TB) is difficult; therefore, there is a need of better understanding of investigating TB DNA in presumed ocular TB patients.
OBJECTIVES
The aim of this study is to correlate tubercular DNA PCR of aqueous/vitreous and blood in cases of presumed ocular TB.
DESIGN
A prospective study.
METHODS
DNA was extracted from aqueous of cases of choroidal tuberculoma (group 1) and serpiginous choroiditis (group 2) and from vitreous of cases of vasculitis (group 3) and macular hole/retinal detachment (group 4). Gel-based PCR and real-time PCR amplification were performed using IS6110 primer on ocular fluids. The same was also performed on the blood samples of cases in which tubercular DNA was detected in the ocular fluids.
RESULTS
Overall, 31 cases were analysed in our study. Tubercular DNA was detected in ocular fluids of seven cases: group 1, two cases (67%); group 2, one case (17%); group 3, four cases (27%); and no case of group 4. Blood samples of six of these seven patients were positive for tubercular DNA. Of these six patients, four had evidence of systemic TB and were on ATT. Two cases had no evidence of active systemic TB, yet PCR was positive from blood and ocular fluids.
CONCLUSION
Tubercular DNA detected from ocular fluids may possibly be due to bystander DNA and may not indicate primary ocular tubercular infection. Thus, caution must be exercised prior to labelling a case of uveitis as being tubercular based on the results of molecular assays on ocular fluids alone. The results of PCR on ocular fluids should be correlated with PCR on blood and systemic findings.
PubMed: 36147308
DOI: 10.1177/25158414221123522 -
Infectious Disease Reports Aug 2022Mucormycosis is a rare but serious fungal infection caused by a mold family known as the Mucorales. These fungi exist throughout the environment, especially in the soil,...
Mucormycosis is a rare but serious fungal infection caused by a mold family known as the Mucorales. These fungi exist throughout the environment, especially in the soil, leaves, compost piles, or decaying woods. Humans contract mucormycosis by coming in contact with the spores from fungus either by inhalation or through cuts on the skin. The population at risk for this life-threatening infection includes diabetes mellitus patients, cancer patients, premature infants, burn patients, and immunocompromised patients. The fungi that most commonly cause mucormycosis are the species, and the least represented are species. Common clinical manifestations of mucormycosis include pulmonary, cutaneous, rhinocerebral, and gastrointestinal mucormycosis. Cases of lung mucormycosis are often misdiagnosed because of non-specific clinical symptoms and radiological features, and in many cases, have been diagnosed as due to similarities in signs, symptoms, and imaging presentation of the lungs. We present a pediatric case of a 6-year-old from Togo who presented to our hospital in Nigeria with dyspnea, fever, and abdominal pain of five-day duration. The child's symptoms began 6-months prior, with dry cough, fever, fatigue, and chest pain and abdominal pain. The hospital in Togo where he lived suspected infection with tuberculosis (TB) despite a false-positive Mantoux test and negative chest X-ray. He was initially treated for TB with Isoniazid and vitamin B6 and was discharged home. Six months later, his symptoms have not improved, but became more severe with high grade fever 40 °C (oral reading), anorexia, fatigue, tachypnea, abdominal distention, and cough. The patient was immediately referred to our hospital in Abuja, Nigeria where more specific tests were ordered. He was eventually diagnosed with chronic granulomatous disease induced pulmonary and gastrointestinal (GI) mucormycosis due to spp. In this report, we discuss an unusual clinical presentation of an infection caused by spp., its management, and outcomes in a child with chronic granulomatous disease (CGD).
PubMed: 36005264
DOI: 10.3390/idr14040062