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Spekker O, Schultz M, Paja L, Váradi OA, Molnár E, Pálfi G, Hunt DR. Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis. PLoS One 2020; 15:e0238444. [PMID: 32870917 PMCID: PMC7462305 DOI: 10.1371/journal.pone.0238444] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
Although endocranial abnormal blood vessel impressions (ABVIs) and periosteal appositions (PAs) have been considered as paleopathological diagnostic criteria for tuberculous meningitis (TBM) based on findings of previous studies, they are not pathognomonic for tuberculosis (TB). Therefore, their utilization in the paleopathological practice can be questioned, especially in consideration that most of the previous studies were not performed on identified skeletal collections but on osteoarchaeological material and did not include statistical data analysis. To fill the aforementioned research gap, for the first time, a macroscopic investigation was conducted on identified pre-antibiotic era skeletons from the Terry Collection. A sample set of 234 individuals who died of TB (TB group) and 193 individuals who died of non-tuberculous causes (NTB group) were examined. The frequency of ABVIs and PAs, as well as other probable TB-related lesions was recorded. To determine the significance of difference (if any) in the frequencies of ABVIs and PAs between the two groups, χ2 testing of our data was performed. We found that ABVIs, PAs, and their co-occurrence with each other and with other probable TB-related lesions were more common in the TB group than in the NTB group. In addition, the χ2 comparative frequencies of ABVIs and PAs revealed a statistically significant difference between individuals who died of TB and individuals who died of NTB causes. Our findings strengthen those of previous studies that ABVIs and PAs are not specific to TBM but can be of tuberculous origin. Therefore, they do have a diagnostic value in the identification of TB in human osteoarchaeological material, especially when they simultaneously occur with other probable TB-related lesions. Their prudent utilization provides paleopathologists with a stronger basis for diagnosing TB and consequently, a more sensitive means of assessing TB frequency in past human populations.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Michael Schultz
- Institut für Anatomie und Embryologie, Zentrum Anatomie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - László Paja
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Orsolya A. Váradi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Erika Molnár
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - György Pálfi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - David R. Hunt
- Department of Anthropology, National Museum of Natural History, Smithsonian Institution, District of Columbia, Washington, D.C., United States of America
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Spekker O, Hunt DR, Paja L, Molnár E, Pálfi G, Schultz M. Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection. PLoS One 2020; 15:e0230418. [PMID: 32187217 PMCID: PMC7080279 DOI: 10.1371/journal.pone.0230418] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/29/2020] [Indexed: 11/22/2022] Open
Abstract
Paleopathological diagnosis of tuberculosis (TB) essentially relies on the identification of macroscopic lesions in the skeleton that can be related to different manifestations of TB. Among these alterations, granular impressions (GIs) on the inner skull surface have been considered as pathognomonic features of tuberculous meningitis (TBM). GIs may be established by pressure atrophy of the tubercles formed on the outermost meningeal layer during later stages of TBM. Although GIs were used as diagnostic criteria for TBM in the paleopathological practice since the late 20th century, their diagnostic value has been questioned. To contribute to strengthening the diagnostic value of GIs, a macroscopic investigation–focusing on the macromorphological characteristics and frequency of GIs–was performed on skeletons of known cause of death from the Terry Collection. The χ2 analysis of our data revealed that GIs were significantly more common in individuals who died of TB than in individuals who died of non-TB causes. Furthermore, GIs were localized on the inner surface of the skull base and of the lower lateral skull vault. The localization pattern and distribution of GIs on the endocranial surface resemble that of the tubercles observed in the affected meninges during the pathogenesis of TBM. Our results strengthen the tuberculous origin of GIs and imply that they can be considered as specific signs of TBM. Therefore, GIs can be used as diagnostic criteria for TBM in the paleopathological practice, and the diagnosis of TBM can be established with a high certainty when GIs are present in ancient human bone remains.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- * E-mail:
| | - David R. Hunt
- Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, District of Columbia, United States of America
| | - László Paja
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Erika Molnár
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - György Pálfi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Michael Schultz
- Institut für Anatomie und Embryologie, Zentrum Anatomie, Universitätsmedizin Göttingen, Göttingen, Germany
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Fillion A, Koutlidis N, Froissart A, Fantin B. [Investigation and management of genito-urinary tuberculosis]. Rev Med Interne 2014; 35:808-14. [PMID: 25240482 DOI: 10.1016/j.revmed.2014.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/28/2014] [Accepted: 07/28/2014] [Indexed: 11/27/2022]
Abstract
Genito-urinary tuberculosis is the fourth most common manifestation of the disease, but it is often underestimated by clinicians because of few and non-specific symptoms and insidious disease course. The most common urinary findings are multiple ureteral stenosis. The most common genital involvement is an epididymal nodule for men and a chronic salpingitis for women. The definite diagnosis of genito-urinary tuberculosis is obtained on the basis of culture studies. Due to the paucibacillary nature of the disease, especially of genital location in woman, a probable or presumptive diagnosis is frequently considered with several parameters including radiological imaging (abdominal CT-scan, pelvic ultrasound, pelvic MRI). Endoscopic and surgical procedures are frequently required to obtain specimens for histopathologic and bacteriological studies. Medical treatment is the method of choice, with a combination of four drugs, namely isoniazid, rifampicin, ethambutol and pyrazinamide, followed by a two-drug regimen, for a total of six month duration. Surgery might be indicated in complicated genito-urinary tuberculosis (decreased renal function, infertility, urologic complaints).
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Affiliation(s)
- A Fillion
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - N Koutlidis
- Service d'urologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - A Froissart
- Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France
| | - B Fantin
- Service de médecine interne, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Fenaroli F, Westmoreland D, Benjaminsen J, Kolstad T, Skjeldal FM, Meijer AH, van der Vaart M, Ulanova L, Roos N, Nyström B, Hildahl J, Griffiths G. Nanoparticles as drug delivery system against tuberculosis in zebrafish embryos: direct visualization and treatment. ACS NANO 2014; 8:7014-7026. [PMID: 24945994 DOI: 10.1021/nn5019126] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nanoparticles (NPs) enclosing antibiotics have provided promising therapy against Mycobacterium tuberculosis (Mtb) in different mammalian models. However, the NPs were not visualized in any of these animal studies. Here, we introduce the transparent zebrafish embryo as a system for noninvasive, simultaneous imaging of fluorescent NPs and the fish tuberculosis (TB) agent Mycobacterium marinum (Mm). The study was facilitated by the use of transgenic lines of macrophages, neutrophils, and endothelial cells expressing fluorescent markers readily visible in the live vertebrate. Intravenous injection of Mm led to phagocytosis by blood macrophages. These remained within the vasculature until 3 days postinfection where they started to extravasate and form aggregates of infected cells. Correlative light/electron microscopy revealed that these granuloma-like structures had significant access to the vasculature. Injection of NPs induced rapid uptake by both infected and uninfected macrophages, the latter being actively recruited to the site of infection, thereby providing an efficient targeting into granulomas. Rifampicin-loaded NPs significantly improved embryo survival and lowered bacterial load, as shown by quantitative fluorescence analysis. Our results argue that zebrafish embryos offer a powerful system for monitoring NPs in vivo and rationalize why NP therapy was so effective against Mtb in earlier studies; bacteria and NPs share the same cellular niche.
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Affiliation(s)
- Federico Fenaroli
- Department of Biosciences, University of Oslo , Blindernveien 31, 0371 Oslo, Norway
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Abstract
Glycemic control is an important aspect of patient care in the surgical Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the potential to cause a rapidly deteriorating condition that the physician should be familiar with. Viral encephalitis frequently accompanies viral meningitis, and can produce focal neurologic findings and cognitive difficulties that can mimic other neurologic disorders. Brain abscesses also have the potential to mimic and present like other neurologic disorders, and cause more focal deficits. Finally, other infectious diseases of the central nervous system, such as prion disease and cavernous sinus thrombosis, are explored in this review.
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Affiliation(s)
- Vevek Parikh
- University of California, San Francisco, CA, USA
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Affiliation(s)
- Leana S Wen
- Harvard Affiliated Emergency Medicine Residency, Division of Emergency Medicine, Brigham & Women's Hospitals/Massachusetts General Hospital, Boston, USA.
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Fortún J, Martín-Dávila P, Navas E, López-Vélez R, Pintado V, Cobo J, González A, Bonilla M, Aneiros V, Gómez-Mampaso E, Moreno S. Changes in the epidemiology of tuberculosis: the influence of international migration flows. Enferm Infecc Microbiol Clin 2011; 29:654-9. [PMID: 21723001 DOI: 10.1016/j.eimc.2011.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/17/2011] [Accepted: 04/27/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The epidemiological characteristics of patients with tuberculosis (TB) in European hospitals have changed in recent years. METHODS A prospective study of patients with culture-proven pulmonary TB admitted to our institution from 1997 to 2008 is shown. RESULTS We analyzed 661 patients with pulmonary TB. An increase in the incidence of TB was confirmed during the study period (P<.001). The proportion of patients with HIV infection decreased from 26% during 1997-2000 to 12% during 2005-2008. However, the proportions of older (>40 years old) and foreign-born patients increased significantly, from 37% to 59% and from 12% to 35%, respectively. Multivariate analysis confirmed previous antituberculous therapy and immigration as factors associated with resistance to isoniazid and to isoniazid+rifampin. After the year 2000, mortality was independently associated with extrapulmonary TB (OR: 3.1; CI 95%: 1.4-7.2), hepatitis C virus infection (OR: 6.0; CI 95%: 2.2-16.3), and diabetes (OR: 6.4; CI 95%: 2.4-16.8). CONCLUSION Immigration from countries with high rates of TB infection has replaced HIV infection as the most relevant risk factor associated with TB. The increase in the number of older patients with TB and the presence of specific comorbid conditions, especially chronic liver dysfunction, could explain the more difficult management and increased mortality.
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Affiliation(s)
- Jesús Fortún
- Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
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Wang GJ, Phypers M, Ellis E. Demographic, laboratory and clinical characteristics of HIV-positive tuberculosis cases in Canada. J Infect Public Health 2009; 2:112-9. [PMID: 20701870 DOI: 10.1016/j.jiph.2009.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 07/09/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is an important risk factor for the global incidence and mortality of tuberculosis (TB) and has had a tremendous impact on the epidemiology and the control of the disease. The purpose of this study was to determine the demographic, laboratory and clinical characteristics of HIV-positive TB cases in Canada as compared to HIV-negative cases. METHODS TB cases reported to the Canadian TB Reporting System (CTBRS) from 1997 to 2006 were retrospectively reviewed and for those with known HIV serostatus, the distributions of age, sex, country of birth, smear and culture positivity, drug resistance, site of disease and treatment outcome were compared. RESULTS 2710 TB cases had a report of an HIV test with a 12.9% positivity rate. HIV-positive cases were more likely to be 30-44 years old, male, Canadian born non-Aboriginal or African born. Sputum and lymph node biopsies were significantly more likely to be smear-positive and sputum was more likely to be culture positive. Anti-TB drug resistant rates were similar, except for lower streptomycin resistance in new HIV-positive cases. HIV-positive cases were significantly more likely to present with miliary or central nervous system TB, to have multi-system disease, to have lower treatment success rates (66.4% versus 88.5%) and to have a 5.6 higher case-fatality rate. INTERPRETATION HIV-positive cases have a different demographic profile, present with more advanced and severe forms of disease, have poorer treatment outcomes and higher mortality. All TB cases should be tested for HIV so as to offer appropriate case management and treatment.
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Affiliation(s)
- G J Wang
- Anti-Tuberculosis Institute, Henan Provincial Centre for Disease Control and Prevention, 105 Nongye East Road, Zhengdong New District, Zhengzhou, Henan 450016 People's Republic of China
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Larsen CP, Moreira RK, Hennigar RA, Bijol V. Kidney Biopsy Findings in a Patient With Fever, Bilateral Pulmonary Infiltrates, and Acute Renal Failure. Am J Kidney Dis 2008; 51:524-9. [DOI: 10.1053/j.ajkd.2007.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/16/2007] [Indexed: 11/11/2022]
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