Tuberculosis peritonitis with features of acute abdomen in HIV infection

Abdominal tuberculosis misdiagnosed as acute surgical abdomen and carcinomatosis

Tuberculosis is a major public health problem worldwide. Tuberculosis can be confused with other diseases and its diagnosis is frequently delayed, especially in areas of low prevalence. Abdominal tuberculosis includes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and/or solid organs; and accounts for 5% of all cases of tuberculosis. We report two cases of young patients who presented preoperatively as acute abdomen due to acute appendicitis. During surgery, these cases were misdiagnosed as "carcinomatosis", and in the postoperative period these cases were complicated with septic shock. In both cases, histopathology showed caseating granulomas which suggested tuberculous peritonitis and enteritis. Subsequently, RT-PCR in peritoneal fluid confirmed  Mycobacterium tuberculosis. In one case the clinical response to treatment was excellent, and the other case was fatal. The aim of this report is to bring attention to the spectrum of tuberculosis, and to serve as a reminder of tuberculosis as the great imitator that can masquerade as cancer. Most tuberculous patients erroneously diagnosed as cancer have extensive "neoplastic" lesions that would suggest an advanced-stage malignancy. Assuming a case as an advanced cancer would reduce the chance of performing more exhaustive studies to get a definitive diagnosis and clinicians would be tempted to offer only palliative treatments.

Green Method Synthesised Graphene-Silver Electrochemical Nanobiosensors for Ethambutol and Pyrazinamide

A novel nanobiosensor was constructed with graphene oxide (GO) sheets coupled to pear extract-based green-synthesised silver nanoparticles (Ag-NPs) to which cytochrome P450-2D6 (CYP2D6) enzyme was attached. The biosensor was applied in the electrochemical detection of the tuberculosis (TB) treatment drugs, ethambutol (EMB) and pyrazinamide (PZA). The surface morphology of the green-synthesised nanocomposites was studied by performing High-Resolution Transmission Electron Microscopy (HR-TEM) and High-Resolution Scanning Electron Microscopy (HR-SEM). Fourier Transform Infrared Spectroscopy (FTIR) and Raman Spectroscopy were used for structural analysis, while Ultraviolet Visible (UV-Vis) Spectroscopy was used in the optical characterisation of the nanocomposite material. Electrochemical studies on glassy carbon electrode (GCE), which were done by Cyclic Voltammetry (CV), showed that the GO|Ag-NPs||GCE electrode was highly conductive, and thereby indicating its suitability as a platform for nanobiosensor development. The non-toxic and low-cost green GO|Ag-NPs|CYP2D6||GCE nanobiosensor was used to determine EMB and PZA. The very low limit of detection (LOD) values of the biosensor for EMB (0.2962 × 10−2 nM, S/N = 3) and PZA (0.897 × 10−2 nM, S/N = 3) demonstrate that the green nanobiosensor is more sensitive than other biosensors reported for EMB and PZA.