Primary oral tuberculosis on the tongue mimicking squamous cell carcinoma

Primary Tuberculosis of Buccal and Labial Mucosa: Literature Review and a Rare Case Report of a Public Health Menace

Tuberculosis (TB) is a chronic granulomatous infectious disorder, caused by Mycobacterium tuberculosis. Despite the recent advancements in antitubercular therapy (ATT), it remains a global public health concern. TB is a leading infectious cause of global mortality, second only to coronavirus disease 2019 (COVID-19). TB of the oral cavity is an uncommon occurrence and may be classified as a primary and secondary form. The primary tubercular lesions are extremely rare, as the intact oral squamous epithelium resists the entry of tubercle bacilli. The commonest oral TB lesion is solitary ulceration with undermined edges, usually on the tongue, that does not exhibit healing with conservative therapies. Owing to the atypical presentation, the oral TB lesions often go unnoticed during clinical examination; hence, an oral physician should be familiar with the various oral manifestations of TB. A timely diagnosis coupled with interdisciplinary treatment is the key to combat disease dissemination. This manuscript aims to report a rare case of primary tuberculosis of the buccal and labial mucosa in a 43-year-old immunocompetent male patient. Buccal and labial mucosa are the infrequently affected sites for primary oral TB lesions. A detailed literature search carried out on the Google Scholar and PubMed search engines revealed only fifteen case reports and two case series of primary tuberculosis of the buccal mucosa and labial mucosa.

Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass

Confusing masses constitute a challenging clinical problem for differentiating between cancer and tuberculosis diagnoses. This review summarizes the major theories designed to identify factors associated with misdiagnosis, such as imaging features, laboratory tests, and clinical characteristics. Then, the clinical experiences regarding the misdiagnosis of cancer and tuberculosis are summarized. Finally, the main diagnostic points and differential diagnostic criteria are explored, and the characteristics of multimodal imaging and radiomics are summarized.

Transbuccal delivery of metal complexes of isoniazid as an alternative to overcome antimicrobial resistance problems

In isolated isoniazid (INH)-resistant strains, deletion or mutations in thekatGgene have been identified, which result in loss of catalase-peroxidase activity. This enzyme plays a key role in the activation of this prodrug. As an alternative, the coordination of the INH to metal complexes has been purposed to activate it regardless of enzyme functionality. Although pentacyanido(isoniazid)ferrate(II) complexes have shown to be effective against resistant strains of Mycobacterium tuberculosis, low oral bioavailability was found. In this context, buccal mucosa was selected as an alternative route to the metal complex delivery. Moreover, oral manifestations of tuberculosis(TB) have been observed in some patients, particularly when resistant strains are present, and no therapeutic options are currently available on the market. Pentacyanidoferrate (PCF-INH) and Prussian-blue (PB-INH) complexes were initially prepared and characterized, followed by buccal permeability studies in Franz-type diffusion cells. The electrochemical potential of the complexes demonstrated their ability to self-activate. Job's method suggested the presence of structural defects in PB-INH complexes, which was correlated with permeability results. In fact, PB-INH showed a higher dissociation rate in salt-rich aqueous medium and thus a high transport rate of INH through the buccal mucosa. Its passage through the tissue would not be possible due to the high molecular size. PCF-INH, in turn, presented a lower dissociation rate in the salt-rich aqueous medium, justifying its slower transport rate through the tissue. Taken together, these results suggest that INH-based metal complexes may be efficiently administered through the buccal route, impacting on both oral bioavailability and microbial resistance.