Tuberculosis: medical management update

Bacterial Lesions of the Oral Mucosa

Nonodontogenic bacterial infections of the oral cavity are not a common finding in the United States. Nevertheless, there has been an increase in prevalence of certain bacterial sexually transmitted diseases, such as syphilis and gonorrhea, and conditions such as tuberculosis still pose a serious threat to certain segments of the population. Finally, given the uncommon nature and pathophysiology of these diseases, diagnosis is often delayed, resulting in more clinically significant disease and potential contamination of individuals. Thus, it is prudent that clinicians be familiar with these uncommon but potentially serious infectious diseases, so treatment can be instituted promptly.

A Clinicopathologic Review of 21 Cases of Head and Neck Primary Tuberculosis

PURPOSE

A diagnosis of tuberculosis (TB) of the head and neck has been a dilemma for clinicians, because the clinical and pathologic features tend to mimic different pathologies. Our study aimed to identify the demographic, clinical, and pathologic features of head and neck TB to help healthcare providers in the early detection of the disease.

MATERIALS AND METHODS

We performed a retrospective analysis using the medical archives at the pathology laboratory. Twenty-one patients with a clinical and pathologic diagnosis of head and neck TB were identified from 2010 to 2019.

RESULTS

The age distribution was broad, with 28.5% of the patients younger than 15 years old. Seven patients had oral TB, with the most common sites affected the labial vestibule (3 cases) and buccal vestibule (3 cases), followed by 1 case in the tongue. The predominant clinical presentation was ulceration, and the most common entity in the clinical differential diagnosis was squamous cell carcinoma. The most common histopathologic pattern of oral TB was a noncaseating granuloma. Most of the tuberculous lymphadenitis was located in the submandibular and submental areas.

CONCLUSIONS

TB of the head and neck region is not, as previously thought, a rare condition. Head and neck TB, in general, and oral TB, in particular, are great mimickers of different pathologic entities. In particular, the absence of the typical histopathologic pattern of TB granuloma has made the diagnosis more complicated. Healthcare providers must be vigilant and consider all the demographic, clinical, and histopathologic features to detect the disease earlier, because an early diagnosis can result in better outcomes.

Prevalence of oral lesions in tuberculosis: A cross sectional study

OBJECTIVE

Tuberculosis (Tb) is a fatal infectious disease that primarily affects the pulmonary system and rarely occurs in other body organs including oral cavity. The aim of this study was to report all patients with primary manifestations of oral tuberculosis and to evaluate the clinical characteristics of oral tuberculosis lesions. All these patients were subsequently diagnosed with tuberculosis based on oral histological findings and referred for management and therapy.

MATERIALS AND METHODS

Twelve patients with oral lesions from the year 2010 to 2018 were histologically diagnosed as having tuberculosis, who did not give any history of the disease, following surgical biopsy. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed.

RESULTS

Oral TB was found in all 12 patients; 8 males and 4 females, with male to female ratio 8:4. Involved oral sites included the angle of the mandible (one case), right mandibular molar region (two cases), left mandibular molar region (four cases), gingiva (three cases), buccal mucosa (one case), and the tongue (one case). Oral TB patients in this series ranged in the age group of 6-65 years. All the lesions were suggestive of primary tuberculosis. The appearance of the affected mucosa in oral TB was variable. The most common manifestation was ulceration and swelling of the mucosa.

CONCLUSION

TB should be considered in patients with oral ulcerations and swellings. A biopsy specimen for histological study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis along with other conditions.

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

Submasseteric tuberculous lesion of mandible: report of a case and review of the literature

Tuberculosis is still a major health hazard in the developing world, while its incidence has recently started to escalate after decreasing for many years. It is a chronic granulomatous disease that can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, are seen in both the primary and secondary stages of the disease. This paper presents a case of tuberculosis of the submasseteric space, manifesting as a persistent swelling at ramus and angle of mandible. The diagnosis was confirmed based on histopathology after an open incisional biopsy. Patient underwent antituberculosis therapy and his extraoral swelling completely resolved after 4 months of the therapy. The purpose of this paper is to emphasize the importance of early and definitive diagnosis of orofacial tuberculosis, to recognize it based on signs and symptoms, and to refer the patients suspected of active tuberculous infection for appropriate medical treatment.

Primary gingival tuberculosis diagnosis: a difficult endeavor

AIM

To highlight the importance of considering tuberculosis in the differential diagnosis even in the absence of confirmation from several investigations and diagnostic aides.

BACKGROUND

Tuberculosis is a common infectious granulomatous disease caused by various strains of mycobacteria. An oral lesion when seen in association with tuberculosis is very rare and in most cases is noticed secondary to pulmonary forms.

CASE REPORT

We report a case of primary gingival tuberculosis in 20-year-old female patient who presented with treatment resistant gingivitis. Patient had no evidence of disease elsewhere in the body and several diagnostic tests also failed to reveal the presence of the causative organism. Resolution of gingivitis was noted following a therapeutic trial of antitubercular drugs.

CONCLUSION

Therefore the importance of including tuberculosis in the differential diagnosis of inflammatory disorder of the gingiva is very essential in order to avoid one of the most lethal forms of infections often overlooked.

CLINICAL SIGNIFICANCE

It is essential to consider tuberculosis as one of the differential diagnosis in India even when several diagnostic tests are negative for tuberculosis.

Tuberculoma of the tongue presenting as hemimacroglossia

The underdiagnosis of extrapulmonary tuberculosis lesions, along with an emerging global resistance to antitubercular drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in atypical lesions of oral cavity. Tongue is the most common site of oral tuberculosis. We report a rare presentation of lingual tuberculosis in a 65-year-old male, a chronic tobacco chewer, who came to us with swelling of the tongue which apparently looked like hemimacroglossia, leading to the clinical diagnosis of submucosal carcinoma of tongue. Enlargement of tongue is a slow process resulting from gradual invasion and lodging of bacilli in the tongue. Biopsy and histopathological examination revealed tuberculous etiology of the lesion and the patient responded well to antitubercular therapy.

Primary lingual tuberculosis in immunocompetent patient: a case report

Oral manifestations of tuberculosis are quite rare with an incidence rate of 1.4%. The tongue is the most common site of oral tuberculosis having varied presentations. Lingual tuberculosis is a diagnostic dilemma because of its rarity, particularly in immunocompetent patients. We are reporting a rare case of primary tuberculosis of the tongue in a 38 year old male diagnosed on fine needle aspiration cytology.

Primary tuberculous lymphadenitis: A case report

Tuberculosis (TB) is a prevalent systemic bacterial infectious disease usually caused by Mycobacterium tuberculosis. It is estimated that approximately 8 million people develop TB each year, and 3 million people die of complications associated with the disease. In this article we report a case of a 17-year-old female patient with a painful swelling in her right submandibular region. She was diagnosed with right submandibular tuberculous lymphadenitis. Tuberculous lymphadenitis, when occurring in the cervical region, continues to be a common cause of extrapulmonary TB. TB is a recognized occupational risk for dentists, as they work in close proximity to the nasal and oral cavities of patients, with the possible generation of potentially infectious sprays during routine operative procedures.

Anti-tuberculosis therapy-induced hepatotoxicity among Ethiopian HIV-positive and negative patients

Background

To assess and compare the prevalence, severity and prognosis of anti-TB drug induced hepatotoxicity (DIH) in HIV positive and HIV negative tuberculosis (TB) patients in Ethiopia.

Methodology/Principal Findings

In this study, 103 HIV positive and 94 HIV negative TB patients were enrolled. All patients were evaluated for different risk factors and monitored biochemically and clinically for development of DIH. Sub-clinical hepatotoxicity was observed in 17.3% of the patients and 8 out of the 197 (4.1%) developed clinical hepatotoxicity. Seven of the 8 were HIV positive and 2 were positive for HBsAg.

Conclusions/Significance

Sub-clinical hepatotoxicity was significantly associated with HIV co-infection (p = 0.002), concomitant drug intake (p = 0.008), and decrease in CD4 count (p = 0.001). Stepwise restarting of anti TB treatment was also successful in almost all the patients who developed clinical DIH. We therefore conclude that anti-TB DIH is a major problem in HIV-associated TB with a decline in immune status and that there is a need for a regular biochemical and clinical follow up for those patients who are at risk.