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Niedermeyer S, Draenert R, Beck A, Todorova R, Jung A, Biczok AM, Tonn JC, Thorsteinsdottir J. Spinal Tuberculosis within the Vertebral Arch Mimicking a Malignant Tumor: Case Report. J Neurol Surg A Cent Eur Neurosurg 2023; 84:91-94. [PMID: 35668672 DOI: 10.1055/s-0042-1746171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Spinal tuberculosis is a manifestation of extrapulmonary tuberculosis. The incidence of tuberculosis is low in high-income countries; however, globally, it still remains one of the most frequent fatal infectious diseases. Because of its rarity in developed countries, spinal tuberculosis can be mistaken for malignant tumors of the spine, especially in case of an atypical radiologic manifestation and without pulmonary affection. METHODS We present the case of a 39-year-old man from South India with quickly progressing gait disturbance and hypesthesia below the Th10 level. Magnetic resonance imaging revealed an osteolytic lesion of the vertebral arch Th2 with central necrosis and compression of the spinal cord altogether highly suspicious for spinal metastasis. RESULTS After surgical removal of the mass by laminectomy, the patient regained normal neurologic function. Histology revealed a severe granulomatous inflammation and DNAhybridization of polymerase chain reaction (PCR) products detected Mycobacterium tuberculosis-specific DNA in the sample. Biopsy of an enlarged hilar lymphnode allowed us to obtain material to successfully perform a drug resistance test to start specific antimicrobial therapy. CONCLUSION Spinal tuberculosis, even with atypical radiologic appearance, has to be considered a differential diagnosis in patients with provenance from endemic countries. A multidisciplinary diagnostic approach helps perform antimicrobial susceptibility testing to avoid delaying the start of antibiotic therapy.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Rika Draenert
- Antibiotic Stewardship, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Alexander Beck
- Center for Neuropathology and Prion Research, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Rumyana Todorova
- Institute of Pathology, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Andreas Jung
- Institute of Pathology, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Anna-Maria Biczok
- Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
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Willgert K, da Silva S, Li R, Dandapat P, Veerasami M, Maity H, Papanna M, Srinivasan S, Wood JLN, Kapur V, Conlan AJK. Is bovine density and ownership associated with human tuberculosis in India? PLoS One 2023; 18:e0283357. [PMID: 36947560 PMCID: PMC10032477 DOI: 10.1371/journal.pone.0283357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
Zoonotic tuberculosis in humans is caused by infection with bacteria of the Mycobacterium tuberculosis complex acquired from animals, most commonly cattle. India has the highest burden of human tuberculosis in the world and any zoonotic risk posed by tuberculosis in bovines needs to be managed at the source of infection as a part of efforts to end human tuberculosis. Zoonotic tuberculosis in humans can be severe and is clinically indistinguishable from non-zoonotic tuberculosis. As a consequence, zoonotic tuberculosis remains under-recognised and the significance of its contribution to human tuberculosis is poorly understood. This study aimed to explore any association between bovine density, bovine ownership, and human tuberculosis reporting in India using self-reported tuberculosis data in households and officially reported tuberculosis cases while controlling for common confounders for human tuberculosis. We find an association between human tuberculosis reporting, bovine density and bovine ownership in India. Buffalo density was significantly associated with an increased risk of self-reported tuberculosis in households (odds ratio (OR) = 1.23 (95% credible interval (CI): 1.10-1.39) at household level; incidence rate ratio (IRR) = 1.17 (95% CI: 1.04-1.33) at district level), while cattle density (OR = 0.80, 95% CI: 0.71-0.89; IRR = 0.78, 95% CI: 0.70-0.87) and ownership of bovines in households (OR = 0.94, 95% CI: 0.9-0.99; IRR = 0.67, 95% CI: 0.57-0.79) had a protective association with tuberculosis reporting. It is unclear whether this relates to differences in tuberculosis transmission dynamics, or perhaps an association between bovines and other unexplored confounders for tuberculosis reporting in humans. Our study highlights a need for structured surveillance to estimate the prevalence of tuberculosis in cattle and buffaloes, characterisation of Mycobacterium tuberculosis complex species present in bovines and transmission analyses at the human-animal interface to better assess the burden and risk pathways of zoonotic tuberculosis in India.
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Affiliation(s)
- Katriina Willgert
- Disease Dynamics Unit (DDU), Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Susie da Silva
- Disease Dynamics Unit (DDU), Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ruoran Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Premanshu Dandapat
- ICAR-Indian Veterinary Research Institute, Eastern Regional Station, Kolkata, West Bengal, India
| | | | - Hindol Maity
- CisGen Biotech Discoveries Pvt Ltd, Chennai, India
| | - Mohan Papanna
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - Sreenidhi Srinivasan
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - James L N Wood
- Disease Dynamics Unit (DDU), Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Vivek Kapur
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States of America
- Department of Animal Science, The Pennsylvania State University, University Park, PA, United States of America
| | - Andrew J K Conlan
- Disease Dynamics Unit (DDU), Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Yadav J, John D, Allarakha S, Menon GR. Rising healthcare expenditure on tuberculosis: Can India achieve the End TB goal? Trop Med Int Health 2021; 26:1256-1275. [PMID: 34192385 DOI: 10.1111/tmi.13648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the out-of-pocket expenditure (OOPE), healthcare burden, catastrophic health expenditure, hardship financing and impoverishment effects of TB treatment in India. METHODS Data of three rounds of National Statistic Surveys 60th 2004-05, 71st 2013-14 and 75th 2017-18. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden, catastrophic health expenditure, hardship financing and impoverishment using standard definitions at December 2019 price values. RESULTS More than two-thirds of the TB cases are seen in the economically productive age group (14-59 years). Illiterate patients had a higher healthcare burden and OOPE. The healthcare burden, hardship financing and catastrophic health expenditure are considerably higher for those utilising private hospitals. Male patients have a higher exposure to hardship financing than female patients. Impoverishment effects are higher among Hindus and illiterate populations due to utilisation of hospitalisation services. CONCLUSION The present analysis helps to understand the trends in the financial burden of TB on households over last 15 years, thus providing evidence to policymakers for more effective channelling of resources in order to achieve a TB-free India by 2025.
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Affiliation(s)
- Jeetendra Yadav
- Department of Health Research, National Institute of Medical Statistics, New Delhi, India
| | - Denny John
- Public Health Department, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | | | - Geetha R Menon
- Department of Health Research, National Institute of Medical Statistics, New Delhi, India
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Sahu S, Ditiu L, Lawson L, Ntoumi F, Arakaki D, Zumla A. UN General Assembly tuberculosis targets: are we on track? Lancet 2020; 395:928-930. [PMID: 32199477 DOI: 10.1016/s0140-6736(20)30565-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Suvanand Sahu
- Stop TB Partnership Secretariat, Global Health Campus, Geneva, Switzerland
| | - Lucica Ditiu
- Stop TB Partnership Secretariat, Global Health Campus, Geneva, Switzerland
| | | | - Francine Ntoumi
- Marien Nguabi University, Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Denise Arakaki
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, Brazil; Ministry of Health, National Tuberculosis Control Program, Brasilia, Brazil
| | - Alimuddin Zumla
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London EC1V 2PD, UK.
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Chaw L, Chien LC, Wong J, Takahashi K, Koh D, Lin RT. Global trends and gaps in research related to latent tuberculosis infection. BMC Public Health 2020; 20:352. [PMID: 32183753 PMCID: PMC7079542 DOI: 10.1186/s12889-020-8419-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/27/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a global commitment to eliminating tuberculosis (TB). It is critical to detect and treat cases of latent TB infection (LTBI), the reservoir of new TB cases. Our study assesses trends in publication of LTBI-related research. METHODS We used the keywords ("latent tuberculosis" OR "LTBI" OR "latent TB") to search the Web of Science for LTBI-related articles published 1995-2018, then classified the results into three research areas: laboratory sciences, clinical research, and public health. We calculated the proportions of LTBI-related articles in each area to three areas combined, the average rates of LTBI-related to all scientific and TB-related articles, and the average annual percent changes (AAPC) in rates for all countries and for the top 13 countries individually and combined publishing LTBI research. RESULTS The proportion of LTBI-related articles increased over time in all research areas, with the highest AAPC in laboratory (38.2%/yr), followed by public health (22.9%/yr) and clinical (15.1%/yr). South Africa (rate ratio [RR] = 8.28, 95% CI 5.68 to 12.08) and India (RR = 2.53, 95% CI 1.74 to 3.69) had higher RRs of overall TB-related articles to all articles, but did not outperform the average of the top 13 countries in the RRs of LTBI-related articles to TB-related articles. Italy (RR = 1.95, 95% CI 1.45 to 2.63), Canada (RR = 1.73, 95% CI 1.28 to 2.34), and Spain (RR = 1.53, 95% CI 1.13 to 2.07) had higher RRs of LTBI-related articles to TB-related articles. CONCLUSIONS High TB burden countries (TB incidence > 100 per 100,000 population) published more overall TB-related research, whereas low TB burden countries showed greater focus on LTBI. Given the potential benefits, high TB burden countries should consider increasing their emphasis on LTBI-related research.
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Affiliation(s)
- Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link BE1410, Gadong, Bandar Seri Begawan, Brunei Darussalam
| | - Lung-Chang Chien
- Epidemiology and Biostatistics, Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119 USA
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam; Commonwealth Drive, BB3910, Bandar Seri Begawan, Brunei Darussalam
| | - Ken Takahashi
- Asbestos Diseases Research Institute, Concord, NSW 2139 Australia
| | - David Koh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link BE1410, Gadong, Bandar Seri Begawan, Brunei Darussalam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549 Republic of Singapore
| | - Ro-Ting Lin
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Room 1610, No. 91, Hsueh-Shih Road, Taichung, 40402 Taiwan
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Affiliation(s)
- Sougat Ray
- Asvini Hospital, Colaba, Mumbai 400005, India.
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