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Jiang J, Cao Z, Li B, Ma X, Deng X, Yang B, Liu Y, Zhai F, Cheng X. Disseminated tuberculosis is associated with impaired T cell immunity mediated by non-canonical NF-κB pathway. J Infect 2024; 89:106231. [PMID: 39032519 DOI: 10.1016/j.jinf.2024.106231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES The mechanism that leads to disseminated tuberculosis in HIV-negative patients is still largely unknown. T cell subsets and signaling pathways that were associated with disseminated tuberculosis were investigated. METHODS Single-cell profiling of whole T cells was performed to identify T cell subsets and enriched signaling pathways that were associated with disseminated tuberculosis. Flow cytometric analysis and blocking experiment were used to investigate the findings obtained by transcriptome sequencing. RESULTS Patients with disseminated tuberculosis had depleted Th1, Tc1 and Tc17 cell subsets, and IFNG was the most down-regulated gene in both CD4 and CD8 T cells. Gene Ontology analysis showed that non-canonical NF-κB signaling pathway, including NFKB2 and RELB genes, was significantly down-regulated and was probably associated with disseminated tuberculosis. Expression of several TNF superfamily ligands and receptors, such as LTA and TNF genes, were suppressed in patients with disseminated tuberculosis. Blocking of TNF-α and soluble LTα showed that TNF-α was involved in IFN-γ production and LTα influenced TNF-α expression in T cells. CONCLUSIONS Impaired T cell IFN-γ response mediated by suppression of TNF and non-canonical NF-κB signaling pathways might be responsible for disseminated tuberculosis.
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Affiliation(s)
- Jing Jiang
- Institute of Research, Beijing Key Laboratory of Organ Transplantation and Immune Regulation, Senior Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Zhihong Cao
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute of Tuberculosis Research, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Binyu Li
- Institute of Research, Beijing Key Laboratory of Organ Transplantation and Immune Regulation, Senior Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xihui Ma
- Institute of Research, Beijing Key Laboratory of Organ Transplantation and Immune Regulation, Senior Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xianping Deng
- Department of Laboratory Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Bingfen Yang
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute of Tuberculosis Research, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Yanhua Liu
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute of Tuberculosis Research, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Fei Zhai
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute of Tuberculosis Research, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoxing Cheng
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute of Tuberculosis Research, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, China.
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2
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Singh B, Pahuja I, Yadav P, Shaji A, Chaturvedi S, Ranganathan A, Dwivedi VP, Das G. Adjunct Therapy With All-trans-Retinoic Acid Improves Therapeutic Efficacy Through Immunomodulation While Treating Tuberculosis With Antibiotics in Mice. J Infect Dis 2024; 229:1509-1518. [PMID: 37863472 DOI: 10.1093/infdis/jiad460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/21/2023] [Accepted: 10/19/2023] [Indexed: 10/22/2023] Open
Abstract
Tuberculosis is the second leading infectious killer after coronavirus disease 2019 (COVID-19). Standard antitubercular drugs exhibit various limitations like toxicity, long treatment regimens, and lack of effect against dormant and drug-resistant organisms. Here, we report that all-trans-retinoic acid (ATRA) improves Mycobacterium tuberculosis clearance in mice during treatment with the antitubercular drug isoniazid. Interestingly, ATRA promoted activities of lysosomes and mitochondria, and production of various inflammatory mediators in macrophages. Furthermore, ATRA upregulated the expression of genes of lipid metabolism pathways in macrophages. We demonstrated that ATRA activated the MEK/ERK pathway in macrophages in vitro and MEK/ERK and p38 MAPK pathways in mice. Finally, ATRA induced both Th1 and Th17 responses in lungs and spleens of M. tuberculosis-infected mice. Together, these data indicate that ATRA provides beneficial adjunct therapeutic value by modulating MEK/ERK and p38 MAPK pathways and thus warrants further testing for human use.
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Affiliation(s)
- Baldeep Singh
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Isha Pahuja
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Priyanka Yadav
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Aishwarya Shaji
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Shivam Chaturvedi
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Anand Ranganathan
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Ved Prakash Dwivedi
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Gobardhan Das
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
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3
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Mezgebe H, Gebrecherkos T, Hagos DG, Muthupandian S. Prevalence of Smear-Positive, Rifampicin-Resistant Mycobacterium tuberculosis and Related Factors Among Residents with Cough in Northern Ethiopian Refugee Health Facilities. Infect Drug Resist 2024; 17:1135-1145. [PMID: 38525474 PMCID: PMC10961074 DOI: 10.2147/idr.s453306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To ascertain the prevalence of Mycobacterium tuberculosis (M.tb) among refugees suspected of tuberculosis (TB) and related risk factors, including smear-positive and Rifampicin-resistant M.tb. Methods A cross-sectional study was conducted between January 2020 and May 2020 among 384 refugees in four refugee camps in Northwest Tigray, Ethiopia. Socio-demographic and clinical data were collected from refugees with a history of cough for more than two weeks prospectively. Spot-spot sputum samples were collected and transported in an ice box to the Shire Suhul Hospital Microbiology laboratory; and then examined using a Fluorescent Microscope. All smear-positive samples were further processed by GeneXpert to detect Rifampicin-resistant MTB. Data were analyzed using SPSS version 21 and a p-value <0.05 was considered statistically significant. Results The overall prevalence of smear-positive PTB infection was 5.5% (21/384), but No TB case was resistant to Rifampicin detected by GeneXpert MTB/RIF assay. About 70% of the smear-positive pulmonary TB identified were females. Five (23.8%) of the smear-positive pulmonary tuberculosis cases were co-infected by HIV. Sharing of drink and food materials (AOR = 4.36, 95% CI = 1.19-15.89), active TB contact (AOR 7.24, 95% CI = 1.62-32.125), BMI (AOR = 5.23, 95% CI = 1.28-21.29), opening window practice (AOR = 4.32, 95% CI = 1.02-18.30) and HIV status (AOR = 9.36, 95% CI = 1.64-53.35) were statistically significant predisposing factors. Conclusion The prevalence of smear-positive pulmonary TB among northwest Tigray refugee camps was still high. The prevalence of TB/HIV co-infection was also high. Minimizing close contact with active TB cases, reducing malnutrition, rapid TB/HIV screening, and establishing a ventilation system can reduce the transmission of TB among refugees.
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Affiliation(s)
- Hailemariam Mezgebe
- Department of Medical Microbiology, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
| | - Teklay Gebrecherkos
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Dawit Gebreegziabiher Hagos
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Saravanan Muthupandian
- AMR and Nanotherapeutics Lab, Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, 600077, India
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4
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Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol 2024; 97:1-12. [PMID: 38263840 PMCID: PMC11027299 DOI: 10.1093/bjr/tqad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024] Open
Abstract
Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.
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Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mouna Chelli Bouaziz
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis, Tunisia
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore
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5
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Roure S, Vallès X, Sopena N, Benítez RM, Reynaga EA, Bracke C, Loste C, Mateu L, Antuori A, Baena T, Portela G, Llussà J, Flamarich C, Soldevila L, Tenesa M, Pérez R, Plasencia E, Bechini J, Pedro-Botet ML, Clotet B, Vilaplana C. Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis. Front Public Health 2023; 11:1175482. [PMID: 37275492 PMCID: PMC10233202 DOI: 10.3389/fpubh.2023.1175482] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Background Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis. Objectives To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period. Methodology We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings. Results We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001). Conclusion There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.
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Affiliation(s)
- Sílvia Roure
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Xavier Vallès
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Nieves Sopena
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rosa Maria Benítez
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Esteban A. Reynaga
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Bracke
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cora Loste
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Mateu
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrià Antuori
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Tania Baena
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Germán Portela
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Judith Llussà
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Clara Flamarich
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Laura Soldevila
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
| | - Montserrat Tenesa
- Servei de Radiodiagnòstic de l’Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Direcció Clínica de Diagnòstic per la imatge de la Gerència Territorial Metropolitana Nord, Badalona, Spain
| | - Ricard Pérez
- Servei de Radiodiagnòstic de l’Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elsa Plasencia
- Departament de Salut, Subdirecció General de Vigilancia i Resposta a Emergències de Salut Pública, Barcelona, Catalonia, Spain
| | - Jordi Bechini
- Servei de Radiodiagnòstic de l’Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Direcció Clínica de Diagnòstic per la imatge de la Gerència Territorial Metropolitana Nord, Badalona, Spain
| | - Maria Lluïsa Pedro-Botet
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bonaventura Clotet
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Vilaplana
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Unitat de Tuberculosi Experimental, Microbiology Department, Germans Trias i Pujol, Badalona, Spain
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Jiang J, Cao Z, Xiao L, Su J, Wang J, Liang J, Yang B, Liu Y, Zhai F, Wang R, Cheng X. Single-cell profiling identifies T cell subsets associated with control of tuberculosis dissemination. Clin Immunol 2023; 248:109266. [PMID: 36796469 DOI: 10.1016/j.clim.2023.109266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
To identify T cell subsets associated with control of tuberculosis, single-cell transcriptome and T cell receptor sequencing were performed on total T cells from patients with tuberculosis and healthy controls. Fourteen distinct subsets of T cells were identified by unbiased UMAP clustering. A GZMK-expressing CD8+ cytotoxic T cell cluster and a SOX4-expressing CD4+ central memory T cell cluster were depleted, while a MKI67-expressing proliferating CD3+ T cell cluster was expanded in patients with tuberculosis compared with healthy controls. The ratio of Granzyme K-expressing CD8+CD161-Ki-67- and CD8+Ki-67+ T cell subsets was significantly reduced and inversely correlated with the extent of TB lesions in patients with TB. In contrast, ratio of Granzyme B-expressing CD8+Ki-67+ and CD4+CD161+Ki-67- T cells and Granzyme A-expressing CD4+CD161+Ki-67- T cells were correlated with the extent of TB lesions. It is concluded that granzyme K-expressing CD8+ T cell subsets might contribute to protection against tuberculosis dissemination.
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Affiliation(s)
- Jing Jiang
- Institute of Research, Beijing Key Laboratory of Organ Transplantation and Immune Regulation, Senior Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Zhihong Cao
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Li Xiao
- Institute of Research, Beijing Key Laboratory of Organ Transplantation and Immune Regulation, Senior Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Jinwen Su
- Division of Critical Care Medicine, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Jinhe Wang
- Second Division of Tuberculosis, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Jianqin Liang
- Second Division of Tuberculosis, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Bingfen Yang
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Yanhua Liu
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Fei Zhai
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Ruo Wang
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoxing Cheng
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China.
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7
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Albrici C, Cefalo J, Mondoni M, Moro A, Bimbatti M, Gianelli U, Centanni S. Left pleural effusion in a young woman with genital tuberculosis. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Disseminated tuberculosis is a rare form of tuberculosis that can cause severe illness if diagnosed and treated late. We present the case of a young Senegalese woman who had a miscarriage due to a pelvic inflammatory disease, followed by the development of a left pleural effusion. Despite laparoscopic findings and a salpinx biopsy that revealed necrotizing granulomas, only microbiological examinations of pleural biopsies revealed the final diagnosis of disseminated, drug-sensitive tuberculosis.
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Abstract
Childhood tuberculosis (TB) has been underreported and underrepresented in TB statistics across the globe. Contributing factors include health system barriers, diagnostic barriers, and community barriers leading to an underdetected epidemic of childhood tuberculosis. Despite considerable progress in childhood TB management, there is a concerning gap in policy and practice in high-burden countries leading to missed opportunities for active case detection, early diagnosis and treatment of TB exposure, and infection and disease in children regardless of human immunodeficiency virus status. Bridging this gap requires multisectoral coordination and political commitment along with an eye to research and innovation with potential to scale.
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Affiliation(s)
- Sadia Shakoor
- Department of Pathology, Section of Microbiology, Aga Khan University, Supariwala Building, PO Box 3500, Karachi, Pakistan
| | - Fatima Mir
- Department of Pediatrics and Child Health, The Aga Khan University, Faculty Office Building, PO Box 3500, Stadium Road, Karachi 74800, Pakistan.
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9
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Theobald SJ, Gräb J, Fritsch M, Suárez I, Eisfeld HS, Winter S, Koch M, Hölscher C, Pasparakis M, Kashkar H, Rybniker J. Gasdermin D mediates host cell death but not interleukin-1β secretion in Mycobacterium tuberculosis-infected macrophages. Cell Death Discov 2021; 7:327. [PMID: 34718331 PMCID: PMC8557205 DOI: 10.1038/s41420-021-00716-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
Necrotic cell death represents a major pathogenic mechanism of Mycobacterium tuberculosis (Mtb) infection. It is increasingly evident that Mtb induces several types of regulated necrosis but how these are interconnected and linked to the release of pro-inflammatory cytokines remains unknown. Exploiting a clinical cohort of tuberculosis patients, we show here that the number and size of necrotic lesions correlates with IL-1β plasma levels as a strong indicator of inflammasome activation. Our mechanistic studies reveal that Mtb triggers mitochondrial permeability transition (mPT) and subsequently extensive macrophage necrosis, which requires activation of the NLRP3 inflammasome. NLRP3-driven mitochondrial damage is dependent on proteolytic activation of the pore-forming effector protein gasdermin D (GSDMD), which links two distinct cell death machineries. Intriguingly, GSDMD, but not the membranolytic mycobacterial ESX-1 secretion system, is dispensable for IL-1β secretion from Mtb-infected macrophages. Thus, our study dissects a novel mechanism of pathogen-induced regulated necrosis by identifying mitochondria as central regulatory hubs capable of delineating cytokine secretion and lytic cell death.
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Affiliation(s)
- Sebastian J Theobald
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany
| | - Jessica Gräb
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany
| | - Melanie Fritsch
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931, Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene (IMMIH), University of Cologne, 50935, Cologne, Germany
| | - Isabelle Suárez
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Hannah S Eisfeld
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany
| | - Sandra Winter
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany
| | - Maximilian Koch
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931, Cologne, Germany
| | - Christoph Hölscher
- Division of Infection Immunology, Research Center Borstel, 23845, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Borstel, 23845, Borstel, Germany
| | - Manolis Pasparakis
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931, Cologne, Germany.,Institute for Genetics, University of Cologne, 50674, Cologne, Germany
| | - Hamid Kashkar
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931, Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene (IMMIH), University of Cologne, 50935, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, University of Cologne, 50937, Cologne, Germany. .,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Cologne, Germany. .,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
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Ye Y, Yang N, Zhou J, Qian G, Chu J. Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Disseminated Tuberculosis of an Immunocompetent Patient. Front Med (Lausanne) 2021; 8:687984. [PMID: 34322503 PMCID: PMC8310911 DOI: 10.3389/fmed.2021.687984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 01/05/2023] Open
Abstract
Disseminated tuberculosis (TB) is a rare disease and mainly occurs in immunodeficient patients. It is marked by hematogenous or lymphatic dissemination of Mycobacterium tuberculosis, causing tuberculous infection involving any organ system. Here, we report a case of disseminated TB involving lung, liver, spine, mediastinum, and prostate in an immunocompetent man. The present patient found a hepatic mass without any symptom during health examination. In the next 2 years, further examinations revealed multiple lesions in the lung, mediastinum, spine, and prostate. Imaging examinations, such as contrast-enhanced abdominal CT, F-18 FDG-PET/CT, and radionuclide bone scan, suggested the diagnosis of malignancy or metastatic tumor. Furthermore, histopathological results of the biopsies of the hepatic mass, mediastinal mass, and prostatic mass demonstrated granulomatous inflammation. Therefore, metagenomic next-generation sequencing (mNGS) was utilized to confirm the diagnosis. Mycobacterium tuberculosis complex was simultaneously detected in the spinal surgical resection specimens and bronchoalveolar lavage fluid (BALF), indicating the diagnosis of disseminated TB. mNGS is an emerging molecular diagnostic technology, and its application in disseminated TB has been rarely reported. We highlight that disseminated TB should be considered even in an immunocompetent patient, and mNGS can be performed when the diagnosis is difficult.
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Affiliation(s)
- Yuanting Ye
- School of Medicine, Ningbo University, Ningbo, China.,Department of General Practice, Ningbo First Hospital, Ningbo, China
| | - Naibin Yang
- Department of Infectious Disease, Ningbo First Hospital, Ningbo, China
| | - Jingying Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guoqing Qian
- Department of Infectious Disease, Ningbo First Hospital, Ningbo, China
| | - Jinguo Chu
- Department of General Practice, Ningbo First Hospital, Ningbo, China
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11
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Nezhad MH, Ganadan A, SeyedAlinaghi S, Abadi FNA, Manshadi SAD, Salehi MR, Ghiasvand F, Khatami SR. Disseminated TB in an Immunocompetent Patient: A Case Report. Infect Disord Drug Targets 2021; 21:297-300. [PMID: 32484114 DOI: 10.2174/1871526520666200528152739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tuberculosis considered as a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affects the lungs. Overall, disseminated TB is rare in immunocompetent patients and its association with seborrheic keratosis has never been reported. ; Case Presentation: We reported a 54-year-old man with a complaint prolonged fever, abdominal pain, weight loss and lymphadenopathy without any immunosuppression who was eventually treated based on the diagnosis of diffuse tuberculosis.
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Affiliation(s)
- Malihe Hassan Nezhad
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ganadan
- Department of Pathology, Razi Hospital and Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nili Ahmad Abadi
- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Salehi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshte Ghiasvand
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Rana Khatami
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
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12
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Suárez I, Fünger SM, Kröger S, Rademacher J, Fätkenheuer G, Rybniker J. The Diagnosis and Treatment of Tuberculosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:729-735. [PMID: 31755407 DOI: 10.3238/arztebl.2019.0729] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/21/2019] [Accepted: 08/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. METHODS This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. RESULTS Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. CONCLUSION Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
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Affiliation(s)
- Isabelle Suárez
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Cologne; German Center for Infection Research, Cologne-Bonn, Partner Site Cologne; Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Department of Pneumonology, Hanover Medical School
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13
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Sahoo H, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, Garg R, Kohli N, Verma R, Sharma PK, Pandey S, Uniyal R. Extra-central nervous system tuberculosis in HIV-uninfected patients of tuberculous meningitis: A prospective evaluation. J Infect Public Health 2020; 13:1101-1106. [PMID: 32439354 DOI: 10.1016/j.jiph.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Disseminated tuberculosis is characterized with involvement of two or more non-contiguous sites. In this work we evaluated patients of tuberculous meningitis for possible extra-central nervous system tuberculosis. METHOD This prospective observational study was performed at a tertiary care institute in Northern India. We included consecutive HIV-uninfected cases of TBM. Patients were evaluated for extra-central nervous system (CNS) tuberculosis. We focussed on peripheral lymph nodes, chest, abdomen, and spinal involvement. All patients were subjected to MRI brain and spine. Patients were also subjected to CT thorax and abdomen. Enlarged lymph nodes, if present, were biopsied. Ascitic and pleural fluid were subjected to biochemical, cellular analysis as well as cartridge-based nucleic acid amplification test (CBNAAT) for detection of Mycobacterium tuberculosis and rifampicin resistance. RESULTS We enrolled 110 patients of TBM. After cerebrospinal fluid examination alone, 14 (12.7%) patients had microbiologically-confirmed TBM. After planned work-up for extra CNS tuberculosis, 5 additional cases were microbiologically confirmed. Similarly, before work-up for extra CNS tuberculosis, 29 (26.4%) patients were categorized as probable TBM. The number of probable cases increased to 72 (65.5%) (P<0.001) with identification of tuberculosis elsewhere. Lung (83.6%) was the most involved site. Abdominal tuberculosis was noted in 29 (26.4%) patients. On imaging spine, 17 (15.5%) patients demonstrated presence of spinal tuberculous. Lymph adenopathy recorded in 2 cases. Lymph node biopsy revealed tuberculous granuloma in both the cases. All 7 patients, who died, had disseminated tuberculosis. CONCLUSION Extra CNS tuberculous involvement is common in TBM. Search for extra CNS tuberculous enables upgrading diagnostic accuracy.
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Affiliation(s)
- Haramohan Sahoo
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajiv Garg
- Department of Respiratory Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
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14
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Wong YJ, Lee SWH. Prevalence of latent tuberculosis among refugee children in Malaysia. ERJ Open Res 2020; 6:00254-2019. [PMID: 32166089 PMCID: PMC7061204 DOI: 10.1183/23120541.00254-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/12/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Tuberculosis remains one of the top 10 major causes of global mortality, imposing social-economic and medical challenges in Malaysia. Refugees sheltered in Malaysia are a high-risk population but basic health checks upon their arrival, including tuberculosis screening, are not practised. This study aimed to identify the prevalence and risk factors of tuberculosis and latent tuberculosis infection (LTBI) among refugee children in Malaysia. Methods A cross-sectional study was performed in three refugee schools in the Klang Valley, Malaysia, using tuberculin skin tests or interferon-γ release assays. Participants who tested positive were sent for further examination with chest radiography to confirm the tuberculosis diagnosis. Results From April 2018 to April 2019, we screened 430 refugee children with a median age of 13.0 years. Most of the children were born in Myanmar (n=274, 63.7%) and Pakistan (n=60, 14.0%). No children were diagnosed with active tuberculosis but 55 of the children (12.8%) were diagnosed with LTBI. Children with LTBI were generally older (OR 3.01, 95% CI 1.71-5.29; p<0.001) than those without LTBI infection. Sex, history of bacille Calmette-Guérin vaccination and country of birth were not associated with increased risk of LTBI. Conclusion The relatively high LTBI burden among refugee children in this study poses an indication of possible LTBI risk among this population nationwide, and thus would be an important group to target for preventive therapy. This provides a unique opportunity for researchers to further examine and implement well-structured preventive strategies in combating the endemic infectious disease in Malaysia.
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Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Selangor, Malaysia
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15
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Mondoni M, Centola M, Viganò O, Ferrarese M, Codecasa L, D'Arminio Monforte A, Carugo S, Centanni S, Lipman M, Sotgiu G. Chest pain and a left parasternal soft tissue swelling in an immunocompetent refugee with disseminated tuberculosis. Int J Infect Dis 2019; 90:116-118. [PMID: 31693940 DOI: 10.1016/j.ijid.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022] Open
Abstract
An immunocompetent migrant with chest pain was admitted to an Italian hospital. Computed tomography showed a left pectoral abscess and osteomyelitis of the sternum. The infection had spread into the anterior mediastinum near to the pericardium and the heart, where an atrial mass was confirmed by echocardiography. Disseminated tuberculosis was diagnosed.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marco Centola
- Division of Cardiology, Cardio-Respiratory Department, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, University of Milan, Milan, Italy
| | - Maurizio Ferrarese
- Regional TB Reference Department, Villa Marelli Institute, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luigi Codecasa
- Regional TB Reference Department, Villa Marelli Institute, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Stefano Carugo
- Division of Cardiology, Cardio-Respiratory Department, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marc Lipman
- University College London Respiratory, Division of Medicine, University College London, London, UK
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy.
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16
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Holden IK, Lillebaek T, Andersen PH, Bjerrum S, Wejse C, Johansen IS. Extrapulmonary Tuberculosis in Denmark From 2009 to 2014; Characteristics and Predictors for Treatment Outcome. Open Forum Infect Dis 2019; 6:ofz388. [PMID: 31660351 PMCID: PMC6786510 DOI: 10.1093/ofid/ofz388] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/30/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Extrapulmonary tuberculosis (EPTB) represents an increasing percentage of tuberculosis (TB) cases in Europe. However, strategies on TB prevention and successful treatment outcomes primarily target pulmonary TB. In this nationwide study, we present characteristics of EPTB, treatment outcomes, and predictors for unfavorable treatment outcomes. METHODS All patients diagnosed with EPTB from 2009 to 2014 were included. Logistic regression analyses were used to identify risk factors for unfavorable outcome. The following definitions were used: unfavorable outcome: the sum of treatment failed, lost to follow-up, and not evaluated; patient delay: time from TB-related symptom onset until first hospital contact related to TB; doctor delay: time from first TB-related contact in the health care system to start of TB treatment. RESULTS A total of 450 EPTB cases were notified, which represented 21.1% of all TB cases in Denmark. Immigrants accounted for 82.9%. Lymph nodes were the most common site of EPTB (55.4%) followed by pleural TB (13.4%). Patient delay was significantly longer among immigrants than Danes (60 vs 30 days; P < .01), whereas doctor delay was significantly longer among Danes (38.5 vs 28 days; P < .01). Treatment completion rates were high and reached 90.9% in 2014. Male gender (odds ratio [OR], 5.18; 95% confidence interval [CI], 1.79-15.04) and age 0-24 years (OR, 16.39; 95% CI, 2.02-132.64) were significantly associated with unfavorable outcome. CONCLUSIONS EPTB represented a significant number of all TB cases and was predominantly seen among younger immigrants in Denmark. To maintain high treatment completion rates, increased focus on male gender and young age is needed.
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Affiliation(s)
- Inge K Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark
- Mycobacterial Centre for Research Southern Denmark – MyCRESD, Odense, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter H Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark
- Mycobacterial Centre for Research Southern Denmark – MyCRESD, Odense, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark
- Mycobacterial Centre for Research Southern Denmark – MyCRESD, Odense, Denmark
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