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Liu P, Gu H, Cai G, Qin Y. A new nomogram based on ultrasound and clinical features for distinguishing epididymal tuberculosis and nontuberculous epididymitis. Sci Rep 2024; 14:15104. [PMID: 38956255 PMCID: PMC11220132 DOI: 10.1038/s41598-024-65682-1] [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: 01/04/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
Using ultrasound findings and clinical characteristics, we constructed and validated a new nomogram for distinguishing epididymal tuberculosis from nontuberculous epididymitis, both of which share similar symptoms. We retrospectively examined data of patients with epididymal tuberculosis and nontuberculous epididymitis hospitalized between January 1, 2013, and March 31, 2023. Eligible patients were randomly assigned to derivation and validation cohorts (ratio, 7:3). We drew a nomogram to construct a diagnostic model through multivariate logistic regression and visualize the model. We used concordance index, calibration plots, and decision curve analysis to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively. In this study, 136 participants had epididymal tuberculosis and 79 had nontuberculous epididymitis. Five variables-C-reactive protein level, elevated scrotal skin temperature, nodular lesion, chronic infection, and scrotal skin ulceration-were significant and used to construct the nomogram. Concordance indices of the derivation and validation cohorts were 0.95 and 0.96, respectively (95% confidence intervals, 0.91-0.98 and 0.92-1.00, respectively). Decision curve analysis of this nomogram revealed that it helped differentiate epididymal tuberculosis from nontuberculous epididymitis. This nomogram may help clinicians distinguish between epididymal tuberculosis and nontuberculous epididymitis, thereby increasing diagnosis accuracy.
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Affiliation(s)
- Pengju Liu
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, China
| | - Hai Gu
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, China
| | - Guofeng Cai
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, China
| | - Yong Qin
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, China.
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Govind N, Romanini T, Winchow LL. Probable endometrial tuberculosis in a patient with rhupus. S Afr J Infect Dis 2023; 38:543. [PMID: 37927913 PMCID: PMC10623593 DOI: 10.4102/sajid.v38i1.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/07/2023] [Indexed: 11/07/2023] Open
Abstract
Endometrial tuberculosis (TB) is an uncommon manifestation of disseminated TB. Rhupus is the coexistence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We describe a case of endometrial TB in rhupus patient an immunosuppressed. Contribution We describe an uncommon presentation of disseminated TB, endometrial TB, in a rare rheumatic disease, rhupus. A high index of suspicion for TB is imperative in immunocompromised patients presenting with chronic urogenital symptoms especially in an endemic area.
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Affiliation(s)
- Nimmisha Govind
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Romanini
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Lai Ling Winchow
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wang T, Zhou C, Shang L, Zhou X. Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study. BMC Infect Dis 2023; 23:586. [PMID: 37674123 PMCID: PMC10483793 DOI: 10.1186/s12879-023-08568-3] [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: 06/01/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area. METHODS We collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables. RESULTS We included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15-44 years (OR 1.817; 95% CI 1.162-2.840; P < 0.01) and 45-59 years (OR 2.175; 95% CI 1.335-3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234-3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107-2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115-3.058; P < 0.05) were significant in the univariate analysis. CONCLUSIONS Sputum smear-positive TB predominated in Yi men (15-44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15-59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.
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Affiliation(s)
- Tao Wang
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Chaoxin Zhou
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Lan Shang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Xiyuan Zhou
- Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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Xia J, Liu Y, Ma Y, Yang F, Ruan Y, Xu JF, Pi J. Advances of Long Non-Coding RNAs as Potential Biomarkers for Tuberculosis: New Hope for Diagnosis? Pharmaceutics 2023; 15:2096. [PMID: 37631310 PMCID: PMC10458399 DOI: 10.3390/pharmaceutics15082096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Tuberculosis (TB), one of the top ten causes of death globally induced by the infection of Mycobacterium tuberculosis (Mtb), remains a grave public health issue worldwide. With almost one-third of the world's population getting infected by Mtb, between 5% and 10% of these infected individuals are predicted to develop active TB disease, which would not only result in severe tissue damage and necrosis, but also pose serious threats to human life. However, the exact molecular mechanisms underlying the pathogenesis and immunology of TB remain unclear, which significantly restricts the effective control of TB epidemics. Despite significant advances in current detection technologies and treatments for TB, there are still no appropriate solutions that are suitable for simultaneous, early, rapid, and accurate screening of TB. Various cellular events can perturb the development and progression of TB, which are always associated with several specific molecular signaling events controlled by dysregulated gene expression patterns. Long non-coding RNAs (lncRNAs), a kind of non-coding RNA (ncRNA) with a transcript of more than 200 nucleotides in length in eukaryotic cells, have been found to regulate the expression of protein-coding genes that are involved in some critical signaling events, such as inflammatory, pathological, and immunological responses. Increasing evidence has claimed that lncRNAs might directly influence the susceptibility to TB, as well as the development and progression of TB. Therefore, lncRNAs have been widely expected to serve as promising molecular biomarkers and therapeutic targets for TB. In this review, we summarized the functions of lncRNAs and their regulatory roles in the development and progression of TB. More importantly, we widely discussed the potential of lncRNAs to act as TB biomarkers, which would offer new possibilities in novel diagnostic strategy exploration and benefit the control of the TB epidemic.
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Affiliation(s)
- Jiaojiao Xia
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Kunming Medical University, Kunming 650500, China
| | - Yilin Liu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan 523808, China
| | - Yuhe Ma
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan 523808, China
| | - Fen Yang
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan 523808, China
| | - Yongdui Ruan
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
| | - Jun-Fa Xu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang 524023, China
| | - Jiang Pi
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China; (J.X.); (Y.L.); (Y.M.); (F.Y.); (Y.R.)
- Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan 523808, China
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang 524023, China
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Tsai YC, Li CC, Chen BT, Wang CY. Coexistence of urinary tuberculosis and urothelial carcinoma: A case report. World J Clin Cases 2023; 11:3921-3928. [PMID: 37383138 PMCID: PMC10294158 DOI: 10.12998/wjcc.v11.i16.3921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Taiwan has a high prevalence of tuberculosis and urothelial carcinoma. However, the simultaneous occurrence of both disorders in one patient is uncommon. Tuberculosis and urothelial carcinoma share some common risk factors and could demonstrate overlapping clinical manifestations.
CASE SUMMARY Herein, we report the case of a patient who presented with fever, persistent hematuria, and pyuria. Chest computed tomography scans revealed a bilateral upper lobes cavitary lesion with fibrosis. Severe hydronephrosis of the right kidney and renal stones and cysts in the left kidney were observed. Initial microbiological testing was negative; however, a polymerase chain reaction assay of the urine confirmed a urinary tuberculosis infection. The patient was started on an anti-tuberculosis regimen. Ureteroscopy performed to resolve obstructive nephropathy revealed the incidental finding of a left middle-third ureteral tumor. Examination after biopsy and transurethral resection of the bladder tumor indicated urothelial carcinoma. The patient underwent laparoscopic nephroureterectomy, with bladder cuff excision for the right kidney and ureter, and holmium laser ablation of the ureteral lesion to preserve the left kidney and ureter. He has remained stable after the procedures.
CONCLUSION Although establishing a causal relationship between tuberculosis and cancer is difficult, medical personnel should consider their correlation.
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Affiliation(s)
- Yu-Chi Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Chiao-Ching Li
- Division of Urology, Department of Surgery, Pingtung branch, Kaohsiung Armed Forces General Hospital, Pingtung 900048, Taiwan
- Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Bing-Tau Chen
- Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Chien-Yao Wang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
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Undie CU, Jibrin P, Nnana EI, Torporo KR. The diagnostic challenge of a tuberculous cold abscess of the epididymis: a case report. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
While genitourinary tuberculosis is a common form of extra-pulmonary tuberculosis, cold abscess of the epididymis is rare with our literature search finding no reports from the West African subregion. Where the index of suspicion is low, diagnosis is missed and unnecessary surgery may be performed on suspicion of a tumour. The aim of this case report is to highlight the diagnostic challenges of this condition in resource-limited settings in order to create awareness within the health community, increase the chance of appropriate diagnosis, thereby facilitating early commencement of treatment so as to avoid needless testicular loss or complications, such as infertility.
Case presentation
A 33-year-old Black African College-educated public service employee resident in Abuja, Nigeria, presented with a one-week history of right scrotal pain and swelling. Genital examination revealed a firm, non-tender epididymal mass which was initially mistaken for a malignancy. There were no constitutional symptoms, and the contralateral testis was normal. The swelling involved only the epididymis. The testis was distinctly palpable but not oedematous. There was some hemi-scrotal oedema. Blood count and urine cultures were normal. Ultrasound scan showed a hypoechogenic, uniformly enlarged epididymis. Testicular tumour markers were negative. However, CT-abdomen showed enlarged para-caval and pelvic nodes which were thought to be due to secondary deposits from a testicular tumour. Scrotal swelling was later found to be due to an abscess of the epididymis at surgery. Histology showed caseous granulomas typical of Mycobacterium tuberculosis. Gene-Xpert, a cartridge-based nucleic acid amplification test, later confirmed that patient had tuberculosis, for which he is being treated.
Conclusion
The differential diagnosis of an epididymal cold abscess from testicular tumour or chronic epididymitis can be challenging. Therefore, a high index of suspicion as well as a complete tuberculosis screen is essential in an apparently healthy patient presenting with a chronic epididymal swelling.
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Sidiq Z, Hanif M, Dwivedi KK, Chopra KK, Khanna A, Vashishat BK. Effectiveness of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis at various stand-alone laboratories in Delhi. Indian J Tuberc 2022; 69:530-534. [PMID: 36460384 DOI: 10.1016/j.ijtb.2021.08.011] [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: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Globally, EPTB accounts for 15% of the notified incident TB cases. Laboratory confirmation of EPTB is challenging and majority of the cases remain undetected for a longer time. A major breakthrough in the diagnosis of EPTB was the introduction of nucleic acid amplification tests (NAAT). One such test-the Xpert MTB/RIF assay also known as Cartridge based nucleic acid amplification test (CBNAAT) was endorsed by the Scientific and Technical Advisory Board of the WHO for the diagnosis of Tuberculosis. The present study was conduct to evaluate the outcome of various extrapulmonary samples tested in the year 2019 at different standalone NAAT laboratories in Delhi. MATERIALS AND METHODS A total of 20,238 samples consisting mainly of Pus (21.77%), Cerebrospinal fluid (CSF) (14.96%), Biopsies (13.87%), Pleural fluid (10.49%), Lymph node aspirations (FNAC aspirates) (6.75%), synovial fluid (0.54%) and gastric aspirates (26.4%) tested at 22 standalone NAAT laboratories were included in this study. RESULTS Mycobacterium tuberculosis was detected in 3496 samples and resistance to rifampicin was detected in 329 of the samples. The overall yield of all the specimens combined was 17.2%. Highest yield was seen in Lymph nodes aspirates (FNAC) (36.0%), followed by pus (35.4%), tissues (15.7%), synovial fluid (13.5%), Endometrial tissues (10.7%), Pleural fluid (9.5%), Gastric aspirates (9.4%) and CSF (6.5%). The lowest yield was seen in Cavitary fluids (6.2%). CONCLUSION The results of this study highlight the usefulness of Xpert MTB/RIF assay in the diagnosis of EPTB. In particular, this assay proved to be of great utility while testing pus samples, tissue samples and lymph node FNACs.
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Affiliation(s)
- Zeeshan Sidiq
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India
| | - M Hanif
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India.
| | - Kaushal Kumar Dwivedi
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India
| | - Kamal Kishore Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India
| | - Ashwani Khanna
- State TB Cell, NTEP Delhi, Health Centre Building, Delhi Government Colony, Gulabi Bagh, Delhi, 110007, India
| | - B K Vashishat
- State TB Cell, NTEP Delhi, Health Centre Building, Delhi Government Colony, Gulabi Bagh, Delhi, 110007, India
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8
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Singh R, Shaheer M, Sobhia ME. Molecular dynamic assisted investigation on impact of mutations in deazaflavin dependent nitroreductase against pretomanid: a computational study. J Biomol Struct Dyn 2022:1-23. [PMID: 35574601 DOI: 10.1080/07391102.2022.2069156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past decade, TB drugs belonging to the nitroimidazole class, pretomanid and delamanid, have been authorised to treat MDR-TB and XDR-TB. With a novel inhibition mechanism and a reduction in the span of treatment, it is now being administered in various combinations. This approach is not the ultimate remedy since the target protein Deazaflavin dependent nitroreductase (Ddn) has a high mutation frequency, and already pretomanid resistant clinical isolates are reported in various studies. Ddn is essential for M.tuberculosis to emerge from hypoxia, and point mutations in critical residues confer resistance to Nitro-imidazoles. Among the pool of available mutants, we have selected seven mutants viz DdnL49P, DdnY65S, DdnS78Y, DdnK79Q, DdnW88R, DdnY133C, and DdnY136S, all of which exhibited resistance to pretomanid. To address this issue, through computational study primarily by MD simulation, we attempted to elucidate these point mutations' impact and investigate the resistance mechanism. Hence, the DdnWT and mutant (MT) complexes were subjected to all-atom molecular dynamics (MD) simulations for 100 ns. Interestingly, we observed the escalation of the distance between cofactor and ligand in some mutants, along with a significant change in ligand conformation relative to the DdnWT. Moreover, we confirmed that mutations rendered ligand instability and were ejected from the binding pocket as a result. In conclusion, the results obtained provide a new structural insight and vital clues for designing novel inhibitors to combat nitroimidazole resistanceCommunicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ravi Singh
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - Muhammed Shaheer
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - M Elizabeth Sobhia
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
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Khastgir J. Advances in the antibiotic management of epididymitis. Expert Opin Pharmacother 2022; 23:1103-1113. [PMID: 35380486 DOI: 10.1080/14656566.2022.2062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acute epididymitis is commonly encountered and typically presents acutely within a wide clinical spectrum. Most cases of acute epididymitis are caused by bacterial infection, most often by sexually transmitted organisms and urinary pathogens. Current treatment regimens remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm. AREAS COVERED The choice of the initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric or other. Adherence of clinical practice remains short of available guidance, which may be improved by thorough clinical and microbiologic assessment, supported by a knowledge of the commonly associated pathogenic organisms, and the appropriate choice of tests required for their identification. Use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms. The authors discuss these points in and provide their expert perspectives on its treatment and future developments. EXPERT OPINION Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis. Much of the presently available guidance is derived from previous guidance recommendations, knowledge of antimicrobial activities of specific agents, and treatment outcomes in uncomplicated infections. Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable.
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Affiliation(s)
- Jay Khastgir
- Princess of Wales Hospital, Cwm Taff Bro Morgannwg NHS University Health Board & Swansea University School of Medicine, Swansea
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Zhang X, Chen P, Xu G. Update of the mechanism and characteristics of tuberculosis in chronic kidney disease. Wien Klin Wochenschr 2022; 134:501-510. [DOI: 10.1007/s00508-022-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
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So PNH, Villanueva ART. Serologic and urinary characteristics of laboratory-confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines. BMC Urol 2021; 21:125. [PMID: 34503465 PMCID: PMC8431859 DOI: 10.1186/s12894-021-00888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. Methods This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. Results Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). Conclusions The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement—a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
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Affiliation(s)
- Paolo Nikolai H So
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines.
| | - Anthony Russell T Villanueva
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines
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Furuto Y, Hashimoto H, Kawamura M, Yamashita J, Yoshikawa T, Namikawa A, Isshiki R, Takahashi H, Morikawa T, Shibuya Y. Acute tubulointerstitial nephritis in a patient with early bronchial tuberculosis. J Formos Med Assoc 2021; 121:557-562. [PMID: 34301423 DOI: 10.1016/j.jfma.2021.07.010] [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: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are commonly at high risk of tuberculosis (TB). Conversely, TB rarely causes tubulointerstitial nephritis. A 75-year-old Japanese man who was undergoing periodic follow-ups for CKD stage G3aA3 with membranous nephropathy was diagnosed with acute kidney injury (AKI) (estimated glomerular filtration rate [eGFR]: 15 mL/min/1.73 m2) without prerenal AKI. He reported developing recent-onset cough 3 weeks prior to presenting to us. Renal biopsy revealed acute tubulointerstitial nephritis along with known membranous nephropathy. CD4+ helper T cells comprised most lymphocytes in the tubulointerstitium. Results of the interferon-gamma release assay, sputum smear test, polymerase chain reaction (PCR), and culture test were positive for TB. Chest computed tomography revealed thickening of the left bronchial wall; therefore, a diagnosis of early bronchial TB was made; his urine culture and PCR were negative for TB. At four months after TB treatment with no immunosuppressive therapy, his eGFR improved to 50 mL/min/1.73 m2, and based on this progress, the AKI was diagnosed as tuberculosis-associated tubulointerstitial nephritis (TATIN). Although TATIN typically occurs with chronic or miliary tuberculosis, it is very rare in early bronchial TB. Identification of TATIN is important in kidney diseases of unknown etiology, and treatment with anti-TB drugs is necessary.
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Affiliation(s)
- Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
| | - Hirotsugu Hashimoto
- Department of Diagnostic Pathology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Mariko Kawamura
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Jumpei Yamashita
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Takahiro Yoshikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Rei Isshiki
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Hiroko Takahashi
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
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13
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Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
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14
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Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
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15
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Chandran S, Rahman A, Norris JM, Tiberi S, Kunst H. Diagnostic pitfalls of urogenital tuberculosis. Trop Med Int Health 2021; 26:753-759. [PMID: 33817915 DOI: 10.1111/tmi.13583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To describe characteristics, details of diagnosis and outcomes of urogenital tuberculosis (UGTB) in a low-prevalence country. METHODS We conducted a retrospective observational study of 37 consecutive patients diagnosed with UGTB between 1st January 2014 and 31st October 2019 in an East London hospital. RESULTS 68% (25/37) of patients were male and the median age was 42 years (IQR 34-55). 89% (33/37) of patients were born outside the United Kingdom with 65% (24/37) born in the South Asian region. Renal (32.4%), epididymal (24.3%) and endometrial TB (21.6%) were the most prevalent forms of UGTB. Only 13.5% of UGTB patients had concurrent pulmonary TB. The median length of time from symptom onset to treatment was 163 days, while endometrial TB had an average delay to diagnosis of 564 days. Approximately half of patients with UGTB were culture positive (51.4%). However, 70% of early morning urines (EMUs) sent in urinary TB were culture positive. 11 patients (30.6%) underwent two or more invasive procedures, such as biopsy to obtain specimen samples. The mean treatment length for all UGTB cases was 7.3 months (SD 3.1). Notably, 25% of patients with endometrial TB required surgery despite antituberculous treatment. CONCLUSIONS UGTB is challenging to diagnose as early disease is often asymptomatic. Clinicians faced with non-specific symptoms, or features suggestive of urogenital malignancy amongst patients from TB-endemic areas, should maintain a high suspicion of UGTB.
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Affiliation(s)
- Shruthi Chandran
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Ananna Rahman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
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16
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Kamra E, Mehta PK. Current updates in diagnosis of male urogenital tuberculosis. Expert Rev Anti Infect Ther 2021; 19:1175-1190. [PMID: 33688791 DOI: 10.1080/14787210.2021.1902305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Urogenital tuberculosis (UGTB) is a common manifestation of extrapulmonary TB (EPTB), which affects both men and women in a ratio of 2:1. Similar to other EPTB types, diagnosis of UGTB is quite challenging owing to atypical clinical presentation and paucibacillary nature of specimens. This review is primarily focused on the current updates developed in the diagnosis of male UGTB.Area covered: Smear/culture, imaging, histopathology, and interferon-γ release assays are the main modalities employed for detecting male UGTB cases. Moreover, we described the utility of nucleic acid amplification tests (NAATs), including loop-mediated isothermal amplification, PCR, nested-PCR, and GeneXpert (MTB/RIF) assays. The possibility of using other novel modalities, such as immuno-PCR (I-PCR), aptamer-linked immobilized sorbent assay (ALISA), and identification of circulating cell-free DNA (cfDNA) by NAATs were also discussed.Expert opinion: The current methods used for the diagnosis of male UGTB are not adequate. Therefore, the latest molecular/immunological tools, i.e. Xpert Ultra, Truenat MTBTM, I-PCR, ALISA, and cfDNA detection employed for the diagnosis of other EPTB forms and pulmonary TB may also be exploited for UGTB diagnosis. Reliable and timely diagnosis of male UGTB may initiate an early start of anti-tubercular therapy that would reduce infertility and other complications associated with disease.
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Affiliation(s)
- Ekta Kamra
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
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17
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Kaba Ö, Kara M, Bayramoğlu Z, Çalışkan E, Çetin B, Karimov E, Özkuvancı Ü, Özlük Y, Hançerli Torun S, Yürük Yıldırım ZN, Ziylan HO, Somer A. An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report. Paediatr Int Child Health 2021; 41:154-157. [PMID: 32990186 DOI: 10.1080/20469047.2020.1822633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmed Mycobacterium tuberculosis. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.
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Affiliation(s)
- Özge Kaba
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Manolya Kara
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zuhal Bayramoğlu
- Department of Radiology, Division of Pediatric Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emine Çalışkan
- Department of Radiology, Division of Pediatric Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bilal Çetin
- Department of Urology, Division of Pediatric Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elnur Karimov
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ünsal Özkuvancı
- Department of Urology, Division of Pediatric Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Özlük
- Department of Pathology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selda Hançerli Torun
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Nagehan Yürük Yıldırım
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasan Orhan Ziylan
- Department of Urology, Division of Pediatric Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Radiology, Division of Pediatric Radiology, Seyhan State Hospital, Adana, Turkey
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18
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Sun Z, Liu W, Zhang J, Wang S, Yang F, Fang Y, Jiang W, Ding L, Zhao H, Zhang Y. The Direct Semi-Quantitative Detection of 18 Pathogens and Simultaneous Screening for Nine Resistance Genes in Clinical Urine Samples by a High-Throughput Multiplex Genetic Detection System. Front Cell Infect Microbiol 2021; 11:660461. [PMID: 33912478 PMCID: PMC8072482 DOI: 10.3389/fcimb.2021.660461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Urinary tract infections (UTIs) are one the most common infections. The rapid and accurate identification of uropathogens, and the determination of antimicrobial susceptibility, are essential aspects of the management of UTIs. However, existing detection methods are associated with certain limitations. In this study, a new urinary tract infection high-throughput multiplex genetic detection system (UTI-HMGS) was developed for the semi-quantitative detection of 18 pathogens and the simultaneously screening of nine resistance genes directly from the clinical urine sample within 4 hours. Methods We designed and optimized a multiplex polymerase chain reaction (PCR) involving fluorescent dye-labeled specific primers to detect 18 pathogens and nine resistance genes. The specificity of the UTI-HMGS was tested using standard strains or plasmids for each gene target. The sensitivity of the UTI-HMGS assay was tested by the detection of serial tenfold dilutions of plasmids or simulated positive urine samples. We also collected clinical urine samples and used these to perform urine culture and antimicrobial susceptibility testing (AST). Finally, all urine samples were detected by UTI-HMGS and the results were compared with both urine culture and Sanger sequencing. Results UTI-HMGS showed high levels of sensitivity and specificity for the detection of uropathogens when compared with culture and sequencing. In addition, ten species of bacteria and three species of fungi were detected semi-quantitatively to allow accurate discrimination of significant bacteriuria and candiduria. The sensitivity of the UTI-HMGS for the all the target genes could reach 50 copies per reaction. In total, 531 urine samples were collected and analyzed by UTI-HMGS, which exhibited high levels of sensitivity and specificity for the detection of uropathogens and resistance genes when compared with Sanger sequencing. The results from UTI-HMGS showed that the detection rates of 15 pathogens were significantly higher (P<0.05) than that of the culture method. In addition, there were 41(7.72%, 41/531) urine samples were positive for difficult-to-culture pathogens, which were missed detected by routine culture method. Conclusions UTI-HMGS proved to be an efficient method for the direct semi-quantitative detection of 18 uropathogens and the simultaneously screening of nine antibiotic resistance genes in urine samples. The UTI-HMGS could represent an alternative method for the clinical detection and monitoring of antibiotic resistance.
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Affiliation(s)
- Zhaoyang Sun
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Wenjian Liu
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Jinghao Zhang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Su Wang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Feng Yang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Yi Fang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Wenrong Jiang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Li Ding
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Hu Zhao
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Yanmei Zhang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
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19
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Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021; 76:130-143. [PMID: 33596517 DOI: 10.1016/j.clinimag.2021.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The ever-growing prevalence of tuberculosis is a cause for concern among both developing and developed countries. Abdominal tuberculosis is the most common site of extrapulmonary tuberculosis and involves almost all of the visceral organs. Clinical presentation of abdominal tuberculosis is often non-specific. Thus, having a high index of clinical suspicion is necessary to aide early diagnosis and guide prompt initiation of appropriate treatment. In this review, we focus on the entire spectrum of abdominal tuberculosis and other diseases mimicking it with an emphasis on their imaging findings.
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Affiliation(s)
- Heta Ladumor
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
| | - Salma Al-Mohannadi
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | | | - Sushila Ladumor
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Shaimaa Fadl
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, Room 2-013, Box 984070, Richmond, VA, 23298, United States of America
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20
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Bottura BF, Bezerra VA, Salim R, Tamura M, Moretti-Marques R. Differential diagnoses of endometrial thickness: A case report. Maturitas 2021; 146:9-10. [PMID: 33722366 DOI: 10.1016/j.maturitas.2021.01.001] [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: 08/30/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
Tuberculosis (TB) is an infectious disease defined by the World Health Organization as a global priority. Extrapulmonary forms include lymph nodal, pleural and urogenital disease (FGTB), which generally affect patients between 20 and 40 years of age, and is rare in postmenopausal women. Its presentation can mimic carcinomatosis due to advanced ovarian and/or endometrial cancer. Non-diagnosis can lead to inappropriate treatment, notably surgical procedures, instead of the standard medical anti-TB chemotherapy.
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21
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Mishra KG, Ahmad A, Singh G, Tiwari R. Current Status of Genitourinary Tuberculosis: Presentation, Diagnostic Approach and Management-Single Centre Experience at IGIMS (Ptana, Bihar, India). Indian J Surg 2020. [DOI: 10.1007/s12262-020-02115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Natarajan A, Beena PM, Devnikar AV, Mali S. A systemic review on tuberculosis. Indian J Tuberc 2020; 67:295-311. [PMID: 32825856 DOI: 10.1016/j.ijtb.2020.02.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 09/07/2019] [Accepted: 02/18/2020] [Indexed: 12/17/2022]
Abstract
Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide. Tuberculosis continues to be a huge peril disease against the human population and according to WHO, tuberculosis is a major killer of the human population after HIV/AIDS. Tuberculosis is highly prevalent among the low socioeconomic section of the population and marginalized sections of the community. In India, National strategic plan (2017-2025) has a national goal of elimination of tuberculosis by 2025. It requires increased awareness and understanding of Tuberculosis. In this review article history, taxonomy, epidemiology, histology, immunology, pathogenesis and clinical features of both pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) has been discussed. A great length of detailed information regarding diagnostic modalities has been explained along with diagnostic algorithm for PTB and EPTB. Treatment regimen for sensitive, drug resistant and extensive drug resistant tuberculosis has been summarized along with newer drugs recommended for multi drug resistant tuberculosis. This review article has been written after extensive literature study in view of better understanding and to increase awareness regarding tuberculosis, as a sincere effort that will help eliminate tuberculosis off the face of the earth in near future.
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MESH Headings
- Humans
- Algorithms
- Culture Techniques
- Extensively Drug-Resistant Tuberculosis
- History, 15th Century
- History, 16th Century
- History, 17th Century
- History, 18th Century
- History, 19th Century
- History, 20th Century
- History, Ancient
- Interferon-gamma Release Tests
- Mycobacterium tuberculosis
- Nucleic Acid Amplification Techniques
- Polymerase Chain Reaction
- Tuberculin Test
- Tuberculosis/diagnosis
- Tuberculosis/epidemiology
- Tuberculosis/history
- Tuberculosis/immunology
- Tuberculosis, Multidrug-Resistant
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/history
- Tuberculosis, Pulmonary/immunology
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Affiliation(s)
- Arvind Natarajan
- Department of Microbiology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - P M Beena
- Department of Microbiology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Anushka V Devnikar
- Department of Microbiology, S Nijalingappa Medical College, Bagalkot, India
| | - Sagar Mali
- SDM Narayanaya Heart Centre, Sri Dharmasthala Manjunatheshwara Medical College, Sri Dharmasthala Manjunatheshwara University, Dharwad, India.
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23
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Ponnayyan NK, Ganapath AS, Ganapathy V. Spectrum of tuberculosis in urology: Case series and review of the literature. Urol Ann 2020; 12:107-111. [PMID: 32565645 PMCID: PMC7292423 DOI: 10.4103/ua.ua_121_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Urologists are confronted with various forms of extrapulmonary tuberculosis (TB) having an atypical presentation. The disease presents late with complications and sequelae. Four cases of extrapulmonary TB who presented to the urology department are reported here. The cases reported are TB adrenalitis, tuberculous cystitis, renal TB, and TB prostatitis. The prsentation of these cases shows GUTB as being a great imitator of other diseases. So there is a need for a very high index of suspicion for early diagnosis and to avoid misdiagnosis to prevent the devastating sequelae like organ damage. Furthermore, there is a need to develop better diagnostic tools for TB. Multidrug chemotherapy and judicious use of surgery form the mainstay of management.
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Affiliation(s)
| | | | - Venugopal Ganapathy
- Department of Urology, Government Medical College, Trivandrum, Kerala, India
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24
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A 32-Year-Old Woman With Miscarriage, Headache, Hepatitis, and Pulmonary Disease. Chest 2020; 155:e101-e105. [PMID: 30955580 DOI: 10.1016/j.chest.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/29/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022] Open
Abstract
CASE PRESENTATION A 32-year-old Nigerian woman, who became pregnant after undergoing in vitro fertilization, was admitted with nausea and abdominal pain. She had a history of two miscarriages and infertility because of tubal blockage treated by salpingectomy. One week prior, she presented to an outside hospital with premature rupture of membranes resulting in stillborn delivery of twins. Endometrial cultures from dilatation and curettage grew Escherichia coli, and she was started on a fluoroquinolone for chorioamnionitis.
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25
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Bladder cancer and its mimics: a sonographic pictorial review with CT/MR and histologic correlation. Abdom Radiol (NY) 2019; 44:3827-3842. [PMID: 31676920 DOI: 10.1007/s00261-019-02276-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bladder cancer is the most common cancer of the urinary system and often presents with hematuria. Despite its relatively high incidence, bladder cancer is often under-recognized sonographically. Moreover, even when bladder abnormalities are identified, numerous other entities may mimic the appearance of bladder cancer. Given the incidence and prevalence of bladder cancer, it is important to recognize its variable appearance sonographically and distinguish it from its common mimics. We review the sonographic appearance of bladder cancer and its mimics, providing correlative CT/MR imaging as well as pathology. We stress the importance and advantage of ultrasound as a dynamic imaging modality, with the ability to optimize distinguishing bladder cancer from similar-appearing entities.
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26
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Hansen KC, Jensen-Fangel S, Hønge BL. Contribution to differential diagnosis of sarcoidosis and disseminated tuberculosis. BMJ Case Rep 2019; 12:12/11/e230652. [PMID: 31690687 DOI: 10.1136/bcr-2019-230652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously healthy 54-year-old ethnically Danish man was referred to the Department of Infectious Diseases at Aarhus University Hospital after an unexpected detection of Mycobacterium tuberculosis DNA in his lungs. Further examination revealed widespread dissemination of the tuberculosis (TB) to brain, mastoid, urinary and gastrointestinal tract. Thirteen months earlier, the patient was orchiectomised due to recurring inflammation of the right testicle. Three and a half months prior to admission to our department the patient started immunosuppressive therapy with steroids due to radiological and histological findings in the lungs that were interpreted as sarcoidosis (SA). This treatment is likely to be co-responsible for the pronounced dissemination of the TB. The patient was Bacillus Calmette-Guérin (BCG)-vaccinated as a child and had no apparent risk factors for TB apart from travelling in TB-endemic countries until 10 years before falling ill. Screening for latent TB was not performed prior to starting steroid treatment.
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Affiliation(s)
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Langhoff Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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27
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Abstract
Isolated genital tuberculosis is rare. We present a case of bilateral tuberculous epididymo-orchitis showing high FDG uptake on FDG PET/CT. In addition, the patient had a prostatic FDG-avid lesion, consistent with tuberculous prostatitis. This case indicates tuberculous epididymo-orchitis, especially in tuberculosis-endemic regions, should be considered as a differential diagnosis in patients with hypermetabolic epididymal or testicular lesions, including benign and malignant tumors, bacterial epididymo-orchitis, abscess, idiopathic granulomatous orchitis, and sarcoidosis.
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Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
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Bhatt M, Soneja M, Tripathi M, Biswas A. Curious case of fever of unknown origin. BMJ Case Rep 2018; 11:11/1/bcr-2018-227258. [PMID: 30567178 DOI: 10.1136/bcr-2018-227258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.
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Affiliation(s)
- Manasvini Bhatt
- Junior Resident, Department of Medicine, All India Institute of Medical Sciences, New Delhi
| | - Manish Soneja
- Associate Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Associate Professor, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi
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Disseminated Tuberculosis Presenting as Chronic Orchiepididymitis in a Military Trainee: A Case Report and Review of the Literature. Case Rep Infect Dis 2018; 2018:7316097. [PMID: 30402306 PMCID: PMC6192136 DOI: 10.1155/2018/7316097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
Orchiepididymitis is a clinical diagnosis. The acute form secondary to sexually transmitted or enteric pathogens is well known to primary care providers. However, chronic orchiepididymitis may be secondary to genitourinary tuberculosis (TB), and physicians in countries with a low prevalence of TB might not consider it in their differential diagnosis. Indeed, cognitive errors, such as anchoring or availability bias, may contribute to a delayed diagnosis of genitourinary TB. We present a case of chronic orchiepididymitis as a result of disseminated TB in a Cameroonian male who was visiting the United States for military training. He experienced diagnostic delay and was ultimately diagnosed by orchiectomy. Early consideration of a diagnosis of TB for chronic or recurrent orchiepididymitis in a patient with epidemiologic risk factors is of utmost importance because delayed diagnosis could lead to organ loss.
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31
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Kim EJ, Lee W, Jeong WY, Choi H, Jung IY, Ahn JY, Jeong SJ, Ku NS, Choi JY, Choi YH, Song YG, Kim JM. Chronic kidney disease with genitourinary tuberculosis: old disease but ongoing complication. BMC Nephrol 2018; 19:193. [PMID: 30071831 PMCID: PMC6090963 DOI: 10.1186/s12882-018-0994-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis (GUTB) is a type of extrapulmonary TB that exerts a deleterious effect on renal function by promoting renal calcification and ureteric stricture. Therefore, we investigated the risk factors for chronic kidney disease (CKD) in GUTB patients after the end of treatment. METHODS This retrospective study was conducted at a tertiary hospital in South Korea. Data from patients (>18 years of age) with GUTB were collected from January 2005 to July 2016. CKD was defined as a glomerular filtration rate <60 mL/min/1.73m2 after the end of treatment. RESULTS In total, 56 patients with GUTB (46.4% males; mean age 52.8 ± 16.6 years) were enrolled in the study. CKD developed in 11 (19.6%) patients and end-stage renal disease in 4 (7.1%). In a univariate analysis, older age (p = 0.029), microscopic haematuria (p = 0.019), proteinuria (p = 0.029), acute renal failure (ARF) (p < 0.001) and a positive polymerase chain reaction-based test result for TB in the urine (p = 0.030) were significantly associated with decreased renal function. In a multivariate analysis, ARF (odds ratio [OR], 54.31; 95% confidence interval [CI], 1.52-1944.00; p = 0.032) and old age (OR, 54.26; 95% CI, 1.52-1932.94; p = 0.028) were independent risk factors for CKD in GUTB patients. CONCLUSIONS ARF and old age were independent risk factors for CKD in GUTB patients. Therefore, in elderly GUTB patients with ARF at the time of diagnosis, regular follow-up of renal function should be performed even after the end of treatment.
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Affiliation(s)
- Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Woonji Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Woo Yong Jeong
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hen Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Young Jung
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Ahn
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jun Yong Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
| | - Young Goo Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - June Myung Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
The morbidity and mortality due to tuberculosis (TB) is high worldwide, and the burden of disease among women is significant, especially in developing countries. Mycobacterium tuberculosis bacilli reach the genital tract primarily by haematogenous spread and dissemination from foci outside the genitalia with lungs as the common primary focus. Genital TB in females is a chronic disease with low-grade symptoms. The fallopian tubes are affected in almost all cases of genital TB, and along with endometrial involvement, it causes infertility in patients. Many women present with atypical symptoms which mimic other gynaecological conditions. A combination of investigations is needed to establish the diagnosis of female genital TB (FGTB). Multidrug anti-TB treatment is the mainstay of management and surgery may be required in advanced cases. Conception rates are low among infertile women with genital TB even after multidrug therapy for TB, and the risk of complications such as ectopic pregnancy and miscarriage is high. More research is needed on the changing trends in the prevalence and on the appropriate methods for diagnosis of FGTB.
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Affiliation(s)
- G Angeline Grace
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - D Bella Devaleenal
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Mohan Natrajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
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Abstract
Necrosis is a hallmark of several widespread diseases or their direct complications. In the past decade, we learned that necrosis can be a regulated process that is potentially druggable. RIPK3- and MLKL-mediated necroptosis represents by far the best studied pathway of regulated necrosis. During necroptosis, the release of damage-associated molecular patterns (DAMPs) drives a phenomenon referred to as necroinflammation, a common consequence of necrosis. However, most studies of regulated necrosis investigated cell lines in vitro in a cell autonomous manner, which represents a non-physiological situation. Conclusions based on such work might not necessarily be transferrable to disease states in which synchronized, non-cell autonomous effects occur. Here, we summarize the current knowledge of the pathophysiological relevance of necroptosis in vivo, and in light of this understanding, we reassess the morphological classification of necrosis that is generally used by pathologists. Along these lines, we discuss the paucity of data implicating necroptosis in human disease. Finally, the in vivo relevance of non-necroptotic forms of necrosis, such as ferroptosis, is addressed.
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Affiliation(s)
- Wulf Tonnus
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Andreas Linkermann
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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He J, Ou Q, Liu C, Shi L, Zhao C, Xu Y, Kong SK, Loo J, Li B, Gu D. Differential expression of long non-coding RNAs in patients with tuberculosis infection. Tuberculosis (Edinb) 2017; 107:73-79. [PMID: 29050775 DOI: 10.1016/j.tube.2017.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 01/30/2023]
Abstract
Tuberculosis (TB) remains a major worldwide health problem and has caused millions of deaths in the past few years. Current diagnostic methods, such as sputum smear microscopy and sputum culture, are time-consuming and cannot prevent the rapid spreading of TB during the diagnostic period. In this connection, detecting biomarkers specific to TB at molecular level in plasma of patients will provide a rapid means for diagnosis. In this study, we first evaluated the differential expression of the long non-coding RNAs (lncRNAs) in the plasma from patients with TB (TB positive), community acquired pneumonia (CAP) and healthy individuals (CG) using lncRNA microarray scanning. It was found that there were 2116 specific lncRNAs differentially expressed in the TB positive samples (1102 up-regulated and 1014 down-regulated), which accounted for 6.96% of total lncRNAs. Twelve differentially expressed lncRNAs discovered in microarray were subsequently validated by using real-time quantitative PCR (RT-qPCR). Two lncRNAs (ENST00000354432 and ENST00000427151) were further validated with more Tuberculosis samples. These results suggested the expression level of lncRNAs and the two validated lncRNAs in plasma could be the potential molecular biomarkers for the rapid diagnosis of Tuberculosis.
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Affiliation(s)
- Jianan He
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China; Shenzhen Academy of Inspection and Quarantine, Shenzhen, 518010, PR China
| | - Qingye Ou
- Zhuhai Center for Chronic Disease Control, Zhuhai, 519000, PR China
| | - Chunxiao Liu
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China
| | - Lei Shi
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China
| | - Chunzhong Zhao
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China
| | - Yunqing Xu
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China
| | - Siu Kai Kong
- Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jacky Loo
- Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Boan Li
- 302 Military Hospital of China, Beijing, 100039, PR China.
| | - Dayong Gu
- Central Laboratory of Health Quarantine, Shenzhen International Travel Health Care Center, Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen, 518033, PR China; Shenzhen Academy of Inspection and Quarantine, Shenzhen, 518010, PR China.
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Abstract
Tuberculous pyelonephritis is rare in children; three case reports are presented. Case 1 was an 11-year-old girl with a previous history of pulmonary tuberculosis who presented with flank pain and fever for 10 days. An ultrasound suggested focal pyelonephritis, and a contrast-enhanced computed tomography (CECT) scan demonstrated acute focal pyelonephritis and a perinephric collection. Mycobacterium tuberculosis was cultured in the urine. She responded well to anti-tuberculous treatment (ATT). Case 2 was a 13-year-old boy who presented with fever, haematuria, burning micturition, proteinuria (3+) and cervical lymphadenopathy. The Mantoux test was strongly positive. Chest radiograph demonstrated right hilar lymphadenopathy and ultrasonography showed evidence of acute pyelonephritis. Tuberculous lymphadenitis was diagnosed by fine-needle aspiration cytology (FNAC) from cervical lymph nodes and he responded to ATT. Follow-up urinalysis and ultrasound were normal. Case 3 was a 6-year-old boy, a known case of pulmonary tuberculosis (from 2 years of age) and a previous defaulter from ATT. He presented with symptoms of lumbar pain and dysuria. Chest radiograph demonstrated mediastinal lymphadenopathy and a CECT of the head showed a tuberculous granuloma. CECT of the abdomen showed an enlarged left kidney with focal pyelonephritis, an abscess in the upper pole and parenchymal calcification. FNAC of the cervical lymph nodes supported a diagnosis of disseminated tuberculosis with tuberculous pyelonephritis. He was given 8 months of ATT. Fifteen months later he presented again with clinical and urinary findings of urinary tract infection. CECT now demonstrated gross hydronephrosis of the left kidney, and it was confirmed to be non-functioning by a DMSA scan and magnetic resonance urogram. Diethylenetriaminepentaacetic acid showed a GFR of 44.3 ml/min/1.73 m2. Nephrectomy was undertaken and the histology confirmed tuberculous pyelonephritis. Six months later he was well with an eGFR of 87.2 ml/min/m2. In patients with symptoms of urinary tract infection but sterile urine who do not respond to antibiotics or have evidence of tuberculous elsewhere in the body, careful consideration should be given to the possibility of tuberculous pyelonephritis.
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Affiliation(s)
- Nimisha Arora
- a Division of Pediatric Nephrology, Department of Pediatrics , Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital , New Delhi , India
| | - Abhijeet Saha
- a Division of Pediatric Nephrology, Department of Pediatrics , Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital , New Delhi , India
| | - Manpreet Kaur
- b Division of Pediatric Nephrology, Department of Pediatrics , Postgraduate Institute of Medical Education & Research and Associated Dr. Ram Manohar Lohia Hospital , New Delhi , India
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Babafemi EO, Cherian BP, Banting L, Mills GA, Ngianga K. Effectiveness of real-time polymerase chain reaction assay for the detection of Mycobacterium tuberculosis in pathological samples: a systematic review and meta-analysis. Syst Rev 2017; 6:215. [PMID: 29070061 PMCID: PMC5657121 DOI: 10.1186/s13643-017-0608-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/12/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of tuberculosis (TB) is key to manage the disease and to control and prevent its transmission. Many established diagnostic methods suffer from low sensitivity or delay of timely results and are inadequate for rapid detection of Mycobacterium tuberculosis (MTB) in pulmonary and extra-pulmonary clinical samples. This study examined whether a real-time polymerase chain reaction (RT-PCR) assay, with a turn-a-round time of 2 h, would prove effective for routine detection of MTB by clinical microbiology laboratories. METHODS A systematic literature search was performed for publications in any language on the detection of MTB in pathological samples by RT-PCR assay. The following sources were used MEDLINE via PubMed, EMBASE, BIOSIS Citation Index, Web of Science, SCOPUS, ISI Web of Knowledge and Cochrane Infectious Diseases Group Specialised Register, grey literature, World Health Organization and Centres for Disease Control and Prevention websites. Forty-six studies met set inclusion criteria. Generated pooled summary estimates (95% CIs) were calculated for overall accuracy and bivariate meta-regression model was used for meta-analysis. RESULTS Summary estimates for pulmonary TB (31 studies) were as follows: sensitivity 0.82 (95% CI 0.81-0.83), specificity 0.99 (95% CI 0.99-0.99), positive likelihood ratio 43.00 (28.23-64.81), negative likelihood ratio 0.16 (0.12-0.20), diagnostic odds ratio 324.26 (95% CI 189.08-556.09) and area under curve 0.99. Summary estimates for extra-pulmonary TB (25 studies) were as follows: sensitivity 0.70 (95% CI 0.67-0.72), specificity 0.99 (95% CI 0.99-0.99), positive likelihood ratio 29.82 (17.86-49.78), negative likelihood ratio 0.33 (0.26-0.42), diagnostic odds ratio 125.20 (95% CI 65.75-238.36) and area under curve 0.96. CONCLUSIONS RT-PCR assay demonstrated a high degree of sensitivity for pulmonary TB and good sensitivity for extra-pulmonary TB. It indicated a high degree of specificity for ruling in TB infection from sampling regimes. This was acceptable, but may better as a rule out add-on diagnostic test. RT-PCR assays demonstrate both a high degree of sensitivity in pulmonary samples and rapidity of detection of TB which is an important factor in achieving effective global control and for patient management in terms of initiating early and appropriate anti-tubercular therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015027534 .
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Affiliation(s)
- Emmanuel O. Babafemi
- Microbiology Department, Pathology Division, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Lee Banting
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Graham A. Mills
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Kandala Ngianga
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
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High incidence of fluoroquinolone resistance and effect of efflux pump inhibitors on moxifloxacin resistance among Mycobacterium tuberculosis isolates causing urinary tract infection in Taiwan. Int J Antimicrob Agents 2017; 50:491-495. [PMID: 28668684 DOI: 10.1016/j.ijantimicag.2017.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
Abstract
This study explored the prevalence of urinary tract tuberculosis (UTB) and whether efflux pump activation accounts for resistance to moxifloxacin in Taiwan. Of 3034 patients with culture-confirmed TB from 2005-2012, 47 patients (1.5%) with UTB were included in this study. Minimum inhibitory concentrations (MICs) of moxifloxacin were determined in the presence and absence of efflux pump inhibitors (EPIs), including verapamil, reserpine and carbonyl cyanide 3-chlorophenylhydrazone (CCCP). EPI responders were defined as isolates with at least a four-fold reduction in MICs in the presence of EPIs. Among the 47 isolates, 24 (51.1%) were resistant to ofloxacin and 22 (46.8%) were resistant to moxifloxacin by the agar proportion method. Among the 22 moxifloxacin-resistant isolates, 19 (86.4%) had low-level resistance (MIC = 1.0-2.0 mg/L). Patients with prior exposure to fluoroquinolones were more likely than non-exposed patients to have moxifloxacin-resistant isolates [14/22 (63.6%) vs. 8/25 (32.0%); P = 0.030]. All 3 isolates with high-level moxifloxacin resistance (MIC ≥ 4.0 mg/L) had mutations in the gyrA or gyrB genes; however, among the 19 isolates with low-level resistance, only 1 (5.3%) had a mutation in the gyrA gene. Among the 19 isolates with low-level moxifloxacin resistance, 16 isolates (84.2%) were EPIs responders, but none of the high-level resistant isolates were EPIs responders. Approximately one-half (46.8%) of the isolates from patients with UTB were resistant to moxifloxacin, and activation of efflux pumps accounted for most low-level moxifloxacin-resistant isolates.
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38
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Altez-Fernandez C, Ortiz V, Mirzazadeh M, Zegarra L, Seas C, Ugarte-Gil C. Diagnostic accuracy of nucleic acid amplification tests (NAATs) in urine for genitourinary tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 2017; 17:390. [PMID: 28583076 PMCID: PMC5460328 DOI: 10.1186/s12879-017-2476-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/18/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis. Diagnosis is difficult because of unspecific clinical manifestations and low accuracy of conventional tests. Unfortunately, the delayed diagnosis impacts the urinary tract severely. Nucleic acid amplification tests yield fast results, and among these, new technologies can also detect drug resistance. There is lack of consensus regarding the use of these tests in genitourinary tuberculosis; we therefore aimed to assess the accuracy of nucleic acid amplification tests in the diagnosis of genitourinary tuberculosis and to evaluate the heterogeneity between studies. METHODS We did a systematic review and meta-analysis of research articles comparing the accuracy of a reference standard and a nucleic acid amplification test for diagnosis of urinary tract tuberculosis. We searched Medline, EMBASE, Web of Science, LILACS, Cochrane Library, and Scopus for articles published between Jan 1, 1990, and Apr 14, 2016. Two investigators identified eligible articles and extracted data for individual study sites. We analyzed data in groups with the same index test. Then, we generated pooled summary estimates (95% CIs) for sensitivity and specificity by use of random-effects meta-analysis when studies were not heterogeneous. RESULTS We identified eleven relevant studies from ten articles, giving information on PCR, LCR and Xpert MTB/RIF tests. All PCR studies were "in-house" tests, with different gene targets and had several quality concerns therefore we did not proceed with a pooled analysis. Only one study used LCR. Xpert studies were of good quality and not heterogeneous, pooled sensitivity was 0·87 (0·66-0·96) and specificity was 0·91 (0·84-0·95). CONCLUSION PCR studies were highly heterogeneous. Among Xpert MTB/RIF studies, specificity was favorable with an acceptable confidence interval, however new studies can update meta-analysis and get more precise estimates. Further high-quality studies are urgently needed to improve diagnosis of genitourinary tuberculosis. PROTOCOL REGISTRATION PROSPERO CRD42016039020.
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Affiliation(s)
- Carlos Altez-Fernandez
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, S.M, P Lima, Perú
| | - Victor Ortiz
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, S.M, P Lima, Perú
| | - Majid Mirzazadeh
- Department of Urology, Wake Forest University, Winston Salem, NC USA
| | - Luis Zegarra
- Servicio de Urología, Hospital Nacional Cayetano Heredia, Lima, Perú
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Cesar Ugarte-Gil
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, S.M, P Lima, Perú
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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39
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Yadav S, Singh P, Hemal A, Kumar R. Genital tuberculosis: current status of diagnosis and management. Transl Androl Urol 2017; 6:222-233. [PMID: 28540230 PMCID: PMC5422679 DOI: 10.21037/tau.2016.12.04] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Genitourinary Tuberculosis (GUTB) is the second most common extra-pulmonary manifestation of tuberculosis (Tb) and an isolated involvement of genital organs is reported in 5–30% of the cases. Genital involvement results from primary reactivation of latent bacilli either in the epididymis or the prostate or by secondary spread from the already infected urinary organs. The epididymis are the commonest involved organs affected primarily by a hematogenous mode of spread. Tb is characterized by extensive destruction and fibrosis, thus an early diagnosis may prevent function and organ loss. The gold standard for diagnosis is the isolation and culture of mycobacterium tuberculosis bacilli and in the cases of suspected GUTB, it is commonly looked for in the urinary samples. All body fluid specimens from possible sites of infection and aspirates from nodules must also be subjected to examination. Radiologic investigations including ultrasonography and contrast imaging may provide supportive evidence. Anti-tubercular chemotherapy is the first line of management for all forms of genital Tb and a 6 months course is the standard of care. Most patients with tubercular epididymo-orchitis respond to antitubercular therapy but may require open or percutaneous drainage. Infertility resulting from the tubercular affliction of the genitalia is multifactorial in origin and may persist even after successful chemotherapy. Multiple organ involvement with obstruction at several sites is characteristic and most of these cases are not amenable to surgical reconstruction. Thus, assisted reproduction is usually required. Post treatment, regular annual follow up is recommended even though, with the current multi drug therapy, the chances of relapse are low.
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Affiliation(s)
- Siddharth Yadav
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Hemal
- Baptist Medical Centre, Wake Forest University, Winston-Salem, NC, USA
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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40
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Xu B, Hu J, Chen A, Hao Y, Liu G, Wang C, Wang X. Risk Factors Related with Retroperitoneal Laparoscopic Converted to Open Nephrectomy for Nonfunctioning Renal Tuberculosis. J Endourol 2017; 31:588-592. [PMID: 28358254 DOI: 10.1089/end.2017.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The present study was designed to investigate the risk factors affecting the conversion to open surgery in retroperitoneal laparoscopic nephrectomy of nonfunctioning renal tuberculosis (TB). PATIENTS AND METHODS The records of 144 patients who underwent a retroperitoneal laparoscopic nephrectomy procedure by a single surgeon were retrospectively reviewed. The following factors, including age, sex, body mass index (BMI), diabetes status, hypertension status, side of kidney, size of kidney, degree of calcification, mild perirenal extravasation, contralateral hydronephrosis, the time of anti-TB, and surgeon experience were analyzed. Univariate and multivariate logistic regression analyses were used for statistical assessment. RESULTS Twenty-three patients were converted to open surgery and the conversion rate was 15.97%. In univariate analysis, BMI ≥35 kg/m2 (p = 0.023), hypertension (p = 0.011), diabetes (p = 0.003), and kidney size (p = 0.032) were the main factors of conversion to open surgery. Sex, age, side, anti-TB time, calcification, mild extravasation, and surgeon experience were not significantly related. In multivariate regression analysis, BMI ≥35 kg/m2, hypertension, diabetes, and enlargement of kidney were the most important factors for conversion to open surgery. CONCLUSIONS Depending on the results achieved by a single surgeon, BMI ≥30 kg/m2, diabetes, hypertension, and enlargement of kidney significantly increased the conversion risk in retroperitoneal laparoscopic nephrectomy for nonfunctioning renal TB.
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Affiliation(s)
- Bo Xu
- 1 Department of Urology, The First Hospital of Jilin University , Changchun, P. R. China
| | - Jinghai Hu
- 1 Department of Urology, The First Hospital of Jilin University , Changchun, P. R. China
| | - Anxiang Chen
- 2 Department of Urology, Ji'an Hospital , Tonghua, P. R. China
| | - Yuanyuan Hao
- 1 Department of Urology, The First Hospital of Jilin University , Changchun, P. R. China
| | - GuoHui Liu
- 3 Department of Cardiology, China-Japan Union Hospital of Jilin University , Changchun, P. R. China
| | - Chunxi Wang
- 1 Department of Urology, The First Hospital of Jilin University , Changchun, P. R. China
| | - Xiaoqing Wang
- 1 Department of Urology, The First Hospital of Jilin University , Changchun, P. R. China
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41
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Tuberculosis of the Urogenital Tract. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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42
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Yang K, Samplaski M, Mazzulli T, Lo K, Grober E, Jarvi KA. Urinary mycobacterium avium presenting as sterile pyuria. Can Urol Assoc J 2016; 10:E186-E188. [PMID: 27790302 DOI: 10.5489/cuaj.3363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 65-year-old healthy woman presented with persistent, asymptomatic sterile pyuria detected by her family physician. While she did not have symptoms, the patient recounts that she has had cloudy urine for years. Cultures of the urine for bacteria showed no growth and no fungi were identified. First-morning urine samples were sent for both tuberculosis and nontuberculosis mycobacterium species testing. The culture grew genotypically identified Mycobaterium avium complex (MAC). Mantoux skin testing was positive. No urological abnormalities were detected by ultrasound and computed tomography (CT) imaging of the urinary tract.
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Affiliation(s)
- Kai Yang
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary Samplaski
- Department of Urology, University of Southern California, CA, U.S
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kirk Lo
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ethan Grober
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PC, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O'Brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf HS, Sotgiu G, Starke JR, Migliori GB, Vernon A. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147-e195. [PMID: 27516382 DOI: 10.1093/cid/ciw376] [Citation(s) in RCA: 652] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 02/06/2023] Open
Abstract
The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Julie M Higashi
- Tuberculosis Control Section, San Francisco Department of Public Health, California
| | - Christine S Ho
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Masahiro Narita
- Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle
| | - Rick O'Brien
- Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France
| | | | | | | | - H Simon Schaaf
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy
| | - Andrew Vernon
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rizvi N, Singh A, Yadav M, Hussain SR, Siddiqui S, Kumar V, Ali S, Agarwal A. Role of alpha-crystallin, early-secreted antigenic target 6-kDa protein and culture filtrate protein 10 as novel diagnostic markers in osteoarticular tuberculosis. J Orthop Translat 2016; 6:18-26. [PMID: 30035079 PMCID: PMC5987026 DOI: 10.1016/j.jot.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 02/05/2023] Open
Abstract
Osteoarticular tuberculosis constitutes about 3% of all tuberculosis cases. Early and accurate diagnosis of tuberculosis is a challenging problem especially in the case of osteoarticular tuberculosis owing to the lower number of bacilli. However, an accurate and timely diagnosis of the disease results in an improved efficacy of the given treatment. Besides the limitations of conventional methods, nowadays molecular diagnostic techniques have emerged as a major breakthrough for the early diagnosis of tuberculosis with high sensitivity and specificity. Alpha-crystallin is a dominantly expressed protein responsible for the long viability of the pathogen during the latent phase under certain stress conditions such as hypoxia and nitric oxide stress. Two other proteins-early secreted antigenic target-6 and culture filtrate protein-10-show high expression in the active infective phase of Mycobacterium tuberculosis. In this article, we focus on the different proteins expressed dominantly in latent/active tuberculosis, and which may be further used as prognostic biomarkers for diagnosing tuberculosis, both in latent and active phases.
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Affiliation(s)
- Nazia Rizvi
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Ajai Singh
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Manish Yadav
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Syed Rizwan Hussain
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Salma Siddiqui
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Vineet Kumar
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Sabir Ali
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
| | - Avinash Agarwal
- Department of Medicine, King George's Medical University, Lucknow 226 018, Uttar Pradesh, India
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Ye Y, Hu X, Shi Y, Zhou J, Zhou Y, Song X, Xie Y, Lu X, Wang L, Ying B, Chen X. Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China: A Cross-sectional Study. Medicine (Baltimore) 2016; 95:e3537. [PMID: 27175652 PMCID: PMC4902494 DOI: 10.1097/md.0000000000003537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the epidemiology, clinical features, and drug-resistance profile of urinary tuberculosis (UTB) in south-western China to improve UTB diagnostics.After the screening of 1036 cases of suspected UTB, 193 patients with UTB were enrolled during 2009 to 2014. Urine samples were collected for routine urinalysis, smear, tuberculosis DNA (TB-DNA) detection, and drug-resistant analysis, whereas blood samples were collected for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and renal function evaluation. Clinical features (such as symptoms and outcome) and imageology results (such as B ultrasonic, computerized tomography, intravenous pyelography, and renography) were also collected and analyzed to investigate the epidemiology, clinical features, and drug-resistance profile.The most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed. The positive rate for TB-DNA was 66.3%. The positive rate for culture was 13.1% and for smear it was 9.8%. The abnormal outcome rates of the computerized tomography, ultrasonography, intravenous pyelography, and the nephrogram were 76.9%, 70.1%, 29.8%, and 37.0%, respectively. The total rate of drug-resistant TB (resistant to at least 1 drug) was 39.7%, of which 20.7% was multidrug-resistance TB. The most prevalent mutation sites were katG S315T1, rpoB S531L, and gyrA D94G.We observed a serious epidemic of drug-resistant UTB and a substantial number of new UTB cases with multidrug resistance TB. Molecular diagnostics is crucial in the definite diagnosis of UTB, and our finding is a supplement and further confirmation of polymerase chain reaction usage for TB diagnosis. We recommend real-time polymerase chain reaction for TB-DNA identification instead of culture, and GenoType tests (MTBDRplus and MTBDRsl assay) for drug resistance as routine assays for patients with suspected UTB.
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MESH Headings
- Adult
- Antitubercular Agents/pharmacology
- Blood Sedimentation
- C-Reactive Protein/analysis
- China
- Cross-Sectional Studies
- DNA, Bacterial/urine
- Drug Resistance, Multiple, Bacterial
- Female
- Hematuria/microbiology
- Humans
- Kidney Function Tests
- Low Back Pain/microbiology
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Proteinuria/microbiology
- Tuberculosis, Multidrug-Resistant/complications
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/metabolism
- Tuberculosis, Renal/complications
- Tuberculosis, Renal/diagnosis
- Tuberculosis, Renal/drug therapy
- Tuberculosis, Renal/metabolism
- Urinary Tract Infections/microbiology
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Affiliation(s)
- Yuanxin Ye
- From the Department of Laboratory Medicine (YY, XH, JZ, YZ, XS, YX, XL, LW, BY), West China Hospital, Sichuan University, Sichuan Province; Department of Nephrology (YS); and Department of Tuberculosis (XC), West China Hospital, Sichuan University, Chengdu, The People's Republic of China
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46
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An Unusual Cause of Dysuria in a 30-Year-Old Woman. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang E, Wang F, Xu Y, Wang H, Hu Y, Shen H, Chen ZW. A lentiviral vector-based therapeutic vaccine encoding Ag85B-Rv3425 potently increases resistance to acute tuberculosis infection in mice. Acta Biochim Biophys Sin (Shanghai) 2015; 47:588-96. [PMID: 26112017 DOI: 10.1093/abbs/gmv059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
Abstract
Few treatment options for multidrug-resistant tuberculosis (TB) and extensively drug-resistant TB call attention to the development of novel therapeutic approaches for TB. Therapeutic vaccines are promising candidates because they can induce antigen-specific cellular immune responses, which play an important role in the elimination of Mycobacterium tuberculosis (MTB). In this study, a novel lentiviral vector therapeutic vaccine for delivering MTB-specific fusion protein Ag85B-Rv3425 was constructed. Results showed that one single-injection of this recombinant lentivirus vaccine could trigger antigen-specific Th1-type immune responses in mice. More importantly, mice with acute infection benefited a lot from a single-dose administration of this vaccine by markedly reduced MTB burdens in lungs and spleens as well as attenuated lesions in lungs compared with untreated mice. These results displayed good prospects of this novel vaccine for the immunotherapy of TB.
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Affiliation(s)
- Enzhuo Yang
- Unit of Anti-Tuberculosis Immunity, Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
| | - Feifei Wang
- Department of Medical Microbiology and Parasitology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ying Xu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200433, China
| | - Honghai Wang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200433, China
| | - Yong Hu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Hongbo Shen
- Unit of Anti-Tuberculosis Immunity, Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
| | - Zheng W Chen
- Unit of Anti-Tuberculosis Immunity, Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
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Tuberculous Epididymitis: A Case of Tuberculous Epididymitis That Was the Presenting Manifestation of Extrapulmonary and Pulmonary Tuberculoses. Ultrasound Q 2015; 31:192-4. [PMID: 25851823 DOI: 10.1097/ruq.0000000000000159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Handmer MM, Winter M, Lee WG, Louie-Johnsun M. Unexpected tuberculosis causing ureteral stricture. ANZ J Surg 2014; 87:515-516. [PMID: 25413173 DOI: 10.1111/ans.12938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Matthew Winter
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Wai Gin Lee
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford Hospital, Gosford, New South Wales, Australia
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50
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Hou W, Wen J, Li J, Ji Z. Usefulness of interferon-gamma release assay in diagnosis of renal tuberculosis. Infect Dis (Lond) 2014; 47:62-4. [PMID: 25342574 DOI: 10.3109/00365548.2014.959045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Weibin Hou
- From the Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P. R. China
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