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Kumbi H, Ali MM, Abate A. Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis. BMC Infect Dis 2024; 24:633. [PMID: 38918686 PMCID: PMC11197254 DOI: 10.1186/s12879-024-09554-z] [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: 02/02/2024] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Proper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis. METHODS Fine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25. RESULTS The sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785). CONCLUSION The fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.
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Affiliation(s)
- Hawi Kumbi
- Department of Laboratory Science, Adama Hospital Medical College, Po Box 84, Adama, Ethiopia.
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Po Box 1560, Hawassa, Ethiopia
| | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Sciences, Oda Bultum University, Po Box 226, Chiro, Ethiopia
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Corydon K, Ørum MB, Nøhr KB, Öbrink-Hansen K. Diagnostic Delay of Spinal Tuberculosis Causing Medullary Compression. Case Rep Infect Dis 2024; 2024:5118600. [PMID: 38737751 PMCID: PMC11087145 DOI: 10.1155/2024/5118600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/31/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
We present a case of a Philippine woman in her late twenties, diagnosed with spinal tuberculosis after surgical intervention due to medullary compression. The diagnosis was preceded by four months of unexplained back pain. Differential diagnoses included ulcer, liver-gallbladder disease, musculoskeletal causes, and cancer. This case highlights the importance of considering tuberculosis as a differential diagnosis in patients from high-endemic areas to avoid diagnostic delay and the risk of disease progression.
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Affiliation(s)
- Krestine Corydon
- Department of Internal Medicine, Gødstrup Regional Hospital, Herning, Denmark
| | - Matilde Bjørn Ørum
- Department of Infectious Diseases, Aalborg University Hospital and Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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Valencia-Trujillo D, Avila-Trejo AM, García-Reyes RL, Narváez-Díaz L, Mújica-Sánchez MA, Helguera-Repetto AC, Becerril-Vargas E, Mata-Miranda MM, Rivera-Gutiérrez S, Cerna-Cortés JF. Phenotypic and Genotypic Drug Resistance of Mycobacterium tuberculosis Strains Isolated from HIV-Infected Patients from a Third-Level Public Hospital in Mexico. Pathogens 2024; 13:98. [PMID: 38392836 PMCID: PMC10891562 DOI: 10.3390/pathogens13020098] [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: 12/14/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (TB) is associated with higher mortality rates in patients with human immunodeficiency virus (HIV). In Mexico, the number of deaths due to TB among the HIV-positive population has tripled in recent years. METHODS Ninety-three Mycobacterium tuberculosis strains isolated from the same number of HIV-infected patients treated in a public hospital in Mexico City were studied to determine the drug resistance to first- and second-line anti-TB drugs and to identify the mutations associated with the resistance. RESULTS Of the 93 patients, 82.7% were new TB cases, 86% were male, and 73% had extrapulmonary TB. Most patients (94%) with a CD4 T-lymphocyte count <350 cells/mm3 were associated with extrapulmonary TB (p <0.0001), whilst most patients (78%) with a CD4 T-lymphocyte count >350 cells/mm3 were associated with pulmonary TB (p = 0.0011). Eighty-two strains were pan-susceptible, four mono-resistant, four poly-resistant, two multidrug-resistant, and one was extensively drug-resistant. In the rifampicin-resistant strains, rpoB S531L was the mutation most frequently identified, whereas the inhA C15T and katG S315T1 mutations were present in isoniazid-resistant strains. The extensively drug-resistant strain also contained the mutation gyrA D94A. CONCLUSIONS These data highlight the need to promptly diagnose the drug resistance of M. tuberculosis among all HIV-infected patients by systematically offering access to first- and second-line drug susceptibility testing and to tailor the treatment regimen based on the resistance patterns to reduce the number of deaths in HIV-infected patients.
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Affiliation(s)
- Daniel Valencia-Trujillo
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico; (D.V.-T.); (R.L.G.-R.); (S.R.-G.)
- Servicio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México 14080, Mexico; (L.N.-D.); (M.A.M.-S.); (E.B.-V.)
- Escuela Militar de Medicina, Centro Militar de Ciencias de la Salud, Secretaría de la Defensa Nacional, Ciudad de México 11200, Mexico;
| | - Amanda Marineth Avila-Trejo
- Laboratorio de Bioquímica Farmacológica, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico;
| | - Rocío Liliana García-Reyes
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico; (D.V.-T.); (R.L.G.-R.); (S.R.-G.)
| | - Luis Narváez-Díaz
- Servicio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México 14080, Mexico; (L.N.-D.); (M.A.M.-S.); (E.B.-V.)
| | - Mario Alberto Mújica-Sánchez
- Servicio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México 14080, Mexico; (L.N.-D.); (M.A.M.-S.); (E.B.-V.)
| | - Addy Cecilia Helguera-Repetto
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México 11000, Mexico;
| | - Eduardo Becerril-Vargas
- Servicio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México 14080, Mexico; (L.N.-D.); (M.A.M.-S.); (E.B.-V.)
| | - Mónica Maribel Mata-Miranda
- Escuela Militar de Medicina, Centro Militar de Ciencias de la Salud, Secretaría de la Defensa Nacional, Ciudad de México 11200, Mexico;
| | - Sandra Rivera-Gutiérrez
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico; (D.V.-T.); (R.L.G.-R.); (S.R.-G.)
| | - Jorge Francisco Cerna-Cortés
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico; (D.V.-T.); (R.L.G.-R.); (S.R.-G.)
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Choe J, Han A, Shin SH, Lee K, Um SW, Kim H, Kim TY, Huh HJ, Choi YL, Han J, Jeong BH. Clinical Course of Patients With Mediastinal Lymph Node Tuberculosis and Risk Factors for Paradoxical Responses. J Korean Med Sci 2023; 38:e348. [PMID: 38050909 PMCID: PMC10695755 DOI: 10.3346/jkms.2023.38.e348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR. METHODS Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR. RESULTS Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81-18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60-46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70-16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB. CONCLUSION As PR occurred in one of six patients with mediastinal LNTB during anti-tuberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
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Affiliation(s)
- Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Areum Han
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Li B, Sun L, Sun Y, Zhen L, Qi Q, Mo T, Wang H, Qiu M, Cai Q. Identification of the key genes of tuberculosis and construction of a diagnostic model via weighted gene co-expression network analysis. J Infect Chemother 2023; 29:1046-1053. [PMID: 37499902 DOI: 10.1016/j.jiac.2023.07.011] [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: 04/18/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Tuberculosis (TB) is an infectious disease with high mortality, and mining key genes for TB diagnosis is vital to raise the survival rate of patients. METHODS The whole microarray datasets GSE83456 (training set) and GSE19444 (validation set) of TB patients were downloaded from the Gene Expression Omnibus (GEO) database. Differential expression was conducted on genes between TB and normal samples (unconfirmed TB) in GSE83456 to yield TB-related differentially expressed genes (DEGs). DEGs were subjected to weighted gene co-expression network analysis (WGCNA) and clustered to form distinct gene modules. The immune scores of 25 kinds of immune cells were obtained by single-sample gene set enrichment analysis (ssGSEA) of TB samples, and Pearson correlation analysis was carried out between the 25 immune scores and diverse gene modules. The gene modules significantly associated with immune cells were retained as Target modules. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on the genes in the modules (p-value <0.05). The protein-protein interaction (PPI) network was established utilizing the STRING database for genes in the Target module, and the selected key genes were intersected with immune-related genes in the ImmPort database. The obtained immune-related module genes were used for subsequent least absolute shrinkage and selection operator (LASSO) regression analysis and diagnostic models were constructed. Finally, the receiver operating characteristic (ROC) curve was utilized to validate the diagnostic model. RESULTS The turquoise and yellow modules had a high correlation with macrophages. LASSO regression analysis of immune-related genes in TB was carried on to finally construct a 5-gene diagnostic model composed of C5, GRN, IL1B, IL23A, and TYMP. As demonstrated by the ROC curves, the diagnostic efficiency of this diagnostic model was 0.957 and 0.944 in the training and validation sets, respectively. Therefore, the immune-related 5-gene model had a good diagnostic function for TB. CONCLUSION We identified 5 immune-related diagnostic markers that may play an important role in TB, and verified that this immune-related key gene model had a good diagnostic performance.
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Affiliation(s)
- Baiying Li
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Lifang Sun
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Yaping Sun
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Libo Zhen
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Qi Qi
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Ting Mo
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Huijie Wang
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Meihua Qiu
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Qingshan Cai
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China.
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Singh S, Gupta S, Jha A, Dhamnetiya D, Jha RP. An Insight Into Tuberculosis Patients in the Chest Clinic of North India: Epidemiological Profile and Treatment Outcomes in the Wake of COVID-19. Cureus 2023; 15:e47161. [PMID: 38021514 PMCID: PMC10651939 DOI: 10.7759/cureus.47161] [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] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Our study aims to re-evaluate the epidemiological profile and treatment outcomes of TB patients enrolled at the chest clinic of a tertiary care center after the third wave of COVID-19 in New Delhi. Patients and methods We have conducted an observational analytical study after taking the IEC approval from October 2022 to February 2022 on the TB patients enrolled from March 2022 to August 2022. The total data of 1114 TB patients was analyzed. The association between various factors and treatment outcomes was assessed using the chi-square test. To identify the independent effects of these factors on treatment outcomes, we did a multiple logistic regression analysis. Results We found that the treatment outcomes were mostly successful (83.9%, n=935), while a few patients lost to follow-up (11.7%, n=130) and died (4.4%, n=49). Deaths were significantly higher among geriatrics (19%, n=15), PTB (4.9%, n=30), and MDR TB (15%, n=3). The treatment success was highest among the new category of patients (85.1%, n=807), followed by retreatment patients (80.1%, n=117) and MDR TB patients (55%, n=11). Adults and geriatrics had a significantly higher risk of death (4.45 times and 27.93 times, respectively) compared to pediatrics. In addition, death risks were higher among males (1.6 times for females), MDR TB patients (17 times for new patients), and HIV-reactive patients (3.05 times for HIV non-reactive patients). Conclusion We found that males, HIV-TB co-infection, the geriatric population, pulmonary TB patients, and MDR TB were at a higher risk of death. By identifying high-risk groups, policymakers can prioritize targeted interventions and allocate resources effectively to address the specific needs of these vulnerable populations.
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Affiliation(s)
- Saran Singh
- Department of Respiratory Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Shweta Gupta
- Department of Respiratory Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Abhinav Jha
- Department of Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Deepak Dhamnetiya
- Community Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
| | - Ravi P Jha
- Department of Community Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
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Thomsen SH, Zinolabedinbik P, Brodersen JB, Knudsen T, Kjeldsen J, Jensen MD. Additional information obtained from mucosal biopsies is limited after pan-enteric capsule endoscopy in patients with suspected Crohn's disease. Endosc Int Open 2023; 11:E1005-E1012. [PMID: 37854123 PMCID: PMC10581819 DOI: 10.1055/a-2180-9537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Background and study aims Pan-enteric capsule endoscopy (CE) is an emerging alternative to ileo-colonoscopy for diagnosing Crohn's disease (CD). However, CE does not offer the opportunity to take biopsies to support the diagnosis. This study examined the additional information obtained with mucosal biopsies and the feasibility of CE as a single diagnostic procedure. Patients and methods This retrospective study was based on a prospective, blind multicenter trial in which patients with suspected CD were examined with ileo-colonoscopy plus segmental biopsies and CE. Histopathological findings were compared to the result of CE. Results A total of 107 patients with a complete CE were included in the analysis. CE was consistent with CD in 44 patients (41.1%) and ulcerative colitis in 10 patients (9.3%). Histopathology confirmed the result of CE in 39.3% of patients and added new diagnostic information in 6.5% of patients. A CE consistent with CD was histologically confirmed in 20.5% of patients. Biopsies most often showed non-specific inflammation (61.4%). Only one patient with a normal CE had a specific histological diagnosis (microscopic colitis). Biopsies altered the diagnosis of ulcerative colitis to CD in two patients, and in two patients with a normal CE, biopsies showed CD or ulcerative colitis. In one patient with lymphoma in the terminal ileum and cecum, CE was misinterpreted as CD. Conclusions In patients with suspected CD and an evident result of CE, the additional information obtained from biopsies is limited, and CE as a single diagnostic procedure might be feasible in selected patients. Biopsies are warranted, however, in patients with an atypical endoscopic appearance or suspected malignancy.
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Affiliation(s)
- Sofia Hjerrild Thomsen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Pantea Zinolabedinbik
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Michael Dam Jensen
- Department of Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
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Kang W, Yu J, Liang C, Wang Q, Li L, Du J, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Yan X, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A. E, Du Y, Liu F, Cui W, Yang S, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Li Y, Dong Y, Tang S. Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China. Int J Clin Pract 2023; 2023:5562495. [PMID: 37609664 PMCID: PMC10442182 DOI: 10.1155/2023/5562495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023] Open
Abstract
Background Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis. Methods The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm. Results Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age. Conclusions Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jiajia Yu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Chen Liang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Quanhong Wang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jian Du
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Hongyan Chen
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Jianxiong Liu
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Mingwu Li
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Jingmin Qin
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wei Shu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Peilan Zong
- Jiangxi Chest (Third People) Hospital, No. 346 Dieshan Road, Donghu District, Nanchang, Jiangxi 330006, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Zaoxian Mei
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qunyi Deng
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenge Han
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Meiying Wu
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Xinguo Zhao
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Lei Tan
- TB Hospital of Siping City, No. 10 Dongshan Road, Tiedong District, Siping, Jilin Province 136001, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Hongwei Liu
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Xinjie Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Ertai A.
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Yingrong Du
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Fenglin Liu
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Song Yang
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Xiaohong Chen
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Junfeng Han
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qingyao Xie
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenyu Liu
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Peijun Tang
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Jian Zheng
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Tong Ren
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Yan Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Lei Wu
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Qiang Song
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Mei Yang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Yuanyuan Liu
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Kun Yan
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Xinghua Shen
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Youcai Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yongkang Dong
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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Chen S, Wang Y, Zhan Y, Liu C, Wang Q, Feng J, Li Y, Chen H, Zeng Z. The incidence of tuberculous pleurisy in mainland China from 2005 to 2018. Front Public Health 2023; 11:1180818. [PMID: 37397728 PMCID: PMC10311513 DOI: 10.3389/fpubh.2023.1180818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Background Currently, tuberculous pleurisy (TP) remains a serious problem affecting global public health, including in China. Our purpose was to comprehensively understand and identify the incidence of TP in mainland China between 2005 and 2018. Methods The data on registered TP cases from 2005 to 2018 were acquired from the National Tuberculosis Information Management System. We analyzed the demographics, epidemiology, and time-space distribution of TP patients. Then, the effects of potentially influential factors on TP incidences, such as medical expenses per capita, GDP per capita, and population density, were assessed using the Spearman correlation coefficient. Results The incidence of TP increased in mainland China from 2005 to 2018, with a mean incidence of 2.5 per 100,000 population. Interestingly, spring was the peak season for TP, with more notified cases. Tibet, Beijing, Xinjiang, and Inner Mongolia had the highest mean annual incidence. A moderate positive relationship was found between TP incidence, medical expenses per capita, and GDP per capita. Conclusions The notified incidence of TP had an elevated trend from 2005 to 2018 in mainland China. The findings of this study provide insight into the knowledge of TP epidemiology in the country, which can help optimize resource allocation to reduce the TP burden.
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Affiliation(s)
- Shuhan Chen
- Second Clinical College, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Zhan
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changyu Liu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Feng
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yufeng Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huilong Chen
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhilin Zeng
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Aljohaney AA. Real time endobronchial ultrasound transbronchial needle aspiration for the diagnosis of tuberculous intrathoracic lymphadenopathy: Saudi Arabian Western region experience. Saudi Med J 2023; 44:178-186. [PMID: 36773981 PMCID: PMC9987700 DOI: 10.15537/smj.2023.44.2.20220434] [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: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES To assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for presumptive tuberculosis (TB) patients with intrathoracic enlarged lymph nodes in a country with low to moderate TB incidence. METHODS Thirty-one patients with clinical features of TB and intrathoracic lymphadenopathy, who had EBUS-TBNA sampling and final confirmation of intrathoracic TB lymphadenopathy, were retrospectively reviewed over an 8-year period. Routine clinical and laboratory evaluations including computerized tomography scans were performed before the EBUS-TBNA. Sociodemographic characteristics, clinical profile, pathological, and microbiological findings were collected. RESULTS The EBUS-TBNA confirmed TB diagnosis in 26 (83.9%) subjects with a consistent pathological finding or positive culture of Mycobacterium tuberculosis. Pathological analysis had findings consistent with TB in 25 (80.6%) patients. Culture of the EBUS-TBNA sample was positive for Mycobacterium tuberculosis in 12 (38.7%) patients. Other supportive investigations like purified protein derivative (PPD) skin test was positive in 28 (90.3%) participants. Overall, the sensitivity of the EBUS-TBNA alone was 83.9%. No complications were recorded during the procedure. The EBUS-TBNA aspirate culture positivity was significantly related to having a larger size lymph node (p=0.048) only, while PPD positivity was significantly related to baseline and clinical features of the participants. CONCLUSION The EBUS-TBNA demonstrated effective utility and safety in the evaluation and diagnosis of intrathoracic TB lymphadenopathy among individuals with compatible symptoms in a country with low-moderate TB-incidence.
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Affiliation(s)
- Ahmed A. Aljohaney
- From the Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Ahmed A. Aljohaney, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-2905-2344
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11
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Bohsas H, Sharif Ahmed EM, Bakkour A, Kashkash F, Khairy LT, Alibrahim H. Isolated humeral tuberculosis lymphadenitis in healthy woman: Case report. Ann Med Surg (Lond) 2022; 78:103658. [PMID: 35734641 PMCID: PMC9206896 DOI: 10.1016/j.amsu.2022.103658] [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: 03/01/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Pulmonary tuberculosis is a disease that may effect on many organs such as the lung, peritoneum and spread to adjacent lymph nodes in advanced stages, but it is rarely to be as an isolated lymph node without accompanying pulmonary or extra pulmonary tuberculosis in healthy persons. Case presentation A 40 –Years-female presented with a chief complaint of Pain in the lateral side of the Right humerus above the elbow, with no medical history, on clinical examination there was a painful palpable mass in mentioned place. The mass was removed surgically under local anesthesia and sent for pathological autopsy. The result of the pathological autopsy was tuberculosis lymphadenitis. After that, the patient has been sent to a specialized center for tuberculosis to receive the suitable treatment. Discussion More studies should be done to investigate the potential causes of these unusual cases and finding the accurate physiological mechanisms that inhibit the usual manifestations of tuberculosis in these patients to avoid advanced complications. Conclusion Isolated tuberculosis lymphadenitis in healthy persons is unusual case in the literature, which the clinical doctors should be careful in examination the patients who admitting with abnormal lymph nodes and unknown history exposure to tuberculosis. . Tuberculous Lymphadenitis is one of the most common accompaniments of pulmonary Tuberculosis. Clinical doctors may pay attention to perform an accurate examination for observed isolated nodes even in healthy people.
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12
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Fallah S, Nasehi M, Etemadinezhad S, Fallah S, Yazdani Charati J. A Five-Year Epidemiological Study of Extra-Pulmonary Tuberculosis and Its Related Risk Factors in Iran. TANAFFOS 2022; 21:221-229. [PMID: 36879733 PMCID: PMC9985131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/10/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tuberculosis is the most common worldwide cause of death from microbial diseases. Extra-pulmonary tuberculosis accounts for 20% to 25% of all cases. In this study, we used generalized estimation equations to investigate the trend of changes in extra-pulmonary tuberculosis incidence. MATERIALS AND METHODS The recorded data of all patients with extra-pulmonary tuberculosis from 2015 to 2019 in Iran's National Tuberculosis Registration Center were included. The trend of standardized incidence changes in provinces of Iran was calculated and reported linearly. Also, we identified the risk factors related to the extra-pulmonary tuberculosis incidence in five consecutive years using generalized estimating equations. RESULTS We studied the data of 12,537 patients with extra-pulmonary tuberculosis, of whom 50.3% were female. The mean age of the subjects was 43.61±19.88 years. Around 15.4% of all patients had a history of contact with a tuberculosis patient, 43% had a history of hospital stay, and 2.6% had a human immunodeficiency virus infection. Regarding disease types, 25% were lymphatic, 22% were pleural, and 14% were bone. Golestan province had the highest (average of 28.50 ± 8.65 cases), and Fars province had the lowest (average of 3.06 ± 0.75 cases) standardized incidences in these five years. Also, time trend (P < 0.001), employment rate (P = 0.037), and average annual rural income (P = 0.001) had a significant effect on reducing extra-pulmonary tuberculosis incidence. CONCLUSION Extra-pulmonary tuberculosis has a decreasing trend in Iran. Still, Golestan, Sistan and Baluchestan, Hormozgan, and Khuzestan provinces have a higher incidence rate compared to the other provinces.
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Affiliation(s)
- Sahar Fallah
- Faculty of Health, Mazandaran university of Medical Sciences, Sari, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Siavash Etemadinezhad
- Department of Occupational Health and Ergonomics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Simin Fallah
- Department of Linguistics, School of Literature and Human Sciences, Razi University, Kermanshah, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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13
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Liao F, Huang Z, Xu R, Luo Z, Qi W, Fan B, Yu J. Analysis of misdiagnosis and 18F-FDG PET/CT findings of lymph node tuberculosis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:941-951. [PMID: 35694951 DOI: 10.3233/xst-221195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate 18F-FDG PET/CT findings of tuberculous lymphadenitis and analyze the causes of misdiagnosis. METHOD Between 2013 and 2021, a retrospective review was conducted on 22 patients at Jiangxi Provincial People's Hospital Affiliated with Nanchang University who had lymph node tuberculosis confirmed by histology or clinical investigation. Subjective judgment and quantitative analysis were adopted. RESULTS Out of 22 patients, 14 are male and 8 are female. The average age was 55.5 years (55.5±12.4). The most common site of lymph node tuberculosis (LNTB) is the mediastinum (41.5%), followed by the neck (24.4%) and the abdominal cavity (21.9%). Half of the patients have more than one site affected. More than half of LNTB patients (54.5%) are concurrent with other types of TB, especially PTB. Among the 41 biggest affected lymph nodes, the average maximum diameter, minimum diameter, SUVmax and the lesion SUVmax/SUVmean liver ratio are 22.04±8.39, 16.93±6.75, 9.72±5.04 and 6.72±3.60, respectively. There is a poor correlation coefficient of 0.236 between the FDG uptake and the size of the biggest affected lymph node. Patients who are concurrent with no other TB have the significantly higher FDG uptake than patients who are concurrent with other TB (12.42 vs 8.02) (p = 0.005). Among these cases, 6 cases (27.3%) are accurately diagnosed with LNTB, all of which have pulmonary tuberculosis as a complication. However, 16 cases (72.7%) are misdiagnosed as lymphoma (50%), sarcoidosis (13.6%), and lymph node metastasis (9%). CONCLUSIONS This study demonstrates that 18F-FDG PET/CT is very useful in detecting LNTB because tuberculous granulomas show significant levels of glucose uptake. It proves to be an effective method for revealing lesion extent and discovering additional lesions that morphological imaging is missed. However, 18F-FDG PET/CT is not able to reliably distinguish LNTB from lymphoma, sarcoidosis, and metastatic lymph nodes. Nonetheless, 18F-FDG PET/CT allows for the selection of the most optimal biopsy location, and thus has potential to detect early treatment response and distinguish between active and inactive lesions.
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Affiliation(s)
- Fengxiang Liao
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zizhen Huang
- Sterilization and Supply Center, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Rong Xu
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zhehuang Luo
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Wanling Qi
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Juhong Yu
- Department of Radiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Khalife S, Jenkins HE, Dolynska M, Terleieva I, Varchenko I, Liu T, Carter EJ, Horsburgh CR, Rybak NR, Petrenko V, Chiang SS. Incidence and Mortality of Extrapulmonary Tuberculosis in Ukraine: Analysis of National Surveillance Data. Clin Infect Dis 2021; 75:604-612. [PMID: 34929028 DOI: 10.1093/cid/ciab1018] [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] [Received: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improved understanding of the epidemiology and mortality risk factors of extrapulmonary tuberculosis (EPTB) may facilitate successful diagnosis and management. METHODS We analyzed national surveillance data from Ukraine to characterize EPTB subtypes (i.e., localized in different anatomic sites). We calculated annual reported incidence, stratified by age, sex, and HIV status. Using Cox regression, we estimated mortality risk factors. RESULTS Between January 2015-November 2018, 14,062 adults/adolescents (≥15 years old) and 417 children (<15 years old) had extrapulmonary TB with or without concomitant pulmonary TB. The most commonly reported EPTB subtypes were pleural, peripheral lymph node, and osteoarticular. Most EPTB subtype notifications peaked at age 30-39 years and were higher in males. In adults/adolescents, most peripheral TB lymphadenitis, central nervous system (CNS) TB, and abdominal TB occurred in those with untreated HIV. CNS TB notifications in people without HIV peaked before age five years. Adults/adolescents with CNS TB (adjusted hazard ratio (aHR) 3.22, 95% CI: 2.89-3.60) and abdominal TB (aHR 1.83, 95% CI: 1.59-2.11) were more likely to die than those with pulmonary TB. Children with CNS TB were more likely to die (aHR 88.25, 95% CI: 43.49-179.10) than those with non-CNS TB. Among adults/adolescents, older age and HIV were associated with death. Rifampicin resistance was associated with mortality in pleural, peripheral lymph node, and CNS TB. CONCLUSION We have identified the most common EPTB subtypes by age and sex; patterns of EPTB disease by HIV status; and mortality risk factors. These findings can inform diagnosis and care for people with EPTB.
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Affiliation(s)
- Sara Khalife
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Mariia Dolynska
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv City, Ukraine
| | - Iana Terleieva
- Public Health Center of the Ministry of Health, Kyiv City, Ukraine
| | - Iurii Varchenko
- Public Health Center of the Ministry of Health, Kyiv City, Ukraine
| | - Tao Liu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - E Jane Carter
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - C Robert Horsburgh
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Natasha R Rybak
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Vasyl Petrenko
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv City, Ukraine
| | - Silvia S Chiang
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
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15
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Ex-vivo immunophenotyping and high dimensionality UMAP analysis of leucocyte subsets in tuberculous lymphadenitis. Tuberculosis (Edinb) 2021; 130:102117. [PMID: 34358992 DOI: 10.1016/j.tube.2021.102117] [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: 05/12/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 11/21/2022]
Abstract
Tuberculous lymphadenitis (TBL) is defined by reduced proinflammatory cytokines and elevated CD4+, CD8+ T cells and decreased CD8+ cytotoxic markers. However, ex-vivo phenotyping of diverse leucocytes in TBL has not been done. We show activated and atypical B cells, myeloid dendritic cells (mDCs), classical, non-classical and intermediate monocytes, T regulatory (T regs) cells, CD4+ T cell effector memory RA (TEMRA), CD4+ effector and CD8+ central memory phenotypes were significantly increased in TBL compared to LTB individuals. In contrast, classical memory and plasma B cells, plasmacytoid DCs (pDCs), CD8+ TEMRA, CD4+ naïve and central memory cells were significantly decreased in TBL compared to LTB individuals. Some of the leucocyte frequencies (atypical memory B cells, pDCs, myeloid-derived suppressor cells, CD4+ effector and CD8+ central memory was increased; activated memory and plasma B cell, mDCs, classical, non-classical, intermediate monocytes, T regs, CD4+ TEMRA, CD4+, CD8+ naïve and effector memory cells and CD8+ central memory cells were decreased) were significantly modulated after anti-TB treatment among TBL individuals. UMAP analysis show that leucocyte subsets or islands expressing specific markers were significantly different in TBL baseline and post-treatment individuals. Overall, we suggest altered frequencies of diverse leucocytes influences the disease pathology and protective immunity in TBL individuals.
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16
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Kathamuthu GR, Moideen K, Sridhar R, Baskaran D, Babu S. Reduced neutrophil granular proteins and post-treatment modulation in tuberculous lymphadenitis. PLoS One 2021; 16:e0253534. [PMID: 34153068 PMCID: PMC8216526 DOI: 10.1371/journal.pone.0253534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Neutrophils are important for host innate immune defense and mediate inflammatory responses. Pulmonary tuberculosis (PTB) is associated with increased neutrophil granular protein (NGP) levels in the circulation. However, the systemic levels of neutrophil granular proteins were not examined in tuberculous lymphadenitis (TBL) disease. Methods We measured the systemic levels of NGP (myeloperoxidase [MPO], elastase and proteinase 3 [PRTN3]) in TBL and compared them to latent tuberculosis (LTB) and healthy control (HC) individuals. We also measured the pre-treatment (Pre-T) and post-treatment (Post-T) systemic levels of neutrophil granular proteins in TBL individuals upon anti-tuberculosis treatment (ATT) completion. In addition, we studied the correlation and discriminatory ability of NGPs using receiver operating characteristic (ROC) analysis. Results Our data suggests that systemic levels of NGPs (MPO, PRTN3, elastase) were significantly reduced in TBL individuals compared to LTB and HC individuals. Similarly, after ATT, the plasma levels of MPO and elastase but not PRTN3 were significantly elevated compared to pre-treatment levels. NGPs (except PRTN3) were positively correlated with absolute neutrophil count of TBL, LTB and HC individuals. Further, NGPs were able to significantly discriminate TBL from LTB and HC individuals. Conclusion Hence, we conclude reduced neutrophil granular protein levels might be associated with disease pathogenesis in TBL.
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Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
- * E-mail:
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Dhanaraj Baskaran
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Kang W, Yu J, Du J, Yang S, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Dong Y, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A E, Du Y, Liu F, Cui W, Wang Q, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Yan X, Li L, Tang S. The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. PLoS One 2020; 15:e0237753. [PMID: 32822367 PMCID: PMC7446809 DOI: 10.1371/journal.pone.0237753] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/01/2020] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) remains a serious global public health problem in the present. TB also affects other sites (extrapulmonary tuberculosis, EPTB), and accounts for a significant proportion of tuberculosis cases worldwide. In order to comprehensively understand epidemiology of EBTB in China, and improve early diagnosis and treatment, we conducted a large-scale multi-center observational study to assess the demographic data and the prevalence of common EPTB inpatients, and further evaluate the prevalence of EPTB concurrent with Pulmonary tuberculosis (PTB) and the associations between multiple EPTB types and gender-age group in China. All consecutive age≥15yr inpatients with a confirmed diagnosis of EPTB during the period from January 2011 to December 2017 were included in the study. The descriptive statistical analysis included median and quartile measurements for continuous variables, and frequencies and proportions with 95% confidence intervals (CIs) for categorical variables. Multinomial logistic regression analysis was used to compare the association of multiple EPTB types between age group and gender. The results showed that the proportion of 15–24 years and 25–34 years in EPTB inpatients were the most and the ratio of male: female was 1.51. Approximately 70% of EPTB inpatients were concurrent with PTB or other types of EPTB. The most common of EPTB was tuberculous pleurisy (50.15%), followed by bronchial tuberculosis (14.96%), tuberculous lymphadenitis of the neck (7.24%), tuberculous meningitis (7.23%), etc. It was found that many EPTB inpatients concurrent with PTB. The highest prevalence of EPTB concurrent with PTB was pharyngeal/laryngeal tuberculosis (91.31%), followed by bronchial tuberculosis (89.52%), tuberculosis of hilar lymph nodes (79.52%), tuberculosis of mediastinal lymph nodes (79.13%), intestinal tuberculosis (72.04%), tuberculous pleurisy (65.31%) and tuberculous meningitis (62.64%), etc. The results from EPTB concurrent with PTB suggested that females EPTB inpatients were less likely to be at higher risk of concurrent PTB (aOR = 0.819, 95%CI:0.803–0.835) after adjusted by age. As age increasing, the trend risk of concurrent PTB decreased (aOR = 0.994, 95%CI: 0.989–0.999) after adjusted by gender. Our study demonstrated that the common EPTB were tuberculous pleurisy, bronchial tuberculosis, tuberculous lymphadenitis of the neck, tuberculous meningitis, etc. A majority of patients with pharyngeal/laryngeal tuberculosis, bronchial tuberculosis, tuberculosis of hilar/mediastinal lymph nodes, intestinal tuberculosis, tuberculous pleurisy, tuberculous meningitis, etc. were concurrent with PTB. Female EPTB inpatients were less likely to be at higher risk of concurrent PTB, and as age increasing, the trend risk of concurrent PTB decreased. The clinicians should be alert to the presence of concurrent tuberculosis in EPTB, and all suspected cases of EPTB should be assessed for concomitant PTB to determine whether the case is infectious and to help for early diagnosis and treatment.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jiajia Yu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jian Du
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Song Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | | | - Jianxiong Liu
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Mingwu Li
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Jingmin Qin
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wei Shu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Peilan Zong
- Jiangxi Chest (third people) Hospital, Nanchang City, Jiangxi Province, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Yongkang Dong
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | | | - Qunyi Deng
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenge Han
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Meiying Wu
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Xinguo Zhao
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Lei Tan
- TB Hospital of Siping City, Siping City, Jilin Province, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | | | - Xinjie Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Ertai A
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Yingrong Du
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Fenglin Liu
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Quanhong Wang
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | | | | | - Qingyao Xie
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyu Liu
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Peijun Tang
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jian Zheng
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | - Tong Ren
- Shenyang chest Hospital, Shenyang, China
| | - Yan Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Lei Wu
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Qiang Song
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Mei Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | | | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Yan
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Xinghua Shen
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, Chongqing, China
- * E-mail: (ST); (LL); (XY)
| | - Liang Li
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
| | - Shenjie Tang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
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Shirzad-Aski H, Hamidi N, Sohrabi A, Abbasi A, Golsha R, Movahedi J. Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health 2020; 25:1131-1139. [PMID: 32501638 DOI: 10.1111/tmi.13452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. METHODS Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. RESULTS Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). CONCLUSION Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
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Affiliation(s)
| | - Niloofar Hamidi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Abbasi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Golsha
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jamileh Movahedi
- Tuberculosis laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
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19
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Holden IK, Lillebaek T, Andersen PH, Wejse C, Johansen IS. Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study. PLoS One 2020; 15:e0231821. [PMID: 32497102 PMCID: PMC7272085 DOI: 10.1371/journal.pone.0231821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Mortality from tuberculosis (TB) has been declining since 2000, nevertheless there is still a significant number of patients who die before or during TB treatment. The aims were to examine and describe predictors associated with TB related mortality. Methods Patients notified with TB from 2009 though 2014 in Denmark were included. Data were extracted from national registers and patient records were examined for clinical information and treatment outcome. Cox proportional hazards regression was used to examine TB related mortality. Results A total of 2131 cases were identified, 141 (6.6%) patients died before or during TB treatment. TB related mortality accounted for 104 cases (73.8%) and decreased significantly from 6.7% to 3.2% (p = .04) during the study period. Within 1 months of diagnosis, 49% of TB related deaths had occurred. The strongest risk factors present at time of diagnosis, associated with TB related mortality, were: age > 70 years, Charlson comorbidity index > 1, alcohol abuse, weight loss, anemia, and C-reactive protein > 100 mg/L (p < .05). Conclusion The majority of TB related deaths occurred soon after diagnosis, emphasizing that TB patients identified to have a high risk of mortality should be closely monitored before and during the intensive treatment period to improve their outcomes.
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Affiliation(s)
- Inge K. Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- * E-mail:
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter H. Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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20
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Holden IK, Andersen PH, Wejse C, Lillebaek T, Johansen IS. Review of tuberculosis treatment outcome reporting system in Denmark, a retrospective study cohort study from 2009 through 2014. BMC Health Serv Res 2020; 20:83. [PMID: 32013962 PMCID: PMC6998178 DOI: 10.1186/s12913-020-4927-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark, reporting of tuberculosis (TB) treatment outcome is voluntary and data incomplete. In the European Centre for Disease Prevention and Control most recent report presenting data from 2017, only 53.9% of Danish pulmonary TB cases had a reported outcome. Monitoring of TB treatment outcome is not feasible based on such limited results. In this retrospective study from 2009 to 2014, we present complete treatment outcome data and describe characteristics of cases lost to follow up. METHODS All cases notified from 2009 through 2014 were reviewed. Hospital records were examined, and TB treatment outcome was categorized according to the World Health Organization's (WHO) definitions. RESULTS A total of 2131 TB cases were included. Treatment outcome was reported to the Surveillance Unit in 1803 (84.6%) cases, of which 468 (26.0%) were reclassified. For pulmonary TB, 339 (28.9%) cases were reclassified between cured and treatment completed. Overall, the proportion of cases who achieved successful treatment outcome increased from 1488 (70.4%) to 1748 (81.8%). CONCLUSION A high number of cases were reclassified during the review process. Increased focus on correct treatment outcome reporting is necessary in Denmark. A more comprehensive and exhaustive categorization of TB treatment outcome could be beneficial, especially for cases where collection of sputum or tissue towards the end of treatment is challenging.
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Affiliation(s)
- Inge K Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark.
| | - Peter H Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
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21
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Liu Y, Jiang Z, Chen H, Jing H, Cao X, Coia JE, Song Z. Description of demographic and clinical characteristics of extrapulmonary tuberculosis in Shandong, China. Hippokratia 2020; 24:27-32. [PMID: 33364736 PMCID: PMC7733363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND According to the clinical manifestation, tuberculosis (TB) is divided into pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). The incidence rate of EPTB has increased in many countries. The demographic and clinical characteristics of EPTB in China remain still unclear. MATERIALS AND METHODS We retrospectively analyzed the medical records of 5,624 hospitalized patients with positive M. tuberculosis culture between January 2008 and June 2013 in Shandong province. We investigated the epidemiological, demographic, and clinical characteristics of patients with EPTB. RESULTS Among 5,624 hospitalized TB patients with positive M. tuberculosis culture, 4,277 (76.05 %) had PTB, 618 (10.99 %) had EPTB, and 729 (12.96 %) had both PTB and EPTB. The proportion of EPTB increased significantly from 6.97 % in 2008 to 19.98 % in 2012 (p <0.001). The most frequent sites or foci of EPTB were pleura (63.27 %), followed by bone/joint (13.75 %), and lymph nodes (8.9 %). The mean duration of treatment for pleural TB was eight months and for EPTB in the other foci was more than 15 months. CONCLUSION The proportion of EPTB in Shandong province has significantly increased. Clinicians need to be aware of the trend and remain vigilant against EPTB. EPTB requires prolonged treatment, and clinical supervision should be strengthened to prevent drug resistance. HIPPOKRATIA 2020, 24(1): 27-32.
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Affiliation(s)
- Y Liu
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Z Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - H Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - H Jing
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - X Cao
- Department of Cardiology, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - J E Coia
- Department of Clinical Microbiology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Z Song
- Department of Clinical Microbiology, Hospital of Southwest Jutland, Esbjerg, Denmark
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22
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Manika K, Kotoulas SC, Papadaki E, Kyreltsi P, Sionidou M, Kontakiotis T, Kioumis I. Tuberculosis treatment outcome in Thessaloniki, Greece - a single center study. Hippokratia 2019; 23:154-159. [PMID: 32742164 PMCID: PMC7377584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Greece is one of the few countries in the European Union/European Economic Area, which do not report tuberculosis (TB) treatment outcome. This study aimed to assess treatment outcomes and identify possible intervening factors in patients with TB in Thessaloniki, Greece, over the period 2012-2017. METHODS All patients diagnosed with TB -excluding rifampicin-resistant/multidrug-resistant (RR/MDR)-TB- during 2015-2017 were included in the study. Data on demographic characteristics, localization, diagnostic methods, resistance, and treatment outcome were recorded and compared to the period 2012-2014. RESULTS During the period 2015-2017, 82 patients (48 men) with a mean age of 53.8 ± 15.6 years were diagnosed with TB. No significant differences in demographics, microbiological, or treatment characteristics were detected between the two three-year periods, except for the percentage of immunocompromised patients, which was higher during 2015-2017 (15.9 % vs 5.6 %, p =0.029). In the total number of patients, two factors were significantly different between patients with a positive and negative outcome. The percentage of favorable outcome was higher for patients with extrapulmonary compared to pulmonary TB (90.9 % vs 70.5 %, p =0.044). Furthermore, the percentage of immunocompetent patients with a positive outcome was significantly higher in the second treatment period compared to the first (treatment success rate 66.7 % in 2012-2014 vs 84.1 % in 2015-2017, p =0.014). This difference was attributed to the presence of a social nurse who joined the center in 2015. CONCLUSIONS TB treatment success rate in Greece is below the World Health Organization standards. Interventions such as appropriate multidisciplinary staffing of TB centers may prove valuable in improving TB care in Greece. HIPPOKRATIA 2019, 23(4): 154-159.
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Affiliation(s)
- K Manika
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - S C Kotoulas
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - E Papadaki
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - P Kyreltsi
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - M Sionidou
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - T Kontakiotis
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - I Kioumis
- Respiratory Failure Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
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