Extrapulmonary TB: what you need to know

Spheno-Orbital Tuberculosis: A Rare Case

A 9-year-old girl presented with progressive, painless protrusion of the right eye for 2 months. She also complained of multiple bilateral neck swellings for 2 months. On examination, there was proptosis of the right eye with the eyeball displaced downwards and forwards. The extra ocular movements of the right eye showed limitation of abduction. The vision was normal in both eyes. A detailed clinical evaluation with investigations led to a diagnosis of spheno-orbital tuberculosis. Prompt initiation of anti-tubercular therapy (ATT) led to resolution of the lesion.

Clinical issues in refugee healthcare: the Somali Bantu population

With an estimated 803,500 refugees residing in the United States, many NPs will encounter patients who do not speak, read, or understand English. Many of these patients have challenging health issues such as parasitic diseases and chronic or acute diseases not commonly seen in the United States and NPs will need to be prepared for these challenges.

Osteoarticular manifestations of Mycobacterium tuberculosis infection

Mycobacterium tuberculosis has affected humans for much of our existence. The incidence of global tuberculosis infection continues to rise, especially in concert with HIV coinfection. Many disease processes, such as diabetes, increase the likelihood of tuberculosis infection. Tuberculosis bacteria can infect any bone, joint, tendon, or bursa; however, the most common musculoskeletal site for infection includes the spine and weight-bearing joints of the hip and knee. Many patients who present with osteoarticular tuberculosis infection will have a gradual onset of pain at the site of infection. Many patients who develop a musculoskeletal tuberculosis infection will have no evidence of a pulmonary tuberculosis infection on x-ray film and many will have very mild symptoms with the initial infection. Healthcare providers must remember that many patients who develop tuberculosis infection do not progress to active tuberculosis disease; however, the latent infection may become active with immune compromise.

Experiences of being diagnosed with tuberculosis among immigrants in Norway — Factors associated with diagnostic delay: A qualitative study

Aims: The aim of this paper is to explore experiences of being diagnosed with tuberculosis (TB) among immigrants in Norway, with a view to factors associated with diagnostic delay. Methods: A qualitative study was conducted among 22 participants diagnosed with TB who originated from Somalia or Ethiopia. Results: One-third of the participants reported less than 2 months from onset of symptoms to treatment were initiated. The factors associated with little delay included a medical history that gave suspicion of TB, presenting with typical TB symptoms, or being screened for TB at arrival. Two-thirds of the participants told about extensive diagnostic processes. Persistent cough not accompanied by symptoms such as: weight loss and weakness; mild, diffuse, atypical, and/or intermittent symptoms; and a sense of not being a likely victim of TB could delay patients’ first initiative to seek help. Participants experienced that the diagnostic process in the health services could endure for months, even years. The diagnosis could be difficult to confirm, but health professionals appeared to have difficulties with associating their symptoms with TB. This resulted in delays in initiating diagnostic tests for TB, especially in cases of extra-pulmonary TB. Conclusions: Public health efforts to increase awareness about TB transmission, its diversity in manifestations, and its progression from latent to active disease, may decrease patient delay. An increased awareness among health professionals about typical and atypical symptoms of TB, aspects of the patient’s history, and being aware and sensitive to patients’ own interpretation of symptoms may reduce diagnostic delay in the health services.