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Liu P, Sun J, Wang Y, Qin Y, Liu B. Influence of preoperative antituberculosis chemotherapy duration on perioperative complications in patients treated with epididymectomy for epididymal tuberculosis. Int J Urol 2024; 31:927-932. [PMID: 38752466 DOI: 10.1111/iju.15493] [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: 05/06/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES We aimed to investigate the influence of preoperative antituberculosis chemotherapy duration on perioperative epididymectomy complications in patients with epididymal tuberculosis (ETB). METHODS This retrospective study examined patients with ETB between January 1, 2013, and March 31, 2023, who underwent unilateral epididymectomy at our hospital. We selected preoperative antituberculosis chemotherapy duration of 2, 4, and 8 weeks as the cutoffs for this study, to explore whether there are differences in the incidence of intraoperative and 30-day postoperative complications among the patients with different preoperative antituberculosis chemotherapy durations. Intraoperative complications were graded according to the Satava classification, and 30-day postoperative complications were defined according to the Clavien-Dindo classification. The study groups were compared using the unpaired t-test, Wilcoxon rank-sum test, Pearson's chi-square test, or Fisher's exact test, as appropriate. RESULTS Overall, 155 patients were included. Statistical analysis revealed that there were no significant differences in the incidence of intraoperative and 30-day postoperative complications between patients with shorter preoperative antituberculosis chemotherapy duration and those with longer preoperative antituberculosis chemotherapy duration. CONCLUSIONS In patients with ETB, preoperative antituberculosis chemotherapy duration did not significantly affect the incidence of perioperative complications after epididymectomy.
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Affiliation(s)
- Pengju Liu
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Jiazhu Sun
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yeqiang Wang
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Yong Qin
- Department of Urology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Ben Liu
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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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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3
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Sakthivel DK, Tiwari M, Bafna S, Ragavan N. Isolated Testicular Tuberculosis Disguised As a Testicular Tumor: A Report of a Rare Case. Cureus 2024; 16:e60763. [PMID: 38903328 PMCID: PMC11188697 DOI: 10.7759/cureus.60763] [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: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Isolated testicular tuberculosis is rare, often diagnosed incidentally during histopathological examination due to its asymptomatic nature. We present a case of a 35-year-old male with a left testicular mass mimicking malignancy. Despite normal tumor markers and negative imaging for pulmonary tuberculosis, left inguinal orchiectomy revealed testicular tuberculosis. Diagnostic challenges are compounded by the disease's rarity and atypical presentation. Genitourinary tuberculosis's diagnostic complexity underscores the need for heightened clinical suspicion, particularly in tuberculosis-endemic regions. While orchiectomy may be necessary, this case underscores the importance of considering tuberculosis in testicular masses. Early recognition facilitates appropriate management and underscores the importance of diagnostic vigilance.
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Zhang B, Li L, Zhang G, Wang J, Cao B, Li Z. Application of ultrasound-guided percutaneous nephrostomy in the treatment of a solitary kidney with hydronephrosis due to renal tuberculosis. Abdom Radiol (NY) 2024; 49:535-541. [PMID: 37936009 PMCID: PMC10830733 DOI: 10.1007/s00261-023-04068-9] [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: 06/27/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To investigate the value of ultrasound-guided percutaneous nephrostomy and nephrostomy tube replacement for treating a solitary kidney with hydronephrosis due to renal tuberculosis. METHODS Clinical data of patients with a solitary kidney with hydronephrosis caused by renal tuberculosis who underwent ultrasound-guided percutaneous nephrostomy in our hospital from January 2011 to December 2022 were retrospectively analyzed. The associated success rate and complications were statistically analyzed, pre- and post-catheterization changes in serum creatinine and blood urea nitrogen levels were compared, success rate and complications of nephrostomy tube replacement in patients with long-term catheterization were statistically analyzed, and the impact of long-term catheterization on patient life was investigated. RESULTS Overall, 32 patients aged 17-75 years (average age: 44.1 ± 16.9 years) underwent ultrasound-guided percutaneous nephrostomy. Sixty-three punctures were performed; the puncture success rate was 100%. The levels of serum creatinine and blood urea nitrogen of patients decreased after catheterization, and the differences between the pre-catheterization and post-catheterization were significant (P < 0.05). There were 1, 3, and 12 cases of serious, minor, and fistula-related complications, respectively. The mean duration of the indwelling catheter was 56.7 ± 36.2 (range, 13-120) months. The number of nephrostomy tube replacements was 344 times, and the success rate was 100%. All patients could take care of the puncture point by themselves. CONCLUSION Ultrasound-guided percutaneous nephrostomy and nephrostomy tube replacement have a high success rate and few complications, which can improve the renal function of patients. It is of great value for treating a solitary kidney with hydronephrosis caused by renal tuberculosis.
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Affiliation(s)
- Bingsong Zhang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lei Li
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Gengchen Zhang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinshan Wang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bingsheng Cao
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Zhuo Li
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
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5
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Miele K, Rock RB, LaCourse SM, Ashkin D, Armitige LY, Pomputius W, Goswami ND. Notes from the Field: Undiagnosed Tuberculosis During Pregnancy Resulting in a Neonatal Death - United States, 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1331-1332. [PMID: 38060433 PMCID: PMC10715820 DOI: 10.15585/mmwr.mm7249a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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6
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Figueiredo AA, Barreto ADA, Lopes HE, Netto JMB. Ureteral obstruction may activate kidney latent tuberculosis. A qualitative study. J Clin Tuberc Other Mycobact Dis 2023; 33:100402. [PMID: 37915382 PMCID: PMC10616550 DOI: 10.1016/j.jctube.2023.100402] [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] [Indexed: 11/03/2023] Open
Abstract
Objectives To analyze the hypothesis that ureteral obstruction may activate kidney latent tuberculous though qualitative study of Urogenital Tuberculosis patients. Methods A qualitative study was conducted using semistructured interviews in eight patients with Urogenital Tuberculosis. The progression of the disease from the initial symptoms was characterized through the analysis of the clinical and radiological data. The presence of ureteral obstruction prior to the onset of renal tuberculosis was observed in three patients. Results Patient 1: A 58-year-old female had five episodes of acute left ureteral lithiasis in two years prior to left kidney tuberculosis. Patient 2: A 55-year-old male patient had a 1.2 cm proximal left ureteral stone and in the following six months, the diagnosis of tuberculosis was made in a nonfunctioning left kidney with ureteral thickening and stenosis. Patient 3: A 47-year-old male patient had a 1.2 cm stone in the proximal right ureter and developed urinary tuberculosis with a nonfunctioning right kidney and a contracted bladder. Conclusion Kidney tuberculosis may appear in the same kidney that had previously suffered stone ureteral obstruction, which may have created local conditions for the activation of latent foci of renal tuberculosis.
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Affiliation(s)
- André Avarese Figueiredo
- NIPU – Núcleo Interdisciplnar de Pesquisa em Urologia, Federal University of Juiz de Fora, Minas Gerais, Brazil
- Department of Surgery, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Augusto de Azevedo Barreto
- NIPU – Núcleo Interdisciplnar de Pesquisa em Urologia, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Humberto Elias Lopes
- NIPU – Núcleo Interdisciplnar de Pesquisa em Urologia, Federal University of Juiz de Fora, Minas Gerais, Brazil
- Department of Surgery, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - José Murillo Bastos Netto
- NIPU – Núcleo Interdisciplnar de Pesquisa em Urologia, Federal University of Juiz de Fora, Minas Gerais, Brazil
- Department of Surgery, Federal University of Juiz de Fora, Minas Gerais, Brazil
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7
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Ambrosini F, Riccardi N, Occhineri S, Matucci T, Paraboschi I, Calarco A, Berrettini A, Tiseo G, Canetti D, Van Der Merwe A, Terrone C, Mantica G. Uncommon Haemorrhagic Cystitis of Infectious Origin: A Narrative Review for Urologists. Res Rep Urol 2023; 15:365-373. [PMID: 37564174 PMCID: PMC10411501 DOI: 10.2147/rru.s412278] [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: 03/13/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Haemorrhagic cystitis may be due to different etiologies with infectious diseases representing an insidious cause to diagnose. The aim of this narrative review is to provide a comprehensive overview of less common but difficult-to-diagnose causes of infectious haemorrhagic cystitis of bacterial, mycobacterial, and parasitic origin, Moreover, we highlight possible diagnostic tools and currently available treatment options in order to give an updated tool for urologists to use in daily practice. Patients and Methods The search engine PubMed was used to select peer-reviewed articles published from 1/Jan/2010 to 31/Aug/2022. Results Bacteria, fungal, TB and schistosomiasis are uncommon causes of haemorrhagic cystitis burdened by high morbidity, especially if not promptly diagnosed. Conclusion Because haemorrhagic cystitis ranges in severity from mild dysuria associated with pelvic discomfort to severe life-threatening haemorrhage, punctual diagnosis, and immediate treatment are essential to avoid further complications.
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Affiliation(s)
- Francesca Ambrosini
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- StopTB Italia Onlus, Milan, Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- StopTB Italia Onlus, Milan, Italy
| | - Tommaso Matucci
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- StopTB Italia Onlus, Milan, Italy
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alfredo Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - André Van Der Merwe
- Department of Urology, Faculty of Medicine and Health Sciences, 26697 Stellenbosch University, Cape Town, South Africa
| | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Guglielmo Mantica
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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8
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Dahiya B, Mehta N, Soni A, Mehta PK. Diagnosis of extrapulmonary tuberculosis by GeneXpert MTB/RIF Ultra assay. Expert Rev Mol Diagn 2023; 23:561-582. [PMID: 37318829 DOI: 10.1080/14737159.2023.2223980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Diagnosis of extrapulmonary tuberculosis (EPTB) is an arduous task owing to different anatomical locations, unusual clinical presentations, and sparse bacillary load in clinical specimens. Although GeneXpert® MTB/RIF is a windfall in TB diagnostics including EPTB, it yields low sensitivities but high specificities in many EPTB specimens. To further improve the sensitivity of GeneXpert®, GeneXpert® Ultra, a fully nested real-time PCR targeting IS6110, IS1081 and rpoB (Rv0664) has been endorsed by the WHO (2017), wherein melt curve analysis is utilized to detect rifampicin-resistance (RIF-R). AREA COVERED We described the assay chemistry/work design of Xpert Ultra and evaluated its performance in several EPTB types, that is, TB lymphadenitis, TB pleuritis, TB meningitis, and so on, against the microbiological reference standard or composite reference standard. Notably, Xpert Ultra exhibited better sensitivities than Xpert, but mostly at the compensation of specificity values. Moreover, Xpert Ultra exhibited low false-negative and false-positive RIF-R results, compared with Xpert. We also detailed other molecular tests, that is, Truenat MTBTM/TruPlus, commercial real-time PCR, line probe assay, and so on, for EPTB diagnosis. EXPERT OPINION A combination of clinical features, imaging, histopathological findings, and Xpert Ultra are adequate for definite EPTB diagnosis so as to initiate an early anti-tubercular therapy.
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Affiliation(s)
- Bhawna Dahiya
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Neeru Mehta
- Department of Medical Electronics, Ambedkar Delhi Skill & Entrepreneurship University, Shakarpur, New Delhi, India
| | - Aishwarya Soni
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal, Sonipat, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
- Microbiology Department, Faculty of Allied Health Sciences, SGT University, Budhera, Gurgaon, India
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9
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Stroeken Y, Broekhuijsen K, Leyten E, Hermes W. Case Report: Subfertility and Pregnancy Loss due to Genital Tuberculosis. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:164. [PMID: 37363360 PMCID: PMC10267541 DOI: 10.1007/s42399-023-01492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
Tuberculosis (TB) is a disease that primarily affects low and middle income countries (LMICs) but is becoming more relevant in Western countries due to increasing migration from high TB burden countries. It is especially difficult to detect in women with fertility issues as it mimics other more common causes. Delayed diagnosis of TB can result in fallopian tube and endometrial pathology leading to subfertility and pregnancy loss. This case report describes a 34-year-old woman from Ivory Coast who was diagnosed with intrauterine tuberculosis after hysteroscopic evacuation of suspected retained placental tissue following an immature delivery. The patient had a complicated fertility history, including pelvic inflammatory disease and IVF/ICSI procedures, before becoming pregnant at the age of 38. She delivered prematurely at 22 weeks with a retained placenta. A diagnosis of TB was confirmed after pathology revealed granulomatous inflammation, without signs of placental tissue, and further testing confirmed rifampicin-resistant TB. The patient underwent a 15-month course of multi-drug-resistant TB treatment, which postponed her pregnancy wish. The case highlights the challenge of diagnosing genital TB in the female genital tract during subfertility investigations and after a complicated pregnancy in a woman without a history of or symptoms of TB. It underscores the importance of considering TB in the differential diagnosis of subfertility. Screening should be considered in women originating from high endemic countries with unexplained fertility loss and during first trimester screening.
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Affiliation(s)
- Y. Stroeken
- Present Address: Leids Universitair Medisch Centrum, Leiden, Netherlands
- HMC Haaglanden Medisch Centrum, Den Haag, Netherlands
| | - K. Broekhuijsen
- HMC Haaglanden Medisch Centrum, Den Haag, Netherlands
- Present Address: Bergman Clinics Hilversum, Hilversum, Netherlands
| | - E. Leyten
- HMC Haaglanden Medisch Centrum, Den Haag, Netherlands
| | - W. Hermes
- HMC Haaglanden Medisch Centrum, Den Haag, Netherlands
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10
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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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Carabalí-Isajar ML, Rodríguez-Bejarano OH, Amado T, Patarroyo MA, Izquierdo MA, Lutz JR, Ocampo M. Clinical manifestations and immune response to tuberculosis. World J Microbiol Biotechnol 2023; 39:206. [PMID: 37221438 DOI: 10.1007/s11274-023-03636-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
Tuberculosis is a far-reaching, high-impact disease. It is among the top ten causes of death worldwide caused by a single infectious agent; 1.6 million tuberculosis-related deaths were reported in 2021 and it has been estimated that a third of the world's population are carriers of the tuberculosis bacillus but do not develop active disease. Several authors have attributed this to hosts' differential immune response in which cellular and humoral components are involved, along with cytokines and chemokines. Ascertaining the relationship between TB development's clinical manifestations and an immune response should increase understanding of tuberculosis pathophysiological and immunological mechanisms and correlating such material with protection against Mycobacterium tuberculosis. Tuberculosis continues to be a major public health problem globally. Mortality rates have not decreased significantly; rather, they are increasing. This review has thus been aimed at deepening knowledge regarding tuberculosis by examining published material related to an immune response against Mycobacterium tuberculosis, mycobacterial evasion mechanisms regarding such response and the relationship between pulmonary and extrapulmonary clinical manifestations induced by this bacterium which are related to inflammation associated with tuberculosis dissemination through different routes.
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Grants
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- b PhD Program in Biomedical and Biological Sciences, Universidad del Rosario, Carrera 24#63C-69, Bogotá 111221, Colombia
- c Health Sciences Faculty, Universidad de Ciencias Aplicadas y Ambientales (UDCA), Calle 222#55-37, Bogotá 111166, Colombia
- d Faculty of Medicine, Universidad Nacional de Colombia, Carrera 45#26-85, Bogotá 111321, Colombia
- e Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411. Colombia
- e Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411. Colombia
- f Universidad Distrital Francisco José de Caldas, Carrera 3#26A-40, Bogotá 110311, Colombia
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Affiliation(s)
- Mary Lilián Carabalí-Isajar
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
- Biomedical and Biological Sciences Programme, Universidad del Rosario, Carrera 24#63C-69, 111221, Bogotá, Colombia
| | | | - Tatiana Amado
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
| | - Manuel Alfonso Patarroyo
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
- Faculty of Medicine, Universidad Nacional de Colombia, Carrera 45#26-85, 111321, Bogotá, Colombia
| | - María Alejandra Izquierdo
- Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, 111411, Bogotá, Colombia
| | - Juan Ricardo Lutz
- Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, 111411, Bogotá, Colombia.
| | - Marisol Ocampo
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia.
- Universidad Distrital Francisco José de Caldas, Carrera 3#26A-40, 110311, Bogotá, Colombia.
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12
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A rare case of kidney loss: urogenital tuberculosis. Porto Biomed J 2023; 8:e201. [DOI: 10.1097/j.pbj.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/15/2022] [Indexed: 02/09/2023] Open
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13
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Wang Y, Tan J, Lei L, Yuan Y, Li W, Zhao Y, Wang Y, Niu X, Li Z, Wei L, Han Y, Cheng M, Guo X, Han X, Wang W. The value of Xpert MTB/RIF assay of urine samples in the early diagnosis of smear-negative urinary tuberculosis. Eur J Med Res 2022; 27:300. [PMID: 36539899 PMCID: PMC9764486 DOI: 10.1186/s40001-022-00947-x] [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: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND According to reports, between 30 and 40 percent of extrapulmonary tuberculosis (EPTB) cases are caused by urinary tract tuberculosis (UTB). It is critical to identify UTB quickly since it frequently precedes delayed medical attention, which can have detrimental effects. This study examined the use of Xpert MTB/RIF, a PCR test that can detect MTB as well as resistance to an important drug, rifampicin (RIF), in UTB particularly, for the early identification of UTB. METHODS 180 participants with clinically presumptive UTB whose urine samples were chosen for urine sediment smear, culture, Xpert MTB/RIF, and TB-DNA testing at Henan Chest Hospital between January 2019 and July 2022. Evaluation of test performance using Composite Reference Standards (CRSs). We studied and compared the positivity rate for various tests using the t-test. The effectiveness of smear, culture, Xpert MTB/RIF, and TB-DNA was assessed using McNemar test. RESULTS In this subject, a total of 108 participants were diagnosed with UTB, and the positivity rate was 67.1%. Compared with CRS, the positivity rate of Xpert MTB/RIF, smear, culture, and TB-DNA was 29.69% (19/64, P < 0.001), 7.56% (9/119, P < 0.1), 12.12% (4/33, P > 0.05), and 18.75% (6/32, P < 0.1), respectively. The sensitivity of Xpert MTB/RIF assay was significantly better than that of smear and culture tests (78.9% vs. 77.8%, P < 0.05; 78.9% vs. 75%, P < 0.05). Under CRS, the positivity rate for Xpert, culture, and TB-DNA was 31.6% (6/19, P < 0.1), 6.2% (1/16, P > 0.05), and 26.7% (4/15, P > 0.05) for TB-DNA, respectively, compared to smear negative. Xpert MTB/RIF assay specificity was significant for culture and TB-DNA (53.6% vs. 25%, P < 0.01; 53.6% vs. 38.9%, P < 0.05), and Xpert MTB/RIF assay FPV was significant for culture and TB-DNA (53.6% vs. 0%, P < 0.001; 53.6% vs. 0%, P < 0.001). CONCLUSION Xpert MTB/RIF outperforms smear, cultures, and TB-DNA in detecting UTB, plus Xpert MTB/RIF is better suited for early diagnosis in smear-negative UTB.
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Affiliation(s)
- Yachun Wang
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Jiao Tan
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Lei Lei
- Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China ,grid.459614.bDepartment of Family Medicine, Henan Provincial Chest Hospital, Zhengzhou, 450003 China
| | - Yingying Yuan
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Wenbo Li
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Yue Zhao
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Yali Wang
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Xiaodong Niu
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Zheng Li
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Lukuan Wei
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Yungang Han
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Meijing Cheng
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Xu Guo
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Xue Han
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
| | - Wei Wang
- grid.207374.50000 0001 2189 3846Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, 450003 China ,Henan Provincial Key Laboratory of Tuberculosis Diagnostic Medicine, Zhengzhou, 450003 China ,Henan Provincial Infectious Diseases (Tuberculosis) Clinical Medical Research Center, Zhengzhou, 450003 China
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Single-stage combined urethroplasty for extended strictures of the anterior urethra of tuberculous origin. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.5-2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Urethral strictures are currently one of the most complex pathologies in reconstructive urology. The most promising direction in this area is the development of single-stage surgical interventions that meets modern requirements for the quality of life of patients.The aim of the study. To evaluate the possibility and the effectiveness of surgical treatment of extended recurrent tuberculous urethral strictures in men using a combination of a skin flap and a buccal graft. In the literature, there is no description of the use of this technique in patients with urethral tuberculosis.Materials and methods. We observed 44 patients with urethral tuberculosis. Three men from this group of patients were diagnosed with tuberculous (post-tuberculous) extended recurrent stricture of the anterior urethra and they underwent combined single-stage urethroplasty with a ventral fasciocutaneous flap and a buccal graft using the inlay method in the penile region and with a buccal graft using the ventral onlay method in the bulbous urethra. Ultrasound of the urethra served as a method that determines the possibility of performing this surgery in case of maintaining a sufficient width of the urethral plate with a moderate degree of spongiofibrosis.Results. Patients were under observation for 34, 50 and 54 months and have good long-term functional results – all patients have unassisted urination and no residual urine. Post-micturition dribbling persists in 1 patient. The overall effectiveness of the treatment of these strictures, taking into account the treatment of repeated cases of the disease recurrence, is high.Conclusion. This technique demonstrates the possibility of performing a single-stage reconstruction of the anterior urethra in patients with extended recurrent tuberculous (post-tuberculous) urethral strictures and is also applicable for the surgical treatment of urethral strictures of other origins.
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Liu QX, Tang DY, Xiang X, He JQ. Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis. Front Cell Infect Microbiol 2022; 12:1013751. [PMID: 36506012 PMCID: PMC9731357 DOI: 10.3389/fcimb.2022.1013751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study was designed to assess and analyze nutritional status (NS) and immune status in patients with tuberculosis. Methods A retrospective analysis was conducted on 93 TB patients hospitalized in the tuberculosis ward of the West China Hospital of Sichuan University. Subgroup comparisons were made according to age (<65 years and ≥65 years), nutritional risk score 2002 (NRS 2002 <3 and ≥3), tuberculosis location [pulmonary tuberculosis and extrapulmonary tuberculosis (including pulmonary tuberculosis complicated with extrapulmonary tuberculosis)], and prognostic nutrition index (PNI) (<45 vs ≥45). Results Significantly increased weight loss was associated with extrapulmonary tuberculosis (P =0.0010). Serum albumin (P =0.0214), total lymphocyte count (P = 0.0009) and PNI (P = 0.0033) were significantly decreased in older patients. Neutrophils/lymphocytes (NLR) (P =0.0002), monocytes/lymphocytes (MLR) (P < 0.0001), and platelets/lymphocytes (PLR) (P =0.0107) were higher. According to NRS 2002, higher nutritional risk was associated with lower body weight and body mass index (BMI) (P < 0.0001), higher weight loss (P = 0.0012), longer duration of hospitalization (P =0.0100), lower serum albumin level and hemoglobin concentration (P <0.01), lower creatinine level, and lower PNI (P < 0.01). 0.0001), lower total lymphocyte count (P = 0.0004), higher neutrophil and monocyte counts (P <0.05), and higher NLR (P = 0.0002), MLR (P = 0.0006), and PLR (P = 0.0156). Lower PNI was associated with lower body weight (P = 0.0001) and BMI (P =0.0074), lower total protein, albumin, and hemoglobin concentrations (P < 0.0001), and lower total lymphocyte count (P < 0.0001) and creatinine levels (P = 0.0336), higher age (P =0.0002) and NRS 2002 score, P < 0.0001), longer hos-pital stay (P = 0.0003), higher neutrophil count (P = 0.0042), and NLR, MLR, and PLR (P <0.0001) were significantly correlated. In multivariate logistic regression analysis, weight loss (OR: 0.209, 95% CI: 0.060-0.722; p =0.013) was significantly associated with higher nutritional risk (NRS 2002≥3). In multiple linear regression analysis, the NRS 2002 score was higher (B=2.018; p =0.023), and extrapulmonary tuberculosis (B=-6.205; p =0.007) was linked with a longer duration of hos-pitalization. Conclusions Older tuberculosis patients are at nutritional risk, and older patients (≥65 years old) need to pay attention to nutritional monitoring and intervention. Older TB patients and those at risk of malnutrition have increased immune ratio and impaired immune function. Management of TB patients using basic diagnostic tools to assess nutritional and immune status and calculate PNI and immunological indexes (NLR, MLR, PLR) to improve treatment outcomes.
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Affiliation(s)
- Quan-Xian Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dao-Yan Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Xiang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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Suehiro Y, Ueda H, Motohashi S, Honma S, Nobayashi H, Ueda R, Maruyama Y, Horino T, Ogasawara Y, Joh K, Tsuboi N, Yokoo T. Interferon-gamma Release Assay-positive Granulomatous Interstitial Nephritis in a Patient with a History of Diffuse Large B Cell Lymphoma. Intern Med 2022. [PMID: 36351581 DOI: 10.2169/internalmedicine.0648-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Tuberculosis is a common etiology of granulomatous interstitial nephritis (GIN). However, the absence of evidence of lung involvement and lack of mycobacterial isolation in cultures make the etiological diagnosis and treatment decision challenging. We herein report a 46-year-old man with severe renal failure, a persistent fever, and a history of lymphoma. A renal biopsy exhibited GIN. Despite no evidence of tuberculosis except for a positive interferon-gamma release assay (IGRA), the patient was successfully treated with anti-tuberculosis drugs. Our case suggests that anti-tuberculosis therapy should be considered for patients with IGRA-positive GIN after excluding other etiologies.
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Affiliation(s)
- Yohei Suehiro
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Hiroyuki Ueda
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Saya Motohashi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Shiko Honma
- Department of Pathology, the Jikei University School of Medicine, Japan
| | - Hiroki Nobayashi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Risa Ueda
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, the Jikei University School of Medicine, Japan
| | - Yoji Ogasawara
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, the Jikei University School of Medicine, Japan
| | - Kensuke Joh
- Department of Pathology, the Jikei University School of Medicine, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
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17
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Liu P, Cai G, Gu H, Qin Y. Diagnostic nomogram to differentiate between epididymal tuberculosis and bacterial epididymitis. Infection 2022; 51:447-454. [PMID: 36114385 DOI: 10.1007/s15010-022-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We developed and validated a diagnostic nomogram for differentiating epididymal tuberculosis (TB) from bacterial epididymitis. METHODS In this retrospective study, we developed a prediction model based on demographics and clinical characteristics. Eligible patients were randomly divided into derivation and validation cohorts (ratio 7:3). Univariate and multivariate regression analyses were used to filter variables and select predictors. Multivariate logistic regression was used to construct the nomogram. Concordance index (C-index), calibration plots, and decision curves analysis (DCA) were used to assess the discrimination, calibration, and clinical usefulness of the nomogram. RESULTS We included 147 patients (epididymal TB, 93; bacterial epididymitis, 54). The derivation cohort included 66 patients with epididymal TB and 38 with bacterial epididymitis; the validation cohort included 27 patients with epididymal TB and 16 with bacterial epididymitis. One regression model was built from three differential variables: body mass index, purified protein derivative, and chronic infection. Accordingly, one nomogram was developed. The model had good discrimination and calibration. C-indexes of the derivation and validation cohorts were 0.89 and 0.98 (95% confidence intervals, 0.83-0.95 and 0.94-1.01), respectively. DCA showed that the proposed nomogram was useful for differentiation. CONCLUSION The nomogram can differentiate between epididymal TB and bacterial epididymitis.
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Epidemiological characteristics of extrapulmonary tuberculosis patients with or without pulmonary tuberculosis. Epidemiol Infect 2022; 150:e158. [PMID: 35904011 PMCID: PMC9472030 DOI: 10.1017/s0950268822001236] [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] [Indexed: 11/20/2022] Open
Abstract
Our study aimed to investigate the epidemiology of extrapulmonary tuberculosis (EPTB) and analyse the epidemiological characteristics of EPTB patients with or without pulmonary tuberculosis (PTB). EPTB cases admitted in our hospital from January 2015 to December 2020 were included. Uni- and multi-variable logistic regression analysis was carried out to identify risk factors and prognostic factors of concomitant EPTB and PTB or exclusively EPTB. A total of 3488 EPTB patients were reviewed, including 2086 patients with concurrent PTB and EPTB, and 1402 patients with exclusively EPTB. Logistic regression analysis showed that age >60 years (OR = 1.674, 95% CI = 1.438–1.949, P < 0.001) and female (OR = 1.325, 95% CI = 1.155–1.520, P < 0.001) were risk factors of exclusively EPTB, while co-morbidities (OR = 0.676, 95% CI = 0.492–0.929, P = 0.016) and severe symptoms (OR = 0.613, 95% CI = 0.405–0.929, P = 0.021) were risk factors for concurrence of EPTB and PTB. Age >60 years was an independent prognostic factor in EPTB patients with or without PTB (HR = 11.059, 95%CI = 5.097–23.999, P < 0.001; HR = 23.994, 95%CI = 3.093–186.151, P = 0.0020). Female gender was an independent prognostic factor in patients with concurrent PTB and EPTB (HR = 23.994, 95%CI = 3.093–186.151, P = 0.002). Our study disclosed the differential epidemiological characteristics of EPTB patients with or without PTB in China.
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Yang YK, Chen HW, Weng LC, Ng KF, Wang HH, Hsieh ML, Chu SH, Chen Y, Wang TM, Chiang YJ, Lin KJ, Lin CT, Pan PY. Incidental tuberculosis epididymitis/epididymo-orchitis: a retrospective analysis at a tertiary center in Taiwan. Urology 2022; 168:116-121. [PMID: 35798186 DOI: 10.1016/j.urology.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
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20
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Rindi L. Rapid Molecular Diagnosis of Extra-Pulmonary Tuberculosis by Xpert/RIF Ultra. Front Microbiol 2022; 13:817661. [PMID: 35633667 PMCID: PMC9130774 DOI: 10.3389/fmicb.2022.817661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Rapid detection of Mycobacterium tuberculosis complex and determination of drug resistance are essential for early diagnosis and treatment of tuberculosis (TB). Xpert MTB/RIF Ultra (Xpert Ultra), a molecular test that can simultaneously identify M. tuberculosis complex and resistance to rifampicin directly on clinical samples, is currently used. Xpert Ultra represents a helpful tool for rapid pulmonary TB diagnosis, especially in patients with paucibacillary infection. The aim of this review is to provide an overview of the diagnostic performance of Xpert Ultra in detection of extra-pulmonary tuberculosis.
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Affiliation(s)
- Laura Rindi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
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21
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Surgical treatment of urethral tuberculosis in men – history and present (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The literature review provides data on tuberculosis of the urethra in men. This disease is rarely recorded, as a rule, at the stage of formation of the urethral stricture, which can develop many years after the onset of the disease. Urethral tuberculosis is usually secondary to other localizations of extrapulmonary tuberculosis, such as tuberculosis of the prostate, penis, kidney, and bladder, but there are also isolated forms of this disease. The most common symptoms of urethral tuberculosis are the presence of strictures, skin-urethral and recto-prostatic fistulas, and purulent urethritis. Almost always, with this disease, conservative specific therapy was carried out, which in some cases made it possible to completely eliminate the symptoms and ensure the patient’s clinical recovery. Tuberculous urethral strictures are operated on according to generally accepted rules, but there is no single algorithm for the surgical treatment of strictures of this etiology, often limiting itself only to urine diversion or urethral dilation. Of the urethroplasty, the most commonly used end-to-end urethral anastomosis. In our opinion, a promising direction is the use of various grafts for the surgical treatment of this disease.
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22
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Huang Y, Chen B, Cao D, Chen Z, Li J, Guo J, Dong Q, Wei Q, Liu L. Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up. BMC Infect Dis 2021; 21:1068. [PMID: 34654377 PMCID: PMC8520285 DOI: 10.1186/s12879-021-06753-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/01/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. METHODS Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. RESULTS Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). CONCLUSIONS We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients' sexual function and fertility during follow up after treatment completed.
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Affiliation(s)
- Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zeyu Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianbing Guo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan, People's Republic of China.
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Kharbach Y, Retal Y, Khallouk A. Is orchiectomy avoidable in testicular tuberculosis mimicking malignancy? A case report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00244-9] [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
Isolated testicular tuberculosis (TB) is extremely uncommon. It has non-specific presentation; thus, diagnosis is challenging and is often discovered on pathology examination after orchiectomy.
Case presentation
We report herein the case of a 73-year-old male, with no significant medical or family history, who presented with left scrotal swelling, physical examination revealed a left testicular firm mass measuring 3 cm and ultrasound was suggestive of testicular tumor. Left inguinal orchiectomy was performed and the pathologic examination revealed testicular TB. The presentation was typically mimicking a testicular cancer with no evocative evidence of TB; this can lead to a dilemma and highlights the need to consider TB in differential diagnosis of testicular tumor, especially in areas endemic for the disease.
Conclusions
The aim of our presentation is to argue if orchiectomy was avoidable. It also illustrates the probable hematogenous or lymphatic spread of Mtb to the testicle.
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Yang G, Ruan L. Imaging findings of prostate tuberculosis by transrectal contrast-enhanced ultrasound and comparison with 2D ultrasound and pathology. Br J Radiol 2021; 95:20210713. [PMID: 34586884 PMCID: PMC8722228 DOI: 10.1259/bjr.20210713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: This study aimed to investigate the contrast-enhanced ultrasound (CEUS) appearances of prostate tuberculosis (PTB) and its correlation with histopathology. Methods: Clinical, transrectal ultrasonography (TRUS) and CEUS data of 12 PTB patients confirmed by pathology were retrospectively analyzed, and compared to the pathological findings to identify the pathological structures corresponding to different image enhancement areas. Results: No specific characteristics could be found for the clinical appearances. Enlarged gland, hypoechoic lesions and calcification due to PTB could be found by TRUS, which were also non-specific. CEUS showed hypo- or non-enhanced lesions with varying size, which were related to different pathological stages of PTB. The incidence rate of non-enhanced lesions was 83.3%. The detection rate of suspected lesion by CEUS was significantly higher than that by TRUS (χ2 = 8.000, p = 0.005). Histopathology showed that the hypoenhanced area consisted of tuberculous granulomas, caseous necrosis and incomplete destruction of the glands, while the non-enhanced area consisted of caseous or liquified necrosis. Conclusion: CEUS could improve the detection rate of PTB lesions, and the diversity of its manifestations was related to different pathological structures. An enlarged, soft gland with non-enhanced on CEUS may provide valuable information for the diagnosis of PTB, but it is not a substitute for biopsy due to the diversity of CEUS findings. Advances in knowledge: When the lesions of prostate gland are unclear in TRUS examination, CEUS is an ideal option for the detection of lesions, which is conducive to targeted guidance of biopsy areas.
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Affiliation(s)
- Gaoyi Yang
- Department of Ultrasonography, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, China
| | - Litao Ruan
- Department of Ultrasonography, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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25
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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] [MESH Headings] [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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26
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Meriglier E, Abergel A, Michelson-Lechat X, Gorisse V, Lapoirie J, Rivoisy C, Vandenhende MA, Bonnet F. Diagnosis of genital tuberculosis on menstrual blood during infertility explorations. Eur J Obstet Gynecol Reprod Biol 2021; 262:259-261. [PMID: 34090731 DOI: 10.1016/j.ejogrb.2021.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
- E Meriglier
- Service de Médecine Interne et Post-Urgences, Hôpital Pellegrin, CHU de Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - A Abergel
- Centre de fertilité GAIA, Polyclinique Jean Villar, Bruges, France.
| | | | - V Gorisse
- Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - J Lapoirie
- Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - C Rivoisy
- Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - M A Vandenhende
- Service de Médecine Interne et Post-Urgences, Hôpital Pellegrin, CHU de Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - F Bonnet
- Université de Bordeaux, Bordeaux, France; Service de médecine interne et maladies infectieuses, Hôpital Saint André, CHU de Bordeaux, France.
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27
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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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Ichikawa C, Tanaka S, Takubo M, Kushimoto M, Ikeda J, Ogawa K, Tsujino I, Suzuki Y, Abe M, Ishihara H, Fujishiro M. Tuberculosis Relapse in the Epididymis After the Completion of Nine Months of Anti-Tuberculosis Chemotherapy in a Patient with Poorly Controlled Diabetes Mellitus. Ther Clin Risk Manag 2021; 17:463-470. [PMID: 34079268 PMCID: PMC8164866 DOI: 10.2147/tcrm.s310463] [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: 03/10/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022] Open
Abstract
The standard six-month tuberculosis (TB) treatment comprises an intensive phase lasting two months, followed by a continuation phase lasting four months. Meanwhile, the nine-month regimen, which has a prolonged continuation phase, is indicated for patients with complicated diabetes mellitus (DM) because of their poor response to treatment. A 61-year-old Japanese man with poorly controlled DM for five years presented with bilateral scrotal swelling noticed two weeks ago. He had a history of pleuritis, pericarditis, and peritonitis two years ago. These symptoms led to the diagnosis of culture-negative extrapulmonary TB. He received the nine-month chemotherapy regimen (isoniazid, rifampin, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampin for seven months), and his symptoms significantly improved. The swollen scrotum was accompanied by mild tenderness and pus discharge from a fistula. Imaging study revealed bilaterally diffusely enlarged epididymis. However, the acid-fast bacilli smear and culture and polymerase chain reaction using urine and pus discharge tested negative. Bilateral epididymectomy was performed. Although the acid-fast bacilli smear was negative, the pathology demonstrated granuloma formation and acid-fast bacilli tissue culture confirmed multi-drug resistant Mycobacterium tuberculosis. The optimal treatment regimen and duration for extrapulmonary TB with unknown drug susceptibility are debatable. The nine-month regimen can be insufficient in some cases. Thus, detailed follow-up is essential, and TB relapse should be thoroughly monitored.
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Affiliation(s)
- Chikako Ichikawa
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sho Tanaka
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
| | - Masahiro Takubo
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
| | - Masaru Kushimoto
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
| | - Jin Ikeda
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
| | - Katsuhiko Ogawa
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan.,Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Tsujino
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan.,Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan.,Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hisamitsu Ishihara
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Midori Fujishiro
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
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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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30
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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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31
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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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32
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Chevalier K, Ferreira J, Cabral D, de Laroche M, Hanslik T, Kahn JE. [An abscessed granulomatous prostatitis]. Rev Med Interne 2020; 41:562-566. [PMID: 32674890 DOI: 10.1016/j.revmed.2020.05.019] [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: 09/06/2019] [Revised: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis. CASE REPORT A 55-year-old man was admitted for acute urinary retention. Urine culture was sterile, with leukocyturia > 106/ml. After failure of antibiotic therapy with cefotaxime, CT scan revealed a necrotic prostatic collection and a nodular non-necrotic tissular lesion in the left upper lung lobe. Trans-rectal drainage of the prostatic lesion and lung biopsies revealed granuloma with multinucleated giant cells (without mycobacteria). The diagnosis of granulomatosis with polyangiitis was confirmed by high level of anti-proteinase 3 antibodies. Treatment with steroids and rituximab resulted in apyrexia, regression of the inflammatory syndrome and clinical manifestations. CONCLUSION The diagnosis of granulomatosis with polyangiitis should be considered in the presence of a non-infectious granulomatous prostatitis with systemic involvement.
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Affiliation(s)
- K Chevalier
- Service de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
| | - J Ferreira
- Service de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - D Cabral
- Service de Radiologie, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - M de Laroche
- Service de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - T Hanslik
- Service de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - J-E Kahn
- Service de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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Fernández-Vidal M, Canllavi Fiel E, Bada Bosch T, Trujillo Cuéllar H, García Martín F, Gutiérrez Martínez E, Molina Gómez M, Alonso Riaño M, Praga Terente M. Nefritis intersticial tuberculosa, un diagnóstico difícil que precisa de una alta sospecha. Nefrologia 2020; 40:475-477. [DOI: 10.1016/j.nefro.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/15/2019] [Accepted: 05/25/2019] [Indexed: 12/01/2022] Open
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34
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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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35
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Chen K, Malik AA, Nantasenamat C, Ahmed S, Chaudhary O, Sun C, Sheng YJ, Chen W, Gang W, Deng CL, Ojha SC. Clinical validation of urine-based Xpert® MTB/RIF assay for the diagnosis of urogenital tuberculosis: A systematic review and meta-analysis. Int J Infect Dis 2020; 95:15-21. [PMID: 32194240 DOI: 10.1016/j.ijid.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Effective methods for diagnosing urogenital tuberculosis (UGTB) are important for its clinical management. Therefore, we undertook a systematic review to assess the performance of the urine-based Xpert MTB/RIF assay for UGTB. METHODS PubMed, Embase, Web of Science, the Cochrane library, and Scopus were systematically searched up to July 30, 2019. A hierarchical summary receiver operating characteristic (HSROC) was applied to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) for the diagnostic accuracy of the Xpert test. RESULTS Our search identified 858 unique articles from which 69 studies were selected for full-text revision, with 12 studies meeting the inclusion criteria. Eleven studies comprising 1202 samples compared Xpert with mycobacterial culture, while 924 samples from eight studies compared it with a composite reference standard (CRS). The values for pooled sensitivity, specificity, PLR, NLR, and OR were 0.89, 0.95, 20.1, 0.18, and 159.53, respectively, when compared with the mycobacterial culture. Likewise, when compared with a CRS, the respective pooled sensitivity, specificity, PLR, NLR, and OR values were 0.55, 0.99, 40.67, 0.43, and 166.17, thereby suggesting a high level of accuracy for diagnosing UGTB. A meta-regression and sub-group analysis of TB-burden countries, study design, decontamination, concentration, and reference standard could not explain the heterogeneity (p > 0.05) in the diagnostic efficiency. CONCLUSIONS Our results suggested that Xpert is a promising diagnostic tool for the diagnosis of UGTB via urine specimen.
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Affiliation(s)
- Ke Chen
- Anatomy and Structural Biology Graduate Program, Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Aijaz Ahmed Malik
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Chanin Nantasenamat
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Sarfraz Ahmed
- Department of Basic Sciences, University of Veterinary and Animal Sciences Lahore, Sub-campus, 51600, Narowal, Pakistan
| | - Omkar Chaudhary
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
| | - Changfeng Sun
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Yun-Juan Sheng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Wen Chen
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Wu Gang
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Cun-Liang Deng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Suvash Chandra Ojha
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Hane J, Duffey B, Kaiser R, Walker PF, Alpern JD. Case Report: Epididymo-Orchitis due to Mycobacterium tuberculosis. Am J Trop Med Hyg 2020; 101:1070-1072. [PMID: 31482781 DOI: 10.4269/ajtmh.19-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Genitourinary tuberculosis (TB) is a rare but well-described form of extrapulmonary TB. We present a case of a 35-year-old man from Ethiopia with scrotal swelling and fever who was found to have epididymo-orchitis due to Mycobacterium tuberculosis. The patient presented to the hospital multiple times before undergoing operative debridement with fine needle aspiration and tissue biopsy to confirm the diagnosis. He improved with antituberculous therapy. Patients with TB risk factors presenting with epididymitis that is refractory to empiric antibiotic therapy warrant consideration of TB epididymitis. Our case demonstrates the high index of suspicion required to establish a diagnosis of genitourinary TB.
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Affiliation(s)
- Jessica Hane
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Branden Duffey
- Department of Urology, HealthPartners, St. Paul, Minnesota
| | - Robyn Kaiser
- Division of Infectious Diseases, HealthPartners, St. Paul, Minnesota
| | - Patricia F Walker
- Travel and Tropical Medicine Center, HealthPartners, Minneapolis, Minnesota
| | - Jonathan D Alpern
- Travel and Tropical Medicine Center, HealthPartners, Minneapolis, Minnesota.,Division of Infectious Diseases, HealthPartners, St. Paul, Minnesota
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37
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Mba B, Lucas BP, Houchens N, Seares JM, Joshi U. All in the Stream. J Hosp Med 2019; 14:777-781. [PMID: 31532744 PMCID: PMC6897536 DOI: 10.12788/jhm.3286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Benjamin Mba
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois
| | - Brian P Lucas
- Department of Medicine, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont
| | - Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Udit Joshi
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois
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38
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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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39
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Stephenson L, Byard RW. An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy. Forensic Sci Med Pathol 2019; 16:143-151. [PMID: 31471869 DOI: 10.1007/s12024-019-00161-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.
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Affiliation(s)
- Lilli Stephenson
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia.
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40
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Fowler ML, Mahalingaiah S. Case report of pelvic tuberculosis resulting in Asherman's syndrome and infertility. FERTILITY RESEARCH AND PRACTICE 2019; 5:8. [PMID: 31388435 PMCID: PMC6670196 DOI: 10.1186/s40738-019-0061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Abstract
Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis, and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis. The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.
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Affiliation(s)
- Mary Louise Fowler
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 E Concord St 6th Floor, Boston, MA 02118 USA
| | - Shruthi Mahalingaiah
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 E Concord St 6th Floor, Boston, MA 02118 USA
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41
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Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples. Sci Rep 2019; 9:11053. [PMID: 31363115 PMCID: PMC6667469 DOI: 10.1038/s41598-019-47358-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/12/2019] [Indexed: 01/11/2023] Open
Abstract
Genitourinary tuberculosis (GUTB) accounts for up to 40% of extrapulmonary tuberculosis cases. Rapid tests for GUTB are urgently needed because it is often associated with delayed health-care seeking, leading to serious consequences. This study evaluated the performance of the Xpert MTB/RIF assay in the rapid diagnosis of urinary tract tuberculosis (UTB) and rifampicin-resistant tuberculosis with urine specimens. In all, 302 patients were included from four hospitals in China. Suspected UTB patients were tested with Xpert, smear, and MGIT 960 culture. Drug susceptibility testing (DST) was conducted for culture-positive cases. The performance of the assays was evaluated against MGIT 960 culture and a composite reference standard (CRS). Among all participants, 150 (49.7%) had CRS-positive UTB, of whom 36 (24.0%) were culture-confirmed. Against culture, Xpert and smear achieved a sensitivity of 94.4% (95% CI: 81.3-99.3%) and 22.2% (95% CI: 10.1-39.2%), respectively. Against CRS, the sensitivity of Xpert, smear and culture was 41.3% (95% CI: 33.4-49.7%), 7.3% (95% CI: 3.7-12.7%), and 24.0% (95% CI: 17.4-31.6%). Xpert had better performance than smear and culture in detecting UTB from urine samples and could be considered for the diagnosis of UTB. Moreover, Xpert showed better performance than MGIT 960-based DST using urine culture.
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42
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Borges WM, Bechara GR, de Miranda MML, de Figueiredo GB, Venturini BA, Laghi CR. Epididymis tuberculosis: Case report and brief review of the literature. Urol Case Rep 2019; 26:100969. [PMID: 31367526 PMCID: PMC6656682 DOI: 10.1016/j.eucr.2019.100969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 02/09/2023] Open
Abstract
Tuberculosis (TB) is a secular disease caused by a bacillus, highly prevalent in Brazil. The genito-urinary tract involvement is rare, with the epididymis the most affected location. Treatment usually involves the combination of 3-4 drugs for TB for 6 months and surgery can be useful in complications.
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Affiliation(s)
- W M Borges
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - G R Bechara
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - M M L de Miranda
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - G B de Figueiredo
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - B A Venturini
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - C R Laghi
- Department of Urology, Federal University of Espírito Santo, Vitória, ES, Brazil
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43
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Riccardi N, Ferrarese M, Castellotti P, Mazzola E, Sozzi F, Rigatti P, Vanzulli A, Sotgiu G, Codecasa L. A rare case of multi-focal human TB after BCG instillation for non-muscle-invasive bladder cancer. Urologia 2019; 87:199-202. [PMID: 31271544 DOI: 10.1177/0391560319860396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe a left epididymitis and para-aortical involvement caused by Mycobacterium tuberculosis hominis reactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer. PATIENT AND METHODS A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible Mycobacterium tuberculosis hominis strain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy. RESULTS Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of Mycobacterium tuberculosis hominis after bacillus Calmette-Guérin treatment. CONCLUSION Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of Mycobacterium tuberculosis should be always ruled out by molecular and conventional microbiology in patients with a history of Mycobacterium tuberculosis hominis exposure.
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Affiliation(s)
- Niccolò Riccardi
- Clinic of Infectious Diseases, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,StopTB Italia Onlus, Milan, Italy
| | - Maurizio Ferrarese
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Paola Castellotti
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ester Mazzola
- Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Sozzi
- U.O. Urology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Angelo Vanzulli
- Departments of Diagnostic and Interventional Radiology and Oncology and Hemato-oncology, Niguarda Ca' Granda Hospital, University of Milan, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi Codecasa
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
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44
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Lin CS, Chao CM, Lai CC. Tuberculous ureteritis. QJM 2019; 112:371-372. [PMID: 30476302 DOI: 10.1093/qjmed/hcy275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C-S Lin
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C-M Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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45
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Challenges in urogenital tuberculosis. World J Urol 2019; 38:89-94. [DOI: 10.1007/s00345-019-02767-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
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46
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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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47
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Affiliation(s)
- Joseph A McBride
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Alexander J Lepak
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Gurpreet Dhaliwal
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Sanjay Saint
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Nasia Safdar
- From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin-Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence - both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
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48
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Kulchavenya E, Cherednichenko A. Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infections. Ther Adv Urol 2017; 10:95-101. [PMID: 29662539 DOI: 10.1177/1756287217745772] [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: 10/02/2017] [Accepted: 10/25/2017] [Indexed: 01/29/2023] Open
Abstract
Background Urogenital tuberculosis (UGTB) is one of the great imitators; it is commonly masked by urinary tract infections (UTIs). We aimed to estimate how many UGTB patients were among patients with a long history of UTIs. Material and Methods A total of 244 patients with recurrent UTIs and suspected UGTB were enrolled in an open, noncomparative prospective study. Their urine and expressed prostate secretion or ejaculate were cultured (a total of 1446 samples), and 421 isolates with growth of ⩾104 colony-forming units (CFU)/ml were investigated for drug resistance. Typically, UGTB diagnosis is made by individual case. Results All 244 patients had a long history of recurrent UTIs (on average, 7.9 ± 3.4 years); all received at least five courses of antibacterial therapy without good result. UGTB was diagnosed in 63 (25.8%), and in 41 of these (65.1%), there was comorbidity of UTI and UGTB. Of 1446 samples investigated, 421 (29.1%) were positive, and 1025 were negative. Escherichia coli was found in 57.3% of gram-negative microflora and in 29.0% only among all uropathogens. E. coli was resistant to amoxicillin/clavulanate in 51.5-57.1%, to cefotaxime in 50.0-52.0%, to gentamycin in 33.3-59.5%, to ciprofloxacin in 63.2-66.7%, to levofloxacin in 54.8-45.2%, and to nitrofurantoin in 23.5-20.8% in 2015 and 2016, respectively. If, in 2015, all isolates of E. coli were susceptible to imipenem, in 2016, 7.1% of strains were resistant to this antibiotic. Level of drug-resistance was higher in 2016, excluding only levofloxacin and nitrofurantoin. Conclusions Total prevalence of UGTB among UTI patients with poor results of antibacterial therapy was 25.8%. Comorbidity of UTI and UGTB was diagnosed in 65.1%.
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Affiliation(s)
- Ekaterina Kulchavenya
- Federal State Budgetary Institution 'The Novosibirsk Tuberculosis Research Institute (NTRI)' of the Ministry of Health of the Russian Federation, Novosibirsk Medical University, Russian Federation
| | - Andrey Cherednichenko
- Federal State Budgetary Institution 'The Novosibirsk Tuberculosis Research Institute (NTRI)' of the Ministry of Health of the Russian Federation, Russian Federation
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Igiraneza G, Hategekimana T, Manzi OM, Ogbuagu O. Obstructive uropathy as initial presentation of genitourinary tuberculosis and masquerading as a postsurgical complication. BMJ Case Rep 2017; 2017:bcr-2017-221270. [PMID: 29038191 DOI: 10.1136/bcr-2017-221270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight loss. On renal imaging, she was found to have bilateral hydronephrosis and hydroureters in the setting of bilateral distal ureteric obstruction complicated with acute kidney injury and severe hyperkalaemia requiring haemodialysis. The initial concern was for ureteric injury, a known complication of abdominal hysterectomy procedures, however, a urological intervention, performed 9 months later to relieve the ureteric obstruction, revealed purulent material within the left ureter that was smear positive for acid fast bacilli. A GeneXpert test was positive for Mycobacterium tuberculosis She was diagnosed with genitourinary tuberculosis and responded well to antitubercular treatment and haemodialysis was discontinued after the surgery relieved her ureteric obstruction.
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Affiliation(s)
- Grace Igiraneza
- Nephrology unit, Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Theobald Hategekimana
- Urology Unit, Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Olivier M Manzi
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Onyema Ogbuagu
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda.,Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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