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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024; 53:2081-2097. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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2
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Asare B, Huang C, Melia J, Fishman EK, Gawande R. Cross-sectional imaging of mimics of inflammatory bowel disease: not everything is Crohn's disease or ulcerative colitis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04436-z. [PMID: 38935092 DOI: 10.1007/s00261-024-04436-z] [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: 04/29/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Acute and chronic bowel pathologies can often be mistaken for manifestations of inflammatory bowel disease (IBD), and there are many entities with imaging and clinical features that overlap with IBD, making diagnosis difficult. We describe multiple inflammatory, infectious, neoplastic, and vascular entities with imaging and clinical features that may mimic IBD, and highlight differentiating features to assist in diagnosis.
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Affiliation(s)
- Belinda Asare
- Department of Radiology, NYU Langone, New York, NY, USA
| | | | - Joanna Melia
- Department of Gastroenterology, Johns Hopkins University, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Rakhee Gawande
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
- Russell H. Morgan Department of Radiology and Radiological Science, Diagnostic Radiology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD, 21287, USA.
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3
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Dahal P, Parajuli S. Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review. Heliyon 2024; 10:e29779. [PMID: 38699716 PMCID: PMC11063446 DOI: 10.1016/j.heliyon.2024.e29779] [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: 10/27/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
Central nervous system (CNS) tuberculosis is a post-primary form of tuberculosis. It has high mortality and morbidity rates despite early diagnosis and treatment. CNS tuberculosis can manifest as subacute/chronic meningitis, parenchymal tuberculous lesions, and spinal tuberculosis. Hematogenous spread of tuberculous bacilli to the brain results in the development of so called "rich foci" on the pial surface, ependyma, and grey-white matter junction. Rupture of these "rich foci" into the subarachnoid space triggers an intense granulomatous inflammatory reaction. Tuberculous meningitis can manifest as leptomeningitis or pachymeningitis. Intracranial parenchymal tuberculous lesions may present as tuberculoma, tuberculous abscess, cerebritis, rhombencephalitis, and encephalopathy, with atypical presentations not uncommon. Complications of CNS tuberculosis encompass hydrocephalus, syrinx formation, vasculitis, infarcts, neuritis, and enduring neurological deficits. Post-contrast 3D fluid-attenuated inversion recovery (FLAIR) and post-contrast T1 spin-echo sequences excel in detecting tuberculous meningitis compared to other conventional magnetic resonance imaging (MRI) sequences. In proton magnetic resonance spectroscopy (PMRS), the presence of a lipid peak at 1.3 ppm is indicative of tuberculous lesions. Magnetization transfer (MT) imaging enhances the detection of tuberculous lesions, as the magnetization transfer ratio (MTR) of tuberculous pathologies, owing to their high lipid content, is lower than that in bacterial or fungal pathologies and higher than that in viral pathologies. This review article delves into the various typical and atypical imaging presentations of CNS tuberculosis in MRI, along with recent advances in imaging techniques.
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Affiliation(s)
- Prajwal Dahal
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Sabina Parajuli
- Resident PGY-1 Pathology, Department of Pathology, Bir Hospital, Kathmandu, Nepal
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4
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Haigh DA, Mistry D, Farooq HZ, Ajdukiewicz KMB. A major pain in the hip - Destruction of the left acetabulum and femoral head secondary to Tuberculosis: A case report and review of the literature. INFECTIOUS MEDICINE 2024; 3:100086. [PMID: 38352920 PMCID: PMC10863318 DOI: 10.1016/j.imj.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/24/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
Abstract
A 68-year-old-gentleman presented with left hip pain, night sweats, fatigue, and weight loss. He had previously experienced pain with white discharge until he underwent an arthroscopic washout and reduction. The left lower limb was shortened and wasted with limited hip movements. He had recently travelled to Zambia, his country of origin. Imaging demonstrated a large mass with chronic erosions of the acetabulum and femoral head. Synovial biopsy grew Mycobacterium tuberculosis, which was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months then 4 months of rifampicin and isoniazid. Whole genome sequencing indicated full sensitivity. Complex reconstructive surgery is scheduled, with a custom femoral head and acetabulum. This case illustrates the importance of considering tuberculosis in patients with erosive joint pathology and a multidisciplinary approach as delayed diagnosis results in high morbidity. Prompt diagnosis using newer modalities such as whole genome sequencing on synovial fluid can enable timely treatment.
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Affiliation(s)
- Dominic A Haigh
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Department of Virology, Manchester University NHS Foundation Trust, M13 9WL Manchester, UK
| | - Dillan Mistry
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
| | - Hamzah Z Farooq
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Department of Virology, Manchester University NHS Foundation Trust, M13 9WL Manchester, UK
| | - Katherine M B Ajdukiewicz
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, UK
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Kanthawang T, Pattamapaspong N, Peh WCG, Hammami N, Bouaziz MC, Ladeb MF. Imaging of infra-thoracic tuberculosis. Br J Radiol 2024; 97:492-504. [PMID: 38288505 DOI: 10.1093/bjr/tqad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024] Open
Abstract
Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis 1007, Tunisia
| | - Mouna Chelli Bouaziz
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
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Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol 2024; 97:1-12. [PMID: 38263840 PMCID: PMC11027299 DOI: 10.1093/bjr/tqad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024] Open
Abstract
Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.
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Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mouna Chelli Bouaziz
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis, Tunisia
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore
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Oliveira VDA, Almeida RAMDB, Cavalcante RDS, de Andrade LGM, Ribeiro SM. Radiological presentation of active pulmonary tuberculosis in kidney transplant recipients: a retrospective study of four cases and a review of the literature. Radiol Bras 2024; 57:e20230124. [PMID: 38993963 PMCID: PMC11235070 DOI: 10.1590/0100-3984.2023.0124] [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: 11/06/2023] [Revised: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 07/13/2024] Open
Abstract
Although kidney transplantation is the best therapeutic option for patients with chronic kidney disease, the immunosuppression required greatly increases susceptibility to infections that are responsible for high post-transplant mortality. Pulmonary tuberculosis (TB) represents a major cause of such infections, and its early diagnosis is therefore quite important. In view of that, we researched the manifestations of active pulmonary TB in kidney transplant recipients, through chest X-ray and computed tomography (CT), as well as determining the number of cases of active pulmonary TB occurring over a 3.5-year period at our institution. We identified four cases of active pulmonary TB in kidney transplant recipients. The CT scans provided information complementary to the chest X-ray findings in all four of those cases. We compared our CT findings with those reported in the literature. We analyzed our experience in conjunction with an extensive review of the literature that was nevertheless limited because few studies have been carried out in lowand middle-income countries, where the incidence of TB is higher.
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Affiliation(s)
- Virgilio de Araujo Oliveira
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
“Júlio de Mesquita Filho” (UNESP). Botucatu, SP, Brazil
| | | | - Ricardo de Souza Cavalcante
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
“Júlio de Mesquita Filho” (UNESP). Botucatu, SP, Brazil
| | | | - Sergio Marrone Ribeiro
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
“Júlio de Mesquita Filho” (UNESP). Botucatu, SP, Brazil
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Du Plessis T, Rae WID, Ramkilawon G, Martinson NA, Sathekge MM. Quantitative Chest X-ray Radiomics for Therapy Response Monitoring in Patients with Pulmonary Tuberculosis. Diagnostics (Basel) 2023; 13:2842. [PMID: 37685380 PMCID: PMC10486768 DOI: 10.3390/diagnostics13172842] [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: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Tuberculosis (TB) remains the second leading cause of death globally from a single infectious agent, and there is a critical need to develop improved imaging biomarkers and aid rapid assessments of responses to therapy. We aimed to utilize radiomics, a rapidly developing image analysis tool, to develop a scoring system for this purpose. A chest X-ray radiomics score (RadScore) was developed by implementing a unique segmentation method, followed by feature extraction and parameter map construction. Signature parameter maps that showed a high correlation to lung pathology were consolidated into four frequency bins to obtain the RadScore. A clinical score (TBscore) and a radiological score (RLscore) were also developed based on existing scoring algorithms. The correlation between the change in the three scores, calculated from serial X-rays taken while patients received TB therapy, was evaluated using Spearman's correlation. Poor correlations were observed between the changes in the TBscore and the RLscore (0.09 (p-value = 0.36)) and the TBscore and the RadScore (0.02 (p-value = 0.86)). The changes in the RLscore and the RadScore had a much stronger correlation of 0.22, which is statistically significant (p-value = 0.02). This shows that the developed RadScore has the potential to be a quantitative monitoring tool for responses to therapy.
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Affiliation(s)
- Tamarisk Du Plessis
- Department of Nuclear Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | | | - Gopika Ramkilawon
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0081, South Africa
| | - Neil Alexander Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg 1862, South Africa
- Centre for Tuberculosis Research, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Mike Michael Sathekge
- Department of Nuclear Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
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du Plessis T, Ramkilawon G, Rae WID, Botha T, Martinson NA, Dixon SAP, Kyme A, Sathekge MM. Introducing a secondary segmentation to construct a radiomics model for pulmonary tuberculosis cavities. LA RADIOLOGIA MEDICA 2023; 128:1093-1102. [PMID: 37474665 PMCID: PMC10474191 DOI: 10.1007/s11547-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Accurate segmentation (separating diseased portions of the lung from normal appearing lung) is a challenge in radiomic studies of non-neoplastic diseases, such as pulmonary tuberculosis (PTB). In this study, we developed a segmentation method, applicable to chest X-rays (CXR), that can eliminate the need for precise disease delineation, and that is effective for constructing radiomic models for automatic PTB cavity classification. METHODS This retrospective study used a dataset of 266 posteroanterior CXR of patients diagnosed with laboratory confirmed PTB. The lungs were segmented using a U-net-based in-house automatic segmentation model. A secondary segmentation was developed using a sliding window, superimposed on the primary lung segmentation. Pyradiomics was used for feature extraction from every window which increased the dimensionality of the data, but this allowed us to accurately capture the spread of the features across the lung. Two separate measures (standard-deviation and variance) were used to consolidate the features. Pearson's correlation analysis (with a 0.8 cut-off value) was then applied for dimensionality reduction followed by the construction of Random Forest radiomic models. RESULTS Two almost identical radiomic signatures consisting of 10 texture features each (9 were the same plus 1 other feature) were identified using the two separate consolidation measures. Two well performing random forest models were constructed from these signatures. The standard-deviation model (AUC = 0.9444 (95% CI, 0.8762; 0.9814)) performed marginally better than the variance model (AUC = 0.9288 (95% CI, 0.9046; 0.9843)). CONCLUSION The introduction of the secondary sliding window segmentation on CXR could eliminate the need for disease delineation in pulmonary radiomic studies, and it could improve the accuracy of CXR reporting currently regaining prominence as a high-volume screening tool as the developed radiomic models correctly classify cavities from normal CXR.
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Affiliation(s)
- Tamarisk du Plessis
- Department of Nuclear Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Gopika Ramkilawon
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Neil Alexander Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Centre for TB Research, Baltimore, MD, USA
| | | | - Andre Kyme
- School of Biomedical Engineering, University of Sydney, Sydney, Australia
| | - Mike Michael Sathekge
- Department of Nuclear Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Laya BF, Concepcion NDP, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 2-extrathoracic tuberculosis. Pediatr Radiol 2023; 53:1782-1798. [PMID: 37074457 DOI: 10.1007/s00247-023-05650-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/20/2023]
Abstract
Despite advances in diagnosis and treatment in recent years, tuberculosis (TB) remains a global health concern. Children are amongst the most vulnerable groups affected by this disease. Although TB primarily involves the lungs and mediastinal lymph nodes, it can affect virtually any organ system of the body. Along with clinical history combined with physical examination and laboratory tests, various medical imaging tools help establish the diagnosis. Medical imaging tests are also helpful for follow-up during therapy, to assess complications and exclude other underlying pathologies. This article aims to discuss the utility, strengths and limitations of medical imaging tools in the evaluation of suspected extrathoracic TB in the pediatric population. Imaging recommendations for the diagnosis will be presented along with practical and evidence-based imaging algorithms to serve as a guide for both radiologists and clinicians.
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Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines
- Department of Radiology, St. Luke's Medical Center College of Medicine William H. Quasha Memorial, Quezon City, Philippines
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Ave., 1634, Taguig, Philippines
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines.
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Ave., 1634, Taguig, Philippines.
| | - Savvas Andronikou
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, and the Children's Hospital of Philadelphia, Philadelphia, USA
| | - Zaleha Abdul Manaf
- Al Islam Specialist Hospital, Kuala Lumpur, Malaysia
- Faculty of Medicine, Bioscience & Nursing, MAHSA University, Kuala Lumpur, Malaysia
| | - Maria Isabel M Atienza
- Institute of Pediatrics and Child Health, St Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines
- Department of Pediatrics, St. Luke's Medical Center College of Medicine William H. Quasha Memorial, Quezon City, Philippines
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Concepcion NDP, Laya BF, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 1-thoracic tuberculosis. Pediatr Radiol 2023; 53:1773-1781. [PMID: 37081179 PMCID: PMC10119015 DOI: 10.1007/s00247-023-05654-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023]
Abstract
Tuberculosis (TB) remains a global health problem and is the second leading cause of death from a single infectious agent, behind the novel coronavirus disease of 2019. Children are amongst the most vulnerable groups affected by TB, and imaging manifestations are different in children when compared to adults. TB primarily involves the lungs and mediastinal lymph nodes. Clinical history, physical examination, laboratory examinations and various medical imaging tools are combined to establish the diagnosis. Even though chest radiography is the accepted initial radiological imaging modality for the evaluation of children with TB, this paper, the first of two parts, aims to discuss the advantages and limitations of the various medical imaging modalities and to provide recommendations on which is most appropriate for the initial diagnosis and assessment of possible complications of pulmonary TB in children. Practical, evidence-based imaging algorithms are also presented.
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Affiliation(s)
- Nathan David P. Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke’s Medical Center – Global City, Rizal Drive cor. 32nd St. and 5th Ave., Taguig, 1634 Philippines
- Section of Pediatric Radiology, Institute of Radiology, St. Luke’s Medical Center – Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
| | - Bernard F. Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke’s Medical Center – Global City, Rizal Drive cor. 32nd St. and 5th Ave., Taguig, 1634 Philippines
- Section of Pediatric Radiology, Institute of Radiology, St. Luke’s Medical Center – Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
- Department of Radiology, St. Luke’s Medical Center College of Medicine William H Quasha Memorial, Quezon City, Philippines
| | - Savvas Andronikou
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Zaleha Abdul Manaf
- Al Islam Specialist Hospital, Kuala Lumpur, Malaysia
- Faculty of Medicine, MAHSA University, Bioscience & Nursing, Kuala Lumpur, Malaysia
| | - Maria Isabel M. Atienza
- Institute of Pediatrics and Child Health, St Luke’s Medical Center, Quezon City, Philippines
- Department of Pediatrics, St. Luke’s Medical Center College of Medicine William H. Quasha Memorial, Quezon City, Philippines
| | - Kushaljit Singh Sodhi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO USA
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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13
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Chopra H, Mohanta YK, Rauta PR, Ahmed R, Mahanta S, Mishra PK, Panda P, Rabaan AA, Alshehri AA, Othman B, Alshahrani MA, Alqahtani AS, AL Basha BA, Dhama K. An Insight into Advances in Developing Nanotechnology Based Therapeutics, Drug Delivery, Diagnostics and Vaccines: Multidimensional Applications in Tuberculosis Disease Management. Pharmaceuticals (Basel) 2023; 16:581. [PMID: 37111338 PMCID: PMC10145450 DOI: 10.3390/ph16040581] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/29/2023] Open
Abstract
Tuberculosis (TB), one of the deadliest contagious diseases, is a major concern worldwide. Long-term treatment, a high pill burden, limited compliance, and strict administration schedules are all variables that contribute to the development of MDR and XDR tuberculosis patients. The rise of multidrug-resistant strains and a scarcity of anti-TB medications pose a threat to TB control in the future. As a result, a strong and effective system is required to overcome technological limitations and improve the efficacy of therapeutic medications, which is still a huge problem for pharmacological technology. Nanotechnology offers an interesting opportunity for accurate identification of mycobacterial strains and improved medication treatment possibilities for tuberculosis. Nano medicine in tuberculosis is an emerging research field that provides the possibility of efficient medication delivery using nanoparticles and a decrease in drug dosages and adverse effects to boost patient compliance with therapy and recovery. Due to their fascinating characteristics, this strategy is useful in overcoming the abnormalities associated with traditional therapy and leads to some optimization of the therapeutic impact. It also decreases the dosing frequency and eliminates the problem of low compliance. To develop modern diagnosis techniques, upgraded treatment, and possible prevention of tuberculosis, the nanoparticle-based tests have demonstrated considerable advances. The literature search was conducted using Scopus, PubMed, Google Scholar, and Elsevier databases only. This article examines the possibility of employing nanotechnology for TB diagnosis, nanotechnology-based medicine delivery systems, and prevention for the successful elimination of TB illnesses.
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Affiliation(s)
- Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Yugal Kishore Mohanta
- Nanobiotechnology and Translational Knowledge Laboratory, Department of Applied Biology, School of Biological Sciences, University of Science and Technology Meghalaya (USTM), Techno City, 9th Mile, Ri-Bhoi, Baridua 793101, Meghalaya, India
| | | | - Ramzan Ahmed
- Nanobiotechnology and Translational Knowledge Laboratory, Department of Applied Biology, School of Biological Sciences, University of Science and Technology Meghalaya (USTM), Techno City, 9th Mile, Ri-Bhoi, Baridua 793101, Meghalaya, India
- Department of Physics, Faculty of Science, Kasetsart University, Bangkok 10900, Thailand
| | - Saurov Mahanta
- National Institute of Electronics and Information Technology (NIELIT), Guwahati Centre, Guwahati 781008, Assam, India
| | | | - Paramjot Panda
- School of Biological Sciences, AIPH University, Bhubaneswar 754001, Odisha, India
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Ahmad A. Alshehri
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Basim Othman
- Department of Public Health, Faculty of Applied Medical Sciences, Albaha University, Albaha 65779, Saudi Arabia
| | - Mohammed Abdulrahman Alshahrani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Ali S. Alqahtani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Khalid University, Abha 61481, Saudi Arabia
| | - Baneen Ali AL Basha
- Laboratory Department, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India
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14
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Maciel-Fiuza MF, Muller GC, Campos DMS, do Socorro Silva Costa P, Peruzzo J, Bonamigo RR, Veit T, Vianna FSL. Role of gut microbiota in infectious and inflammatory diseases. Front Microbiol 2023; 14:1098386. [PMID: 37051522 PMCID: PMC10083300 DOI: 10.3389/fmicb.2023.1098386] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
Thousands of microorganisms compose the human gut microbiota, fighting pathogens in infectious diseases and inhibiting or inducing inflammation in different immunological contexts. The gut microbiome is a dynamic and complex ecosystem that helps in the proliferation, growth, and differentiation of epithelial and immune cells to maintain intestinal homeostasis. Disorders that cause alteration of this microbiota lead to an imbalance in the host’s immune regulation. Growing evidence supports that the gut microbial community is associated with the development and progression of different infectious and inflammatory diseases. Therefore, understanding the interaction between intestinal microbiota and the modulation of the host’s immune system is fundamental to understanding the mechanisms involved in different pathologies, as well as for the search of new treatments. Here we review the main gut bacteria capable of impacting the immune response in different pathologies and we discuss the mechanisms by which this interaction between the immune system and the microbiota can alter disease outcomes.
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Affiliation(s)
- Miriãn Ferrão Maciel-Fiuza
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Guilherme Cerutti Muller
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Daniel Marques Stuart Campos
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Perpétua do Socorro Silva Costa
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Department of Nursing, Universidade Federal do Maranhão, Imperatriz, Brazil
| | - Juliano Peruzzo
- Dermatology Service of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Pathology, Universidade Federal De Ciências Da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Tiago Veit
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Sales Luiz Vianna
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- *Correspondence: Fernanda Sales Luiz Vianna,
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15
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Gallardo MEA. Giant Rasmussen's aneurysm in a 9-year-old boy: A case report. Radiol Case Rep 2022; 17:4168-4175. [PMID: 36105835 PMCID: PMC9464773 DOI: 10.1016/j.radcr.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/02/2022] Open
Abstract
Rasmussen's aneurysm is a pseudoaneurysm caused by tuberculosis, when cavitation occurs adjacent to a pulmonary artery, which can be lethal. It is a rare complication usually affecting adults. This is a case of an 9-year-old boy initially admitted for pneumonia that developed hemoptysis during admission. Chest X-ray done after this episode showed development of a left hilar mass not present in the previous studies. A chest CT with contrast subsequently revealed a saccular aneurysm arising from the left lower lobe pulmonary artery adjacent to a cavity, a Rasmussen's aneurysm. The patient was treated conservatively with continuation of anti-TB medication and serial monitoring due to the size of the aneurysm being less than 6 cm and spontaneous resolution of the hemoptysis. This report stresses that a Rasmussen's aneurysm should always be in the differential diagnosis of a hilar mass in a patient with hemoptysis, regardless of the patient's age.
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16
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Rawal N, Maldjian P. Urachal Remnant Calcification: A Rare Cause of Calcification Within the Urinary Bladder. Cureus 2022; 14:e29443. [DOI: 10.7759/cureus.29443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
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17
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Merchant SA, Shaikh MJS, Nadkarni P. Tuberculosis conundrum - current and future scenarios: A proposed comprehensive approach combining laboratory, imaging, and computing advances. World J Radiol 2022; 14:114-136. [PMID: 35978978 PMCID: PMC9258306 DOI: 10.4329/wjr.v14.i6.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) remains a global threat, with the rise of multiple and extensively drug resistant TB posing additional challenges. The International health community has set various 5-yearly targets for TB elimination: mathematical modelling suggests that a 2050 target is feasible with a strategy combining better diagnostics, drugs, and vaccines to detect and treat both latent and active infection. The availability of rapid and highly sensitive diagnostic tools (Gene-Xpert, TB-Quick) will vastly facilitate population-level identification of TB (including rifampicin resistance and through it, multi-drug-resistant TB). Basic-research advances have illuminated molecular mechanisms in TB, including the protective role of Vitamin D. Also, Mycobacterium tuberculosis impairs the host immune response through epigenetic mechanisms (histone-binding modulation). Imaging will continue to be key, both for initial diagnosis and follow-up. We discuss advances in multiple imaging modalities to evaluate TB tissue changes, such as molecular imaging techniques (including pathogen-specific positron emission tomography imaging agents), non-invasive temporal monitoring, and computing enhancements to improve data acquisition and reduce scan times. Big data analysis and Artificial Intelligence (AI) algorithms, notably in the AI sub-field called “Deep Learning”, can potentially increase the speed and accuracy of diagnosis. Additionally, Federated learning makes multi-institutional/multi-city AI-based collaborations possible without sharing identifiable patient data. More powerful hardware designs - e.g., Edge and Quantum Computing- will facilitate the role of computing applications in TB. However, “Artificial Intelligence needs real Intelligence to guide it!” To have maximal impact, AI must use a holistic approach that incorporates time tested human wisdom gained over decades from the full gamut of TB, i.e., key imaging and clinical parameters, including prognostic indicators, plus bacterial and epidemiologic data. We propose a similar holistic approach at the level of national/international policy formulation and implementation, to enable effective culmination of TB’s endgame, summarizing it with the acronym “TB - REVISITED”.
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Affiliation(s)
- Suleman Adam Merchant
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai 400022, Maharashtra, India
| | - Mohd Javed Saifullah Shaikh
- Department of Radiology, North Bengal Neuro Centre, Jupiter magnetic resonance imaging, Diagnostic Centre, Siliguri 734003, West Bengal, India
| | - Prakash Nadkarni
- College of Nursing, University of Iowa, Iowa 52242, IA, United States
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18
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Rydzak CE, Lima AS, Meirelles GS. Endemic Thoracic Infections in Sub-Saharan Africa. Radiol Clin North Am 2022; 60:461-479. [DOI: 10.1016/j.rcl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Baykan AH, Sayiner HS, Aydin E, Koc M, Inan I, Erturk SM. Extrapulmonary tuberculosıs: an old but resurgent problem. Insights Imaging 2022; 13:39. [PMID: 35254534 PMCID: PMC8901940 DOI: 10.1186/s13244-022-01172-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) primarily affects the lungs, but some of its most devastating clinical consequences arise because of its ability to spread from the lungs to other organs. Extrapulmonary TB (EPTB) constitutes 15-20% of all TB cases. Imaging findings are not always specific and can mimic many diseases; therefore, EPTB should be considered in the differential diagnosis, particularly in patients with immune system disorders (AIDS, patients receiving chemotherapy, etc.) and those in other high-risk groups including people with diabetes. The bacterium's passage to the regional lymph nodes is essential for developing a protective T-cell-mediated immune response, but the bacterium can spread hematologically and via the lymphatic system, leading to extrapulmonary involvement. Diagnosis of EPTB in high-risk patients is made based on suspected clinical and radiological findings, but further positive culture and histopathological confirmation may be required in some instances. Radiological evaluations are critical for diagnosis and crucial in planning the treatment and follow-up. This paper aims to review the typical and atypical imaging features and the differential diagnosis of EPTB.
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Affiliation(s)
- Ali H Baykan
- Department of Radiology, Faculty of Medicine, Adiyaman University, Yunus Emre Mahallesi 1164 Sokak No:13, 02200, Merkez, Adıyaman, Turkey.
| | - Hakan S Sayiner
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Elcin Aydin
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mustafa Koc
- Department of Radiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ibrahim Inan
- Department of Radiology,, King's College Hospital London, Dubai, United Arab Emirates
| | - Sukru M Erturk
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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20
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Benign lung diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Zheng SM, Lin N, Tang SH, Yang JY, Wang HQ, Luo SL, Zhang Y, Mu D. Isolated hepatic tuberculosis associated with portal vein thrombosis and hepatitis B virus coinfection: A case report and review of the literature. World J Clin Cases 2021; 9:9310-9319. [PMID: 34786418 PMCID: PMC8567534 DOI: 10.12998/wjcc.v9.i30.9310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While tuberculosis (TB) itself is a common disease, isolated TB of the liver is a rare entity. Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma. In contrast, isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice, with only a few sporadic cases and short series available in the current literature. Vascular complications, such as portal vein thrombosis (PVT), have rarely been reported previously.
CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg. He had a 10-year hepatitis B virus (HBV) infection in his medical history. Contrast-enhanced computed tomography (CECT) confirmed hepatosplenomegaly, with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein. A liver biopsy showed epithelioid granulomas with a background of caseating necrosis. Ziehl-Nelson staining showed acid-fast bacilli within the granulomas. The patient was diagnosed with isolated hepatic TB with PVT. Anti-TB therapy (ATT), including isoniazid, rifapentine, ethambutol, and pyrazinamide, was administered. Along with ATT, the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant. He remained asymptomatic, and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.
CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection, ATT and anticoagulants should be initiated to prevent subsequent portal hypertension. Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.
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Affiliation(s)
- Shu-Mei Zheng
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Ning Lin
- Department of Clinical Nutrition, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shan-Hong Tang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Jia-Yi Yang
- School of Medical Imaging, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Hai-Qiong Wang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shu-Lan Luo
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Yong Zhang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Dong Mu
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
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22
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Jiang G, Sun LL, Ye YJ, Yang ZT, Ji QL, Pang J, Gao CP. Giant cell tumors of the mobile spine with invasion of adjacent vertebrae: an unusual imaging finding. BMC Musculoskelet Disord 2021; 22:726. [PMID: 34429076 PMCID: PMC8385806 DOI: 10.1186/s12891-021-04610-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background Giant cell tumors of the mobile spine invasion of the adjacent vertebrae are an ignored imaging finding. Methods Nine patients with giant cell tumors of the mobile spine with invasion of the adjacent vertebrae confirmed by pathology were enrolled. Eight patients had pure giant cell tumors (GCTs), while one patient also had an aneurysmal bone cyst. All patients underwent conventional computed tomography, three-dimensional reconstruction, and conventional magnetic resonance imaging, while seven patients also underwent post-contrast magnetic resonance imaging. Results All patients showed GCTs of the mobile spine that arose from the vertebral body and extended to the vertebral arch. The tumors showed soft-tissue attenuation with no evidence of a mineralized matrix. Pathological fracture was seen in five patients. The margin of the original tumor showed partial sclerosis in four patients and involved an adjacent vertebral body with a sclerotic rim in two patients. The tumors showed a homogeneous and similar signal intensity to the normal spinal cord on T1WI (T1-weighted image) in five patients. The cystic area of the tumors was hyperintense on T2WI in the remaining four patients, while one patient showed hemorrhage that was hyperintense on T1WI. The solid components of the GCTs show marked enhancement in all cases, while the cystic area of the tumors was observed without enhancement on contrast-enhanced images in four patients. Bone destruction of the adjacent vertebral body showed a homogeneous signal on T1WI and T2WI and marked enhancement on contrast-enhanced images. Conclusions Giant cell tumors of the mobile spine with invasion into adjacent vertebrae are an unusual imaging finding. Radiologists should be familiar with this imaging characteristic.
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Affiliation(s)
- Gang Jiang
- Department of Radiology, The affiliated hospital of Qingdao University, Qingdao, 266003, China
| | - Ling-Ling Sun
- Department of Pathology, The affiliated hospital of Qingdao University, Qingdao, 266003, China
| | - Yong-Jun Ye
- Department of Radiology, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Zhi-Tao Yang
- Department of Radiology, The affiliated hospital of Qingdao University, Qingdao, 266003, China
| | - Qing-Lian Ji
- Department of Radiology, The affiliated hospital of Qingdao University, Qingdao, 266003, China
| | - Jing Pang
- Department of Radiology, The affiliated hospital of Qingdao University, Qingdao, 266003, China
| | - Chuan-Ping Gao
- Department of Radiology, The affiliated hospital of Qingdao University, Qingdao, 266003, China.
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23
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Chernick L, Kalla IS, Venter M. Clinical, radiological, and laboratory predictors of a positive urine lipoarabinomannan test in sputum-scarce and sputum-negative patients with HIV-associated tuberculosis in two Johannesburg hospitals. South Afr J HIV Med 2021; 22:1234. [PMID: 34394971 PMCID: PMC8335785 DOI: 10.4102/sajhivmed.v22i1.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is a major cause of mortality in persons living with HIV (PLWH). Sputum-based diagnosis of TB in patients with low CD4 counts is hampered by paucibacillary disease and consequent sputum scarcity or negative sputum results. Urine lipoarabinomannan (LAM) has shown promise in the point-of-care detection of TB in this patient subset but lacks sensitivity, and its exact role in a diagnostic algorithm for TB in South Africa remains to be clarified. Objectives The objective of this study was to better define the patient profile and the TB characteristics associated with a positive urine LAM (LAM+ve) test. Method This multicentre retrospective record review examined the clinical, radiological, and laboratory characteristics of hospitalised PLWH receiving urine LAM testing with sputum-scarce and/or negative sputum GeneXpert ® (mycobacterium tuberculosis/resistance to rifampicin [MTB/RIF]) results. Results More than a third of patients, 121/342 (35%), were LAM+ve. The positive yield was greater in the sputum-scarce than the sputum-negative group, 66/156 (42%) versus 55/186 (30%), P = 0.0141, respectively. Patients who were LAM+ve were more likely to be confused (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2–3.7, P = 0.0045), have a higher median heart rate (P = 0.0135) and an elevated quick sepsis-related organ failure assessment score (≥ 2), OR = 3.5, 95% CI = 1.6–7.6, P = 0.0014. A LAM+ve test was significantly associated with disseminated TB (dTB), P < 0.0001, TB-related immune reconstitution inflammatory syndrome (IRIS), P = 0.0035, and abdominal TB, P < 0.0001. Laboratory predictors of a LAM+ve status included renal dysfunction, P = 0.044, severe anaemia, P = 0.0116, and an elevated C-reactive protein, P = 0.0131. Of the 12 PLWH with disseminated non-TB mycobacteria cultured from the blood and/or bone marrow, n = 9 (75%) had a LAM+ve result (OR = 5.8, 95% CI = 1.6–20.8, P = 0.0053). Conclusion Urine LAM testing of hospitalised PLWH with suspected active TB had significant diagnostic utility in those that were sputum-scarce or sputum-negative. A LAM+ve result was associated with dTB, clinical and laboratory markers of severe illness, and TB-IRIS. Disseminated non-tuberculous mycobacterial infection of hospitalised PLWH may also yield urine LAM+ve results, and mycobacterial cultures must be checked in those non-responsive to conventional TB treatment. Selective use of the LAM test in the critically ill is likely to maximise the diagnostic yield, improve the test’s predictive value, and reduce the time to TB diagnosis and initiation of treatment.
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Affiliation(s)
- Lior Chernick
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ismail S Kalla
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Michelle Venter
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Infectious Diseases, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
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24
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Vangone L, Cardillo L, Riccardi MG, Borriello G, Cerrone A, Coppa P, Scialla R, Sannino E, Miletti G, Galiero G, Fusco G. Mycobacterium tuberculosis SIT42 Infection in an Abused Dog in Southern Italy. Front Vet Sci 2021; 8:653360. [PMID: 34239909 PMCID: PMC8258403 DOI: 10.3389/fvets.2021.653360] [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: 01/14/2021] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Abstract
A case of Mycobacterium tuberculosis infection is described in a dead adult male dog in Southern Italy. The carcass was found by the Health Authority in a gypsy encampment. It was admitted to our forensic veterinary medicine unit, with a suspicion of cruelty to the animal. Necropsy showed beating and traumatism signs, and mistreating was confirmed. Gross lesions included multiple nodular hepatic lesions, hemorrhagic enteritis with enlarged mesenteric lymph nodes, body cavity effusions, and an adrenal neoplasm. Bacteriological and molecular analyses were carried out on the liver lesions that enabled to identify M. tuberculosis SIT42 (LAM9). Drug-resistance patterns were evaluated by screening mutations on the rpoB and katG genes that showed susceptibility to both rifampin and isoniazid, respectively. Very few studies report canine tuberculosis, and little is known about the disease in Italy. To the authors' knowledge, this is the first report of Mycobacterium tuberculosis SIT42 infection in a dog in Italy.
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Affiliation(s)
- Lucia Vangone
- Department of Animal Health, Unit of Forensic Veterinary Medicine and Anatomopathology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Lorena Cardillo
- Department of Animal Health, Unit of Virology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Marita Georgia Riccardi
- Department of Animal Health, Unit of Applied Biotechnologies and Bioinformatics, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Giorgia Borriello
- Department of Animal Health, Unit of Applied Biotechnologies and Bioinformatics, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Anna Cerrone
- Department of Animal Health, Unit of Special Diagnostics and Fish Pathology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Paolo Coppa
- Department of Animal Health, Unit of Special Diagnostics and Fish Pathology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Roberto Scialla
- Department of Animal Health, Unit of Special Diagnostics and Fish Pathology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Emanuela Sannino
- Department of Animal Health, Unit of Applied Biotechnologies and Bioinformatics, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Gianluca Miletti
- Department of Animal Health, Unit of Forensic Veterinary Medicine and Anatomopathology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Giorgio Galiero
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Giovanna Fusco
- Department of Animal Health, Unit of Virology, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
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25
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Zahid M, Nepal P, Nagar A, Batchala PP, Kumar D, Ojili V. Imaging of ureter: a primer for the emergency radiologist. Emerg Radiol 2021; 28:815-837. [PMID: 33851303 DOI: 10.1007/s10140-021-01930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.
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Affiliation(s)
- Mohd Zahid
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Devendra Kumar
- Department of Clinical Imaging, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA.
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26
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Sharma A, De Rosa M, Singla N, Singh G, Barnwal RP, Pandey A. Tuberculosis: An Overview of the Immunogenic Response, Disease Progression, and Medicinal Chemistry Efforts in the Last Decade toward the Development of Potential Drugs for Extensively Drug-Resistant Tuberculosis Strains. J Med Chem 2021; 64:4359-4395. [PMID: 33826327 DOI: 10.1021/acs.jmedchem.0c01833] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tuberculosis (TB) is a slow growing, potentially debilitating disease that has plagued humanity for centuries and has claimed numerous lives across the globe. Concerted efforts by researchers have culminated in the development of various strategies to combat this malady. This review aims to raise awareness of the rapidly increasing incidences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, highlighting the significant modifications that were introduced in the TB treatment regimen over the past decade. A description of the role of pathogen-host immune mechanisms together with strategies for prevention of the disease is discussed. The struggle to develop novel drug therapies has continued in an effort to reduce the treatment duration, improve patient compliance and outcomes, and circumvent TB resistance mechanisms. Herein, we give an overview of the extensive medicinal chemistry efforts made during the past decade toward the discovery of new chemotypes, which are potentially active against TB-resistant strains.
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Affiliation(s)
- Akanksha Sharma
- Department of Biophysics, Panjab University, Chandigarh 160014, India.,UIPS, Panjab University, Chandigarh 160014, India
| | - Maria De Rosa
- Drug Discovery Unit, Ri.MED Foundation, Palermo 90133, Italy
| | - Neha Singla
- Department of Biophysics, Panjab University, Chandigarh 160014, India
| | - Gurpal Singh
- UIPS, Panjab University, Chandigarh 160014, India
| | - Ravi P Barnwal
- Department of Biophysics, Panjab University, Chandigarh 160014, India
| | - Ankur Pandey
- Department of Chemistry, Panjab University, Chandigarh 160014, India
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27
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Liu M, Lu L, Liu Q, Bai Y, Dong A. FDG PET/CT in Disseminated Intracranial and Intramedullary Spinal Cord Tuberculomas. Clin Nucl Med 2021; 46:266-269. [PMID: 33443950 DOI: 10.1097/rlu.0000000000003483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 54-year-old woman was referred because of dizziness with fatigue for 2 months. MRI of the head and spinal cord revealed multiple ring or homogeneous enhancing nodules in the brain and spinal cord, concerning for metastases. FDG PET/CT showed multiple hypermetabolic nodules in the brain and spinal cord corresponding to the gadolinium-enhanced nodules and diffuse FDG uptake in the bilateral lower lobes of the lungs. Chest high-resolution CT showed diffuse, bilateral miliary opacities, most predominant in the lower lobes. The imaging findings and results of cerebrospinal fluid analysis were consistent with disseminated central nervous system tuberculomas with miliary pulmonary tuberculosis.
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Affiliation(s)
- Mingyuan Liu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
| | - Lingdan Lu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
| | - Qianyun Liu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
| | | | - Aisheng Dong
- Nuclear Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
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28
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Saxena D, Pinto DS, Tandon AS, Hoisala R. MRI findings in tubercular radiculomyelitis. eNeurologicalSci 2021; 22:100316. [PMID: 33604460 PMCID: PMC7875821 DOI: 10.1016/j.ensci.2021.100316] [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: 09/02/2020] [Revised: 12/02/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
This article aims to familiarize the reader with the MR imaging findings of tubercular radiculomyelitis (TBRM) and to identify the sources of infection. We evaluated 29 patients on a 1.5 T GE MRI in a cross-sectional study. MRI of the spine with contrast and lumbar puncture were performed in all patients. MRI brain was performed for 13 patients. The typical and atypical manifestations enlisted in this article, will enable early detection of TBRM when the clinical history is ambiguous, as TBRM can present with low backache in both retrovirus positive and negative patients.
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Affiliation(s)
- Deepali Saxena
- Department of Radiodiagnosis, St. John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560034, India
| | - Denver Steven Pinto
- Department of Radiodiagnosis, St. John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560034, India
| | - Anisha S. Tandon
- Department of Radiodiagnosis, St. John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560034, India
| | - Ravi Hoisala
- Department of Radiodiagnosis, St. John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560034, India
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29
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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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30
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Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis. Pulm Med 2021; 2021:5285841. [PMID: 33510909 PMCID: PMC7826226 DOI: 10.1155/2021/5285841] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction Vitamin D has a significant role in host immune defense against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was therefore undertaken to identify the association between vitamin D deficiency and pulmonary tuberculosis. Methods A case-control study was conducted in a tertiary care hospital from 2014 to 2016, including 50 adult newly diagnosed sputum positive pulmonary tuberculosis patients as cases and 50 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D, calcium, and sputum for AFB. The clinical characteristics, X-ray findings, sputum AFB, and vitamin D levels were analyzed and compared with data obtained from healthy controls. Results In both groups, the majority were men (88%). BMI was significantly (<0.0001∗) lower in the tuberculosis group (19.40 (17.20, 22.0) vs. 24.00 (22.50, 25.47)). Serum vitamin D levels were significantly lower (P = 0.012) in the tuberculosis group (19 (7.75, 27.25) ng/dl) as compared to the control group (25 (19.75, 32.00) ng/dl). Out of 50 TB patients, 27 (54%) had vitamin D deficiency, while among healthy controls, only 13 (26%) had vitamin D deficiency. Among vitamin D deficient PTB patients, 44% had 3+/hpf AFB in sputum smear examination. Conclusion The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high. Hypovitaminosis D was associated with more severe clinical symptoms, higher sputum smear positivity, and extensive lesions in chest radiograph among pulmonary tuberculosis patients.
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Radwan A, Menias CO, El-Diasty MT, Etchison AR, Elshikh M, Consul N, Nassar S, Elsayes KM. Multimodality Imaging of Genitourinary Tuberculosis. Curr Probl Diagn Radiol 2020; 50:867-883. [PMID: 33272721 DOI: 10.1067/j.cpradiol.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 01/27/2023]
Abstract
Tuberculosis (TB) prevalence has increased over the past few decades, especially in the developing world. The genitourinary tract is the most common extra-pulmonary location of TB. Symptoms of genitourinary TB are often vague. Diagnosis of genitourinary TB requires a high level of clinical suspicion. Healthcare providers must be familiar with genitourinary TB imaging features on different imaging modalities and how to correlate these findings with urine studies and histologic analysis to definitively diagnose genitourinary TB.
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Affiliation(s)
- Ahmed Radwan
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Mohamed T El-Diasty
- Radiology department, King AbdulAziz University Hospital, Jeddah, Saudi Arabia
| | | | | | | | - Sameh Nassar
- University of Texas MD Anderson Cancer Center, Houston, TX
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32
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Zulfiqar M, Menias C, Shetty A, Ludwig DR, Rehman SSU, Orlowski H, Mellnick V. Imaging Spectrum of Infections in the Setting of Immunotherapy and Molecular Targeted Therapy. Curr Probl Diagn Radiol 2020; 51:86-97. [PMID: 33272723 DOI: 10.1067/j.cpradiol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Advances in genomics and immunology are revolutionizing our understanding and treatment of cancer with improved treatment outcomes and patient quality of life. With the increasing use of immunotherapy and molecular targeted therapy, a variety of unusual and/or opportunistic infections are also observed. A variety of factors including use of immunosuppression for immune-mediated adverse effects play an important role for increasing the likelihood of these infections and form the basis of this case-based review. Imaging features of infections arising in patients undergoing immunotherapy regimens have not been previously highlighted. Prompt recognition of the spectrum of mycobacterial, bacterial, invasive fungal and viral pathogens can potentially lead to reduction in the high morbidity and mortality in this patient population.
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Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
| | - Christine Menias
- Mayo Clinic School of Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sana Saif Ur Rehman
- Department of Hematology Oncology, Washington University School of Medicine, St Louis, MO
| | - Hilary Orlowski
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Abdominal Involvement in Children With Bacteriologically Confirmed Tuberculosis: A Five-year Experience From Cape Town, South Africa. Pediatr Infect Dis J 2020; 39:914-919. [PMID: 32496408 DOI: 10.1097/inf.0000000000002749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abdominal tuberculosis (TB) in children is poorly described and often poses a diagnostic challenge. We evaluated abdominal involvement in children presenting with bacteriologically confirmed TB. METHODS We undertook a retrospective study at Tygerberg Hospital, Cape Town, from January 1, 2014, through December 31, 2018, of all children (<13 years) diagnosed with bacteriologically confirmed TB, in whom abdominal involvement was found. Demographic and clinical data were collected through folder review, laboratory records and imaging reports. RESULTS Of 966 children with bacteriologically confirmed TB, 111 (11.5%) had abdominal involvement; 16 (14.4%) were excluded from further analysis because of lack of clinical data. The median age of the remaining 95 children was 43 months (interquartile range 20-94); 26 (27%) were HIV positive. The main gastrointestinal symptoms/signs were weight loss (84.2%), abdominal distention (54.7%), hepatomegaly (60.0%) and abdominal pain (26.3%). The main pathologic types were intra-abdominal lymph nodes (68.4%), solid organ involvement (54.7%), peritoneal type (23.2%) and intestinal type (10.5%). Splenic abscesses and solid organ involvement on ultrasonography were more common in HIV-positive children (P < 0.001 and P = 0.008, respectively). Liver abscesses were associated with age less than 5 years (P = 0.03), while abdominal lymphadenopathy on ultrasonography was more common in children older than 5 years (P = 0.038). Abdominal specimens were collected in an attempt to identify Mycobacterium tuberculosis in 15 of 95 (15.8%) patients and were positive in 13 of 15 (86.7%). CONCLUSIONS Over 10% of children with confirmed TB had abdominal involvement. Abdominal TB should be considered in any pediatric TB case with abdominal symptoms, and ultrasonography should be the radiologic study of choice.
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34
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Revzin MV, Moshiri M, Katz DS, Pellerito JS, Mankowski Gettle L, Menias CO. Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for Radiologists. Radiographics 2020; 40:1473-1501. [DOI: 10.1148/rg.2020200051] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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35
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Fatima R, Usman M, Faryal R. Association of TLR2 polymorphisms, Arg753Gln and Arg677Trp, with tuberculosis in Pakhtun population of Pakistan. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 83:104291. [PMID: 32240801 DOI: 10.1016/j.meegid.2020.104291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Rabia Fatima
- Departement of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Usman
- Departement of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Rani Faryal
- Departement of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.
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36
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Salvador GLO, Basso ACN, Barbieri PP, Leitao CA, Teixeira BCA, Neto AC. Central nervous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging 2020; 69:158-168. [PMID: 32853843 DOI: 10.1016/j.clinimag.2020.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Tuberculosis is a worldwide pandemic. Estimated that about 25% humans are colonized by Mycobacterium tuberculosis and about 1% are believed to develop the infection in the central nervous system (CNS-TB). Given the importance of this disease and its high levels of morbidity and mortality, it is imperative that every radiologist must be reminded of the most common findings of CNS-TB as there are several related differential diagnoses for this disease. The most common form CNS-TB is tuberculous meningitis (TBM), characterized mostly by basal meningitis, but infarction, hydrocephalus and tuberculomas could be present. Intracerebral tuberculosis is characterized by tuberculomas that can have different imaging features according to their stage. Vascular and spinal complications of tuberculosis are also reported. This review compiles the classic and unusual findings regarding CNS-TB together with new diagnostic scores in which neuroimaging have an important role.
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Affiliation(s)
- Gabriel L O Salvador
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Ana C N Basso
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana P Barbieri
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Cleverson A Leitao
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Bernardo C A Teixeira
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Arnolfo C Neto
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
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37
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Multimodal imaging of Spina Ventosa (TB Dactylitis) of the foot. Radiol Case Rep 2020; 15:1373-1376. [PMID: 32636976 PMCID: PMC7327125 DOI: 10.1016/j.radcr.2020.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/22/2022] Open
Abstract
We present the case of a 29-year-old male healthcare worker with a 6 month history of progressive left foot pain resulting in presentation to the emergency department on 3 occasions. He denied systemic symptoms. Multimodal imaging demonstrated an expansile erosive inflammatory lesion centered on the neck of the second metatarsal with aggressive features. CT of the thorax, abdomen, and pelvis demonstrated calcified mediastinal lymph nodes and left inguinal adenopathy. The lesion was biopsied under ultrasound guidance demonstrating a necrotizing granulomatous osteomyelitis with acid fact bacilli. This is consistent with TB dactylitis (spina ventosa). Treatment with antimycobacterial drugs was commenced.
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Maduakonam DE, Lee LY, Kenneth HWY, Raymond YCH, Shek Tony WH. Tuberculous osteomyelitis of the proximal femur masquerading as bone secondary: A case report. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720907492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tuberculosis is a mycobacterial infection, but it can mimic many diseases including diseases of the musculoskeletal system. The need to consider it as a differential diagnosis of musculoskeletal tumours and tumour-like conditions cannot be overemphasized. The opinions of some, that tuberculosis is a disease of the undeveloped world, can no longer be sustained especially in the presence of immunodeficiency disorders, including HIV/AIDS, which have a worldwide prevalence. Traditionally, literature evidence shows that tuberculosis can mimic quite a number of diseases, including cancers. This has been found to be true, even in some technologically advanced countries. We present a case of hepatocellular cancer patient incidentally found to have concomitant hepatic tuberculosis who complained of bone lesion, with clinico-radiologic features of metastasis, but which turned out to be a tuberculous infection of the bone.
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Affiliation(s)
- Dim Edwin Maduakonam
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Lam Ying Lee
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Ho Wai Yip Kenneth
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Yau Ching Hin Raymond
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - WH Shek Tony
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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39
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Extrapulmonic presentation of tuberculosis: An atypical urogenital presentation of a common disease. Radiol Case Rep 2020; 15:596-601. [PMID: 32215160 PMCID: PMC7090312 DOI: 10.1016/j.radcr.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/04/2022] Open
Abstract
Mycobacterium tuberculosis is the leading cause of infectious disease-related death worldwide. However, it is less frequently encountered in developed countries, and 90% of cases are reported in adults, making it a less commonly encountered entity in pediatric radiology. The disease is treatable, but symptoms of renal disease are nonspecific and should be identified early. A high index of clinical suspicion and supportive imaging studies, particularly in immigrant or exposed children, is prudent to prevent irreversible organ damage. We report a rare case of a 16-year-old Mexican immigrant male who presented with chronic dysuria, urinary frequency, intermittent hematuria, hydronephrosis, ureteral stenosis, and evolving autonephrectomy secondary to renal M. tuberculosis.
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40
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Dangvard Pedersen D, Milner GR, Kolmos HJ, Boldsen JL. The association between skeletal lesions and tuberculosis diagnosis using a probabilistic approach. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 27:88-100. [PMID: 30661884 DOI: 10.1016/j.ijpp.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
Sensitivity and specificity estimates for 18 skeletal lesions were generated from modern skeletons for future paleoepidemiological analyses of tuberculosis prevalence in archaeological samples. A case-control study was conducted using 480 skeletons from 20th century American skeletal collections. One-half of the skeletons were documented tuberculosis cases (Terry Collection). The remaining age and sex-matched skeletons were controls (Bass Collection). The association between 18 candidate skeletal lesions and tuberculosis was established by comparing lesion distributions in case and control groups. Lesion indicators at six locations - visceral surface of ribs, ventral vertebral bodies, lateral part of ilium, acetabular fossa, iliac auricular surface, and ulna olecranon process - occurred significantly more often among cases than in controls, and were associated with one another. The most useful indicator proved to be a bony reaction on ventral thoracic and lumbar vertebral bodies. Its presence means a 53.3% probability of a true tuberculosis diagnosis. Because of the nature of the reference sample - 20th century American cases - sensitivity and specificity estimates will better estimate disease prevalence in archaeological samples from cultural settings where pulmonary tuberculosis predominated. The general approach of this proof-of-concept study is applicable to other diseases that occur commonly and affect bone.
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Affiliation(s)
- Dorthe Dangvard Pedersen
- Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark.
| | - George R Milner
- Department of Anthropology, Pennsylvania State University, USA
| | - Hans Jørn Kolmos
- Department of Clinical Microbiology, Odense University Hospital, Denmark
| | - Jesper Lier Boldsen
- Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark
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41
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Duffin C, Mirpour S, Catanzano T, Moore C. Radiologic Imaging of Bowel Infections. Semin Ultrasound CT MR 2019; 41:33-45. [PMID: 31964493 DOI: 10.1053/j.sult.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although radiologic imaging of bowel infections is often a precursor to definitive diagnosis by endoscopy, biopsy, or stool cultures, imaging can provide critical information for diagnosis and management. Many infectious entities such as viral, bacterial, and parasitic infections can be discovered on imaging. Furthermore, imaging characterizes the extent of infection, involvement of specific bowel segments, and presence of complications in the abdomen. Utilizing a multimodality approach using ultrasound, computed tomography, and magnetic resonance imaging, we describe the spectrum of imaging findings that distinguish a number of infectious etiologies that affect the bowel, as well as differentiate from ischemic and inflammatory bowel processes.
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Affiliation(s)
- C Duffin
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA.
| | - S Mirpour
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA
| | - T Catanzano
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA
| | - C Moore
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA
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42
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Kandasamy D, Sharma R, Gupta AK. Bowel Imaging in Children: Part 2. Indian J Pediatr 2019; 86:817-829. [PMID: 30790185 DOI: 10.1007/s12098-019-02878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
Abstract
The bowel is a challenging abdominal organ to image. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Imaging forms an integral part of management of these disorders. This article will cover inflammatory/infective, neoplastic and miscellaneous disorders affecting the bowel. The authors will highlight the salient imaging features for those entities.
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Affiliation(s)
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
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43
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Abstract
Lung cancer is a histologically, immunologically and therefore morphologically and functionally very heterogeneous group of neoplasms with the highest cancer mortality worldwide. Therefore, the range of diseases mimicking lung cancer is also very broad and includes congenital, infectious and inflammatory changes as well as other benign space-occupying lesions and other primary and secondary pulmonary neoplasms. The difficulty in radiology lies in the ability to diagnose lung cancer with a high degree of certainty. This must take the limits of the specific diagnosis, knowledge of the classical pitfalls and rare entities that can imitate lung cancer into consideration. Narrowing the differential diagnosis requires close interdisciplinary cooperation and consideration of the patient's clinical and medical history. An accurate analysis of the computed tomography (CT) pattern and distribution of the lesions as well as consideration of additional changes and involvement of other organ systems can be the key to the diagnosis. The use of fluorodeoxyglucose positron-emission tomography CT (FDG-PET-CT) is helpful only in a few mimics of lung cancer. The article describes clinical and radiological findings of mimics of lung cancer also pointing out the limitations of CT and PET-CT for the diagnosis.
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Affiliation(s)
- E Eisenhuber
- Institut für Röntgendiagnostik, Krankenhaus Göttlicher Heiland, Dornbacher Str. 20-28, 1170, Wien, Österreich.
| | - C Schaefer-Prokop
- Abteilung Radiologie, Meander Medisch Centrum, Maatweg 3, 3813 TZ, Amersfoort, Niederlande.,Abteilung Radiologie, Radboud Universität, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Niederlande
| | - G Mostbeck
- Institut für Röntgendiagnostik, Otto-Wagner-Spital, Baumgartner Höhe 1, 1140, Wien, Österreich.,Institut für Diagnostische und Interventionelle Radiologie, Wilhelminenspital, Montleartstraße 37, 1160, Wien, Österreich
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44
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Dawani A, Gupta AK, Jana M. Imaging in Pediatric Extra-Pulmonary Tuberculosis. Indian J Pediatr 2019; 86:459-467. [PMID: 30697676 DOI: 10.1007/s12098-019-02858-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
Abstract
Extrapulmonary tuberculosis in children tends to be more severe than the adults. It can affect almost any organ system of the body. The clinical manifestations are often non-specific. Imaging findings are also not always very specific. This article describes the imaging spectrum of pediatric extrapulmonary tuberculosis.
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Affiliation(s)
- Anuradha Dawani
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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45
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Hu Y, Feng Y, Wu J, Liu F, Zhang Z, Hao Y, Liang S, Li B, Li J, Lv N, Xu Y, Zhu B, Sun Z. The Gut Microbiome Signatures Discriminate Healthy From Pulmonary Tuberculosis Patients. Front Cell Infect Microbiol 2019; 9:90. [PMID: 31001490 PMCID: PMC6456665 DOI: 10.3389/fcimb.2019.00090] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Cross talk occurs between the human gut and the lung through a gut-lung axis involving the gut microbiota. However, the signatures of the human gut microbiota after active Mycobacterium tuberculosis infection have not been fully understood. Here, we investigated changes in the gut microbiota in tuberculosis (TB) patients by shotgun sequencing the gut microbiomes of 31 healthy controls and 46 patients. We observed a dramatic changes in gut microbiota in tuberculosis patients as reflected by significant decreases in species number and microbial diversity. The gut microbiota of TB patients were mostly featured by the striking decrease of short-chain fatty acids (SCFAs)-producingbacteria as well as associated metabolic pathways. A classification model based on the abundance of three species, Haemophilus parainfluenzae, Roseburia inulinivorans, and Roseburia hominis, performed well for discriminating between healthy and diseased patients. Additionally, the healthy and diseased states can be distinguished by SNPs in the species of B. vulgatus. We present a comprehensive profile of changes in the microbiota in clinical TB patients. Our findings will shed light on the design of future diagnoses and treatments for M. tuberculosis infections.
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Affiliation(s)
- Yongfei Hu
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing, China.,CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yuqing Feng
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jiannan Wu
- Translational Medicine Research Center, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Fei Liu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Zhiguo Zhang
- Department of Laboratory Medicine, Tuberculosis Control Institute in Changping District, Beijing, China
| | - Yanan Hao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Shihao Liang
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Boxing Li
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jing Li
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Na Lv
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yuhui Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoli Zhu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Department of Pathogenic Biology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Zhaogang Sun
- Translational Medicine Research Center, Beijing Chest Hospital, Capital Medical University, Beijing, China
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46
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Bi AS, Li D, Ma Y, Wu D, Ma Y. Mycobacterium tuberculosis as a Cause of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Review of the Literature. Cureus 2019; 11:e4325. [PMID: 31183304 PMCID: PMC6538407 DOI: 10.7759/cureus.4325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 01/21/2023] Open
Abstract
Total knee arthroplasty (TKA) has become one of the most popular and successful surgeries performed in the world. Infection remains one of the most dreaded complications following TKA, and while rare, tuberculosis as a microbial etiology remains difficult to both diagnose and treat. A review was performed using PubMed, the Cochrane Database of Systematic Reviews, and EMBASE to identify literature pertinent to Mycobacterium tuberculosis infection, TKAs, periprosthetic joint infections, and any combination of the three. The diagnosis of tuberculosis infection after TKA is difficult due to nonspecific signs and symptoms and diagnostic testing. The surgeon should use a comprehensive approach to incorporate the patient's medical history, physical exam, and blood and imaging diagnostics. Among these, bacterial culture and histopathological examination remain the gold standard of diagnosis, but Polymerase chain reaction technology offers another, more sensitive and rapid option. Treatment strategy centers around on the cornerstone of anti-tuberculosis medical therapy and surgery depending on the clinical situation. While there is a lack of primary literature and standardized guidelines for the diagnosis and treatment of tuberculosis infection after TKA, the overarching principles of the treatment of tuberculosis and the treatment of the periprosthetic infection can be implemented together. There remains room for original research and improvements in both diagnostic testing and treatment.
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Affiliation(s)
- Andrew S Bi
- Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Daniel Li
- Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Yunlong Ma
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
| | - Decheng Wu
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
| | - Yuangzheng Ma
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
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47
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Deshpande SS, Joshi AR, Deshpande SS, Phajlani SA. Computed tomographic features of abdominal tuberculosis: unmask the impersonator! Abdom Radiol (NY) 2019; 44:11-21. [PMID: 30027495 DOI: 10.1007/s00261-018-1700-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. METHODS We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. RESULTS Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. CONCLUSION ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
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Affiliation(s)
- Sneha Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
| | - Anagha Rajeev Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Saurabh Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Soyaf A Phajlani
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
- Department of Radiology, Government Medical College, Nagpur, 440009, India
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48
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49
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Dojode CMR, Joseph G, Shah NN. A deceptive presentation of Tuberculosis hip as Staphylococcal infection, its successful management and literature review. BMJ Case Rep 2018; 2018:bcr-2018-224558. [PMID: 30139782 DOI: 10.1136/bcr-2018-224558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old man presented with septic arthritis of the hip with an initial culture growth of methicillin-sensitive Staphylococcus aureus (MSSA) masking the diagnosis of tuberculosis (TB). Based on joint aspirate culture and sensitivity results, the patient was first diagnosed with MSSA arthritis. He was started on intravenous antibiotics and underwent washout and debridement of hip. During the procedure, the surgeons observed characteristic tubercular changes and samples were sent for tubercular testing. The reports of cultures for acid-fast bacilli and synovial biopsies confirmed our intraoperative suspicion of TB. Antitubercular medication was started and it helped patient to improve quickly. He completed 9 months of tubercular treatment regimen and at completion total hip replacement was offered. At 8-year follow-up, the patient was doing fine with no recurrence of infection in his hip. High index of suspicion for skeletal TB was raised based on clinical and radiological signs especially if there was a delay or absence of response to appropriate therapy.
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Affiliation(s)
- Chetan Muralidhara Rao Dojode
- Furlong Fellow in Arthroplasty & Revision Surgery, Trauma & Orthopaedic Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, UK
| | - George Joseph
- Furlong Fellow in Arthroplasty & Revision Surgery, Trauma & Orthopaedic Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, UK
| | - Nirav N Shah
- Consultant Trauma & Orthopaedic Surgeon, Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, UK
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50
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Potter CA, Hsu L. Emergent Neuroimaging in the Oncologic and Immunosuppressed Patient. Neuroimaging Clin N Am 2018; 28:397-417. [DOI: 10.1016/j.nic.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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