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Disseminated Mycobacterium Tuberculosis and IgA Nephropathy. Case Rep Nephrol 2022; 2022:3785713. [DOI: 10.1155/2022/3785713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
Mycobacterium tuberculosis (MTB) is an under-recognised cause of genitourinary disease. IgA nephropathy (IgAN), a leading cause of glomerulonephritis worldwide, has been described as a rare consequence of disseminated MTB infection. In this case report, we present the first case of MTB associated IgAN in Africa. Finding IgAN on kidney biopsy in an MTB endemic area should prompt a thorough investigation for MTB to increase the chance of remission of IgAN and prevent inappropriate use of immunosuppression.
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das Neves Romaneli MT, Zuanazzi SP, de Freitas LLL, Belangero VMS, Tresoldi AT, Pereira RM. Kidney impairment in a child with acute-subacute paracoccidioidomycosis: Answers. Pediatr Nephrol 2022; 38:1779-1781. [PMID: 36214887 DOI: 10.1007/s00467-022-05749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mariana Tresoldi das Neves Romaneli
- Departamento de Pediatria, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil.
| | - Sumara Pinto Zuanazzi
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
| | - Leandro Luiz Lopes de Freitas
- Departamento de Anatomia Patológica, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil.,Multipat Laboratório de Anatomia Patológica, Praça Mauá, 58. Jardim Chapadão, Campinas, SP, 13020-220, Brazil
| | - Vera Maria Santoro Belangero
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
| | - Antonia Teresinha Tresoldi
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
| | - Ricardo Mendes Pereira
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
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Du ZX, Chang FQ, Wang ZJ, Zhou DM, Li Y, Yang JH. A risk prediction model for acute kidney injury in patients with pulmonary tuberculosis during anti-tuberculosis treatment. Ren Fail 2022; 44:625-635. [PMID: 35373713 PMCID: PMC8986302 DOI: 10.1080/0886022x.2022.2058405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is not a rare complication during anti-tuberculosis treatment in some patients with pulmonary tuberculosis (PTB). We aimed to develop a risk prediction model for early recognition of patients with PTB at high risk for AKI during anti-TB treatment. Methods This retrospective cohort study assessed the clinical baseline, and laboratory test data of 315 inpatients with active PTB who were screened for predictive factors from January 2019 to June 2020. The elements were analyzed by logistic regression analysis. A nomogram was established by the results of the logistic regression analysis. The prediction model discrimination and calibration were evaluated by the concordance index (C-index), ROC curve, and Hosmer-Lemeshow analysis. Results A total of 315 patients with PTB were enrolled (67 patients with AKI and 248 patients without AKI). Seven factors, including microalbuminuria, hematuria, cystatin-C (CYS-C), albumin (ALB), creatinine-based estimated glomerular filtration rates (eGFRs), body mass index (BMI), and CA-125 were acquired to develop the predictive model. According to the logistic regression, microalbuminuria (OR = 3.038, 95%CI 1.168–7.904), hematuria (OR = 3.656, 95%CI 1.325–10.083), CYS-C (OR = 4.416, 95%CI 2.296–8.491), and CA-125 (OR = 3.93, 95%CI 1.436–10.756) were risk parameter, while ALB (OR = 0.741, 95%CI 0.650–0.844) was protective parameter. The nomogram demonstrated good prediction in estimating AKI (C-index= 0.967, AUC = 0.967, 95%CI (0.941–0.984), sensitivity = 91.04%, specificity = 93.95%, Hosmer-Lemeshow analysis SD = 0.00054, and quantile of absolute error = 0.049). Conclusions Microalbuminuria, hematuria, ALB reduction, elevated CYS-C, and CA-125 are predictive factors for the development of AKI in patients with PTB during anti-TB treatments. The predictive nomogram based on five predictive factors is achieved good risk prediction for AKI during anti-TB treatments.
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Affiliation(s)
- Zhi Xiang Du
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Fang Qun Chang
- Department of Geriatric respiratory and critical illness, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zi Jian Wang
- Department of Infectious Diseases, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Da Ming Zhou
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Yang Li
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Jiang Hua Yang
- Department of Infectious Diseases, Yijishan Hospital, Wannan Medical College, Wuhu, China
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Pal M, Sengupta M, Basu K, Roychowdhury A. Membranous nephropathy associated with Tuberculosis- a diagnostic enigma. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.340571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mizerska-Wasiak M, Winiarska M, Nogal K, Cichoń-Kawa K, Pańczyk-Tomaszewska M, Małdyk J. IgA Vasculitis Complicated by Both CMV Reactivation and Tuberculosis. Pediatr Rep 2021; 13:416-420. [PMID: 34449697 PMCID: PMC8396185 DOI: 10.3390/pediatric13030048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis in the pediatric population. We present the case of a patient with IgA vasculitis with nephritis who developed cytomegalovirus (CMV) infection followed by Mycobacterium tuberculosis infection. In the literature, there are a few cases of IgA nephropathy accompanied by reactivation of CMV or tuberculosis. To the best of our knowledge, this is the first reported case of IgA vasculitis complicated by both CMV reactivation and tuberculosis. It is important to detect infections in patients with IgA vasculitis because they can induce and exacerbate the symptoms of the disease. Effective antimicrobial treatment facilitates the management of proteinuria and slows down the decline of renal function. Immunosuppressive therapy is a risk factor for reactivation of latent infections and makes patients more susceptible to its generalized and complicated course. This can be prevented by actively screening for hidden sites of infection.
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Affiliation(s)
- Małgorzata Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (K.C.-K.); (M.P.-T.)
- Correspondence:
| | - Maria Winiarska
- Student’s Scientific Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.W.); (K.N.)
| | - Karolina Nogal
- Student’s Scientific Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.W.); (K.N.)
| | - Karolina Cichoń-Kawa
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (K.C.-K.); (M.P.-T.)
| | | | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Mesangiocapillary glomerulonephritis complicating pulmonary tuberculosis. CEN Case Rep 2021; 11:17-21. [PMID: 34260011 DOI: 10.1007/s13730-021-00626-6] [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: 11/04/2020] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
Glomerulonephritis in tuberculosis may be a direct manifestation of renal infection or a result of immune-complex deposition complicating extra-renal infection, such as in pulmonary tuberculosis. A 17-year-old adolescent boy from Somalia was found to have pulmonary tuberculosis during routine health screening performed on entering Malta, with computed tomography of the chest showing scarring and calcification of the left upper lobe, left lower lobe consolidation, and a small left-sided pleural effusion. Five days after starting anti-tuberculous therapy, he developed lower limb and sacral oedema: urinary albumin: creatinine ratio was > 400 µg albumin/mg creatinine, and 24-h urinary protein showed nephrotic-range proteinuria of 4.963 g/day. In view of worsening lower limb, sacral and periorbital oedema and ascites, he was started on oral prednisolone, omeprazole and penicillin V prophylaxis. As heavy proteinuria persisted, a renal biopsy was performed after 8 days of prednisolone treatment, which confirmed the presence of mesangiocapillary glomerulonephritis (MCGN), with electron microscopy showing effacement of the podocytes, with hypercellularity and subendothelial immune deposits, confirming an immune-mediated pathophysiology. Ziehl-Neelsen staining did not reveal acid-fast organisms. The patient received a total of 3 weeks of oral prednisolone with subsequent tailing doses, 2 months of pyrazinamide and ethambutol and 6 months of rifampicin and isoniazid with complete resolution of his clinical and radiological signs, though heavy proteinuria persisted, so he was commenced on oral enalapril. This case highlights the potential association of MCGN with tuberculosis in adolescence. Timely recognition and treatment can prevent progression to chronic kidney disease.
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Yıldırım R, Üsküdar Cansu D, Uludoğan BCE, Dinler M, Tekin E, Korkmaz C. The coexistence of IgA vasculitis and tuberculosis: a case-based review. Rheumatol Int 2021; 41:1683-1689. [PMID: 34132892 DOI: 10.1007/s00296-021-04922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
Immunoglobulin (Ig) A vasculitis (IgAV), formerly known as Henoch-Schonlein purpura (HSP), is a relatively uncommon form of vasculitis primarily targeting the skin, gastrointestinal system, and the kidneys. Although the pathogenesis has not yet been well identified, several triggering factors, such as infections, drugs, have been implicated in the development of IgAV. Tuberculosis (TB), albeit rare, may precipitate IgAV. Herein, we have presented a case manifested by purpuric skin rash and proteinuria 6 weeks following diagnosis of pulmonary tuberculosis while receiving anti-TB drugs. The case was diagnosed as having active tuberculosis and TB-related IgA vasculitis with multi-organ involvement. In this case-based review, we recruited cases with TB-related Ig A vasculitis from the literature and discussed the features of tuberculosis that mimic vasculitides and vice versa. We also discussed the difficulties in diagnosis and the therapeutic approach in the light of the literature.
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Affiliation(s)
- Reşit Yıldırım
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Eskişehir Osmangazi University, Eskisehir, 26480, Turkey.
| | - Döndü Üsküdar Cansu
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Eskişehir Osmangazi University, Eskisehir, 26480, Turkey
| | - Burcu Ceren Ekti Uludoğan
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Eskişehir Osmangazi University, Eskisehir, 26480, Turkey
| | - Mustafa Dinler
- Division of Rheumatology, Department of Internal Medicine, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Emel Tekin
- Department of Pathology, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Cengiz Korkmaz
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Eskişehir Osmangazi University, Eskisehir, 26480, Turkey
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Letertre O, Anii V, Jullie ML, Milpied B, Seneschal J, Darrigade AS. Linear immunoglobulin A bullous dermatosis associated with disseminated tuberculosis. Int J Dermatol 2021; 60:e361-e362. [PMID: 33742695 DOI: 10.1111/ijd.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Oriane Letertre
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Veronica Anii
- Department of Internal Medicine, CH d'Arcachon, France
| | - Marie-Laure Jullie
- Department of Pathology, Hôpital du Haut Lévêque, CHU de Bordeaux, France
| | - Brigitte Milpied
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Julien Seneschal
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
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McLean MR, Lu LL, Kent SJ, Chung AW. An Inflammatory Story: Antibodies in Tuberculosis Comorbidities. Front Immunol 2019; 10:2846. [PMID: 31921122 PMCID: PMC6913197 DOI: 10.3389/fimmu.2019.02846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
Mycobacterium tuberculosis (Mtb) resides in a quarter of the world's population and is the causative agent for tuberculosis (TB), the most common infectious reason of death in humans today. Although cellular immunity has been firmly established in the control of Mtb, there is growing evidence that antibodies may also modulate the infection. More specifically, certain antibody features are associated with inflammation and are divergent in different states of human infection and disease. Importantly, TB impacts not just the healthy but also those with chronic conditions. While HIV represents the quintessential comorbid condition for TB, recent epidemiological evidence shows that additional chronic conditions such as diabetes and kidney disease are rising. In fact, the prevalence of diabetes as a comorbid TB condition is now higher than that of HIV. These chronic diseases are themselves independently associated with pro-inflammatory immune states that encompass antibody profiles. This review discusses isotypes, subclasses, post-translational modifications and Fc-mediated functions of antibodies in TB infection and in the comorbid chronic conditions of HIV, diabetes, and kidney diseases. We propose that inflammatory antibody profiles, which are a marker of active TB, may be an important biomarker for detection of TB disease progression within comorbid individuals. We highlight the need for future studies to determine which inflammatory antibody profiles are the consequences of comorbidities and which may potentially contribute to TB reactivation.
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Affiliation(s)
- Milla R McLean
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Lenette L Lu
- Division of Infectious Disease and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.,Infectious Diseases Department, Melbourne Sexual Health Centre, Alfred Health, Central Clinical School, Monash University, Brisbane, VIC, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, SA, Australia
| | - Amy W Chung
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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Pradeep I, Anupama SH, Koshy P, Kurien A, Rohit A, Mathew M, Parthasarathy R, Abraham G. A rare association of Mycobacterium tuberculosis infection of kidney and urinary tract with immunoglobulin A nephropathy. Indian J Med Microbiol 2019; 37:587-589. [PMID: 32436885 DOI: 10.4103/ijmm.ijmm_19_482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mycobacterium tuberculosis(MTB)-related secondary immunoglobulin A (IgA) nephropathy is reported in a 72-year-old male patient. The patient was diagnosed to have MTB infection of the kidney and genitourinary tract which was diagnosed by the demonstration of the organism by GeneXpert Ultra and culture. Concurrent kidney biopsy showed IgA nephropathy. The patient responded to urethral double-J stenting and four-drug antituberculous therapy with improvement of kidney function and resolution of MTB. IgA nephropathy can present as primary glomerulonephritis or secondary to MTB infection.
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Affiliation(s)
- Immanuel Pradeep
- Department of Pathology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | - Priyanka Koshy
- Department of Pathology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Abraham Kurien
- Department of Urology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Milly Mathew
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
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