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Hoornaert E, Yildiz H, Pothen L, De Greef J, Gheysens O, Kozyreff A, Castanares-Zapatero D, Yombi JC. A Comparison Study of Lymph Node Tuberculosis and Sarcoidosis Involvement to Facilitate Differential Diagnosis and to Establish a Predictive Score for Tuberculosis. Pathogens 2024; 13:398. [PMID: 38787250 PMCID: PMC11124455 DOI: 10.3390/pathogens13050398] [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: 04/19/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Tuberculosis (TB) and sarcoidosis are two common granulomatous diseases involving lymph nodes. Differential diagnosis is not always easy because pathogen demonstration in tuberculosis is not always possible and both diseases share clinical, radiological and histological patterns. The aim of our study was to identify factors associated with each diagnosis and set up a predictive score for TB. Methods: All cases of lymph node tuberculosis and sarcoidosis were retrospectively reviewed. Demographics, clinical characteristics, laboratory and imaging data, and microbiological and histological results were collected and compared. Results: Among 441 patients screened, 192 patients were included in the final analysis. The multivariate analysis showed that weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia were significantly associated with TB. A risk score of TB was built based on these variables and was able to discriminate TB versus sarcoidosis with an AUC of 0.85 (95% CI: 0.79-0.91). Using the Youden's J statistic, its most discriminant value (-0.36) was associated with a sensitivity of 80% and a specificity of 75%. Conclusions: We developed a score based on weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia with an excellent capacity to discriminate TB versus sarcoidosis. This score needs still to be validated in a multicentric prospective study.
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Affiliation(s)
- Ellen Hoornaert
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Lucie Pothen
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Alexandra Kozyreff
- Department of Ophthalmology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Diego Castanares-Zapatero
- Department of Intensive Care Medicine, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
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Freund O, Hadad Y, Lagziel T, Friedman Regev I, Kleinhendler E, Unterman A, Bar-Shai A, Perluk TM. The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples. Adv Respir Med 2023; 92:15-24. [PMID: 38392033 PMCID: PMC10885945 DOI: 10.3390/arm92010003] [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: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024]
Abstract
Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in this patient population is scarce. To address this issue, we included consecutive HS-PTB patients with negative sputum samples who underwent BAL between 2017 and 2018. Chest X-rays (CXR) and CT scans were evaluated by a chest radiologist blind to the final diagnosis. Independent predictors for PTB were assessed by multivariate regression, using all positive PTB patients between 2017 and 2019 (by sputum or BAL) as a control group (n = 41). Overall, 42 HS-PTB patients were included (mean age 51 ± 9, 36% female). BAL was a viable diagnostic for PTB in three (7%) cases and for other clinically relevant pathogens in six (14%). Independent predictors for PTB were ≥2 sub-acute symptoms (adjusted OR 3.18, 95% CI 1.04-9.8), CXR upper-lobe consolidation (AOR 8.70, 95% CI 2.5-29), and centrilobular nodules in chest CT (AOR 3.96, 95% CI 1.20-13.0, p = 0.02). In conclusion, bronchoscopy with BAL in hospitalized patients with HS-PTB had a 7% added diagnostic value after negative sputum samples. Our findings highlight specific predictors for PTB diagnosis that could be used in future controlled studies to personalize the diagnostic evaluation.
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Affiliation(s)
- Ophir Freund
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Yitzhac Hadad
- Radiology Department, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel
| | - Tomer Lagziel
- Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Inbal Friedman Regev
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Eyal Kleinhendler
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Avraham Unterman
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Tal Moshe Perluk
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
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Jung MK, Lee SY, Min EJ, Ko JM. CT Scan Differences of Pulmonary TB According to Presence of Pleural Effusion. Chest 2023; 164:1387-1395. [PMID: 37423294 DOI: 10.1016/j.chest.2023.06.043] [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: 01/11/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Subpleural micronodules and interlobular septal thickening are common CT scan findings in TB pleural effusion. These CT scan features could help us differentiate between TB pleural effusion and nonTB empyema. RESEARCH QUESTION Does the frequency of subpleural micronodules and interlobular septal thickening correlate with the presence of pleural effusion in patients with pulmonary TB? STUDY DESIGN AND METHODS CT scan findings of pulmonary TB, micronodules and their distribution (peribronchovascular, septal, subpleural, centrilobular, and random), large opacity (consolidation/macronodule), cavitation, tree-in-buds, bronchovascular bundle thickening, interlobular septal thickening, lymphadenopathy, and pleural effusion were retrospectively analyzed. Patients were divided into two groups according to the presence of pleural effusion. Clinicoradiologic findings of the two groups were then analyzed. We presented Benjamini-Hochberg critical value for multiple testing correction of CT scan findings, with a false discovery rate of 0.05. RESULTS Of a total of 338 consecutive patients diagnosed with pulmonary TB who underwent CT scans, 60 were excluded because of coexisting pulmonary diseases. The frequency of subpleural nodules (47/68, 69% in pulmonary TB with pleural effusion vs 30/210, 14% in pulmonary TB without effusion, P < .001, Benjamini-Hochberg [B-H] critical value = 0.0036) and interlobular septal thickening (55/68, 81% vs 134/210, 64%, P = .009, B-H critical value = 0.0107) was significantly higher in the group of patients with pulmonary TB with pleural effusion than in the group without pleural effusion. In contrast, tree-in-buds (20/68, 29% vs 101/210, 48%, P = .007, B-H critical value = 0.0071) were less frequently seen in patients with pulmonary TB with pleural effusion. INTERPRETATION Subpleural nodules and septal thickening were more common in pulmonary TB patients with pleural effusion than in those without pleural effusion. TB involvement of the lymphatics in the peripheral interstitium could be associated with the development of pleural effusion.
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Affiliation(s)
- Min Kyung Jung
- Department of Radiology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Young Lee
- Department of Radiology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jeong Min
- Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Min Ko
- Department of Radiology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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4
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Taheri A, Bremmell KE, Joyce P, Prestidge CA. Battle of the milky way: Lymphatic targeted drug delivery for pathogen eradication. J Control Release 2023; 363:507-524. [PMID: 37797891 DOI: 10.1016/j.jconrel.2023.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/14/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023]
Abstract
Many viruses, bacteria, and parasites rely on the lymphatic system for survival, replication, and dissemination. While conventional anti-infectives can combat infection-causing agents in the bloodstream, they do not reach the lymphatic system to eradicate the pathogens harboured there. This can result in ineffective drug exposure and reduce treatment effectiveness. By developing effective lymphatic delivery strategies for antiviral, antibacterial, and antiparasitic drugs, their systemic pharmacokinetics may be improved, as would their ability to reach their target pathogens within the lymphatics, thereby improving clinical outcomes in a variety of acute and chronic infections with lymphatic involvement (e.g., acquired immunodeficiency syndrome, tuberculosis, and filariasis). Here, we discuss approaches to targeting anti-infective drugs to the intestinal and dermal lymphatics, aiming to eliminate pathogen reservoirs and interfere with their survival and reproduction inside the lymphatic system. These include optimized lipophilic prodrugs and drug delivery systems that promote lymphatic transport after oral and dermal drug intake. For intestinal lymphatic delivery via the chylomicron pathway, molecules should have logP values >5 and long-chain triglyceride solubilities >50 mg/g, and for dermal lymphatic delivery via interstitial lymphatic drainage, nanoparticle formulations with particle size between 10 and 100 nm are generally preferred. Insight from this review may promote new and improved therapeutic solutions for pathogen eradication and combating infective diseases, as lymphatic system involvement in pathogen dissemination and drug resistance has been neglected compared to other pathways leading to treatment failure.
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Affiliation(s)
- Ali Taheri
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kristen E Bremmell
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Paul Joyce
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Clive A Prestidge
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
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5
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Song Y, Sung YE, Beck KS, Chang S, Jung JI, Park GS. Radiological and pathological analysis of the galaxy sign in patients with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Thorac Cancer 2023; 14:2459-2466. [PMID: 37409441 PMCID: PMC10447172 DOI: 10.1111/1759-7714.15029] [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: 05/08/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma sometimes presents as large pulmonary nodules composed of small nodular opacities (galaxy sign) on computed tomography (CT). The aim of this study was to assess the presence, usefulness, and pathological characteristics of the galaxy sign on CT of pulmonary MALT lymphoma. METHODS From January 2011 to December 2021, chest CTs of 43 patients with pulmonary MALT lymphoma were reviewed by two radiologists for the galaxy sign and various other findings. Interreader agreement to characterize the galaxy sign and factors associated in making a correct first impression on CT prior to pathological diagnosis were assessed. Resected specimens were reviewed by two pathologists, and the proportion of peripheral lymphoma infiltrates was compared between lesions with and without the galaxy sign. RESULTS Of 43 patients, 22 patients (44.2%) showed the galaxy sign (κ = 0.768, p < 0.0001). The galaxy sign (p = 0.010) was associated with making a correct first impression on CT prior to pathological diagnosis. On pathological examination, lesions showing the galaxy sign on CT demonstrated a significantly higher proportion of peripheral lymphoma infiltrates (p = 0.001). CONCLUSION The galaxy sign can be seen on CT of pulmonary MALT lymphoma with a higher proportion of peripheral lymphoma infiltrates and may be useful in making a correct diagnosis of pulmonary MALT lymphoma.
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Affiliation(s)
- Yeongran Song
- Department of Radiology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Yeoun Eun Sung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Kyongmin S. Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Suyon Chang
- Department of Radiology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Gyeong Sin Park
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Wetscherek MTA, Sadler TJ, Lee JYJ, Karia S, Babar JL. Active pulmonary tuberculosis: something old, something new, something borrowed, something blue. Insights Imaging 2022; 13:3. [PMID: 35001143 PMCID: PMC8743064 DOI: 10.1186/s13244-021-01138-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis remains a major global health issue affecting all countries and age groups. Radiology plays a crucial role in the diagnosis and management of pulmonary tuberculosis (PTB). This review aims to improve understanding and diagnostic value of imaging in PTB. We present the old, well-established findings ranging from primary TB to the common appearances of post-primary TB, including dissemination with tree-in-bud nodularity, haematogenous dissemination with miliary nodules and lymphatic dissemination. We discuss new concepts in active PTB with special focus on imaging findings in immunocompromised individuals. We illustrate PTB appearances borrowed from other diseases in which the signs were initially described: the reversed halo sign, the galaxy sign and the cluster sign. There are several radiological signs that have been shown to correlate with positive or negative sputum smears, and radiologists should be aware of these signs as they play an important role in guiding the need for isolation and empirical anti-tuberculous therapy.
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Affiliation(s)
- Maria T A Wetscherek
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK. .,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babeș Street, 400000, Cluj-Napoca, Romania.
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Janice Y J Lee
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Sumit Karia
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Judith L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
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Bhalla AS, Das A, Naranje P, Goyal A, Guleria R, Khilnani GC. Dilemma of diagnosing thoracic sarcoidosis in tuberculosis endemic regions: An imaging-based approach. Part 1. Indian J Radiol Imaging 2021; 27:369-379. [PMID: 29379230 PMCID: PMC5761162 DOI: 10.4103/ijri.ijri_200_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sarcoidosis is a multi-systemic disorder of unknown etiology, although commonly believed to be immune-mediated. Histologically, it is characterized by noncaseating granuloma which contrasts against the caseating granuloma seen in tuberculosis (TB), an infectious disease that closely mimics sarcoidosis, both clinically as well as radiologically. In TB-endemic regions, the overlapping clinico-radiological manifestations create significant diagnostic dilemma, especially since the management options are markedly different in the two entities. Part 1 of this review aims to summarize the clinical, laboratory, and imaging features of sarcoidosis, encompassing both typical and atypical manifestations, in an attempt to distinguish between the two disease entities.
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Affiliation(s)
- Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - P Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Gopi C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Zeng Y, Zhai XL, Wáng YXJ, Gao WW, Hu CM, Lin FS, Chai WS, Wang JY, Shi YL, Zhou XH, Yu HS, Lu XW. Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis. Quant Imaging Med Surg 2021; 11:1651-1667. [PMID: 33816198 DOI: 10.21037/qims-20-1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis is a serious public health challenge facing mankind and one of the top ten causes of death. Diagnostic imaging plays an important role, particularly for the diagnosis and treatment planning of tuberculosis patients with negative microbiology results. This article illustrates a number of atypical computed tomography (CT) appearances of pulmonary tuberculosis (PTB), including (I) clustered micronodules (CMNs) sign; (II) reversed halo sign (RHS); (III) tuberculous pneumatocele; (IV) hematogenously disseminated PTB with predominantly diffuse ground glass opacity manifestation; (V) hematogenously disseminated PTB with randomly distributed non-miliary nodules; (VI) PTB changes occur on the background of emphysema or honeycomb changes of interstitial pneumonia; and (VII) PTB manifesting as organizing pneumonia. While the overall incidence of PTB is decreasing globally, the incidence of atypical manifestations of tuberculosis is increasing. A good understanding of the atypical CT imaging changes of active PTB shall help the diagnosis and differential diagnosis of PTB in clinical practice.
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Affiliation(s)
- Yi Zeng
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Li Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei-Wei Gao
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Mei Hu
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Fei-Shen Lin
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Wen-Shu Chai
- Department of Respiratory Medicine, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jian-Yun Wang
- Department of Radiology, Lanzhou Lung Hospital, Lanzhou, China
| | - Yan-Ling Shi
- Department of Radiology, Second Hospital of Daqing City, Daqing, China
| | - Xin-Hua Zhou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui-Shan Yu
- Department of Radiology, Wuhan Pulmonary Hospital, Wuhan, China
| | - Xi-Wei Lu
- Department of Tuberculosis, Dalian Tuberculosis Hospital, Dalian, China
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Marušić A, Kuhtić I, Mažuranić I, Janković M, Glodić G, Sabol I, Stanić L. Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections. Wien Klin Wochenschr 2020; 133:470-477. [PMID: 32617707 DOI: 10.1007/s00508-020-01701-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 06/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated the prevalence of spreading pathways in nontuberculous mycobacteria (NTM) pulmonary infections according to nodular distribution patterns seen on chest computed tomography (CT). METHODS This study included 63 patients diagnosed with NTM lung infections who underwent CT at our institution. A retrospective analysis of CT images focused on the presence and distribution of nodules, presence of intrathoracic lymphadenopathy and the predominant side of infection in the lungs. The findings were classified into five groups; centrilobular (bronchogenic spread), perilymphatic (lymphangitic spread), random (hematogenous spread), combined pattern and no nodules present. The groups were then compared according to other CT findings. RESULTS Among 51 (81%) patients identified with a nodular pattern on chest CT, 25 (39.8%) presented with centrilobular, 7 (11.1%) with perilymphatic, 6 (9.5%) with random and 13 (20.6%) with combined nodular patterns but located in different areas of the lungs. The right side of the lungs was predominant in 38 cases (60.3%). Intrathoracic lymphadenopathy was evident in 20 patients (31.7%). Significant differences in distributions of nodular patterns were seen in patients infected with Mycoplasma avium complex (MAC) associated with centrilobular pattern (p = 0.0019) and M. fortuitum associated with random pattern (p = 0.0004). Some of the findings were related to perilymphatic nodules between other isolated species of NTM (p = 0.0379). CONCLUSION The results of this study showed a high proportion of perilymphatic nodules and right-sided predominance in the upper lobe, which, combined with intrathoracic lymphadenopathy is highly suggestive of the lymphangitic spread of lung NTM infections.
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Affiliation(s)
- Ante Marušić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia.
| | - Ivana Kuhtić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Ivica Mažuranić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Mateja Janković
- Department for Respiratory Diseases, University Hospital Center, University of Zagreb Medical School, Kišpatićeva, Zagreb, Croatia
| | - Goran Glodić
- Department for Respiratory Diseases, University Hospital Center, University of Zagreb Medical School, Kišpatićeva, Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular medicine, Laboratory of Molecular Virology and Bacteriology, Ruder Boskovic Institute, Bijenička cesta, Zagreb, Croatia
| | - Lucija Stanić
- Emergency Department of Zagreb County, Matice Hrvatske, Zagreb, Croatia
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10
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Hong JH, Yoon SH, Goo JM, Yim JJ, Jeon YK. Clustered micronodules as predominant manifestation on CT: A sign of active but indolently evolving pulmonary tuberculosis. PLoS One 2020; 15:e0231537. [PMID: 32302345 PMCID: PMC7164656 DOI: 10.1371/journal.pone.0231537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/25/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the prevalence, patient characteristics, and natural history of clustered micronodules (CMs) in active pulmonary tuberculosis. MATERIALS AND METHODS From January 2013 through July 2018, 833 consecutive patients with bacteriologically or polymerase chain reaction-proven active pulmonary tuberculosis were retrospectively evaluated. CMs were defined as a localized aggregation of multiple dense discrete micronodules, which primarily distributed around small airways distal to the level of the segmental bronchus: small airways surrounded by CMs maintained luminal patency and the CMs might coalesce into a larger nodule. The patients were dichotomized according to whether the predominant computed tomography (CT) abnormalities were CMs. We analyzed radiologic and pathologic findings in patients whose predominant diagnostic CT abnormalities were CMs, along with those of incidental pre-diagnostic CT scans, if available. Chi-square, McNemar, Student t-test and Wilcoxon-signed rank test were performed. RESULTS CMs were the predominant CT abnormality in 2.6% of the patients (22/833, 95% CI, 1.8-4.0%) with less sputum smear-positivity (4.8% vs 31.0%; p = .010) and a similar proportion of immunocompromised status (40.9% vs 46.0%; p = .637) than those without having CMs as the predominant CT abnormality. The time interval for minimal radiologic progression was 6.4 months. The extent of CMs increased with disease progression, frequently accompanied by consolidation and small airway wall thickening. Pathologically, smaller CMs were non-caseating granulomas confined to the peribronchiolar interstitium, whereas larger CMs were caseating granulomas involving lung parenchyma. Two of the five patients with a pre-diagnostic CT scan obtained more than 50 months pre-diagnosis showed an incipient stage of CMs, in which they were small peribronchiolar nodules. CONCLUSION Active pulmonary tuberculosis manifested predominantly as CMs in 2.6% of patients, with scarce of acid-fast bacilli smear-positivity and no association with impaired host immunity. CMs indolently progressed, accompanied by consolidation and small airway wall thickening, and originated from small nodules.
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Affiliation(s)
- Jung Hee Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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11
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Nakamoto K, Sasaki Y, Kokuto H, Okumura M, Yoshiyama T, Goto H. Multi-drug-resistant tuberculosis with galaxy and cluster signs on high-resolution computed tomography. Respirol Case Rep 2018; 6:e00369. [PMID: 30237890 PMCID: PMC6138543 DOI: 10.1002/rcr2.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 11/13/2022] Open
Abstract
The galaxy sign and cluster sign were first reported in pulmonary sarcoidosis. From those reports, these two signs became known as one of the characteristic computed tomography (CT) findings of sarcoidosis. We report a patient with pulmonary tuberculosis who had these two signs. A 44-year-old man was referred to our hospital for general fatigue, cough, and low-grade fever lasting about two months. Thoracic CT showed a large parenchymal nodule arising from coalescent small nodules (galaxy sign) and clusters composed of numerous small nodules (cluster sign) in the bilateral lungs. Three specimens of sputum acid-fast smear were negative. However, we performed a bronchoscopy, and Mycobacterium tuberculosis was proven to be positive by the acid-fast culture test of the obtained bronchoalveolar lavage fluid. Moreover, drug sensitivity testing revealed this to be a case of multi-drug-resistant tuberculosis. Patients with these signs must be examined carefully to differentiate tuberculosis from pulmonary sarcoidosis.
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Affiliation(s)
- Keitaro Nakamoto
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
| | - Yuka Sasaki
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
| | - Hiroyuki Kokuto
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
| | - Masao Okumura
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
| | - Takashi Yoshiyama
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
| | - Hajime Goto
- Department of Respiratory MedicineFukujuji Hospital, Japan Anti‐Tuberculosis AssociationKiyoseJapan
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12
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Im JG, Itoh H. Tree-in-Bud Pattern of Pulmonary Tuberculosis on Thin-Section CT: Pathological Implications. Korean J Radiol 2018; 19:859-865. [PMID: 30174474 PMCID: PMC6082770 DOI: 10.3348/kjr.2018.19.5.859] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/18/2018] [Indexed: 11/24/2022] Open
Abstract
The “tree-in-bud-pattern” of images on thin-section lung CT is defined by centrilobular branching structures that resemble a budding tree. We investigated the pathological basis of the tree-in-bud lesion by reviewing the pathological specimens of bronchograms of normal lungs and contract radiographs of the post-mortem lungs manifesting active pulmonary tuberculosis. The tree portion corresponds to the intralobular inflammatory bronchiole, while the bud portion represents filling of inflammatory substances within alveolar ducts, which are larger than the corresponding bronchioles. Inflammatory bronchiole per se represents the “tree” (stem) and inflammatory alveolar ducts constitute the “buds” or clubbing. “Clusters of micronodules”, seen on 7-mm thick post-mortem radiographs with tuberculosis proved to be clusters of tree-in-bud lesions within the three-dimensional space of secondary pulmonary lobule based on radiological/pathological correlation. None of the post-mortem lung specimens showed findings of lung parenchymal lymphatics involvement.
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Affiliation(s)
- Jung-Gi Im
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Radiology, Samsung Medical Center, Seoul 06351, Korea
| | - Harumi Itoh
- University of Fukui, School of Medical Sciences, Bunkyo, Fukui-shi, Fukui 910-8507, Japan
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13
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Kim PM, Lee JJ, Choi D, Eoh H, Hong YK. Endothelial lineage-specific interaction of Mycobacterium tuberculosis with the blood and lymphatic systems. Tuberculosis (Edinb) 2018; 111:1-7. [PMID: 30029892 DOI: 10.1016/j.tube.2018.04.009] [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] [Received: 03/06/2018] [Revised: 04/22/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022]
Abstract
Mycobacterium tuberculosis (Mtb) has plagued humanity for tens of thousands of years, yet still remains a threat to human health. Its pathology is largely associated with pulmonary tuberculosis with symptoms including fever, hemoptysis, and chest pain. Mtb, however, also manifests in other extrapulmonary organs, such as the pleura, bones, gastrointestinal tract, central nervous system, and lymph nodes. Compared to the knowledge of pulmonary tuberculosis, extrapulmonary pathologies of Mtb are quite understudied. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis, and presents significant challenges in its diagnosis, management, and treatment due to its elusive etiologies and pathologies. The objective of this review is to overview the current understanding of the tropism and pathogenesis of Mtb in endothelial cells of the extrapulmonary tissues, particularly, in lymph nodes. Lymphatic endothelial cells (LECs) are derived from blood vascular endothelial cells (BECs) during development, and these two types of endothelial cells demonstrate substantial molecular, cellular and genetic similarities. Therefore, systemic comparison of the differential and common responses of BECs vs. LECs to Mtb invasion could provide new insights into its pathogenesis, and may promote new investigations into this deadly disease.
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Affiliation(s)
- Paul M Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jae-Jin Lee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dongwon Choi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hyungjin Eoh
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Young-Kwon Hong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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14
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Collu C, Fois A, Crivelli P, Tidore G, Fozza C, Sotgiu G, Pirina P. A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma. Int J Infect Dis 2018; 70:38-41. [PMID: 29477363 DOI: 10.1016/j.ijid.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/18/2022] Open
Abstract
Clinical and radiological manifestations of tuberculosis (TB) are heterogeneous, and differential diagnosis can include both benign and malignant diseases (e.g., sarcoidosis, metastatic diseases, and lymphoma). Diagnostic dilemmas can delay appropriate therapy, favoring Mycobacterium tuberculosis transmission. We report on a case of TB in an immunocompetent, Somalian 22-year-old boy admitted in the respiratory unit of an Italian university hospital. His symptoms and clinical signs were thoracic pain, weight loss, latero-cervical, mediastinal, and abdominal lymphadenopathy. Smear microscopy and PCR were negative for Mycobacterium tuberculosis. The unclear histological pattern, the unusual clinical presentation, the CT scan signs, the BAL lymphocytes suggested the suspicion a lymphoma. Culture conversion proved Mycobacterium tuberculosis infection. This case report highlights the risk of misdiagnosis in patients with generalized lympho-adenopathy and pulmonary infiltrates, particularly in Africans young patients.
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Affiliation(s)
- Claudia Collu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alessandro Fois
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Paola Crivelli
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Gianni Tidore
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Pietro Pirina
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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15
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Qian Y, Han Q, Wang W, Ouyang Y, Yuan W, Fan C. Surgical release for tubercular elbow stiffness. Infect Drug Resist 2018; 11:9-16. [PMID: 29317839 PMCID: PMC5743118 DOI: 10.2147/idr.s145323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background For decades, tuberculosis (TB) has posed a great threat to people worldwide. Bone and joint TB is one of the most common types of extrapulmonary TB, with elbow TB comprising a small proportion of these cases. The treatment for elbow stiffness associated with TB has been rarely reported. Patients and methods We retrospectively analyzed six patients (four females and two males) with tubercular elbow stiffness during a 7-year period. All of them received open arthrolysis and hinged external fixation to restore functional extension, flexion, supination and pronation. Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were evaluated preoperatively and at final follow-up. Results At final follow-up after surgery, we evaluated the average active ROM, which was 111.7° (90°–135°). The average extension was 11.7° (0°–30°), while the average flexion was 123.3° (115°–135°). At the same time, the average supination was increased to 70° (40°–90°) and the average pronation was increased to 68.3° (45°–80°). The MEPS was elevated to 92.5 (85–100). Three patients displayed complications and were treated and cured with dressing changes and antibiotics. Conclusion Open arthrolysis and hinged external fixation are useful for the treatment of non-traumatic elbow stiffness with TB.
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Affiliation(s)
- Yun Qian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | | | - Wei Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | - Yuanming Ouyang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | - Weien Yuan
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
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16
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Reply to “Tubercular Sarcoidosis: An Intriguing Concoction of Tuberculosis and Sarcoidosis”. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.15.14597] [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]
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17
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Tubercular Sarcoidosis: An Intriguing Concoction of Tuberculosis and Sarcoidosis. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.15.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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18
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Ko JM, Park HJ, Kim CH, Song SW. The relation between CT findings and sputum microbiology studies in active pulmonary tuberculosis. Eur J Radiol 2015; 84:2339-44. [PMID: 26259700 DOI: 10.1016/j.ejrad.2015.07.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/17/2015] [Accepted: 07/27/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate whether CT findings suggesting active pulmonary tuberculosis correlate with sputum microbiological studies, and to determine whether CT could predict infectivity. MATERIALS AND METHODS Total 108 patients with active pulmonary tuberculosis were enrolled. We reviewed CT findings and sputum microbiological studies. Then, we analyzed the statistical difference in CT findings between the positive and negative groups of each sputum microbiological study (AFB smear, PCR, and culture). Also, we divided the patients into five groups according to sputum AFB smear grade and analyzed linear trends of CT findings between the five groups. RESULTS Both frequencies and extents of centrilobular micronodules (63% vs 38%, p=0.011 for frequency; 1.6 ± 1.6 vs 0.6 ± 1.1, p=0.001 for extent), tree-in-bud opacities (63% vs 33%, p=0.002; 1.6 ± 1.6 vs 0.5 ± 0.9, p<0.001, respectively), consolidation (98% vs 81%, p=0.003; 2.7 ± 1.5 vs 1.3 ± 1.1, p<0.001, respectively), and cavitation (86% vs 33%, p<0.001; 1.5 ± 1.2 vs 0.4 ± 0.7, p<0.001, respectively), were significantly increased in the sputum AFB-positive group than in the negative group. These four CT findings were increase in frequency and extent in the sputum PCR-positive group with or without statistical significance. They did not show significant differences between the sputum culture-positive and negative groups. As the AFB smear grade increased, frequencies and extents of centrilobular micronodules, tree-in-bud, consolidation, and cavitation also increased. CONCLUSION CT features representing active tuberculosis-centrilobular nodules, tree-in-bud, consolidation, and, cavitation-strongly correlate with the positivity and grading of AFB smear.
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Affiliation(s)
- Jeong Min Ko
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Jin Park
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Chi Hong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Wha Song
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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