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Gama L, Duarte J, Martins I, Santos E Silva A, Rita H. Tuberculosis: Cliché or Outsider? Cureus 2024; 16:e53956. [PMID: 38469008 PMCID: PMC10926896 DOI: 10.7759/cureus.53956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
Tuberculosis is an infectious disease with the potential for multisystemic dissemination, including the central nervous system (CNS). It is difficult to diagnose when the central nervous system is involved. Brain biopsy is the diagnostic method par excellence for diagnostic confirmation; however, as it is an invasive method and therefore not free from risks, before carrying it out, extra-CNS sites should be privileged, whenever available, through mycobacteriological culture. Here, we present a case of a 34-year-old female with chronic onset of neurologic semiology, whose diagnostic evolution culminated in the diagnosis of cerebral tuberculomas and miliary tuberculosis. Rapid commencement of antibacillaty therapy led to the resolution of the neurologic deficits. Although we face a cliché clinical presentation, in the sense that is very common, the authors consider it outsider because such a presentation is rarely seen in Portugal.
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Affiliation(s)
- Leonor Gama
- Internal Medicine, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Josiana Duarte
- Internal Medicine, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Inês Martins
- Intensive Medicine Service, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Ana Santos E Silva
- Internal Medicine, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Henrique Rita
- Internal Medicine, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
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Yadav S. Multiple Tubercular Cervical, Supraclavicular, and Pretracheal Lymphadenitis With Scrofuloderma: A Rare Case. Cureus 2023; 15:e51134. [PMID: 38283508 PMCID: PMC10811415 DOI: 10.7759/cureus.51134] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
In clinical settings, cutaneous tuberculosis is an uncommon occurrence. On the other hand, incidences of this kind of tuberculosis are usually documented in high-burden nations. Despite being the most prevalent variety of cutaneous tuberculosis, scrofuloderma frequently goes undiagnosed. The present case is a rare case of simultaneous involvement of cervical, supraclavicular, and pretracheal lymph nodes and skin due to Mycobacterium tuberculosis. A 26-year-old Indian female was diagnosed after a careful diagnostic workup involving fine needle aspiration cytology, a cartridge-based nucleic acid amplification test, and a biopsy. The case is remarkable as there was no pulmonary involvement. She was initiated on antitubercular treatment per national policy.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Kumbi H, Reda DY, Solomon M, Teklehaimanot A, Ormago MD, Ali MM. Magnitude of tuberculosis lymphadenitis, risk factors, and rifampicin resistance at Adama city, Ethiopia: a cross-sectional study. Sci Rep 2023; 13:15955. [PMID: 37743370 PMCID: PMC10518321 DOI: 10.1038/s41598-023-43206-7] [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: 04/09/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
Mycobacterium tuberculosis complex has an impact on public health and is responsible for over one million deaths per year. Substantial numbers of people infected with M. tuberculosis can develop tuberculosis lymphadenitis; however, there is a limited study in Adama, Ethiopia. The aim of this study was to determine the magnitude of Tuberculosis lymphadenitis, its predictors, and rifampicin-resistance gene-positive M. tuberculosis. A total of 291 patients with enlarged lymph nodes were recruited from May 2022 to August 30 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). GeneXpert, Ziehl-Neelsen staining, and cytology were used for the diagnosis of TB lymphadenitis from the Fine Needle Aspirate (FNA) specimen. Rifampicin-resistant gene was detected using GeneXpert. For data entry and analysis, Epi Data version 3.0 and SPSS version 25 were used respectively. A binary logistic regression model was used to identify predictors of TB lymphadenitis. A p < 0.05 with a 95% confidence interval (CI) was taken as a cut point to determine the significant association between dependent and independent variables. The prevalence of TB lymphadenitis using GeneXpert, Ziehl-Neelsen staining, and cytology were 138 (47.4%) (95% CI 41.70-53.10), 100 (34.4%) (95% CI 28.94-39.85), and 123 (42.3%) (95% CI 36.63-47.00) respectively. Nine (3.1%) participants were infected with rifampicin-resistant gene-positive M. tuberculosis. Out of the total M. tuberculosis detected by GeneXpert (n = 138), 9 (6.5%) were positive for rifampicin resistance-gene. Participants with a chronic cough had 2 times odds of developing TB lymphadenitis (AOR: 2.001, 95% CI 1.142-3.508). Close to half of patients with enlarged lymph nodes were positive for M. tuberculosis by the GeneXpert method in the study area. Chronic cough was significantly associated with TB lymphadenitis. Rifampicin-resistant gene-positive M. tuberculosis was relatively prevalent among patients with enlarged lymph node in the study area.
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Affiliation(s)
- Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Dawit Yihdego Reda
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Manyahlehal Solomon
- Department of Pathology, Adama Comprehensive Specialized Hospital Medical College, Adama, Ethiopia
| | - Alemwosen Teklehaimanot
- Department of Pathology, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Moges Desta Ormago
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
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Junus HN, Mertaniasih NM, Soedarsono S. Validity of Method for MTBC and NTM Detection in FNAB Specimens from Tuberculous Lymphadenitis Using Microscopy, XPERT MTB / RIF and Culture Method. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2021. [DOI: 10.20473/ijtid.v9i1.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium tuberculosis and Nontuberculous Mycobacteria usually cause infection in tuberculous lymphadenitis. To improve accuracy of the detection MTB and NTM bacteria it is necessary to select valid methods. This study aims to compare validity of diagnostic methods from FNAB specimens for determining tuberculous lymphadenitis patients. a descriptive observational laboratory study involved 35 samples were obtained from tuberculous lymphadenitis patients in Dr. Soetomo Hospital Surabaya East Java. All specimens examined Ziehl-Neelsen staining microscopy, Xpert MTB/RIF , culture method Middlebrook7H10 solid media and MGIT as Gold standard. Identification of MTB dan NTM with SD Bioline TB Ag MPT64 and niacin paper strip BD . Used diagnostic test 2x2 to analyze sensitivity, specificity, negative predictive value and positive predictive value. Ziehl-Neelsen staining microscopy Sensitivity 83,33 % and Specificity 95,65% of , PPV 90,91%and NPV 91,67%, Diagnostic Accuracy 91,43 % . Xpert MTB/RIF Sensitivity 75% and Specificity 95,65% , PPV 90 % and NPV 88 %, Diagnostic Accuracy 88,57 % with 95% CI (Confidence Interval ) . Characteristics female dominated 23/35 (65.7%) while Male numbered 12/35 (34.3%), age range distribution of TB lymphadenitis patients is highest in young adults 17 years to 25 years as many as 15/35 (42.9%) the second highest is the age group of 36 years to 45 years by 8/35 (22.9%), Clinicial presentation are mostly lymph node enlargement in cervical 37% patients other locations supraclavicular ,mamae. Clinical symptoms mostly lymphadenopathy 31,5% and other lymphadenopathy with fever. Microscopy method still have the good validity shoul be conjunction with the molecular rapid tests and culture as gold standard in determining the diagnosis of TB lymphadenitis.
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Das R, Bohara S, Tripathi N, Verma L. Clinical and cytomorphological patterns of granulomatous inflammation and its correlation with Ziehl–Neelsen staining. ACTA MEDICA INTERNATIONAL 2021. [DOI: 10.4103/amit.amit_145_21] [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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Ramos JM, Comeche B, Tesfamariam A, Reyes F, Tiziano G, Balcha S, Edada T, Biru D, Pérez-Butragueño M, Górgolas M. Sex differences and HIV status of tuberculosis in adults at a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study. Afr Health Sci 2020; 20:605-614. [PMID: 33163021 PMCID: PMC7609105 DOI: 10.4314/ahs.v20i2.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of the study was to compare the epidemiology, clinical characteristics and treatment outcome of tuberculosis (TB), including HIV status, in women and men in southern rural Ethiopia. Methods We conducted a register-based retrospective cohort study covering the period from September 1998 to August 2015. Result We included records of 2252 registered TB patients: 1080 (48%) women and 1172 (52%) men. Median age was similar for women and men: 27.5 years and 25.0 years, respectively. Median weight in women was 43.0 kg (interquartile range IQR: 38.0, 49.0), significantly lower than in men (50.0 kg, IQR 44.0, 55.0; p = 0.01). Extrapulmonary TB was significantly more common in women than in men (34.1% versus 28.7%; p=0.006). Treatment outcomes were similar in both sexes: in 70.3% of women and 68.9% of men, TB mortality was slightly lower in women than men (4.7% vs. 6.5%; p=0.08). In patients with TB, female sex was independently associated with low weight (adjusted aOR: 0.91; 95% CI 0.90, 0.92), less mortality (aOR: 0.54; 95% CI 0.36, 0.81), and lymph node TB (aOR: 1.57; 95% CI 1.13, 2.19) Conclusion Lymph node TB was more common in women. Treatment outcomes were similar in both sexes, but women had a lower mortality rate.
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Affiliation(s)
- José M Ramos
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
- Department of Internal Medicine. Alicante General University Hospital, ISABIAL, and Miguel Hernández University of Elche, Alicante, Spain
- Correspondence author: José Manuel Ramos, Department of Internal Medicine. Hospital General Universitario de Alicante Calle Pintor Baeza 12. Alicante 03010, Spain Tel: +34 96 593 30 00
| | - Belén Comeche
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
- National Referral Unit for Tropical Disease, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain
| | - Abraham Tesfamariam
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Francisco Reyes
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Gebre Tiziano
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Seble Balcha
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Tamasghen Edada
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Dejene Biru
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
| | - Mario Pérez-Butragueño
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
- Departament of Pedaitrics, Infanta Leonor University Hospital, Madrid, Spain
| | - Miguel Górgolas
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Ethiopia
- Division of Infectious Diseases, Fundación Jiménez Diaz University Hospital, and Autonomic University of Madrid, Madrid, Spain
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Agarwal M, Nabavizadeh SA, Mohan S. Chapter 6 Non-Squamous Cell Causes of Cervical Lymphadenopathy. Semin Ultrasound CT MR 2017; 38:516-530. [PMID: 29031368 DOI: 10.1053/j.sult.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cervical lymphadenopathy is a common indication for imaging evaluation of the neck. Besides metastatic squamous cell carcinoma of the head and neck, cervical lymphadenopathy can be due to many causes, with simple reactive lymphadenopathy on one end of the spectrum and malignant lymphadenopathy due to a distant infraclavicular primary, on the other end. A systematic approach to the cause of cervical lymphadenopathy, which includes pattern of lymph node enlargement, lymph node characteristics, systemic symptoms, and extranodal abnormalities, can be very useful in arriving at the correct diagnosis. In this article, various patterns of cervical lymphadenopathy due to non-squamous cell causes are discussed.
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Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Seyed Ali Nabavizadeh
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Extrapulmonary tuberculosis among females in South Asia-gap analysis. Int J Mycobacteriol 2016; 5:392-399. [PMID: 27931679 DOI: 10.1016/j.ijmyco.2016.09.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/22/2022] Open
Abstract
The percentage of extrapulmonary tuberculosis (EPTB) among new and relapse tuberculosis cases in South Asia (Afghanistan, Pakistan, India, and Bangladesh) ranged from 19% to 23% in 2014. While tuberculosis was reportedly more prevalent in males, a higher preponderance of EPTB was observed in females. National tuberculosis control programs are highly focused on pulmonary tuberculosis. This creates gaps in the surveillance, diagnosis, and study of EPTB among females, which is especially pronounced in the South Asian setting. We have reviewed recently published literatures from January 2010 to June 2016 reporting EPTB in females with a view to evaluate the current epidemiology, risk factors, diagnostic modalities, and treatment outcomes. We report significant gaps in the surveillance of EPTB among women in South Asia, emphasizing the need for greater focus on EPTB in females to overcome current surveillance and knowledge gaps.
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