The relevance of biopsy in tuberculosis patients without human immunodeficiency virus infection

Total elbow arthroplasty for active primary tuberculosis of the elbow: a curious case of misdiagnosis

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pandemic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%–5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative synovial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts post total elbow arthroplasty. Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good functional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should investigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.

Cervical spine TB - Current concepts in management

OBJECTIVE

Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them.

RESULTS

The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included.

CONCLUSION

AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.

Abdominal tuberculosis misdiagnosed as acute surgical abdomen and carcinomatosis

Tuberculosis is a major public health problem worldwide. Tuberculosis can be confused with other diseases and its diagnosis is frequently delayed, especially in areas of low prevalence. Abdominal tuberculosis includes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and/or solid organs; and accounts for 5% of all cases of tuberculosis. We report two cases of young patients who presented preoperatively as acute abdomen due to acute appendicitis. During surgery, these cases were misdiagnosed as "carcinomatosis", and in the postoperative period these cases were complicated with septic shock. In both cases, histopathology showed caseating granulomas which suggested tuberculous peritonitis and enteritis. Subsequently, RT-PCR in peritoneal fluid confirmed  Mycobacterium tuberculosis. In one case the clinical response to treatment was excellent, and the other case was fatal. The aim of this report is to bring attention to the spectrum of tuberculosis, and to serve as a reminder of tuberculosis as the great imitator that can masquerade as cancer. Most tuberculous patients erroneously diagnosed as cancer have extensive "neoplastic" lesions that would suggest an advanced-stage malignancy. Assuming a case as an advanced cancer would reduce the chance of performing more exhaustive studies to get a definitive diagnosis and clinicians would be tempted to offer only palliative treatments.

Biopsy and Tracheobronchial Aspirates as Additional Tools for the Diagnosis of Bovine Tuberculosis in Living European Bison (Bison bonasus)

Simple Summary

In this study, additional methods of collecting material for bovine tuberculosis diagnosis in living European bison were introduced. We showed a potential usage of tracheobronchial aspirates and ultrasound-guided biopsies from lateral retropharyngeal lymph nodes in living animals for diagnostics. We confirmed that the isolation of Mycobacterium caprae in living European bison is possible, as is the respiratory shedding of viable M. caprae in this host. This study is important as tuberculosis is a real threat for European bison which is an endangered species and the improvement of diagnostics can help with better health monitoring and further restitution.

Abstract

The diagnosis of bovine tuberculosis (BTB) in living wildlife remains a complex problem, and one of particular importance in endangered species like European bison (Bison bonasus). To identify infection and avoid the unnecessary culling of such valuable individuals, current best practice requires the collection and culture of material from living animals, as mycobacteria isolation remains the gold standard in BTB diagnosis. However, such isolation is challenging due to the need for the immobilization and collection of appropriate clinical material, and because of the sporadic shedding of mycobacteria. In the present study, we evaluated the potential of sampling for the detection of BTB in a group of seven living European bison suspected of being infected with Mycobacterium caprae. The specimens were collected both as swabs from the nasal and pharyngeal cavities, tracheobronchial aspirates (TBA), ultrasound-guided biopsies from lateral retropharyngeal lymph nodes, and post mortem, from mandibular, retropharyngeal and mediastinal lymph nodes. Clinical samples were tested for mycobacterial species via mycobacteriological culture and PCR. M. caprae was isolated from collected material in two out of four living infected individuals (TBA, biopsy) and mycobacterial DNA was detected in three out of four (TBA, pharyngeal swab) bison. This is the first report of isolation of M. caprae in living European bison. Our findings demonstrate the value of diagnostic tests based on both molecular testing and culture in European bison and confirm the respiratory shedding of viable M. caprae in this host species.

Uncommon testicular localization of Disseminated TB: a case report from Mozambique

Tuberculosis (TB) of the testicle is a rarely reported and poorly described disease localization. There are no well-defined clinical features suggestive of testicular TB, which makes the diagnosis difficult to establish, especially in low-income settings like Mozambique, where TB is endemic and often associated with HIV-infection; both considered leading causes of death worldwide. We reported the case of a 45-year-old male, HIV positive, naïve to antiretroviral treatment, admitted to the Department of Medicine of the Central Hospital of Beira to investigate chronic enlargement of the testicles.

Imaging manifestations of B-mode ultrasound combined with CT in tuberculous pleuritis patients and the diagnostic value

Clinical diagnostic values of B-mode ultrasound and computed tomography (CT) for tuberculous pleuritis were investigated. A total of 685 patients clinically diagnosed with tuberculous pleuritis in Yantaishan Hospital from January 2012 to August 2016 were selected as study subjects. The patients were examined by B-mode ultrasound and CT. The accuracy of B-mode ultrasound and CT in the diagnosis of tuberculous pleuritis was evaluated and the benefit-cost ratios of the two auxiliary diagnostic methods were compared. According to the imaging diagnostic results of 685 tuberculous pleuritis patients, B-mode ultrasound examinations identified 415 cases with tuberculous pleuritis and the accuracy rate was 60.15%. CT examinations identified 501 cases with the tuberculous pleuritis and the accuracy rate was 70.07%. The combined use of these two methods identified 546 cases with the tuberculous pleuritis and the accuracy rate was significantly increased to 85.99%. B-mode ultrasound imaging findings showed that the lesions of tuberculous pleuritis were localized on the right pleural cavities and the majority of images presented the free type; multiple anechoic areas were seen in the effusion. CT findings indicated obvious free effusion in the pleural cavities, local thickening of the pleural cavities, encapsulated pleural effusion and extensive pleural adhesion, thickening and calcification. Both B-mode ultrasound and CT examinations can be used to accurately diagnose tuberculous pleuritis and the combined diagnosis can significantly improve the accuracy.