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Abstract
There is abundant literature reporting about the use of antibiotics in inflammatory bowel disease (IBD), but their role in the management of IBD is not entirely clear. Diverse infectious organisms have been implicated in the pathogenesis of Crohn's disease. Also, infections are believed to be a trigger for flares of ulcerative colitis. The benefit of the routine use of antibiotics in IBD is equivocal. However, there are certain situations, where antibiotics have a clear role and evidence of benefit: perianal fistula, intra-abdominal abscesses in Crohn's disease, acute pouchitis and infection-related flares. However, there is a lack of supportive evidence for the routine use of antibiotics in all disease-related flares. Evidence indicates a lack of benefit of intravenous antibiotics in acute severe ulcerative colitis and only limited benefit in active ulcerative colitis. Limited evidence suggests the role of a combination of oral antibiotics in pediatric ulcerative colitis. Certain targeted antibiotic regimens have been used in IBD. In ulcerative colitis, limited evidence suggests the benefit of the use of an antibiotic cocktail directed against Fusobacterium varium. Therapy directed against Escherichia coli does not seem to have a benefit in inflammatory Crohn's disease. In Crohn's disease, antimycobacterial therapy may result in symptomatic improvement but no durable benefit. Antitubercular therapy (ATT), on the contrary, may result in fibrotic transformation, suggesting a need to avoid misdiagnosis and limit the duration of ATT in Crohn's disease. This review assesses the published literature with respect to antibiotic use and provides guidance to clinicians in appropriate antibiotic use in various situations in the setting of IBD.
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Affiliation(s)
- Daya K Jha
- Indian Navy, Visakhapatnam, 530 014, India
| | | | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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Shanmuganathan R, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. N Am Spine Soc J 2023; 16:100267. [PMID: 37736557 PMCID: PMC10510092 DOI: 10.1016/j.xnsj.2023.100267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. Methods Using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with "spinal tuberculosis," "diagnosis," "epidemiology," and "etiology","management," "surgery," and "therapy" as subheadings. Results Progressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. Conclusions Clinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the "End TB strategy" is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.
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Affiliation(s)
- Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
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3
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Eppakayala S, Sathu S, Kashyap A, Maley D, Kumar R, Lakkireddy M. Tubercular osteomyelitis of calcaneum in an immunocompetent adult. Int J Mycobacteriol 2023; 12:501-504. [PMID: 38149550 DOI: 10.4103/ijmy.ijmy_162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Tuberculosis (TB) affecting calcaneum is relatively rare in immunocompetent adults. Due to its nonspecific presentation and the absence of constitutional symptoms of TB, diagnosis is often delayed. The authors present a case of TB of calcaneum in a young male. A 20-year-old male presented with persistent pain and mild swelling of the right heel for 6 months. Upon evaluation with radiographs, a lytic lesion was noted in the posteromedial aspect of the right calcaneum. Magnetic resonance imaging was done and was reported as subacute osteomyelitis with Brodie's abscess. An open biopsy was performed and the obtained tissue was sent for histopathological examination. Histopathology showed features suggestive of Koch's etiology. All the microbiological investigations, including polymerase chain reaction for TB were negative. The patient was started on antitubercular therapy (ATT) based on weight. After 4 months of ATT, the patient developed multiple discharging sinuses over a previous open biopsy scar for which repeat debridement was done. After 12 months of ATT, the patient was asymptomatic, and radiologically, the lesion was healed. Early diagnosis and treatment with ATT will prevent massive destruction and collapse of the calcaneal body and further spread into the subtalar joint. Repeated debridements may be needed in case of nonhealing discharging sinuses to decrease the local infection load.
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Affiliation(s)
- Srikanth Eppakayala
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Sreedhar Sathu
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Adinarayana Kashyap
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Deepak Maley
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Ravi Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rajkot, Gujrat, India
| | - Maheshwar Lakkireddy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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Panda BK, Suryawanshi VR, Raut A, Joshi S, Purandare B. Antitubercular therapy causing drug reaction with eosinophilia and systemic symptoms manifesting multi-organ dysfunction syndrome and death in an elderly patient: A case report with review of literature. Int J Mycobacteriol 2023; 12:360-363. [PMID: 37721245 DOI: 10.4103/ijmy.ijmy_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
We present the case of a drug reaction with eosinophilia and systemic symptoms (DRESS) manifesting multi-organ dysfunction syndrome (MODS) that led to death in an elderly patient during the intensive phase of antitubercular therapy (ATT). A 74-year-old male developed skin rash (morbilliform), patchy erythematous macules, pustular-purpuric nonblanching spots, fever, lymphadenopathy, liver dysfunction, leukocytosis, and eosinophilia during intensive phase of ATT (ATT: day 45). Laboratory tests revealed hypereosinophilia (eosinophils; 10500/μL), hyperacute fulminant hepatic failure (aspartate transaminase/alanine transaminase; 1444/1375 IU/L, total bilirubin; 11.3 mg/dL), hepatic encephalopathy (Child-Pugh score: 15), coagulopathy (international normalized ratio; 3.0 and activated partial thromboplastin time; 52 s), and acute renal failure (serum creatinine; 2.6 mg/dL). The patient was diagnosed with DRESS with a RegiSCAR score of 7 (definite). ATT was discontinued. Despite immediate treatment with pulse methylprednisolone, N-acetylcysteine and sustained low-efficiency dialysis, the patient's clinical condition evolved to shock due to MODS (sequential organ failure Assessment: 15 points), and on day 51, he succumbed. Concluding, an elderly patient with high-dose antitubercular drugs needs a clinical management review. Clinical symptoms pertaining to DRESS may paradoxically worsen after 3-4 days of discontinuation of the offending drug.
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Affiliation(s)
- Bijoy Kumar Panda
- Department of Pharmacy Practice, Krishna Institute of Pharmacy, Krishna Vishwa Vidyapeeth (Deemed to be University), Satara, Maharashtra, India
| | - Vaibhav Rajendra Suryawanshi
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Asawari Raut
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Samrudhi Joshi
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Bharat Purandare
- Department of Infectious Diseases, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, India
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Kumar D, Singh D, Modi T, Sharma R, Awasthy AK, Shree R, Goyal MK, Narang D, Chand S, Vyas S, Sharma K, Sharma N, Gowda R, Goel A, Ranjan R, Modi M. Role of vascular endothelial growth factor in tuberculous meningitis: A prospective study from a tertiary care center in North India. Indian J Pharmacol 2023; 55:216-222. [PMID: 37737073 PMCID: PMC10657616 DOI: 10.4103/ijp.ijp_743_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The status of vascular endothelial-derived growth factor (VEGF) in the pathogenesis of tuberculous meningitis (TBM) remains far from clear. We prospectively evaluated the role of serum and cerebrospinal fluid (CSF) VEGF in TBM. PATIENTS AND METHODS This prospective study was conducted at a tertiary care center in North India from January 2018 to June 2019. Consecutive drug-naive patients (n = 82) of TBM diagnosed on the basis of modified Ahuja's criteria were included in the study. The results were compared with 49 control subjects (n = 49). Serum and CSF VEGF were done in all the cases and controls. Follow-up serum VEGF levels were done in 34 patients after 3 months of completion of antitubercular therapy. The VEGF levels were estimated using the human VEGF enzyme-linked immunosorbent assay kit. RESULTS The mean age was 29.9 ± 13.1 years. The study group consisted of 33 (40.2%) men and 49 (59.8%) women. BACTEC MGIT960 was positive in 15 (18%) patients while multiplex tuberculosis polymerase chain reaction was positive in 73 (89%) patients. Levels of VEGF in serum and CSF of TBM patients were not elevated when compared to controls. There was no association between final outcome in TBM and decrease in serum levels of VEGF at follow-up. CONCLUSION VEGF may not be playing a significant role in the pathogenesis of TBM. Future studies with larger sample size may clarify the status of VEGF further in TBM.
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Affiliation(s)
- Devesh Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deependra Singh
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Riya Sharma
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Keshav Awasthy
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Shree
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dhawal Narang
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Chand
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rudresh Gowda
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abeer Goel
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Ranjan
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lin CJ, Hsia NY, Hwang DK, Hwang YS, Chang YC, Hsu YR, Yeh PT, Lin CP, Hsu AY, Ho MW, Sheu SJ. Diagnosis and Treatment of Tubercular Uveitis in Taiwan - Consensus of Expert Panels. Ocul Immunol Inflamm 2023:1-7. [PMID: 37186887 DOI: 10.1080/09273948.2023.2208660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
There is currently a lack of guidelines with regard to tubercular uveitis (TBU) management in Taiwan. We therefore propose an evidence-based consensus on the management for TBU. The Taiwan Ocular Inflammation Society conducted a meeting that included nine ophthalmologist and one infection disease expert that focused on three broad areas of (1) nomenclature for TBU, (2) assessment and diagnosis for TBU, and (3) treatment of TBU. Brief literature review on TBU diagnosis and management was conducted that informed this panel meeting in order to make decisions on each consensus statements. In terms of our results, a consensus statements and recommendations for the diagnosis and management of TBU were developed. This consensus statement provides an algorithmic approach toward diagnosing and managing TBU. These statements are meant to enhance but not replace individual clinician-patient interactions and to facilitate real-world clinical practice improvement in terms of TBU patients care.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Alan Y Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mao-Wang Ho
- Division of Infectious Diseases, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Ophthalomology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Elmekresh A, Al Shaikh Y, Alhayek R, Saeedi Y. Renal BCGosis managed conservatively with antituberculous medications. Urol Ann 2023; 15:232-234. [PMID: 37304506 PMCID: PMC10252775 DOI: 10.4103/ua.ua_117_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 06/13/2023] Open
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) therapy for nonmuscle-invasive bladder cancer rarely leads to the development of granulomatous renal masses (renal BCGosis). The management includes nephroureterectomy, antitubercular therapy (ATT), or both. Here, we present a case of a 62-year-old male who was treated with ATT alone for renal masses. Six months after intravesical BCG therapy for transitional cell carcinoma, he developed high-grade fever and night sweat and had multiple renal parenchymal hypodensities on computed tomography (CT) scan. Repeat CT scan 6 months after ATT revealed full resolution of renal hypodensities. This case report highlights the importance of follow-up for early detection of adverse effects of BCG treatment.
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Affiliation(s)
- Amr Elmekresh
- Department of Urology, Dubai Health Authority, Dubai Hospital, Dubai, United Arab Emirates
| | - Yazan Al Shaikh
- Department of Urology, Dubai Health Authority, Dubai Hospital, Dubai, United Arab Emirates
| | - Rafe Alhayek
- Department of Urology, Dubai Health Authority, Dubai Hospital, Dubai, United Arab Emirates
| | - Yaser Saeedi
- Department of Urology, Dubai Health Authority, Dubai Hospital, Dubai, United Arab Emirates
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Griffith A, Trabue C. You Have Gut TB Kidding Me. J Community Hosp Intern Med Perspect 2023; 13:30-2. [PMID: 36817298 DOI: 10.55729/2000-9666.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 01/11/2023] Open
Abstract
Tuberculosis is a disease that affects millions of individuals worldwide every year.1 Most cases present as pulmonary tuberculosis, though there are rare reports of abdominal tuberculosis. These presentations make up only 1-3% of all tuberculosis cases worldwide.1 Symptoms are often vague, presenting as abdominal pain, discomfort, or weight changes.2 These symptoms can be misdiagnosed for other more common gastrointestinal disorders. Unfortunately, misdiagnosis or a prolongation in diagnosis can lead to worsened patient outcome due to delay of initiation of anti-tubercular therapy.3 It is therefore imperative that providers understand the spectrum of symptoms associated with this illness as well as having a high clinical suspicion for patients at risk. Incorporating this knowledge and using a thorough diagnostic work up to confirm this disease is crucial, as delay of care can lead to poor patient prognosis or death.3.
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Rengarajan S, Krishnasamy L. Calvarial tuberculosis - A report of seven cases from a tertiary care hospital. J Neurosci Rural Pract 2023; 14:123-126. [PMID: 36891110 PMCID: PMC9943936 DOI: 10.25259/jnrp_13_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023] Open
Abstract
Tuberculosis primarily affecting the calvarium is one of the rare diseases which is on the rise in the past few decades. This disease has been rarely reported in the literature even from endemic regions. We report seven patients diagnosed with calvarial tuberculosis. All cases had histological features of tuberculosis and were mantoux positive. All were negative for AFB smears. Two out of four cases tested for TB GeneXpert were positive. The clinical presentations, radiological features and the management of the cases are discussed. Early diagnosis with high index of suspicion and awareness about the features of calvarial tuberculosis would help in proper management of the condition.
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Affiliation(s)
- Santhanam Rengarajan
- Department of Neurosurgery, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Lakshmi Krishnasamy
- Department of Microbiology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Yen DJ, Betzler BK, Neo E, Lai SS, Arora A, Agrawal R, Gupta V. An excursion into ocular tuberculosis. Saudi J Ophthalmol 2022; 36:365-373. [PMID: 36618567 PMCID: PMC9811922 DOI: 10.4103/sjopt.sjopt_195_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023] Open
Abstract
Till today, ocular tuberculosis (OTB) presents clinicians with significant challenges in diagnosis and management. There is no one-size-fits-all approach to a heterogeneous disease like OTB, and clinicians often have to consider a multitude of factors when initiating treatment, such as tuberculosis endemicity, the probability of a true OTB diagnosis in the setting of nonspecific ocular features, the effective duration of treatment, and the likelihood of vision-threatening complications in the patient. It is no wonder that treatment protocols are widely varied globally. There have been recent developments in the standardization of nomenclature and therapeutic strategies for OTB, as established by the Collaborative OTB Study Working Group. In this review, we referred to findings in retrospective studies, international clinical guidelines, and OTB consortiums, to explore the clinical presentations, investigations, and updated management principles for patients with presumed tubercular uveitis.
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Affiliation(s)
- Dayna J.S. Yen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bjorn K. Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elvine Neo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ser S. Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore,Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom,Singapore Eye Research Institute, Singapore National Eye Center, Nanyang Technological University, Singapore,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Nanyang Technological University, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Vishali Gupta, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
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Mehra A, Semwal P, Bhat NK, Bolia R. A Prospective Observational Study of Hepatic Dysfunction in Children on Antitubercular Drugs. Indian J Pediatr 2022; 89:1126-1128. [PMID: 35867272 DOI: 10.1007/s12098-022-04317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
The frequency, risk factors, and prognosis of antitubercular drug-induced liver injury (TB-DILI) was assessed in this prospective observational study. All consecutive children < 18 y put on antitubercular therapy (ATT) for pulmonary or extrapulmonary tuberculosis between July 2019 and December 2020 were included. Liver function tests (LFTs) were done at baseline and at 2, 4, 6 wk, and then 2 monthly after initiation of therapy till completion of ATT regimen. A total of 81 children [14.27 ± 3.38 y, 34 (42%) males] were included. Out of the patients enrolled, 10 (12.3%) developed TB-DILI at a median of 8.5 (3-18) d of starting ATT. All patients were symptomatic with the most common symptoms being anorexia and nausea (80%). A higher baseline ALT was independently associated with DILI with adjusted OR 2.1 (95% CI 1.3-3.4), p = 0.01. Eight patients tolerated reintroduction of ATT in a sequential manner, 9-24 d after discontinuation.
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Affiliation(s)
- Anju Mehra
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Pooja Semwal
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Nowneet Kumar Bhat
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Rishi Bolia
- Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Vaz C, Jose NK, Tom JJ, Goodman GR, Lee JS, Padappayil RP, Madathil M, O'Cleirigh C, Rodrigues R, Chai PR. Formative acceptance of ingestible biosensors to measure adherence to TB medications. BMC Infect Dis 2022; 22:754. [PMID: 36171553 PMCID: PMC9517983 DOI: 10.1186/s12879-022-07756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis (TB) represents a significant public health threat in India. Adherence to antitubercular therapy (ATT) is the key to reducing the burden of this infectious disease. Suboptimal adherence to ATT and lack of demonstrated feasibility of current strategies for monitoring ATT adherence highlights the need for alternative adherence monitoring systems.
Methods A quantitative survey was conducted to assess the acceptance of and willingness to use a digital pill system (DPS) as a tool for monitoring ATT adherence among stakeholders directly involved in the management of patients with TB in India. Participants reviewed a video explaining the DPS and completed a survey, which covered sociodemographics, degree of involvement with TB patients, initial impressions of the DPS, and perceived challenges for deploying the technology in India. Participants were also asked to interpret mock DPS adherence data. Results The mean age was 34.3 (SD = 7.3), and participants (N = 50) were predominantly male (70%). The sample comprised internists (52%) and pulmonologists (30%), with a median of 4 years’ experience (IQR 3, 6) in the management of TB patients. No participants had previously used a DPS, but some reported prior awareness of the technology (22%). Most reported that they would recommend use of a DPS to patients on ATT (76%), and that they would use a DPS in both the intensive and continuation phases of TB management (64%). The majority viewed the DPS (82%) as a useful alternative to directly observed therapy-short course (DOTS), particularly given the ongoing COVID-19 pandemic. Participants reported that a DPS would be most effective in patients at risk of nonadherence (64%), as well as those with past nonadherence (64%). Perceived barriers to DPS implementation included lack of patient willingness (92%), cost (86%), and infrastructure constraints (66%). The majority of participants were able to accurately interpret patterns of adherence (80%), suboptimal adherence (90%), and frank nonadherence (82%) when provided with mock DPS data. Conclusions DPS are viewed as an acceptable, feasible, and useful technology for monitoring ATT adherence by stakeholders directly involved in TB management. Future investigations should explore patient acceptance of DPS and pilot demonstration of the system in the TB context. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07756-x.
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Affiliation(s)
- Clint Vaz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02114, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Nisha K Jose
- Division of Non-Communicable Diseases, Indian Council of Medical Research, HQs, New Delhi, India
| | - Jeremiah Jacob Tom
- Department of Gastroenterology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02114, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jasper S Lee
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Manjunath Madathil
- Department of Dermatology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.,Department of Dermatology, Imbichibava Memorial Co-Operative Hospital and Research Center, Malappuram, Kerala, India
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rashmi Rodrigues
- Department of Community Health, St. John's Medical College, St. John's Research Institute, Bangalore, India
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02114, USA. .,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA. .,Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
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13
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Peters NJ, Samujh R, Gunasekaran V, Sodhi KS, Duseja R. Pediatric PseudoTumoral Hepatic Tuberculosis. A Great Mimicker!! J Indian Assoc Pediatr Surg 2022; 27:368-370. [PMID: 35733599 PMCID: PMC9208692 DOI: 10.4103/jiaps.jiaps_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/15/2021] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Pediatric liver masses are rare and difficult to treat. Common liver masses in children include hepatoblastoma, hemangiomas, liver abscesses, and hydatid disease. Isolated liver tuberculosis (TB) is rare in children and can have variable clinical presentations. We report a child with isolated liver TB masquerading as a liver tumor.
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Affiliation(s)
- Nitin James Peters
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Nitin James Peters, Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidhya Gunasekaran
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K. S. Sodhi
- Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambara Duseja
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Saxena R, Singh D, Phuljhele S, Kalaiselvan V, Karna S, Gandhi R, Prakash A, Lodha R, Mohan A, Menon V, Garg R. Ethambutol toxicity: Expert panel consensus for the primary prevention, diagnosis and management of ethambutol-induced optic neuropathy. Indian J Ophthalmol 2021; 69:3734-3739. [PMID: 34827033 PMCID: PMC8837289 DOI: 10.4103/ijo.ijo_3746_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ethambutol use may lead to permanent vision loss by inducing a dose- and duration-dependent optic neuropathy. This has been of concern to ophthalmologists and physicians both; however, ethambutol continues to be used because of its anti-mycobacterial action with relative systemic safety. Recently, the guidelines of the Revised National Tuberculosis Control Programme of India have been revised to allow for fixed dose and longer duration of ethambutol use; this is likely to result in an increase in vision-threatening adverse effects. Taking cognizance of this, neuro-ophthalmologists, infectious disease specialists, and scientists met under the aegis of the Indian Neuro-Ophthalmology Society to deliberate on prevention, early diagnosis, and management of ethambutol-related toxic optic neuropathy. The recommendations made by the expert group focus on early suspicion of ethambutol toxicity through screening at the physician’s office and opportunistic screening by the ophthalmologist. Further, they focus on an early diagnosis through identification of specific clinical biomarkers and on management in way of early stoppage of the drug and supportive therapy. This statement also describes the mechanism of reporting a case of toxic optic neuropathy through the Pharmacovigilance Programme of India and emphasizes the need for spreading awareness regarding vision-threatening adverse effects among patients and healthcare workers.
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Affiliation(s)
- Rohit Saxena
- Strabismus and Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Swati Phuljhele
- Strabismus and Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - V Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Noida, Uttar Pradesh, India
| | - Satya Karna
- Department of Ophthalmology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Rashmin Gandhi
- Neuro-Ophthalmology Services, Centre for Sight, Hyderabad and University of Hyderabad, Telangana, India
| | - Anupam Prakash
- Department of Medicine, Lady Harding Medical College and Affiliated hospitals, New Delhi, India
| | - Rakesh Lodha
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vimla Menon
- Neuro-Ophthalmology Services, Centre for Sight, Delhi, India
| | - Rajeev Garg
- Directorate General of Health Services, Government of India, New Delhi, India
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15
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Orazulike N, Sharma JB, Sharma S, Umeora OUJ. Tuberculosis (TB) in pregnancy - A review. Eur J Obstet Gynecol Reprod Biol 2021; 259:167-177. [PMID: 33684671 DOI: 10.1016/j.ejogrb.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common infectious pathology especially in low-income countries, which may complicate pregnancy. Although pulmonary TB is more common in pregnancy than extra pulmonary TB (EPTB), EPTB is becoming more common especially in those living with human deficiency virus (HIV) co infection or have other comorbidities. The diagnosis of TB may be delayed in pregnancy due to the masking of its symptoms by those of pregnancy. If diagnosed and treated on time both pulmonary TB and EPTB are associated with excellent maternal and perinatal outcome. If, however, there is delay in diagnosis and treatment then there could be adverse maternal and fetal consequences like preterm labour, fetal growth restriction and even stillbirths. Similarly severe forms of TB like disseminated disease (miliary TB) or multi drug resistant TB (MDR TB) are associated with poor outcome. Diagnosis and management is same as in non-pregnant patients. Both drug sensitive pulmonary TB and EPTB are treated with four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) orally daily for 2 months followed by three drugs (isoniazid, rifampicin and ethambutol) orally daily for 4 months. Drug resistant TB is treated with second line drugs with caution, as some of these drugs are teratogenic. Optimum antenatal care and nutrition therapy along with anti-tuberculosis drugs provide for optimum maternal and perinatal outcome. This review discusses maternal and perinatal outcomes, diagnosis and management of pulmonary TB and extrapulmonary TB as well as perinatal tuberculosis.
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Affiliation(s)
- Ngozi Orazulike
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - J B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Odidika U J Umeora
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
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16
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Sankar J, Majumdar SS, Unniyal M, Singh H, Khullar A, Kumar K. Bilateral ptosis: An unusual presentation of mid brain tuberculoma. Med J Armed Forces India 2021; 77:96-100. [PMID: 33487874 DOI: 10.1016/j.mjafi.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022] Open
Abstract
Central nervous system tuberculoma can have different clinical manifestations like headache, seizures, papilledema or other signs of raised intracranial pressure depending up on the site and number of tuberculoma. We report a case of 56 year old female reported with history of bilateral asymmetric ptosis of one month duration,with no other neurological defecit. Magnetic resonance imaging (MRI) brain revealed well defined ring enhancing lesion in the medial aspect of left hemi midbrain with diffuse disproportionate perilessional edema. Contrast Enhanced Computed Tomogram (CECT) of chest and abdomen revealed features of disseminated tuberculosis. She was diagnosed as a case of disseminated tuberculosis and started on antitubercular therapy with steroids and the ptosis almost resolved after 01 month of antitubercular therapy. Our case report is unique in the sense that only few cases of midbrain tuberculoma causing occulomotor abnormalities are reported in literature.
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Affiliation(s)
- J Sankar
- Graded Specialist (Medicine), Military Hospital Chennai, Tamilnadu, India
| | - S S Majumdar
- Graded Specialist (Medicine), Military Hospital Chennai, Tamilnadu, India
| | - Manish Unniyal
- Classified Specialist (Radiodiagnosis), Military Hospital Chennai, Tamilnadu, India
| | - Harmanpreet Singh
- Graded Specialist(Ophthalmology), Military Hospital Chennai, Tamilnadu, India
| | - Atul Khullar
- Commandant, Military Hospital Chennai, Tamilnadu, India
| | - Kishore Kumar
- Senior Advisor (Medicine&Oncology), Command Hospital (Air Force), Bengaluru, India
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17
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Garg D, Goyal V. Spinal Tuberculosis Treatment: An Enduring Bone of Contention. Ann Indian Acad Neurol 2020; 23:441-448. [PMID: 33223659 PMCID: PMC7657285 DOI: 10.4103/aian.aian_141_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/16/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal tuberculosis is the most common form of extrapulmonary tuberculosis. It is of great importance to neurologists because of the potentially devastating complication of paraplegia, which may set in during active disease or the healed phase. Due to the deep-seated nature of the disease, definitive diagnosis is often challenging. There is no clear consensus on the appropriate duration of therapy for spinal tuberculosis, with various guidelines recommending treatment from as short as 6 months to up to 18 months. In this article, we present a critical appraisal of the evidence on the same. In our opinion, the duration of antitubercular therapy needs to be individualized and the decision to terminate therapy should be multifactorial (clinical, radiological, pathological/microbiological where possible) rather than being enmeshed within any particular guideline.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Institute of Neurosciences, Medanta, Gurugram, Haryana, India
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18
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Nahon-Esteve S, Martel A, Maschi C, Alketbi M, Baillif S, Tieulie N. Uveitis associated with latent tuberculosis: A comparative study of the impact of antitubercular therapy combined or not with systemic corticosteroids. Eur J Ophthalmol 2020; 31:2457-2466. [PMID: 33008274 DOI: 10.1177/1120672120962066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the outcome of latent tubercular uveitis (LTBU) treated with antitubercular therapy (ATT) combined or not with adjuvant systemic corticosteroids. METHODS Twenty patients (27 eyes) with LTBU were included in a monocentric retrospective study and evaluated for the absence of active disease after treatment. Data on the clinical outcomes (active inflammation), vision (best-corrected visual acuity, BCVA) and treatment were collected retrospectively. RESULTS Fourteen patients received ATT alone and six patients received ATT combined with systemic corticosteroids. The two groups were not comparable in terms of proportion of tubercular panuveitis cases and initial BCVA (59.3 ± 8.2 letters vs 44.2 ± 15.2 letters). There was no significant difference in remission rate and in BCVA between both groups 3 months after ATT discontinuation. CONCLUSION Patients with LTBU treated with ATT alone had visual and inflammatory outcomes at least comparable to those of patients treated with ATT combined with systemic corticosteroids.
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Affiliation(s)
- Sacha Nahon-Esteve
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Arnaud Martel
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Celia Maschi
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Mohamed Alketbi
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Stephanie Baillif
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
| | - Nathalie Tieulie
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Ophthalmology, Nice, France
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19
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Hammami F, Koubaa M, Ben Ayed H, Rekik K, Ben Jemaa M, Ben Hmida M, Trigui M, Marrakchi C, Dammak J, Ben Jemaa M. Update on urogenital tuberculosis in Southern Tunisia: a review of a 26-year period. Germs 2020; 10:150-156. [PMID: 33134192 DOI: 10.18683/germs.2020.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022]
Abstract
Introduction Tuberculosis affects commonly the lungs, but any other organs can be affected as well. Urogenital tuberculosis is usually misdiagnosed. In this perspective, we aimed to give an update on the epidemiological, clinical and evolutionary features of urogenital tuberculosis in Southern Tunisia. Methods We conducted a retrospective study including all patients with extrapulmonary tuberculosis notified during the period from 1992 to 2017 in Southern Tunisia. We specified the particularities of urogenital tuberculosis cases, and we compared them with other extrapulmonary tuberculosis cases. Results Overall, we analyzed 240 cases with urogenital tuberculosis, among 1702 patients with extrapulmonary tuberculosis (14.1%). There were 121 women (50.4%). The mean age was 49±17 years. Multifocal tuberculosis was noted in 29 cases (12.1%). There were 169 cases with urinary tract tuberculosis (70.4%). Chronological trends analysis showed that the median age at diagnosis increased significantly (Rho=0.41; p=0.039) and the number of urogenital tuberculosis declined during the study period, without a statistical significance (Rho = -0.07; p=0.721). Compared to other extrapulmonary tuberculosis sites, patients aged 60 years and above (OR=2.7; p<0.001) and coming from rural areas (OR=1.4; p=0.021) were more frequently diagnosed with urogenital tuberculosis. Treatment duration was significantly longer in patients with urogenital tuberculosis (10.13±3.79 vs 9.20±3.77 months; p<0.001). As for the disease evolution, relapse was significantly more frequent in patients with urogenital tuberculosis (OR=4.1; p=0.045). Conclusions Although decreasing trends over time were noted, the prognosis of urogenital tuberculosis was more severe compared to other extrapulmonary tuberculosis sites.
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Affiliation(s)
- Fatma Hammami
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Makram Koubaa
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Houda Ben Ayed
- MD, Community Health and Epidemiology Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Khaoula Rekik
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Maissa Ben Jemaa
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Mariem Ben Hmida
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Maroua Trigui
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Chakib Marrakchi
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Jamel Dammak
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Mounir Ben Jemaa
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
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20
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Testi I, Agrawal R, Mehta S, Basu S, Nguyen Q, Pavesio C, Gupta V. Ocular tuberculosis: Where are we today? Indian J Ophthalmol 2020; 68:1808-1817. [PMID: 32823397 PMCID: PMC7690544 DOI: 10.4103/ijo.ijo_1451_20] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023] Open
Abstract
Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Mumbai, India
| | | | - Quan Nguyen
- Byres Eye Institute, Stanford University, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Kang SH, Moon HS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Lee BS, Sung JK, Jeong HY, Lee KH. Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report. Ann Coloproctol 2020; 37:S18-S23. [PMID: 32674552 PMCID: PMC8359699 DOI: 10.3393/ac.2020.03.16.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/16/2020] [Indexed: 11/10/2022] Open
Abstract
Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.
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Affiliation(s)
- Sung Hoon Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Ha Lee
- Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
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22
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Kaur H, Mittal GK, Singhdev J. Intradural extramedullary tuberculoma of the spinal cord in patient of tubercular meningitis - an uncommon scenario. Indian J Tuberc 2020; 67:426-429. [PMID: 32825887 DOI: 10.1016/j.ijtb.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare and unanticipated manifestation of CNS tuberculosis. A 28 years old female diagnosed case of tubercular meningitis (TBM), already on antitubercular therapy (ATT) for last nine months, developed sensory and motor weakness in lower limbs along with saddle anaesthesia. Magnetic resonance imaging (MRI) with contrast of the spine revealed the presence of multiple space occupying lesions in dorsal spinal cord. She received oral steroid therapy for six weeks with escalation of ATT after which neurological functions improved remarkably.
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Affiliation(s)
- Harleen Kaur
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
| | | | - Jennifer Singhdev
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
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23
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Agrawal R, Testi I, Mahajan S, Yuen YS, Agarwal A, Rousselot A, Raje D, Gunasekeran DV, Kon OM, Barisani-Asenbauer T, Kempen JH, Gupta A, Jabs DA, Smith JR, Bodaghi B, Zierhut M, DeSmet M, Cluskey PM, Agarwal M, Agarwal M, Aggarwal K, Agrawal M, Al-Dhibi H, Androudi S, Asyari F, Balasundaram MB, Murthy KB, Baglivo E, Banker A, Bansal R, Basu S, Behera D, Biswas J, Carreño E, Caspers L, Chee SP, Chhabra R, Cimino L, Del Rio LEC, Cunningham ET, Curi ALL, Das D, Denisova E, Denniston AK, Errera MH, Fonollosa A, George A, Goldstein DA, Crosier YG, Gurbaxani A, Invernizzi A, Isa HM, Md Islam S, Jones N, Katoch D, Khairallah M, Khosla A, Kramer M, Kumar A, Kumar A, Nora RLD, Lee R, Lowder C, Luthra S, Mahendradas P, Makhoul D, Mazumdar S, Mehta S, Miserocchi E, Mochizuki M, Mohamed OS, Muccioli C, Munk MR, Murthy S, Narain S, Nascimento H, Neri P, Nguyen M, Okada AA, Ozdal P, Palestine A, Pichi F, Rathinam SR, Schlaen A, Sehgal S, Sen HN, Sharma A, Sharma K, Shoughy SS, Singh N, Singh R, Soheilian M, Sridharan S, Thorne JE, Tappeiner C, Teoh S, Tognon MS, Tugal-Tutkun I, Tyagi M, Uy H, Santos DVV, Valentincic NV, Westcott M, Yanai R, Alvarez BY, Zahedur R, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings. Ocul Immunol Inflamm 2020; 28:85-95. [PMID: 32250731 DOI: 10.1080/09273948.2020.1716025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom.,Singapore Eye Research Institute, Singapore, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Sarakshi Mahajan
- Byers Eye Institute, Stanford Medical School, Palo Alto, CA, United States
| | - Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador of Buenos Aires, Buenos Aires, Argentina
| | | | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom.,Byers Eye Institute, Stanford Medical School, Palo Alto, CA, United States
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Heathcare Service Trust, London, United Kingdom
| | - Talin Barisani-Asenbauer
- OCUVAC - Centre of Ocular Inflammation and Infection, Laura Bassi Centre of Expertise, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Douglas A Jabs
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Bahram Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Marc DeSmet
- Department of Ophthalmology ZNA Middelheim, Antwerp, Belgium
| | - Peter Mc Cluskey
- Department of Ophthalmology, Director Save Sight Institute, The University of Sydney, Sydney, Australia
| | | | - Manisha Agarwal
- Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | - Kanika Aggarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mukesh Agrawal
- VIMTA's Clinical Research and Clinical Reference Lab, Hyderabad, India
| | - Hassan Al-Dhibi
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Fatma Asyari
- INOIIS, Department of Ophthalmology, University of Indonesia, Indonesia
| | | | | | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de l'oeil, Geneva, Switzerland
| | - Alay Banker
- Banker's Retina Clinic and Laser Centre, 5 Subhash Society, Ahmedabad, India
| | - Reema Bansal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Digamber Behera
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Ester Carreño
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - Laure Caspers
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Soon Phaik Chee
- Singapore Eye Research Institute, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Romi Chhabra
- Department of Ophthalmology, University of Manchester, Manchester, United Kingdom
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | | | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | | | - Dipankar Das
- Department of Ocular Pathology, Uveitis & Neuro-Ophthalmology Services, Sankaradeva Nethralaya, Guwahati, India
| | | | - Alastair K Denniston
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Marie-Hélène Errera
- Centre National d'Ophtalmologie des 15-20, Paris, Sorbonne-Universités, Paris 6, France
| | | | | | - Debra A Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Yan Guex Crosier
- Jules Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
| | - Avinash Gurbaxani
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, United Kingdom
| | - Deeksha Katoch
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Amitabh Kumar
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Richard Lee
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Careen Lowder
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Shahana Mazumdar
- Department of Vitreoretina and Uvea, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Bandra Reclamation, Mumbai, India
| | - Elisabetta Miserocchi
- Ophthalmology Department, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Cristina Muccioli
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Somasheila Murthy
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | | | - Heloisa Nascimento
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), SP, Brazil
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Pinar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas "Jose de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Shobha Sehgal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - H Nida Sen
- The Laboratory of Immunology, National Eye Institute, Bethesda, MD, USA
| | - Aman Sharma
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kusum Sharma
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyad, Saudi Arabia
| | - Nirbhai Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Jennifer E Thorne
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Maria Sofia Tognon
- Ocular Immunology Unit, Department of Ophthalmology, S. Antonio Hospital, Padova, Italy
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | | | - Harvey Uy
- Ocular Immunology and Uveitis Service, Asian Eye Institute, Makati, Philippines
| | | | | | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Palo Alto, CA, United States
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bagchi A, Bhagwati M, Rathi RK. Complete reversal of constriction physiology with antitubercular treatment without steroid: a case report. Eur Heart J Case Rep 2019; 3:1-5. [PMID: 32123798 PMCID: PMC7042141 DOI: 10.1093/ehjcr/ytz193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/13/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
Abstract
Background Constrictive pericarditis is a chronic inflammation of the pericardium leading to the thickening of the pericardium that restricts cardiac filling. Globally tuberculosis is the commonest aetiology of constrictive pericarditis. Though normally considered to be an irreversible pathology; which requires surgical pericardiectomy, in early stage of the disease antitubercular therapy (ATT) along with steroids and other anti-inflammatory therapy can reverse the pathology. But, complete reversal of constrictive physiology with ATT without any anti-inflammatory drugs is not documented. Case summary Here, we describe a case where a 54-year-old lady presented with progressive dyspnoea and pedal oedema for 2 years along with anorexia and weight loss for two months. Two-dimensional echocardiography and computed tomography scan was suggestive of constrictive pericarditis. In view of systemic features and high acute phase reactants, patient was started on oral ATT without any steroids. After 4 months, constriction physiology was completely reversed. Discussion Constriction physiology if treated timely can be largely reversed only with ATT without adjuvant anti-inflammatory therapy. Further studies are required to find out the specific indications of anti-inflammatory therapy in tubercular constrictive pericarditis.
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Affiliation(s)
- Avishek Bagchi
- Department of Cardiology, Max Super Speciality Hospital, 1 & 2, Press Enclave Marg Saket District Centre, Saket Institutional Area Saket, New Delhi, Delhi 110017, India
| | - Mohit Bhagwati
- Department of Cardiology, Max Super Speciality Hospital, 1 & 2, Press Enclave Marg Saket District Centre, Saket Institutional Area Saket, New Delhi, Delhi 110017, India
| | - Rajeev Kumar Rathi
- Department of Cardiology, Max Super Speciality Hospital, 1 & 2, Press Enclave Marg Saket District Centre, Saket Institutional Area Saket, New Delhi, Delhi 110017, India
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25
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Abstract
A paradoxical upgradation response in tuberculosis (TB) is defined as the worsening of a pre-existing tubercular lesion or the appearance of a new lesion in a patient whose clinical symptoms initially improved with anti-TB treatment. A paradoxical response is common in HIV patients in the form of immune reconstitution inflammatory syndrome. A similar kind of response can also be seen in immunocompetent patients. Here, we present two cases of non-HIV TB who initially improved with antitubercular therapy (ATT) but worsened thereafter. After excluding possibilities such as multidrug-resistant TB, treatment failure or a superadded infection, a paradoxical upgradation response was diagnosed. Both the cases improved after treatment with corticosteroids in addition to ATT.
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Affiliation(s)
- Meghana Nathani Kabra
- Department of Internal Medicine, Batra Hospital and Medical Research Centre, New Delhi, India
| | - Thrinadh Kunapareddy
- Department of Internal Medicine, Batra Hospital and Medical Research Centre, New Delhi, India
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Swain SK, Sahu MC. Tubercular Otitis Externa in an Elderly Male- A Case Report. Iran J Otorhinolaryngol 2019; 31:127-130. [PMID: 30989081 PMCID: PMC6449525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tuberculosis is one of the most common diseases in developing countries, resulting in significant morbidity and mortality. Tuberculosis has varied clinical presentations, varying from common primary pulmonary tuberculosis to the extremely rare tubercular otitis externa, as in this case. Tubercular otitis externa has an extremely low clinical incidence. CASE REPORT We report the case of an immunocompetent elderly male with chronic otorrhea, otalgia, and pale granulation tissue at the ear canal with a positive biopsy report for tuberculosis, confirming the diagnosis. Subsequently, sputum culture positive for Mycobacterium tuberculosis indicated disseminated tuberculosis. The patient's symptoms resolved after antitubercular therapy (ATT). CONCLUSION Tuberculosis at a rare location such as the external auditory canal is possible in regions like India where tuberculosis has the highest burden in the world. In the case of chronic ear discharge resistant to routine antibiotic treatment, the clinician should not rule out suspicion of tuberculosis.
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Affiliation(s)
- Santosh-Kumar Swain
- Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha“O”Anusandhan (Deemed to be University), K8, Kalinganagar,Bhubaneswar-751003, Odisha, India.,Corresponding Author: Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha“O”Anusandhan (Deemed to be University), K8, Kalinganagar, Bhubaneswar-751003, Odisha, India. Tel: +91-9556524887, E-mail:
| | - Mahesh-Chandra Sahu
- Medical Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan (Deemed to be University), K8, Kalinganagar, Bhubaneswar-751003, Odisha, India.
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Mistry S, Majumder PD, Biswas J. Serial swept-source optical coherence tomography: Tale of a choroidal tuberculoma. Oman J Ophthalmol 2019; 12:42-45. [PMID: 30787534 PMCID: PMC6380144 DOI: 10.4103/ojo.ojo_183_2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Choroidal tuberculoma is a solitary elevated choroidal mass-like lesion regarded often characteristic of intraocular tuberculosis. Serial swept-source optical coherence tomography (SS-OCT) is a very important tool in monitoring the course of choroidal tuberculoma and allows in early detection of complications such as choroidal neovascular membrane (CNVM). We describe a 26-year-old young Indian female, who presented with a solitary choroidal mass lesion in the left eye. Based on positive Mantoux test, biopsy of cervical lymph nodes showing acid-fast bacilli and radiographic findings, a diagnosis of choroidal tuberculoma was made. Serial SS-OCT during subsequent follow-up visits up to 14 months demonstrated the characterization of the lesion and assessment of response to antitubercular therapy and oral steroid. The patient was subsequently diagnosed to have concurrent CNVM and successfully treated with two anti-vascular endothelial growth factor intravitreal injections.
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Affiliation(s)
- Saurabh Mistry
- Department of Uvea and Medical Retina, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Goyal V, Elavarasi A, Abhishek, Shukla G, Behari M. Practice Trends in Treating Central Nervous System Tuberculosis and Outcomes at a Tertiary Care Hospital: A Cohort Study of 244 Cases. Ann Indian Acad Neurol 2019; 22:37-46. [PMID: 30692758 PMCID: PMC6327709 DOI: 10.4103/aian.aian_70_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Tubercular meningitis (TBM) is a common cause of chronic meningitis in India; however, there is a paucity of literature on optimum duration and choice of drug therapy. Materials and Methods This was an ambispective cohort study. Results Two hundred and forty-four patients of central nervous system tuberculosis (CNS TB) who were seronegative for HIV were studied of whom 198 had TBM and 46 patients had tuberculoma without meningitis. Before completion of treatment, 84% of TBM patients underwent imaging. There was no difference in disability or mortality in patients, who were treated with various drug regimens in terms of duration of therapy or number of drugs at initiation of treatment. However when patients developed new complications, adding more drugs improved survival. Prolonging corticosteroid administration in patients with nonsatisfactory improvement at 8 weeks was not associated with prevention of disability. Conclusions CNS TB is treated by neurologists and physicians in India, as per their experience due to different recommendations in various guidelines. There is a tendency to decide when to stop treatment based on neuroimaging given the fear of poor outcomes associated with recurrence of the disease. The duration of treatment or choice of drugs at the start of treatment did not affect disability.
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Affiliation(s)
- Vinay Goyal
- Department of Neurology, AIIMS, New Delhi, India
| | | | - Abhishek
- Department of Neurology, AIIMS, New Delhi, India
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29
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Kim HS, Singh R, Adsul NM, Oh SW, Noh JH, Kim PY, Park JH, Park CH, Jang IT. Symptomatic Tuberculous Ligamentum Flavum Cyst Treated by Full Endoscopic Resection: Review with Technical Notes. World Neurosurg 2018; 122:112-115. [PMID: 30391612 DOI: 10.1016/j.wneu.2018.10.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tuberculosis (TB) of the posterior spinal element is an uncommon condition. In a developed country its diagnosis is becoming difficult due to low incidence. CASE DESCRIPTION A 60-year-old lady presented with low back pain and right leg pain for 6 months. On examination there was tenderness over L4 and L5, a positive straight leg raise test at 70 degrees on the right side and free on the left, and sensory involvement on the right L5 dermatome. Initial magnetic resonance imaging (MRI) showed an L4-5 ligamentum flavum cyst, high signal intensity in the right pedicle and facet joint. It was considered to be a degenerative spinal disorder. Later MRI showed increased size of the cyst, and computed tomography revealed erosion of the right pedicle of the L5 vertebrae, which raised the suspicion of the tubercular pathology. Initially the patient was managed for a degenerative spinal disorder. Later, when tubercular pathology was suspected, she underwent full endoscopic uniportal stenosis decompression and excision biopsy of the cyst. The histology of the cyst revealed chronic granulomatous inflammation with central necrosis. The diagnosis of a TB cyst was confirmed, and antitubercular therapy was started. CONCLUSION TB of the posterior elements of the spine is a diagnostic challenge in developed parts of the world. We describe the first likely case of tubercular ligamentum flavum cyst, which was managed by a full endoscopic uniportal approach.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea.
| | - Ravindra Singh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Nitin Maruti Adsul
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Sung Woon Oh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Patrick Y Kim
- University of Mississippi Medical Center, Department of Neurosurgery, Jackson, Mississippi, USA
| | | | | | - Il Tae Jang
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
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30
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Soni H, Bellam BL, Rao RK, Kumar PM, Mandavdhare HS, Singh H, Dutta U, Sharma V. Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 2019; 47:387-94. [PMID: 30324229 DOI: 10.1007/s15010-018-1235-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of adjunctive steroids in abdominal tuberculosis is unclear. OBJECTIVE To evaluate effect of adjunctive use of steroids for abdominal tuberculosis in reducing/preventing complications. METHODS We searched electronic databases (Medline, Embase, CENTRAL, Scopus, Web of Science, CINAHL) from inception to 25th June 2018 using the terms "abdominal tuberculosis" OR "intestinal tuberculosis" OR "peritoneal tuberculosis" OR "tuberculous peritonitis" AND steroids OR methylprednisolone OR prednisolone. Bibliography of potential articles was also searched. We included studies comparing adjunctive steroids to antitubercular therapy (ATT) alone. We excluded non-English articles, case reports, reviews and unrelated papers. The primary outcome was a comprehensive clinical outcome including need for surgery or the presence of symptomatic stricture (abdominal pain or intestinal obstruction). Quality assessment of included studies was done using ROBINS-I tool. Random-effects model was used to calculate the summary effect for all the outcomes. RESULTS Of total 633 records, three studies on peritoneal tuberculosis were included in meta-analysis. These papers were of poor quality (one quasi-randomised study and two retrospective cohort studies). Meta-analyses showed adjunctive steroids, with ATT is more effective than ATT alone in tuberculous peritonitis patients for the prevention of composite end point (RR 0.15 [0.04, 0.62], p = 0.008), symptomatic stricture(RR 0.15 [0.04-0.62] p = 0.008) and intestinal obstruction (RR 0.18 [0.03-0.99] p = 0.05). CONCLUSION The data on use of steroids for abdominal tuberculosis are limited to peritoneal tuberculosis. Although steroids seem to have some benefit in patients of tubercular peritonitis, the poor quality of studies limits the generalisability of the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42016047347.
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31
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Jhaj R, Sharma S, Sabir M, Kokane A. A pilot study to determine the occurrence of concomitant diseases and drug intake in patients on antituberculosis therapy. J Family Med Prim Care 2018; 7:414-419. [PMID: 30090786 PMCID: PMC6060940 DOI: 10.4103/jfmpc.jfmpc_103_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Altered pharmacokinetics of antituberculosis (anti-TB) drugs due to interaction with non-TB medications or concomitant diseases may lead to suboptimal plasma levels of the affected drugs and hence contribute to the emergence of drug resistance in mycobacteria. Yet, few studies have investigated the prevalence of concomitant drug intake or concurrent diseases in patients on anti-TB therapy (ATT). The objective of this study is to study the prevalence of concomitant diseases and intake of non-TB drugs in patients on ATT. Methods: Adult patients who were undergoing treatment for TB at a directly observed treatment short-course (DOTS) center were interviewed to find out any concomitant drug intake and ailments they were suffering from. Data were also collected from the patients’ treatment cards. Results: A total of 105 patients were interviewed for the study over a period of 1 month. Among these, 66 (62.9%) patients reported having taken a non-ATT drug in the last 3 months, 61 (58.1%) of which were drugs that may affect the ATT. A comparable number of patients (61 [58.1%]) reported suffering from one or the other concurrent illnesses or symptoms while on DOTS, including one patient with AIDS and eight with diabetes mellitus. Fluoroquinolones had been prescribed to four patients while on DOTS. Conclusion: A large proportion of the patients with TB were found to be on non-TB concomitant medications including drugs with potential for interactions that are capable of affecting ATT outcomes. It is, therefore, important that the patients and prescribing physicians be aware of any possible drug interactions.
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Affiliation(s)
- Ratinder Jhaj
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shweta Sharma
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammed Sabir
- Department of Medical Student, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arun Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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32
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Abstract
Childhood tuberculosis (TB) has a high incidence and prevalence in developing countries like India with tubercular meningitis (TBM) being the most common cause of death. Most cases of TBM are diagnosed late when despite adequate therapy; morbidity and mortality continue to remain high. This review aims to provide a pragmatic approach at dealing with cases of tubercular meningitis in children including clinical features, laboratory and radiological criteria, treatment options and prognostic implications. The objective of this review is to assist in early identification, proper investigation and timely treatment of TBM in children in order to reduce neurological morbidity and mortality associated with it.
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Affiliation(s)
- Roosy Aulakh
- Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Sanya Chopra
- Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
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33
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Sadashiva N, Tiwari S, Shukla D, Bhat D, Saini J, Somanna S, Devi BI. Isolated brainstem tuberculomas. Acta Neurochir (Wien) 2017; 159:889-897. [PMID: 28190145 DOI: 10.1007/s00701-017-3108-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/01/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Isolated brainstem tuberculomas are rare lesions and account for up to 5% of all intracranial tuberculomas in endemic areas. The difficulties in diagnosis and management of this condition are sparsely reported. The aim of this study is to illustrate the nuances in managing brainstem tuberculomas, define prognosis, and demonstrate a shift in management strategies with newer imaging modalities. METHOD A retrospective review of 14 patients diagnosed and treated with a diagnosis of 'isolated brainstem tuberculoma' between 2011 and 2015 was done. Diagnosis was made after combining the findings at clinical history, examination, as well as imaging features. Patients were treated with steroids for 6 weeks or until they made a meaningful clinical recovery, and antitubercular therapy (ATT) for a minimum of 18 months or until there was resolution of the tuberculoma. Confirmation of tubercular pathology was done by observing if response to treatment resulted in clinical improvement, which happened in all of our cases. RESULTS Mean age at diagnosis was 24.7 years and nine were males. Twelve patients had a combination of cranial nerve deficits with pyramidal weakness or sensory symptoms. Mean duration of symptoms was 4.7 months and tests for human immunodeficiency virus (HIV) infection were negative in all patients. Only two patients had a previous history of tubercular meningitis. Most lesions were located in the pons with size ranging from 1 to 22.2 cm3. Eight patients showed complete resolution of the lesion at latest follow-up and the rest were still on ATT. Mean duration of ATT received for resolution of the lesion was 22 months. Almost all of our patients improved clinically on steroids and ATT. CONCLUSIONS Intracranial tuberculomas may present with or without meningitis. A high index of suspicion is essential, especially in endemic areas. A combination of clinical symptoms, investigations, and imaging features help in coming to a diagnosis. Biopsy of a brainstem lesion is fraught with complications. Antitubercular therapy has a very good prognosis, though the duration of therapy required may be longer.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India
| | - Sarbesh Tiwari
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India
| | - Jitender Saini
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India.
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Sharma K, Gautam N, Sharma M, Dogra M, Bajgai P, Tigari B, Sharma A, Gupta V, Sharma SP, Singh R. Ocular mycobacteriosis-dual infection of M. tuberculosis complex with M. fortuitum and M. bovis. J Ophthalmic Inflamm Infect 2017; 7:2. [PMID: 28091937 PMCID: PMC5236055 DOI: 10.1186/s12348-016-0121-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/27/2016] [Indexed: 11/24/2022] Open
Abstract
Background We report unfavorable outcome in a patient with subretinal granuloma caused by dual infection of Mycobacterium tuberculosis complex with Mycobacterium fortuitum and Mycobacterium bovis in an immunosuppressed, non-HIV patient. We did a systematic review of literature on dual infection due to M. tuberculosis and M. fortuitum via MEDLINE and PUBMED and could not find any case reported of causing this kind of dual infection in the eye. Results A 38-year-old Indian male patient presented with decreased vision in the left eye for 3 months, diagnosed as tubercular choroidal granuloma with associated retinal angiomatosis proliferans (RAP) lesion. He also had multiple enlarged lymph nodes in the chest, and sternal pus sample was positive for acid-fast bacilli (AFB). M. tuberculosis complex was detected by gene expert. The patient was started on antitubercular treatment (ATT) whereby the lung lesions improved but the ocular lesion showed initial clinical improvement followed by worsening. Twenty-five-gauge diagnostic pars plana core vitreous surgery was done whereby sample demonstrated a large number of AFB on Ziehl-Neelsen stain and auramine-rhodamine stain. The vitreous sample showed growth on routinely inoculated mycobacteria growth indicator tube (MGIT) 960 tubes, and multiplex polymerase chain reaction (PCR), Gene Xpert MTB/ RIF assay (Cepheid, Sunnyvale, CA), and line probe assay (LPA) were positive for ocular tuberculosis. In view of nonresponse to conventional ATT, a suspicion of dual infection of M. tuberculosis complex with a nontubercular mycobacteria was kept and a subculture was made onto the solid Lowenstein-Jensen (LJ) medium from the positive MGIT 960 tubes. Two morphologically distinct types of colonies were obtained on LJ slopes. Subsequently, the two etiological agents were identified as M. fortuitum and M. bovis by PCR from the vitreous sample. Conclusions Co-infection of M. tuberculosis complex with nontubercular mycobacterium (NTM) has never been reported from ocular tuberculosis before. In immunosuppressed individuals, who test positive for MTB, not responding to the standard ATT, one needs to have a high index of clinical suspicion to rule out associated NTM infection and initiate appropriate multidrug systemic antibiotic therapy early.
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Affiliation(s)
- Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Natasha Gautam
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Megha Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Priya Bajgai
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Basavaraj Tigari
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Surya Prakash Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
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Puri P, Kaur N, Pathania S, Kumar S, Sharma PK, Sashindran VK. Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals. Med J Armed Forces India 2017; 73:12-17. [PMID: 28123239 DOI: 10.1016/j.mjafi.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Both antitubercular therapy (ATT) and antiretroviral therapy (ART) can cause drug induced liver injury (DILI) in tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection. The aim of this research was to study ATT-induced liver function test (LFT) abnormalities in HIV-infected patients. METHODS HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapine-based ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks. RESULTS We studied 100 patients with HIV ([M - 67, F - 23], mean age: 40.05 ± 10.75 years, mean CD4 cell count: 239.157 ± 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT (p = 0.044) and with baseline LFT abnormalities (p = 0.00016). There was no case of acute liver failure or mortality. CONCLUSION Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.
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Affiliation(s)
- Pankaj Puri
- Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | - Navjyot Kaur
- Assistant Professor (Medicine), Command Hospital (Southern Command), Pune 411040, India
| | - Sunny Pathania
- Resident, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - Sandeep Kumar
- Assistant Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - P K Sharma
- Associate Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - V K Sashindran
- Professor & Head, Department of Geriatric Medicine, Armed Forces Medical College, Pune 411040, India
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Bavikatte AP, Sudhindran S, Dhar P, Sudheer OV, Unnikrishnan G, Balakrishnan D, Menon RN. Live donor liver transplantation for antitubercular drug-induced acute liver failure. Indian J Gastroenterol 2017; 36:56-61. [PMID: 28066854 DOI: 10.1007/s12664-016-0725-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/07/2016] [Indexed: 02/04/2023]
Abstract
Antitubercular therapy (ATT)-induced hepatotoxicity is often over looked and active tuberculosis is considered a contraindication for liver transplantation, however it might be the only lifesaving option to certain patients of acute liver failure (ALF) due to ATT. We have assessed the outcome of live donor liver transplantation in ATT-induced ALF. A retrospective analysis of all the cases of ALF that underwent liver transplantation from 2006 to 2014 at the Amrita Institute of Medical Sciences was done. A total of seven (7.7%) patients with ATT-induced ALF who had underwent live donor liver transplantation were included in the study. Out of seven patients, three (42.8%) had established diagnosis of tuberculosis and the remaining (58.2%) patients were started on ATT empirically. The median duration of ATT intake was 2 months. All the patients underwent live donor liver transplant as they met King's College criteria, and their model for end-stage liver disease score was above 35 on admission, receiving graft from first degree relatives. Histopathology of explant liver showed pan acinar necrosis. Restarting of ATT after transplant was individualized. It was restarted only in two (28%) patients with prior sputum-positive pulmonary tuberculosis after a median time of 27 days after transplant. ATT was not restarted in rest of the (72%) patients. Postoperative mortality was seen in two (28%) patients due to conditions that masquerade the ATT-induced acute liver failure. The overall survival rate was 71.4% with a median follow up of 22 months. Live donor-related transplantation is feasible option in ATT-induced acute liver failure. Restarting of ATT post liver transplant is feasible and should be individualized along with frequent monitoring of immunosuppressant levels; however, if the primary diagnosis of tuberculosis was empirical, reintroduction of ATT can be omitted.
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Gupta A, Mrigpuri P, Faye A, Bandyopadhyay D, Singla R. Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature. Lung India 2017; 34:65-69. [PMID: 28144063 PMCID: PMC5234201 DOI: 10.4103/0970-2113.197110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.
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Affiliation(s)
- Amitesh Gupta
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Parul Mrigpuri
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Abhishek Faye
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Debdutta Bandyopadhyay
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rupak Singla
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Lhaj HA, Benjelloun A, Bouia Y, Bennouk Y, Mouzari Y, Kamouni YE, Kriet M. Latent tuberculosis-related scleritis: a case report. BMC Res Notes 2016; 9:446. [PMID: 27646473 PMCID: PMC5029063 DOI: 10.1186/s13104-016-2251-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scleritis is a painful inflammatory process centered in the sclera that may involve the cornea and the underlying uvea. The etiology is commonly idiopathic or autoimmune but some cases are associated with systemic infection such as tuberculosis. CASE PRESENTATION In this report, we describe an unusual case of a female Moroccan patient who had a long history of bilateral recurrent scleritis associated with peripheral keratopathy and anterior uveitis. The patient was diagnosed with latent tuberculosis and responded to antitubercular therapy administrated after exclusion of other aetiologies. This patient was finally diagnosed with latent tuberculosis- related scleritis. CONCLUSIONS Although systemic tuberculosis is reported as a possible cause of scleritis and other ocular inflammatory manifestations, assessment of the diagnosis of tuberculosis-related ocular inflammation is challenging especially in latent forms. The treatment is largely presumptive. However, a favorable response to antitubercular therapy without relapse is taken as evidence of the disease.
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Affiliation(s)
| | - Amine Benjelloun
- Pulmonology Unit, Avicenne Military Hospital, Marrakech, Morocco.
| | - Youssef Bouia
- Ophtalmology Unit, Avicenne Military Hospital, Marrakech, Morocco
| | - Youssef Bennouk
- Ophtalmology Unit, Avicenne Military Hospital, Marrakech, Morocco
| | - Yassine Mouzari
- Ophtalmology Unit, Avicenne Military Hospital, Marrakech, Morocco
| | | | - Mohamed Kriet
- Ophtalmology Unit, Avicenne Military Hospital, Marrakech, Morocco
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Affiliation(s)
- R K Mishra
- Classified Specialist (ENT), Military Hospital Kirkee, Pune 411020, India
| | - B K Prasad
- Classified Specialist (ENT), Military Hospital Kirkee, Pune 411020, India
| | - Sunil Mathew
- Resident (ENT), Armed Forces Medical College, Pune 411040, India
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Sambharia AK, Goel A, Karkhur Y, Tiwari A, Sharma S, Kataria A. Isolated tubercular osteomyelitis of acromion: A case report and review of literature. J Clin Orthop Trauma 2016; 7:55-7. [PMID: 28018073 DOI: 10.1016/j.jcot.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/21/2016] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis is an infectious disease of public health interest, infecting one-third of the world population. Up to 3% of all Tubercular cases have musculoskeletal involvement with less than 1% involving the scapular. To the best of our knowledge, we present the third case of acromion involvement in reported literature. An adolescent female with complains of shoulder pain with no restriction of movements, no local symptoms, no fever, no history of tuberculosis was being treated on analgesics for three months at a primary health centre. With a provisional diagnosis of Chondroblastoma, surgical exploration was done, but pus was drained. It was realized in retrospect that tuberculosis needs to be considered as a differential diagnosis for any undefined bony pain, however uncommon the site of involvement may be, especially in Indian subcontinent.
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41
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Yadav S, Rawal G. Primary Extrapulmonary Multidrug-Resistant Tuberculosis of the Sternum without HIV Infection. J Clin Diagn Res 2016; 10:RD01-3. [PMID: 26894135 DOI: 10.7860/jcdr/2016/15395.7096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
Skeletal tuberculosis (TB) accounts for about 9% of all TB cases. Tuberculosis of the sternum is not a common presentation. The case of primary multidrug-resistant (MDR) TB of the sternum is even rare. So far no such case has been reported in the medical literature. Herein, we present the very first case of primary extrapulmonary MDR TB of the sternum in a 21-year-old immunocompetent Indian female who presented with chest pain and an increased swelling over the anterior chest with an intermittently discharging sinus. She was diagnosed with multidrug-resistant tuberculosis of the sternum without the active pulmonary disease. Conservative management with oral multidrug antitubercular therapy (ATT) completely cured the patient.
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Affiliation(s)
- Sankalp Yadav
- General Duty Medical Officer-II, Department of Medicine & TB, Chest Clinic Moti Nagar , North Delhi Municipal Corporation, New Delhi, India
| | - Gautam Rawal
- Attending Consultant, Department of Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
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Padhi S, Ravichandran K, Sahoo J, Varghese RG, Basheer A. Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis. Lung India 2015; 32:593-601. [PMID: 26664166 PMCID: PMC4663863 DOI: 10.4103/0970-2113.168100] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated Mycobacterium tuberculosis (MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable. Materials and Methods: Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975–March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (n = 44/63) was 5963 ng/mL (range 500–38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (n = 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03–7.56, P = 0.03], presence of comorbidities (HR 4.59, CI: 1.08–19.52, P = 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16–6.05, P = 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51–7.87, P = 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (P > 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66–3.22, P = 0.35) did not alter the outcome in these patients. Conclusion: HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.
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Affiliation(s)
- Somanath Padhi
- Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Kandasamy Ravichandran
- Department of Biostatistics, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Renu G'Boy Varghese
- Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Aneesh Basheer
- Department of General Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
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Zeng M, Xie J, Wang L, Hu Y. Total knee arthroplasty in advanced tuberculous arthritis of the knee. Int Orthop 2016; 40:1433-9. [PMID: 26578080 DOI: 10.1007/s00264-015-3050-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Controversies regarding the treatment of advanced tuberculosis of the knee still exist. We retrospectively investigated protocols of total knee arthroplasty (TKA) and their efficacy in patients with advanced tuberculosis. METHODS Nine TKAs associated with advanced tuberculosis were performed at our institution between 2008 and 2013, with a mean follow-up of 4.4 years (range 2-7 years). In four cases with elevated inflammatory biomarkers, patients received three months of antitubercular drug treatment followed by two-stage TKA. In the remaining five cases with normal biomarkers, patients received one-stage TKA with no pre-operative drug therapy. All patients received antitubercular therapy for one year post-operatively. Clinical and radiological data during follow-up were gathered to evaluate the effects of treatment. RESULTS There was no tuberculosis reactivation and all cases demonstrated marked improvement in function and favorable states of prostheses. Specifically, the mean Hospital for Special Surgery (HSS) knee score increased from 44.8 (range 30-60) preoperatively to 82.7 (range 64-92) at last follow-up (P < 0.05). The average range of motion was 56° (range 10° to 90°) before surgery and 94° (range 80-110) at final follow-up (P < 0.05). Elevated erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP) levels returned to normal in a mean of 4.0 months (range 3-5 months) and 3.9 months (range 3-6 months) post-operatively, respectively. CONCLUSION Although a consensus of views regarding surgical timing, prosthesis selection, and peri-operative antitubercular therapy has not been reached, our results suggest that TKA can be performed for advanced tuberculous arthritis.
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Abstract
Tuberculosis of tonsils is an extremely rare variety of extra-pulmonary tuberculosis which frequently simulates the tonsillar malignancy, especially in elderly individuals. Secondary form is more common than primary one, and in present day, contact with the infected sputum or saliva in a case of sputum smear positive pulmonary tuberculosis is the main source of the disease. Chronic or recurrent tonsillitis with enlarged tonsils and sore throat is the main clinical presentation. As it is very difficult to differentiate it from tonsillar malignancy on clinical ground, histopathological examination of the tissue is must for the diagnosis of tonsillar TB. Antitubercular therapy is adequate for its successful resolution. Here, we report a primary form of tonsillar tuberculosis in a 76-year-old male, in whom, no pulmonary tuberculosis was documented.
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Affiliation(s)
- Anirban Das
- Department of Pulmonary Medicine, Medical College, Kolkata, West Bengal, India
| | - Sibes K Das
- Department of Pulmonary Medicine, Medical College, Kolkata, West Bengal, India
| | - Sudipta Pandit
- Department of Pulmonary Medicine, Medical College, Kolkata, West Bengal, India
| | - Sumitra Basuthakur
- Department of Pulmonary Medicine, Medical College, Kolkata, West Bengal, India
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Babu K, Mukhopadhyay M, Bhat SS, Chinmayee J. Orbital and adnexal tuberculosis: a case series from a South Indian population. J Ophthalmic Inflamm Infect 2014; 4:12. [PMID: 24940452 PMCID: PMC4042138 DOI: 10.1186/1869-5760-4-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/30/2014] [Indexed: 11/27/2022] Open
Abstract
Background Orbital tuberculosis (OTb) is rare and may be regarded as a manifestation of extrapulmonary tuberculosis. We report an interesting case series of six patients with varied presentations of orbital and adnexal tuberculosis in a South Indian patient population. Results A retrospective, interventional case series of six patients diagnosed with orbital and adnexal tuberculosis on the basis of clinical, radiological and histopathological evaluations between 2010 and 2013 was performed. Among the six patients with histopathologically proven OTb, five were women. The varied presentations included tubercular dacryoadenitis (two cases), classical periostitis (two cases), OTb with bone involvement (one case) and ocular adnexal tuberculosis (one case). Systemic involvement was seen in one case. All cases were treated with a regimen of antitubercular therapy (ATT). Conclusions OTb, though rare, should form a part of the differential diagnosis of orbital lesions in a high tuberculosis (TB) endemic country like ours. Biopsy still remains the mainstay of diagnosis.
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Affiliation(s)
- Kalpana Babu
- Vittala International Institute of Ophthalmology, Bangalore 560085, India ; Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, India
| | - Moupia Mukhopadhyay
- Vittala International Institute of Ophthalmology, Bangalore 560085, India ; Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, India
| | - Soumya S Bhat
- Vittala International Institute of Ophthalmology, Bangalore 560085, India ; Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, India
| | - Jt Chinmayee
- Vittala International Institute of Ophthalmology, Bangalore 560085, India ; Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, India
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Kumar N, Kedarisetty CK, Kumar S, Khillan V, Sarin SK. Antitubercular therapy in patients with cirrhosis: Challenges and options. World J Gastroenterol 2014; 20:5760-5772. [PMID: 24914337 PMCID: PMC4024786 DOI: 10.3748/wjg.v20.i19.5760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) has been a human disease for centuries. Its frequency is increased manyfold in patients with liver cirrhosis. The gold standard of TB management is a 6-mo course of isoniazid, rifampicin, pyrazinamide and ethambutol. Although good results are seen with this treatment in general, the management of patients with underlying cirrhosis is a challenge. The underlying depressed immune response results in alterations in many diagnostic tests. The tests used for latent TB have many flaws in this group of patients. Three of four first-line antitubercular drugs are hepatotoxic and baseline liver function is often disrupted in patients with underlying cirrhosis. Frequency of hepatotoxicity is increased in patients with liver cirrhosis, frequently leading to severe liver failure. There are no established guidelines for the treatment of TB in relation to the severity of liver disease. There is no consensus on the frequency of liver function tests required or the cut-off used to define hepatotoxicity. No specific treatment exists for prevention or treatment of hepatotoxicity, making monitoring even more important. A high risk of multidrug-resistant TB is another major worry due to prolonged and interrupted treatment.
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Abstract
Cutaneous drug reactions are frequent in hospitalized patients and vary from simple manifestations like rash and erythema to severe life threatening conditions like angio-oedema, erythroderma, Stevens-Johnson syndrome and toxic epidermal necrolysis. However drug eruptions with antitubercular drugs are largely unknown except few case reports. We highlight here one similar case which presented with pleomorphic cutaneous manifestations after taking anti tubercular therapy and closely mimicked vasculitis. But when the offending drugs were stopped the lesions disappeared and the patient improved.
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Affiliation(s)
- Ramesh Aggarwal
- Assistant Professor, Department of Medicine, Lady Hardinge Medical College and Associated Smt. S.K. Hospital, New Delhi, India
| | - Shridhar Dwivedi
- Dean, Professor, Department of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, Jamia Hamdard (Hamdard University), New Delhi, India
| | - Meenakshi Aggarwal
- Assistant Professor, Department of Microbiology, Lady Hardinge Medical College and Associated Smt. S.K. Hospital, New Delhi, India
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