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Magnaterra E, Scandagli I, Zuccaro B, Maio V, Simi S, Massi D, Fiallo P, Francalanci S, Difonzo E, Pisano L. Leprosy misdiagnosed as chronic urticaria in a migrant. J Travel Med 2024; 31:taad099. [PMID: 37490396 DOI: 10.1093/jtm/taad099] [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: 07/19/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
A Sri Lankan man presents with the suspicion of chronic idiopathic urticaria with angioedema, but facial swelling leads to an unexpected discovery. Thickened skin, nodules and neurological symptoms reveal the true culprit. Leprosy challenges diagnosis in non-endemic regions. Vigilance and comprehensive assessment are crucial to unmask this great imitator.
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Affiliation(s)
- Elisabetta Magnaterra
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Ilaria Scandagli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Biancamaria Zuccaro
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Vincenza Maio
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Simi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Fiallo
- Unit of Social Dermatology and National Reference Center for Hansen's Disease, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Francalanci
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Elisa Difonzo
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Luigi Pisano
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
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Sharma JB. JB Sharma's white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis. J Minim Access Surg 2024; 20:24-29. [PMID: 36695245 PMCID: PMC10898634 DOI: 10.4103/jmas.jmas_227_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Abdominopelvic tuberculosis (TB) is a variant of extrapulmonary TB causing significant morbidity, including infertility. MATERIALS AND METHODS Results of 87 cases of diagnostic laparoscopy in cases of abdominopelvic TB diagnosed on composite reference standard (CRS) for demonstration of new laparoscopic white cotton ball sign are presented. RESULTS Mean age, parity and duration of infertility were 27.2 years, 0.21 and 3.1 years, respectively. Oligomenorrhoea and hypomenorrhea were seen in 35 (40.22%) and 32 (36.78%) cases, while infertility was seen in all 87 (100%) cases while abdominal mass was seen in 27 (31.03%) cases and pelvic mass in 37 (42.58%) cases. Positive acid fast bacilli on microscopy and culture of endometrial biopsy was seen in 3.34% and 6.89% cases while epithelioid granuloma was seen in 12.64% cases on endometrial biopsy and in 13.79% cases on peritoneal biopsy. Positive polymerase chain reaction was seen in all cases while definitive abdominal pelvic TB was seen in 35 (40.1%) cases and probable findings in 42 (48.27%) cases. A new laparoscopic white cotton ball sign (resembling a large white cotton ball) was observed in 5 (5.74%) cases and biopsy from 3 showed it to be epithelioid granulomas positive. CONCLUSION Demonstration of a new white cotton ball sign on laparoscopy seems to be a useful finding in abdominal pelvic TB.
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Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Ksoo R, Barman H, De M, Lynser D, Duwarah SG, Lyngdoh C. Clinical Profile of Pediatric Tuberculosis in a Tertiary Hospital in Northeast India: A Retrospective Analysis. Cureus 2023; 15:e38660. [PMID: 37288235 PMCID: PMC10243406 DOI: 10.7759/cureus.38660] [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] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Context Tuberculosis (TB) is India's major public health problem. The profile of childhood TB in the northeast region of India is still limited. Aim To analyze the clinical, radiological, and bacteriological profiles of children with TB at a tertiary health care facility. Materials and methods A three years retrospective descriptive analysis of children admitted to a tertiary centre with TB before the introduction of cartridge-based nucleic acid amplification test (CBNAAT) for testing. Children below 18 years who were admitted from 2012 to 2014 and were diagnosed with TB were included. Relevant data were extracted in a predesigned format and entered into a Microsoft Excel sheet. Descriptive statistic was used for analysis. The results of variables are given in proportions and means and a Chi-square test was done for the test of significance using Epi-info tools. The study was done after getting ethical approval from the institute. Results A total of 150 children were included in the analysis with a Male: Female ratio of 1.1:1. A majority of the cases were under five years (n=46) and 11 to 15 years old (n=45) with a mean age of 9.3 ± 4.4 years. Fever was a common presentation (70%). Disseminated TB was seen in 31.3%, isolated central nervous system (CNS) TB was found in 30.6%, and all CNS TB with dissemination was found in 46 cases (40.7%) making extra-pulmonary TB a common finding in our study (83.3%). Isolated pulmonary TB was seen in 16.7% and total pulmonary cases along with dissemination was seen in 60 cases (40%). A bacteriological diagnosis was made in 23%. Overall mortality was 9.3%, out of which mortality in CNS TB was 13% with a p-value of 0.004 as compared to mortality other than CNS TB which was significant and mortality in under-five years was significant with a p-value of 0.001. Conclusions Pulmonary and extra-pulmonary were both causes of admission in the pediatric age group. We found that extra-pulmonary TB was the most common cause of admission in children, with CNS manifestation and disseminated TB, being the most common presentations and significant mortality was seen in under-five years and in children diagnosed with CNS TB.
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Affiliation(s)
- Rosina Ksoo
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Himesh Barman
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Manisha De
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Sourabh G Duwarah
- Paediatrics and Neonatology, Akanksha and Ayursundra Hospital, Guwahati, IND
| | - Clarissa Lyngdoh
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Adepoju VA, Adejumo OA, Adepoju OE, Adeniyi MO, Etuk V, Nzekwe I, Inegbeboh JO, Adelekan A, Oladimeji O. Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country. Front Public Health 2022; 10:924132. [PMID: 36211674 PMCID: PMC9540382 DOI: 10.3389/fpubh.2022.924132] [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: 04/20/2022] [Accepted: 08/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background Treatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results. Method A retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public-private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019. Results Of the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56-19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91-10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome. Conclusion Frontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria,*Correspondence: Victor Abiola Adepoju ;
| | - Olusola Adedeji Adejumo
- Department of Community Medicine and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Oluwatoyin Elizabeth Adepoju
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Nigeria
| | - Marius Olusola Adeniyi
- Department of Primary Healthcare Services, Ondo State Primary Healthcare Development Agency, Akure, Nigeria
| | - Victoria Etuk
- International Research Center of Excellence (IRCE), Institute of Human Virology of Nigeria, Abuja, Nigeria
| | - Iheoma Nzekwe
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria
| | - Jude O. Inegbeboh
- Department of HIV/AIDS, Birnin Kebbi, Kebbi State Children Emergency Fund (UNICEF), Abuja, Nigeria
| | | | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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Hazarika N, Gupta PK, Dhanta A, Singh A, Mohanty A, Gupta P. Renaissance of Hansen's Disease in Post-Elimination Era in North India: A Retrospective Clinico-Bacteriological Study. Cureus 2021; 13:e17514. [PMID: 34603886 PMCID: PMC8476198 DOI: 10.7759/cureus.17514] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Hansen's disease is a chronic infectious disease caused by Mycobacterium leprae. India declared the elimination of leprosy in December 2005, but a slow resurgence of the disease still continues in several parts of India. The diagnosis of leprosy is primarily clinical but slit-skin smear microscopy aids in an accurate diagnosis. There are very few studies on clinico-bacteriological patterns of leprosy at this post-elimination phase. Aim This study aimed to analyze the clinical and bacteriological findings of newly diagnosed cases of Hansen's disease in the post-elimination era. Materials and methods This is a descriptive, hospital-based, retrospective study of newly diagnosed cases of Hansen's disease, enrolled in the Hansen's disease clinic attached to the dermatology outpatient department (OPD) of a tertiary care hospital in North India. A retrospective chart review of newly diagnosed cases of leprosy for a period of one year was done. Information about demographics, clinical characteristics, spectrum of disease, and slit skin smear data of patients were collected. Statistical analysis was performed using SPSS Version 16.0 (Chicago, IL, SPSS Inc.). Result A total of 116 patients were included of which 68.1% (79) were males. The age of patients ranged from 7 to 72 years and children (<15 years) constituted 6% (7/116) of all cases. The most common clinical spectrum was borderline lepromatous leprosy 37.9% (44/116) followed by lepromatous leprosy 32.8% (38/116). Out of 116 cases, 39.6% of cases showed slit-skin smear positivity. Conclusion The study brings forth evidence on the slow re-emergence of leprosy in India. In this study, multibacillary cases outnumber the paucibacillary cases; also, childhood cases were encountered indicating active community spread of the disease in the "post-elimination era." There is an urgent need to step up the surveillance for Hansen's disease to curb the further spread of the bacilli in the community.
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Affiliation(s)
- Neirita Hazarika
- Dermatology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Puneet K Gupta
- Microbiology, All India Institute of Medical Sciences, Bilaspur, IND
| | - Aditi Dhanta
- Dermatology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Arpana Singh
- Clinical Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Aroop Mohanty
- Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Pratima Gupta
- Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
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Mittal R, Agarwal S, Muduli KC, Sahu S, Das S. Acid and heat fastness in microsporidia: How acid fast are acid fast microsporidium? Med Mycol 2021; 58:1010-1013. [PMID: 31965173 DOI: 10.1093/mmy/myz137] [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: 09/16/2019] [Revised: 11/27/2019] [Accepted: 12/24/2019] [Indexed: 11/14/2022] Open
Abstract
Microsporidia are obligate spore-forming microorganisms with strong resemblance to fungi and can affect almost every organ system in immunocompetent or immunocompromised individuals. Mixed infections are also reported in immunocompromised hosts. Microsporidial spores show marked morphological variations and the small and slender forms can resemble bacilli. Modified Zeihl Neelsen (ZN) stain, cold method demonstrates them as bright red in color, leaving several spores blue or incompletely stained; thus, they are reported as weakly or variably acid fast. Variability in staining results with ZN stain and considering the fact that Mycobacterium tuberculosis, the commoner bug in developing countries is identified by its resistance to stronger acids on ZN staining, authors wished to demonstrate acid and heat fastness in microsporidium using corneal tissue specimens. Microsporidial spores stained bright red in color with conventional ZN stain, demonstrated strong acid fastness, and interestingly the staining results improved on heating. Thus, the authors conclude that they are strongly acid and heat fast and care must be warranted so that they are not misdiagnosed as Mycobacterium or other acid-fast organisms. Careful observation of morphology, battery of special stains, and molecular diagnostics should be advocated for diagnostic confirmation. To the best of the authors' knowledge, this is the first explicit report on acid and heat fastness on microsporidial spores.
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Affiliation(s)
- Ruchi Mittal
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Sunil Agarwal
- Department of Pathology, Hi-Tech Medical College and Hospital, Odisha, India
| | - Kalandi Ch Muduli
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Srikant Sahu
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Sujata Das
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
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Satturwar S, Pantanowitz L, Xing J, Schoedel K, Weber D, Monaco SE. Cytomorphology of Mycobacterium avium intracellulare-associated ascites. Diagn Cytopathol 2020; 48:E10-E13. [PMID: 32592614 DOI: 10.1002/dc.24532] [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: 04/16/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/11/2022]
Abstract
Ascites due to Mycobacterium avium intracellulare (MAI) infection is extremely rare and associated with a poor outcome. The cytomorphology of this condition has not been previously reported. We present a unique case of a 45-year-old woman with iatrogenic immunodeficiency who developed MAI-associated chylous ascites. The ascitic fluid cytology showed numerous lymphocytes and foamy histiocytes with abundant intracytoplasmic MAI organisms. The diagnosis was confirmed by tissue biopsy showing MAI mesenteritis. It is important to consider MAI-associated ascites in the differential diagnosis whenever ascitic fluid shows a predominant population of lymphocytes and macrophages, especially in immunocompromised patients.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karen Schoedel
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David Weber
- Department of Infectious Disease Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Navas ME, Jump R, Canaday DH, Wnek MD, SenGupta DJ, McQuiston JR, Bell M. Can anaerobes be acid fast? A novel, clinically relevant acid fast anaerobe. JMM Case Rep 2016; 3:e005036. [PMID: 28348766 PMCID: PMC5330234 DOI: 10.1099/jmmcr.0.005036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Anaerobic acid fast bacilli (AFB) have not been previously reported in clinical microbiology. This is the second case report of a novel anaerobic AFB causing disease in humans. CASE PRESENTATION An anaerobic AFB was isolated from an abdominal wall abscess in a 64-year-old Caucasian diabetic male, who underwent distal pancreatectomy and splenectomy for resection of a pancreatic neuroendocrine tumour. The isolated bacteria were gram-variable and acid-fast, consisting of small irregular rods. The 16S rRNA gene sequence analysis showed that the isolate is a novel organism described in the literature only once before. The organism was studied at the CDC (Centers for Disease Control and Prevention) by the same group that worked with the isolates from the previous report; their findings suggest that the strain belongs to the suborder Corynebacterineae. CONCLUSION This is the fifth reported case of an anaerobic AFB involved in clinical disease; its microbiological features and 16S RNA sequence are identical to previously reported cases. Clinical disease with this organism seems to be associated with recent history of surgery and abscess formation in deep soft tissues. Acquisition from surgical material is uncertain but seems unlikely.
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Affiliation(s)
- Maria E Navas
- Microbiology Laboratory, Louis Stokes Cleveland Veterans Affairs Medical Center , Cleveland, Ohio , USA
| | - Robin Jump
- Geriatric Research Education and Clinical Center, Louis Stokes Cleveland VAMC, Cleveland, Ohio and Department of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University , Cleveland, Ohio , USA
| | - David H Canaday
- Geriatric Research Education and Clinical Center, Louis Stokes Cleveland VAMC, Cleveland, Ohio and Department of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University , Cleveland, Ohio , USA
| | - Maria D Wnek
- Microbiology Laboratory, Louis Stokes Cleveland Veterans Affairs Medical Center , Cleveland, Ohio , USA
| | - Dhruba J SenGupta
- Department of Laboratory Medicine, University of Washington Medical Center , Seattle, Washington , USA
| | - John R McQuiston
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Melissa Bell
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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Thakkar K, Ghaisas SM, Singh M. Lymphadenopathy: Differentiation between Tuberculosis and Other Non-Tuberculosis Causes like Follicular Lymphoma. Front Public Health 2016; 4:31. [PMID: 26942176 PMCID: PMC4766275 DOI: 10.3389/fpubh.2016.00031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/12/2016] [Indexed: 11/25/2022] Open
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Makeshkumar V, Madhavan R, Narayanan S. Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis. Indian J Med Res 2014; 139:161-6. [PMID: 24604051 PMCID: PMC3994732] [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] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Diagnosis of extrapulmonary tuberculosis (EPTB) is difficult using conventional diagnostic methods. This study was conducted to evaluate the use of polymerase chain reaction (PCR) in diagnosis of definitive and probable extrapulmonary tuberculosis patients, and to assess the performance of insertion sequence (IS) 6110 based PCR assay as compared to conventional culture by Lowenstein-Jensen (LJ) method for the diagnosis of EPTB. METHODS A total of 178 non repeated clinical specimens were collected from clinically suspected extrapulmonary tuberculosis patients. The specimens included 59 ascitic fluid, 54 pleural fluid, 25 cerebrospinal fluid (CSF), 12 fine needle aspiration (FNA), 8 urine, 7 pus, 6 synovial fluid, 2 skin tissue, one pericardial fluid, one liver abscess, one pancreatic cyst fluid, one omental biopsy and one semen sample. All these clinical samples were subjected to Ziehl-Neelsen staining (ZN) for acid fast bacilli (AFB) and culture on LJ medium. PCR was performed by targeting 123bp fragment of insertion sequence IS6110 of Mycobacterium tuberculosis (MTB). RESULTS Of the 178 specimens, 10 (5.61%) were ZN smear positive for AFB, six (3.37%) were L-J culture positive from 10 AFB smear positive cases and 48 (26.96%) were PCR IS 6110 positive for M. tuberculosis. INTERPRETATION & CONCLUSIONS PCR using IS6110 primer was able to pick up more EPTB patients compared to conventional L-J culture method for detection of M. tuberculosis. False positive PCR IS6110 in three CSF samples may be due to latent TB infection which was limitation in this study.
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Affiliation(s)
- V. Makeshkumar
- Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Kanchipuram, India
| | - Radha Madhavan
- Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Kanchipuram, India,Reprint requests: Dr Radha Madhavan, Professor & Head, Department of Microbiology, SRM Medical College Hospital & Research Centre, SRM University, Potheri Village, Kattankulathur 603203, Kanchipuram District, Tamil Nadu, India e-mail:
| | - Sujatha Narayanan
- Department of Immunology, National Institute for Research in Tuberculosis (ICMR), Chennai, India
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Chatterjee M, Bhattacharya S, Karak K, Dastidar SG. Effects of different methods of decontamination for successful cultivation of Mycobacterium tuberculosis. Indian J Med Res 2013; 138:541-8. [PMID: 24434262 PMCID: PMC3868068] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND & OBJECTIVES There has been an extensive invasion of tuberculosis at the global level by multidrug resistant as well as extensively drug resistant organisms. Attempts to recover the pathogen in pure culture have frequently failed since the specimens are often highly contaminated and also due to use of insufficient or over-active decontamination procedures. Hence in the present study different methods of decontamination were tested to evaluate their independent efficacies for culture of Mycobacterium tuberculosis. METHODS A total of 359 samples (241 sputum, 59 urine, 50 endometrium biopsy, 9 pus samples) from clinically suspected cases of tuberculosis were subjected to four different methods of decontamination followed by inoculation in Lowenstein-Jensen medium (LJM), and bilayered medium (BLM) and Kirchner's liquid medium (KLM) to determine the influence of differential decontamination processes. Sputum scanty and positive specimens were graded and each sample was subjected to decontamination by four different techniques. RESULTS Treatment of specimens with 4 per cent NaOH yielded minimum recovery of pure cultures, while use of 2 per cent NaOH produced higher number of contaminants compared to other methods of decontamination. Addition of N-acetyl L-cystein (NALC) coupled with 2 per cent NaOH to the samples for decontamination provided fairly reasonable recovery, but the highest number of M. tuberculosis cultures could be obtained when the specimens were treated with tri-sodium phosphate and benzalkonium (TSPB). Among the sputum positive cases recovery of growth of M. tuberculosis was higher with greater number of bacilli present in the specimens. Regarding the influence of culture media, BLM produced not only rapid growth, but reasonably higher rate of isolation of M. tuberculosis. INTERPRETATION & CONCLUSIONS Although use of TSPB was found to be an efficient method of decontamination for successful isolation of M. tuberculosis from contaminated samples, both NALC+ 2 per cent NaOH and TSPB also showed significant recovery of M. tuberculosis cultures in BLM that can facilitate early diagnosis and initiation of treatment.
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Affiliation(s)
- Mitali Chatterjee
- Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, India
| | | | - Kalpana Karak
- Department of Microbiology, K.P.C. Medical College, Kolkata, India
| | - Sujata G. Dastidar
- Department of Microbiology, Herbicure Healthcare Bio-Herbal Research Foundation, Kolkata, India,Reprint requests: Prof. Sujata G. Dastidar, Research Director, Herbicure Healthcare Bio-herbal Research Foundation, Saral Dighi (E), Boral, Kolkata 700 154, India e-mail:
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Shrivastava P, Bagchi T. Differential expression of alpha II spectrin in monocytes of tuberculosis patients. Int Immunopharmacol 2013; 17:759-62. [PMID: 24055022 DOI: 10.1016/j.intimp.2013.09.005] [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] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Monocytes play a crucial role in immune response to tuberculosis. The present study focuses on identifying differences in the monocyte proteome profile of tuberculosis patients, household contacts and healthy controls. Differential protein expression was studied by two-dimensional (2D) gel electrophoresis. One of the spots consistently showed either lower intensity or was absent in patients and was identified as alpha II-spectrin. The decreased expression of αII-spectrin was further validated by quantitative PCR (qPCR) and western blot analysis. This study suggests the possible role of decreased levels of αII-spectrin in the pathology of tuberculosis.
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Affiliation(s)
- Parul Shrivastava
- Department of Microbiology and Biotechnology Centre, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara 390002, India
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Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: a histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Physicians 2013; 1:56-61. [PMID: 21938251 PMCID: PMC3167969 DOI: 10.4103/0974-2727.59700] [Citation(s) in RCA: 37] [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: 11/04/2022] Open
Abstract
BACKGROUND Along with the increased incidence of pulmonary tuberculosis in parallel with the increase in population in various parts of the world, in recent years, the incidence of abdominal tuberculosis has also increased. The pathogenetic events in intestinal tuberculosis, which culminate in ulcer formation, perforation, and stricture, still have to be identified. AIM To correlate the gross and microscopic features in intestinal tuberculosis, in particular tuberculous perforation with changes in mesenteric vasculature. PATIENTS AND METHODS A one-year prospective study of excised/resected tissues from patients with abdominal tuberculosis requiring surgical intervention was conducted. Tissues from fifty-six patients were included in the study-of which 36 were resected intestinal segments and 20 were intestinal and lymph node biopsies. Hematoxylin and Eosin and Ziehl-Neelsen stains were used for histopathological examination. RESULTS Tuberculous enteritis was found to be present in 49 of the 56 patients (87.5%) (ileum being the site most commonly affected), while nodal involvement was seen in 39 (69.6%) patients. Perforations were present in 39 out of 49 (79.6%) intestinal tissues; most being solitary and ileum was the commonest site. Typical epithelioid cell granulomas were seen in the intestine and lymph nodes, with caseation being more prevalent in the latter. The mesenteric vasculature was frequently involved by granulomatous inflammation, with intravascular organizing thrombus being present in 30% of the resected specimens with perforation. Acid fast bacilli were demonstrated in the tissue sections of 37.5% of the patients. AFB positivity was higher in caseating granulomas. CONCLUSION Involvement of mesenteric vasculature by granulomatous inflammation was commonly associated with the ulcerative type with perforation, suggesting that ischemia caused by vascular thrombosis is responsible for tissue breakdown. This implies that vasculitis plays an important role in the natural history of abdominal tuberculosis.
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Affiliation(s)
- Alakananda Dasgupta
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Zenebe Y, Anagaw B, Tesfay W, Debebe T, Gelaw B. Smear positive extra pulmonary tuberculosis disease at University of Gondar Hospital, Northwest Ethiopia. BMC Res Notes 2013; 6:21. [PMID: 23331864 PMCID: PMC3558382 DOI: 10.1186/1756-0500-6-21] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/09/2013] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED BACKGROUND While pulmonary tuberculosis is the most common presentation, extra pulmonary tuberculosis is also an important clinical problem. However, no adequate information had been made available on the prevalence of smear positive extra pulmonary tuberculosis in Gondar. The aim of this study was to assess the prevalence and possible risk factors of smear positive extra pulmonary tuberculosis among suspected patients at University of Gondar Hospital. METHODS A cross-sectional study on extra pulmonary tuberculosis suspected patients was conducted at University of Gondar Hospital from January 2012 to April, 2012. Specimens of patients suspected of extra pulmonary tuberculosis were obtained from fine needle aspiration and body fluid samples collected by pathologist. Demographic characteristics and other variables were collected using a pretested semi-structured questionnaire. Smears were prepared from each sample and stained by Ziehel Neelson and Wright stain. The result of the study was analyzed with bivariate and multivariate logistic regression. RESULT A total of 344 extra pulmonary tuberculosis suspected clients were included in the study and specimens were taken from lymph node aspirates and body fluids. The overall prevalence of smear positive extra pulmonary tuberculosis was 34 (9.9%). Of these cases of extra pulmonary tuberculosis, lymph node tuberculosis constituted the largest proportion (82.4%). Among the 34 extra pulmonary tuberculosis patients, over half of them (52.9%) were positive for human immunodeficiency virus. The largest proportion of tuberculosis and human immunodeficiency virus cases occurred among persons with in the age group of 31-40 years. Previous history of tuberculosis (OR = 4.77, 95% CI 1.86-12.24), contact to a known tuberculosis cases (OR = 6.67 95% CI 2.78-16.90), history of underlying diseases (OR = 2.79 95% CI 1.15-6.78) and income (OR = 12.9 95% CI 2.25-68.02) were significantly associated with extra pulmonary tuberculosis infection. CONCLUSION The prevalence of smear positive extra pulmonary tuberculosis infection in Gondar is high. Screening of lymph node and other body fluid specimens for extra pulmonary tuberculosis could help for treatment, control and prevention of the disease.
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Affiliation(s)
- Yohannes Zenebe
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Belay Anagaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wogahta Tesfay
- Department of Pathology, School of Medicine; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Debebe
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Primary breast tuberculosis is a rare entity in the developed world but is slightly more common in the developing world. All lesions that clinically, pathologically and imaging wise appear benign but do not respond to routine antibiotics, must be worked up for possible tubercular aetiology especially when they present as plain oedema, induration or as non-healing ulcers. Imaging has a role in defining the extent, deciding the type of management and duration of follow-up. This article highlights the clinical and sonographic imaging findings in one such case which was followed up for a period of one year.
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Dwari BC, Ghosh A, Paudel R, Kishore P. A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a tertiary care teaching hospital in pokhara, Nepal. Indian J Dermatol 2010; 55:233-7. [PMID: 21063513 PMCID: PMC2965907 DOI: 10.4103/0019-5154.70670] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/19/2022] Open
Abstract
BACKGROUND Cutaneous tuberculosis (TB) is essentially an invasion of the skin by Mycobacterium tuberculosis, the same bacteria that causes pulmonary tuberculosis. AIM This study was conducted to study the common types of cutaneous TB and to find the management pattern in a tertiary teaching hospital in Pokhara, Nepal. MATERIALS AND METHODS All the cases of cutaneous TB were biopsied and furthermore investigated by performing Mantoux test, sputum examination, fine needle aspiration cytology, chest X-ray and ELISA. RESULTS In this study, we found that tuberculosis verrucous cutis (48%) had a higher incidence than other types of cutaneous TB. More males were affected than were females (1.2:1). Commonly affected sites were the limb and the buttock (48%). The most commonly affected age group was 16-25 years (40%). All cases (except two) were more than 15 mm in size in the Mantoux test. The histopathological picture was typical in all except three cases. All patients were treated with antitubercular treatment as per the national guidelines. CONCLUSION The most common type of cutaneous TB was tuberculosis verrucous cutis and the most commonly affected sites were the limb and the buttock. As cutaneous TB sometimes reflects the presence of pulmonary tuberculosis, its incidence should not be ignored.
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Affiliation(s)
- Binayak Chandra Dwari
- From the Department of Dermatology, Manipal Teaching Hospital & Manipal College of Medical Sciences Pokhara, Nepal
| | - Arnab Ghosh
- From the Department of Pathology, Manipal Teaching Hospital & Manipal College of Medical Sciences Pokhara, Nepal
| | - Raju Paudel
- From the Medicine, Manipal Teaching Hospital & Manipal College of Medical Sciences, Pokhara, Nepal
| | - P Kishore
- From the Medicine, Manipal Teaching Hospital & Manipal College of Medical Sciences, Pokhara, Nepal
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Premkumar M, Anumakonda V, Cormican L, Ruiz G, Greenough A. Feeding intolerance due to connatal tuberculosis in a prematurely born infant. Eur J Pediatr 2008; 167:955-6. [PMID: 17885763 PMCID: PMC7101876 DOI: 10.1007/s00431-007-0605-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 08/28/2007] [Indexed: 11/28/2022]
Abstract
A prematurely born infant had three episodes of feeding intolerance in the first three weeks after birth. In the post-partum period, his mother, who was from the Ukraine, had a respiratory arrest; unusually, a high-resolution computerised tomograph demonstrated miliary tuberculosis (TB). As a consequence, and due to the continuing ill health of the infant, gastric aspirates were sent from the infant. Acid fast bacilli were seen on microscopy. Variable nucleotide tandem repeat analysis of acid fast bacilli facilitated the rapid diagnosis of connatal TB. We conclude that connatal TB should be considered in a prematurely born infant poorly responsive to standard management and whose mother falls into a high-risk group.
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Affiliation(s)
| | | | - Liam Cormican
- Department of Chest Medicine, King’s College Hospital, London, UK
| | - Gary Ruiz
- Department of Child Health, King’s College Hospital, London, UK
| | - Anne Greenough
- King’s College London, MRC–Asthma Centre, Division of Asthma, Allergy and Lung Biology, King’s College Hospital, London, UK
- 4th Floor Golden Jubilee Wing, King’s College Hospital, Denmark Hill, London, SE5 9RS UK
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