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Diagnosis and treatment of tuberculosis

Works Count: 47660

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Description

This cluster of papers focuses on the diagnosis and management of abdominal tuberculosis, with a particular emphasis on the challenges in differentiating it from other conditions such as Crohn's disease, the use of imaging and PCR for diagnosis, and the implications of tuberculous peritonitis and genitourinary tuberculosis. The cluster also explores the impact of abdominal tuberculosis on infertility.

Keywords

Abdominal Tuberculosis; Diagnostic Challenges; Peritoneal Tuberculosis; Imaging Features; Genitourinary Tuberculosis; Differential Diagnosis; Endoscopic Evaluation; Tuberculous Peritonitis; PCR Diagnosis; Infertility

Tuberculosis of the gastrointestinal tract and peritoneum.

1993-07-01

John B. Marshall

Gastrointestinal and peritoneal tuberculosis remain common problems in impoverished areas of the world, but is relatively infrequent in the United States. A resurgence of tuberculosis in America since the mid-1980s … Gastrointestinal and peritoneal tuberculosis remain common problems in impoverished areas of the world, but is relatively infrequent in the United States. A resurgence of tuberculosis in America since the mid-1980s means that clinicians will continue to see cases. Immigrants and AIDS patients are two population groups at particular risk for abdominal tuberculosis in this country; the urban poor, the elderly, and Indians on reservations are others. The symptoms and signs of GI and peritoneal tuberculosis are nonspecific, and unless a high index of suspicion is maintained, the diagnosis can be missed or delayed resulting in increased morbidity and mortality. Only 15-20% of patients have concomitant active pulmonary tuberculosis. Tuberculous peritonitis needs to be considered in all cases of unexplained exudative ascites. Laparoscopy with directed biopsy currently is the best way to make a rapid specific diagnosis. The measurement of ascites adenosine deaminase levels represents a major diagnostic advance in tuberculous peritonitis, particularly in underdeveloped areas where the affliction is common and laparoscopy may not be available. With greater experience, this testing procedure could also supersede invasive studies in western countries, particularly in high-risk patient groups. The commonest sites of tuberculous involvement of the GI tract are the ileocecal area, the ileum and the colon, although any area of the gut can be involved. If the area of affected gut is within reach of the flexible endoscope, rapid diagnosis may be possible with biopsy (if acid-fast bacilli or caseating granulomas are seen). Not infrequently, the disease is not considered until it is diagnosed at the time of surgery. In countries with a high prevalence of intestinal tuberculosis, a therapeutic trial of antituberculous drugs may be reasonable if the clinical picture is compatible. The diagnosis of tuberculous enteritis can be taken as highly probable if the patient responds to treatment and this is followed by no recurrence. Serologic tests for diagnosing tuberculosis are being improved and evaluated in intestinal tuberculosis. Gastrointestinal and peritoneal tuberculosis are treated with antituberculous drugs. Surgery is reserved for complications or uncertainty in diagnosis. Six-, 9-, and 18- to 24-month regimens are all effective for extrapulmonary tuberculosis. Standard therapy of at least 9 months duration is also effective in most AIDS patients who are started on appropriate treatment in a timely fashion and who are compliant. The potential for multidrug resistance needs to be kept in mind and accounted for.

Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy.

1992-01-01

D. K. Bhargava , Shriniwas , Prem Chopra +3 more

We report laparoscopic findings in 38 proven cases of peritoneal tuberculosis. The laparoscopic appearances can be classified into three types: thickened peritoneum with miliary yellowish white tubercles with or without … We report laparoscopic findings in 38 proven cases of peritoneal tuberculosis. The laparoscopic appearances can be classified into three types: thickened peritoneum with miliary yellowish white tubercles with or without adhesions (n = 25), only thickened peritoneum with or without adhesions (n = 8), and fibroadhesive pattern (n = 5). Biopsies were avoided from fibroadhesive lesions due to risk of complications. Visual diagnosis was accurate in 95% of patients. In comparison, in 27 (82%) of 33 patients, the examination enabled a histologic diagnosis to be made on the basis of typical granulomas. The combined use of guinea pig inoculation and culture isolated Mycobacterium tuberculosis in six (37.5%) of 16 patients. Mycobacteria were scarcely (3%) seen on histological sections. We conclude that, although target biopsy is an effective method of obtaining an early diagnosis of peritoneal tuberculosis, chemotherapy may be started on the basis of visual laparoscopic appearances alone.

Genitourinary tuberculosis

1977-09-01

Harvey B Simon , Allan J. Weinstein , Mark S. Pasternak +2 more

Inflammatory bowel disease

1975-01-01

Ashley B. Price , B C Morson

HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.

1992-01-01

Mario Raviǵlione , J P Narain , Adriano Nunes Kochi

This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summarizes WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons … This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summarizes WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe adverse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed.This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summaries WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy, and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe averse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed. (author's)

Congenital Tuberculosis

1994-04-14

Michael F. Cantwell , Ziad M. Shehab , A. Costello +5 more

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Diagnosis of abdominal tuberculosis: Experience from 11 cases and review of the literature

2004-01-01

Ali Uzunköy

AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 … AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white 'miliary nodules' or plaques, enlarged lymph nodes, ascites, 'violin string' fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobacterium tuberculosis (M.tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites.Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.

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CT of Bowel Wall Thickening

2001-05-01

Michael Macari , Emil J. Balthazar

CT of Bowel Wall ThickeningSignificance and Pitfalls of InterpretationMichael Macari1 and Emil J. BalthazarAudio Available | Share CT of Bowel Wall ThickeningSignificance and Pitfalls of InterpretationMichael Macari1 and Emil J. BalthazarAudio Available | Share

GENITOURINARY TUBERCULOSIS: REVIEW OF 102 CASES

1974-09-01

WILLIAM I CHRISTENSEN

Clinical presentations, laboratory features, and responses to therapy of 102 patients treated at an army medical center for genitourinary tuberculosis between January 1961 and September 1972 are described. During that … Clinical presentations, laboratory features, and responses to therapy of 102 patients treated at an army medical center for genitourinary tuberculosis between January 1961 and September 1972 are described. During that time, a total of 3109 patients had been treated for tuberculosis of all types. The study group included 72 men aged 18-59 with a mean age of 29, and 31 women aged 17-66, with a mean age of 31. There was often a latent period of 20 years or more between infection with the tubercle bacillus and the expression of genitourinary tuberculosis. The principal means of diagnosis was isolation of Mycobacterium tuberculosis from urine, obtained in 80%, or sputum, obtained in 38%. M. tuberculosis was not cultured in 13 patients. In patients with negative cultures, diagnosis was made by combinations of positive tuberculin skin test, caseating granulomata on biopsy, characteristic changes in the excretory urogram, characteristic bladder lesions on cystoscopy, and the presence of sterile pyuria or microscopic hematuria. A wide variety of signs and symptoms were encountered as was a high frequency of involvement of other organ systems. The most common laboratory abnormalities were pyuria, albuminuria, and hematuria. 75% of patients had an abnormal chest roentgenogram on admission. 88% of patients tested had positive skin tests and 63% tested had abnormal excretory urography. 16% showed renal calcification. Only 1 nephrectomy was done in the latter 5 years of the study, for hypertension. 2 women and 6 men had hypertension, but 1 woman and 2 men had nontuberculous renal disease which could have caused the hypertension. The evidence from the series is that infectivity of genitourinary tuberculosis is low. There was only 1 initial treatment failure, in a 47-year old man with active pulmonary and renal tuberculosis caused by an isoniazid-resistant organism. 2 men, only 1 of whom had had genitourinary disease originally, had recurrences of tuberculous disease after prematurely discontinuing medication.

Infections of the Gastrointestinal Tract

1996-01-24

Edward S. Wong

Gastrointestinal infections, particularly cholera and dysentery, have had an impact on human history. In the words of Tramont and Gangarosa, contributing authors to this text, diarrheal infections "have accounted for … Gastrointestinal infections, particularly cholera and dysentery, have had an impact on human history. In the words of Tramont and Gangarosa, contributing authors to this text, diarrheal infections "have accounted for the outcome of more battles than the instruments of war." Today, diarrheal diseases continue to affect humankind. Globally, an estimated four to six million children die each year from diarrheal diseases, making them the leading cause of death in developing countries. While the number of deaths in the United States is much smaller, gastrointestinal infections constitute the second or third most common clinical syndrome seen in general practice. Thus, physicians in practice today must be comfortable and knowledgeable in the diagnosis and management of at least the common gastrointestinal infections. In the last decade, new or newly recognized enteric diseases have emerged. Examples include gastrointestinal syndromes associated with<i>Escherichia coli</i>O157:H7,<i>Cryptosporidium</i>, and AIDS. The diagnosis and treatment of these

Identification of Risk Factors for Extrapulmonary Tuberculosis

2004-01-06

Zhenhua Yang , Ying Kong , Frank J. Wilson +5 more

The proportion of extrapulmonary tuberculosis cases in the United States has increased from 16% of tuberculosis cases, in 1991, to 20%, in 2001. To determine associations between the demographic, clinical, … The proportion of extrapulmonary tuberculosis cases in the United States has increased from 16% of tuberculosis cases, in 1991, to 20%, in 2001. To determine associations between the demographic, clinical, and life style characteristics of patients with tuberculosis and the occurrence of extrapulmonary tuberculosis, a retrospective case-control study was conducted. This study included 705 patients with tuberculosis, representing 98% of the culture-proven cases of tuberculosis in Arkansas from 1 January 1996 through 31 December 2000. A comparison between 85 patients with extrapulmonary tuberculosis (case patients) and 620 patients with pulmonary tuberculosis (control patients) showed women (OR, 1.98; 95% CI, 1.25-3.13), non-Hispanic blacks (OR, 2.38; 95% CI, 1.42-3.97), and HIV-positive persons (OR, 4.93; 95% CI, 1.95-12.46) to have a significantly higher risk for extrapulmonary tuberculosis than men, non-Hispanic whites, and HIV-negative persons. This study expands the knowledge base regarding the epidemiology of extrapulmonary tuberculosis and enhances our understanding of the relative contribution of host-related factors to the pathogenesis of tuberculosis.

Imaging of abdominal tuberculosis

2001-07-07

Okan Akhan , J Pringot

Abdominal tuberculosis of the gastrointestinal tract: Revisited

2014-01-01

Uma Debi

occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera.Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis.Early diagnosis and initiation of antituberculous therapy and … occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera.Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis.Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality.Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases.Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important.We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.

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Intestinal Tuberculosis: Return of an Old Disease

1998-05-01

Karen D. Horvath , Richard L. Whelan

Objective: Tuberculosis (TB) can no longer be considered a rare disease in the United States due, in part, to the AIDS epidemic. Because the signs and symptoms of intestinal TB … Objective: Tuberculosis (TB) can no longer be considered a rare disease in the United States due, in part, to the AIDS epidemic. Because the signs and symptoms of intestinal TB are nonspecific, a high index of suspicion must be maintained to ensure a timely diagnosis. The aim of this article is to review the history, epidemiology, pathophysiology, and treatment of TB. Methods: This review is based on an examination of the world literature. Results: In only 20% of TB patients is there associated active pulmonary TB. Areas most commonly affected are the jejunoileum and ileocecum, which comprise >75% of gastrointestinal TB sites. Diagnosis requires colonoscopy with multiple biopsies at the ulcer margins and tissue sent for routine histology, smear, and culture. If intestinal TB is suspected, empiric treatment is warranted despite negative histology, smear, and culture results. Treatment is medical, and all patients should receive a full course of antituberculous chemotherapy. Exploratory laparotomy is necessary if the diagnosis is in doubt, in cases in which there is concern about a neoplasm, or for complications that include perforation, obstruction, hemorrhage, or fistulization. Conclusions: This review draws attention to the resurgence of tuberculosis in the United States. An increased awareness of intestinal tuberculosis, coupled with knowledge of the pathophysiology, diagnostic methods, and treatment should increase the number of cases diagnosed, thus improving the outcome for patients with this disease.

FEMALE GENITAL TUBERCULOSIS

1976-03-01

George Schaefer

Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical College, New York, New York Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical College, New York, New York

Tuberculous Peritonitis

1969-11-13

Madan M. Singh , A N BHARGAVA , Kranti P. Jain

Of 47 patients with tuberculous peritonitis followed for an average of three years x-ray examination showed a parenchymal pulmonary lesion in only 6 per cent. Barium-enema and barium-meal studies, intravenous … Of 47 patients with tuberculous peritonitis followed for an average of three years x-ray examination showed a parenchymal pulmonary lesion in only 6 per cent. Barium-enema and barium-meal studies, intravenous pyelography and salpingography revealed no tuberculous lesion in the adjacent organs in this series. With the use of about 1 liter of ascitic fluid, acid-fast bacilli were cultured in 83 per cent of the patients. Percutaneous peritoneal biopsy proved to be a simple and useful method of arriving at a quick diagnosis, and a caseating granuloma was demonstrated by this technic in 64 per cent. Other serous membranes were often involved in patients with tuberculous peritonitis. Pleural effusion was present in 32 per cent and cryptic pericarditis characterized by electrocardiographic changes only in 13 per cent. Antituberculous drugs were highly effective, and concomitant use of steroids prevented the late fibrotic complications of tuberculosis in the form of constrictive pericarditis and intestinal obstruction from adhesive bands.

Systematic review: tuberculous peritonitis – presenting features, diagnostic strategies and treatment

2005-09-30

Faisal M. Sanai , Khalid Bzeizi

Summary The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Peritoneal tuberculosis remains a significant problem in parts of the world where tuberculosis is prevalent. Increasing … Summary The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Peritoneal tuberculosis remains a significant problem in parts of the world where tuberculosis is prevalent. Increasing population migration, usage of more potent immunosuppressant therapy and the acquired immunodeficiency syndrome epidemic has contributed to a resurgence of this disease in regions where it had previously been largely controlled. Tuberculous peritonitis frequently complicates patients with underlying end‐stage renal or liver disease that further adds to the diagnostic difficulty. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation and the limitations of available diagnostic tests. A high index of suspicion is needed whenever confronted with unexplained ascites, particularly in high‐risk patients. Based on a systematic review of the literature, we recommend: tuberculous peritonitis should be considered in the differential diagnosis of all patients presenting with unexplained lymphocytic ascites and those with a serum‐ascites albumin gradient (SAAG) of <11 g/L; culture growth of Mycobacterium of the ascitic fluid or peritoneal biopsy as the gold standard test; further studies to determine the role of polymerase chain reaction, ascitic adenosine deaminase and the BACTEC radiometric system for acceleration of mycobacterial identification as means of improving the diagnostic yield; increasing utilization of ultrasound and computerized tomographic scan for the diagnosis and as a guidance to obtain peritoneal biopsies; low threshold for diagnostic laparoscopy; treatment for 6 months with the first‐line antituberculous drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in uncomplicated cases.

Textbook of Gastrointestinal Radiology

2008-10-14

Sahar Ghassemi

Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT Conflict of Interest: None. Financial Disclosure: None. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT Conflict of Interest: None. Financial Disclosure: None.

Diagnosis and Treatment of Extrapulmonary Tuberculosis

2015-01-01

Ji Yeon Lee

Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus … Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment. Keywords: Tuberculosis; Diagnosis; Therapeutics; Surgical Procedures, Operative

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Clinical, Endoscopic, and Histological Differentiations Between Crohn's Disease and Intestinal Tuberculosis

2010-01-19

Govind Makharia , Siddharth Srivastava , Prasenjit Das +7 more

The clinical, endoscopic, and histological features of Crohn's disease (CD) and intestinal tuberculosis mimic each other so much that it becomes difficult to differentiate between them. The aim was to … The clinical, endoscopic, and histological features of Crohn's disease (CD) and intestinal tuberculosis mimic each other so much that it becomes difficult to differentiate between them. The aim was to find out clinical, endoscopic, and histological predictor features for differentiation between CD and intestinal tuberculosis.We recruited 106 patients, 53 each with CD and intestinal tuberculosis, in this study. The clinical, histological, and endoscopic features were subjected to univariate, bivariate, and multivariate analyses. On the basis of regression coefficients of the final multivariate logistic model, a score to discriminate between CD and intestinal tuberculosis was devised. For the validation of the score, the same model was tested on 20 new patients, each with CD and intestinal tuberculosis.On univariate analysis, although longer duration of disease, chronic diarrhea, blood in stool, perianal disease, extra-intestinal manifestations, involvement of left colon, skip lesions, aphthous ulcers, cobblestoning, longitudinal ulcers, focally enhanced colitis, and microgranulomas were significantly more common in CD, partial intestinal obstruction, constipation, presence of nodular lesions, higher number, and larger granulomas were significantly more common in intestinal tuberculosis. On multivariate analysis, blood in stool (odds ratio (OR) 0.1 (confidence interval (CI) 0.04-0.5)), weight loss (OR 9.8 (CI 2.2-43.9)), histologically focally enhanced colitis (OR 0.1 (CI 0.03-0.5)), and involvement of sigmoid colon (OR 0.07(0.01-0.3)) were independent predictors of intestinal tuberculosis. On the basis of regression coefficients of the final multivariate logistic model, a score that varied from 0.3 to 9.3 was devised. Higher score predicted more likelihood of intestinal tuberculosis. Once the cutoff was set at 5.1, then the sensitivity, specificity, and ability to correctly classify the two diseases were 83.0, 79.2, and 81.1%, respectively. Area under the curve for receiver-operating characteristic (ROC) to assess the ability of these features to discriminate between CD and intestinal tuberculosis was 0.9089. The area under ROC in the validation data set was 89.2% (95% CI 0.79-0.99). With a similar cutoff score of 5.1, sensitivity and specificity in the validation model were 90% (95% CI 66.9-98.2) and 60% (95% CI 36.4-80.0), respectively.Blood in stool, weight loss, focally enhanced colitis, and involvement of the sigmoid colon were the most important features in differentiating CD from intestinal tuberculosis.

Differentiating Intestinal Tuberculosis From Crohn's Disease: A Diagnostic Challenge

2009-02-24

Majid A. Almadi , Subrata Ghosh , Abdulrahman Aljebreen

With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has increased, … With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has increased, and the morbidity and mortality resulting from a delayed diagnosis or misdiagnosis is considerably high. In this article, we examine the changing trends in the epidemiology of CD and ITB, in addition to clinical features that aid in the differentiation of both diseases. The value of various laboratory, serological, and the tuberculin skin tests are reviewed as well. The use of an interferon-gamma-release assay, QuantiFERON-TB Gold, in the workup of these patients and its value in populations where the bacillus Calmette-Guérin vaccine is still administered is discussed. Different radiological, endoscopic, and pathological similarities and features that can aid the clinician in reaching a rapid diagnosis are reviewed as well. The association between mycobacteria and CD, the concerns with the practice of antituberculosis medication trials in areas where tuberculosis (TB) is endemic, as well as extrapulmonary TB induced by the use of antitumor necrosis factor-alpha agents are delineated in this article. Furthermore, we propose an algorithm for the investigation of patients in whom the differential diagnosis encompasses CD and ITB.

Analysis of Colonoscopic Findings in the Differential Diagnosis Between Intestinal Tuberculosis and Crohn’s Disease

2006-06-01

Young Jin Lee , Shiang‐Yu Yang , Je-Yeon Byeon +7 more

Background and Study Aims: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value … Background and Study Aims: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Patients and Methods: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up. Results: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %). Conclusions: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.

Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals.

1984-01-01

Salvador Álvarez , William R. McCabe

During a 10-year period, 136 patients with extrapulmonary tuberculosis were seen at Boston City Hospital and other hospitals affiliated with Boston University School of Medicine. Review of these cases revealed … During a 10-year period, 136 patients with extrapulmonary tuberculosis were seen at Boston City Hospital and other hospitals affiliated with Boston University School of Medicine. Review of these cases revealed that the prevalence of extrapulmonary tuberculosis was declining less rapidly than that of pulmonary disease. Extrapulmonary disease represented 4.5% of all new cases of active tuberculosis and tended to occur in older patients than in previous reports. Sites of involvement included lymph nodes, blood, genitourinary tract, bone and articular sites, the meninges, peritoneum, adrenal glands, pericardium, and miscellaneous sites, in this order. Diagnosis was confirmed by a variety of techniques whose relative merits are discussed. Overall, 14 deaths occurred among the 136 patients. One-half of the deaths resulted from causes other than tuberculosis and two patients died before diagnosis and initiation of therapy. Evaluation of the relative efficacy of therapeutic regimens was hampered by a high degree of recidivism in this population and the multitude of regimens utilized. These observations indicate that extrapulmonary tuberculosis still occurs with substantial frequency among patients seen in "inner-city" hospitals and that its recognition may be complicated by its occurrence in older patients with other medical conditions.

Lymph node tuberculosis: A comparison of various methods of treatment

1977-12-01

I. A. Campbell , A.J. Dyson

Radiological manifestations of pulmonary tuberculosis

2004-06-17

Jordi Andreu , J. Cáceres , Esther Pallisa +1 more

Extrapulmonary Tuberculosis in Patients with Human Immunodeficiency Virus Infection

1991-11-01

Robert W. Shafer , Dong S. Kim , Jeffrey P. Weiss +1 more

Shafer, Robert W. M.D.; Kim, Dong S. M.D.; Weiss, Jeffrey P. M.D.; Quale, John M. M.D. Author Information Shafer, Robert W. M.D.; Kim, Dong S. M.D.; Weiss, Jeffrey P. M.D.; Quale, John M. M.D. Author Information

Pathology of intestinal tuberculosis and its distinction from Crohn's disease

1972-04-01

H. D. Tandon , A Prakash

Intestinal lesions of 212 cases presenting with symptoms of intestinal obstruction were studied. Of these, 159 cases were diagnosed as tuberculosis and 10 as Crohn's disease. Forty-three cases could not … Intestinal lesions of 212 cases presenting with symptoms of intestinal obstruction were studied. Of these, 159 cases were diagnosed as tuberculosis and 10 as Crohn's disease. Forty-three cases could not be classified into any of these entities and are excluded from this account. The amount of chemotherapeutic drugs received by each patient preoperatively was recorded. Cases proved as tuberculosis at the first operation were put on antituberculosis chemotherapy. Thirteen of these cases were operated on a second time, and tissue reactions under the influence of chemotherapy were studied. Fresh diseased tissue was studied for acid-fast organisms by culture and animal inoculation.Morphological features of the tuberculosis group are described in detail. Although the cases were broadly classified into the ulcerative and ulcerohypertrophic varieties, a distinction was not always sharp and the two types of lesions were at times found to coexist. The macroscopic features presented a very wide range, and at times distinction from Crohn's disease, especially in the ulcerohypertrophic variety, was difficult. Microscopically, however, they could be distinguished without much difficulty. Caseation, although a characteristic feature of tuberculous granulomas may, albeit rarely, be absent. Granulomas which are characteristically confluent may be present only in the mesenteric lymph nodes. Acid-fast organisms are not grown consistently from diseased tissues; where grown, they are of human type. Reparative changes during chemotherapy are described in detail; these follow a non-specific pattern. In the group of Crohn's disease, transmural cracks and fissures were consistently observed in all cases. Distinguishing features between the two diseases are discussed in detail.

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A NEW AND RAPID METHOD FOR THE ISOLATION AND CULTIVATION OF TUBERCLE BACILLI DIRECTLY FROM THE SPUTUM AND FECES

1915-01-01

S. A. Petroff

Sixty-nine positive cultures were obtained from sixty-nine specimens of sputum from practically all stages of tuberculosis. Six of these specimens were negative by direct microscopic examination, but the cultures gave … Sixty-nine positive cultures were obtained from sixty-nine specimens of sputum from practically all stages of tuberculosis. Six of these specimens were negative by direct microscopic examination, but the cultures gave positive findings. These six specimens have been positive for tubercle bacilli at some time. Nineteen positive cultures were isolated from thirty-two specimens of feces. All these thirty-two specimens, upon direct microscopical examination, gave positive findings, some showing only a few tubercle bacilli. Six specimens were not free from contaminating organisms, and the remaining seven were negative. The method presented in this paper has proved very simple and accurate for the isolation of tubercle bacilli from sputum. The partial success in isolating tubercle bacilli from feces may be due to the fact that many of the bacilli may be dead.

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The lung in inflammatory bowel disease

2000-01-01

P. Camus , Thomas V. Colby

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Primary tuberculosis in childhood: radiographic manifestations.

1992-01-01

Ann N. Leung , Néstor L. Müller , Pintag Rumiñahui Terán Pineda +1 more

The aim of the study was to review the radiologic features of primary tuberculosis in childhood and to determine whether differences in patterns of disease occur among age and ethnic … The aim of the study was to review the radiologic features of primary tuberculosis in childhood and to determine whether differences in patterns of disease occur among age and ethnic groups. Chest radiographs of 191 children with pediatric primary tuberculosis were reviewed by two observers. Lymphadenopathy, present in 92% of cases, was the most common abnormality identified on the initial chest radiograph and typically involved the hilar and paratracheal regions. Parenchymal abnormalities, identified in 70% of cases, occurred more commonly in the right lung (P less than .001). Children 0-3 years of age had a higher prevalence of lymphadenopathy (P less than .01) and a lower prevalence of parenchymal abnormalities (P less than .001) than older children. A lower prevalence of lymphadenopathy was found in whites than in nonwhites (P less than .02). The radiologic abnormalities often progressed in the initial follow-up. Lymphadenopathy, with or without concomitant parenchymal abnormality, is the radiologic hallmark of primary tuberculosis in childhood. However, distinct age-related and racial differences in presenting patterns of disease exist and should be recognized.

Tuberculous Peritonitis–Associated Mortality Is High among Patients Waiting for the Results of Mycobacterial Cultures of Ascitic Fluid Samples

2002-08-15

Kai Ming Chow , Viola Chi Ying Chow , Lawrence C.T. Hung +2 more

We identified 60 cases of tuberculous peritonitis during the past 12 years at our health care center. Most of the patients had severe underlying medical conditions, such as cirrhosis, renal … We identified 60 cases of tuberculous peritonitis during the past 12 years at our health care center. Most of the patients had severe underlying medical conditions, such as cirrhosis, renal failure, diabetes mellitus, and malignancy. Abnormal chest radiograph findings, ascitic fluid lymphocytosis, and biochemical findings for exudates could only identify 33%, 37%, and 53% of the cases, respectively. On the other hand, peritoneal biopsy allowed early definitive diagnosis for 9 patients. Thirty-one patients died, 26 of whom died ⩽6 weeks after their initial presentation, often before the result of mycobacterial culture was available. Only 8 patients died of advanced disease after antituberculous therapy was started. Univariate analysis showed that advanced age, underlying diagnosis, and delayed initiation of therapy were associated with higher mortality rates. Standard antituberculous chemotherapy is highly effective. However, conventional microbiologic diagnostic methods are slow and not sensitive enough for establishing a diagnosis of tuberculous peritonitis

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MEDIASTINAL FIBROSIS COMPLICATING HEALED PRIMARY HISTOPLASMOSIS AND TUBERCULOSIS

1972-05-01

Robert Goodwin , J Nickell , Roger M. Des Prez

From the Pulmonary Disease Section and Medical Service, VA Hospital, and the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 2Trainee in Infectious Diseases, VA Hospital, Nashville, Tennessee. … From the Pulmonary Disease Section and Medical Service, VA Hospital, and the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 2Trainee in Infectious Diseases, VA Hospital, Nashville, Tennessee. Present address; 1501 Summit Ave., Ft. Worth, Texas

Multiple roles of cord factor in the pathogenesis of primary, secondary, and cavitary tuberculosis, including a revised description of the pathology of secondary disease.

2006-01-01

Robert L. Hunter , Margaret Olsen , Chinnaswamy Jagannath +1 more

Tuberculosis, once thought to have been controlled, is now resurgent in many parts of the world. Many gaps exist in understanding the pathogenesis of tuberculosis, especially secondary and cavitary disease. … Tuberculosis, once thought to have been controlled, is now resurgent in many parts of the world. Many gaps exist in understanding the pathogenesis of tuberculosis, especially secondary and cavitary disease. Evidence presented here suggests that cord factor (trehalose 6,6'-dimycolate, TDM) is a key driver of these processes. It is the most abundant lipid released by virulent M. tuberculosis (MTB) and can switch between two sets of activities. On organisms, TDM is non-toxic and protects them from killing by macrophages. On lipid surfaces, it becomes antigenic and highly toxic. Caseating granulomas, the hallmark of primary tuberculosis, develop from interaction of TDM with lipid within granulomas. New evidence indicates that secondary tuberculosis begins as a lipid pneumonia that accumulates mycobacterial antigens and host lipids in alveoli before developing conditions for activation of the toxicity and antigenicity of TDM. This rapidly produces caseation necrosis that leads to cavities. Finally, virulent MTB release large amounts of TDM during growth as a pellicle within cavities. We propose that such growth results in activation of the toxicity and antigenicity of TDM at the air interface and that presence of the activated TDM perpetuates the cavity.

Abdominal tuberculosis: CT evaluation.

1985-10-01

Donald H. Hulnick , Alec J. Megibow , David P. Naidich +3 more

The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of … The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of intravenous drug abuse, alcoholism, acquired immunodeficiency syndrome (AIDS), cirrhosis, or steroid therapy. The etiologic agent was Mycobacterium tuberculosis in 23 patients and M. avium-intracellulare in four patients with AIDS. In five patients, tuberculosis was limited to the abdomen. CT findings included adenopathy, splenomegaly, hepatomegaly, ascites, bowel involvement, pleural effusion, intrasplenic masses, and intrahepatic masses. Characteristic features were a tendency for adenopathy to prominently involve peripancreatic and mesenteric compartments, low-density centers within enlarged nodes, complex nature of the ascites, and adenopathy adjacent to sites of gastrointestinal tract involvement. Recognition of these manifestations and maintenance of an index of suspicion, especially in patients at risk, should help optimize the correct diagnosis and management of intraabdominal tuberculosis.

Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis

1999-10-01

Anna Pulimood , Banumathi Ramakrishna , George Kurian +4 more

Intestinal tuberculosis and Crohn's disease are chronic granulomatous disorders that are difficult to differentiate histologically.To characterise distinctive diagnostic features of tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at … Intestinal tuberculosis and Crohn's disease are chronic granulomatous disorders that are difficult to differentiate histologically.To characterise distinctive diagnostic features of tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy.Selected histological parameters were evaluated retrospectively in a total of 61 biopsy sites from 20 patients with tuberculosis and 112 biopsy sites from 20 patients with Crohn's disease. The patients were chosen on the basis of clinical history, colonoscopic findings, diagnostic histology, and response to treatment.The histological parameters characteristic of tuberculosis were multiple (mean number of granulomas per section: 5.35), large (mean widest diameter: 193 microm), confluent granulomas often with caseating necrosis. Other features were ulcers lined by conglomerate epithelioid histiocytes and disproportionate submucosal inflammation. The features characteristic of Crohn's disease were infrequent (mean number of granulomas per section: 0.75), small (mean widest diameter: 95 microm) granulomas, microgranulomas (defined as poorly organised collections of epithelioid histiocytes), focally enhanced colitis, and a high prevalence of chronic inflammation, even in endoscopically normal appearing areas.The type and frequency of granulomas, presence or absence of ulcers lined by epithelioid histiocytes and microgranulomas, and the distribution of chronic inflammation have been identified as histological parameters that can be used to differentiate tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy.

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EXTRAPULMONARY TUBERCULOSIS IN THE UNITED STATES1

1979-02-01

Laurence S. Farer , Anthony M. Lowell , MARION P. MEADOR

In recent years, the decrease in reported tuberculosis in the United States has been due almost entirely to a drop in the number of cases of pulmonary disease. There has … In recent years, the decrease in reported tuberculosis in the United States has been due almost entirely to a drop in the number of cases of pulmonary disease. There has been little change in the average number of extrapulmonary cases reported. A retrospective survey of extrapulmonary tuberculosis has shown that it differs from pulmonary tuberculosis with regard to sex and race distribution, diagnosing physician's speciality and proportion of cases bacteriologically confirmed. There is variation within extrapulmonary cases according to specific anatomic site with regard to the above characteristics as well as age distribution. These epidemiologic differences in tuberculosis of different sites are unexplained.

CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis.

1996-09-01

Hyun Kwon Ha , Jung Im Jung , Myeong Soo Lee +5 more

The purpose of this study was to determine the potential of CT for distinguishing tuberculous peritonitis from peritoneal carcinomatosis in 135 clinically or pathologically proven cases.Abdominal CT scans in 135 … The purpose of this study was to determine the potential of CT for distinguishing tuberculous peritonitis from peritoneal carcinomatosis in 135 clinically or pathologically proven cases.Abdominal CT scans in 135 patients of tuberculous peritonitis (n = 42) and peritoneal carcinomatosis (n = 93) with documented omental, mesenteric, or peritoneal pathology were retrospectively reviewed. CT findings were evaluated in each group of patients for the morphologic appearance of mesenteric or omental abnormalities as well as for visualization of the spleen and liver, the lymph nodes, and ascites. Statistical comparisons using multivariate logistic regression analysis were performed to adjust for the differences in CT findings between the two groups.Mesenteric changes were more commonly seen in patients with tuberculous peritonitis (98%) than in patients with peritoneal carcinomatosis (70%) (p < .01). Micronodules (less than 5 mm in diameter) were noted in approximately one half of patients with tuberculous peritonitis or peritoneal carcinomatosis, but macronodules (> or = 5 mm in diameter) were much more frequently seen in patients with tuberculous peritonitis (52%) than in patients with peritoneal carcinomatosis (12%) (p < .01). The omentum appeared to be more irregularly infiltrated in peritoneal carcinomatosis patients (p < .01). The thin omental line covering the infiltrated omentum was seen in 13 patients with tuberculous peritonitis but in only four patients with peritoneal carcinomatosis (p < .01). In peritoneal or extraperitoneal masses in patients with tuberculous peritonitis, a low-density center was seen in 18 cases (43%) and calcification was noted in six cases (14%). The prevalences of splenomegaly and splenic calcification were higher in patients with tuberculous peritonitis. Using multivariate analysis, we calculated the sensitivity of CT for predicting tuberculous peritonitis and peritoneal carcinomatosis as 69% and 91%, respectively.Although most CT findings that we analyzed overlap these diseases, using a combination of CT findings increased our ability to distinguish tuberculous peritonitis from peritoneal carcinomatosis.

Abdominal tuberculosis: Imaging features

2005-05-24

José Miguel Pereira , António J. Madureira , Alberto Vieira +1 more

Colonoscopic study of 50 patients with colonic tuberculosis.

1992-03-01

Sudeep R. Shah , Varghese Thomas , M. Mathan +4 more

Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain … Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%). A nodular mucosa with areas of ulceration was the usual colonoscopic finding. Ileocaecal disease was found in 16, ileocaecal and contiguous ascending colon disease in 14, segmental colonic tuberculosis in 13, ileocaecal disease and non-confluent involvement of another part of the colon in five, and pancolitis in two patients. This report emphasises that colonoscopy is a useful procedure for diagnosing colonic tuberculosis and that segmental colonic tuberculosis is not uncommon.

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Abdominal tuberculosis. Experiences with 300 cases.

1977-04-01

Bhansali Sk

Problems in the management of abdominal tuberculosis are discussed with reference to 300 surgically verified cases. The protean clinical manifestations depend on the site and extent of the disease, and … Problems in the management of abdominal tuberculosis are discussed with reference to 300 surgically verified cases. The protean clinical manifestations depend on the site and extent of the disease, and its complications. Operation was resorted to for complications when diagnosis was in doubt and when intrinsic intestinal disease was proved. Surgery was preceded by antituberculous drugs whenever possible. At operation, the disease was found to involve the alimentary canal in 196 cases; in the remaining 104, only the lymph nodes and/or the peritoneum were affected. Intestinal resection was carried out in 100 cases. Emergency surgery carries a high mortality (18/76) because of toxemia, hypoproteinemia, anemia, etc. Positive histology was obtained in 229 cases. One hundred and seventy-nine cases showed evidence of caseation. Caseation and peritoneal tubercles (103 cases) differentiate intestinal tuberculosis from Crohn's disease. Despite considerable progress made in therapy and prophylaxis during the last quarter of the century, tuberculosis of various sites continues to be a major health hazard in India. The precise prevalence of Koch's disease of the abdomen has not been determined due to lack of a survey in random samples of population. This common malady, however, with its protean profiles and varied complications continues to challenge the diagnostic acumen and therapeutic skill of clinicians practicing various discplines of medicine.

Renal Pathology with Clinical and Functional Correlations.

1990-05-01

This important reference has been brought as up-to-date as possible, with more than one-third of the chapters completely rewritten. Renal Pathology, Second Edition is edited by specialists in renal medicine … This important reference has been brought as up-to-date as possible, with more than one-third of the chapters completely rewritten. Renal Pathology, Second Edition is edited by specialists in renal medicine and pathology and distinguished by an emphasis on correlating pathology to clinical findings. Covers normal renal structure and function and the clinical patterns of functional disturbances due to immunologic, infectious, vascular and metabolic causes. Helps the reader analyze renal biopsy specimens and define and categorize renal structural injury at its earliest stages. New in the second edition: new chapters on AIDS, renal tuberculosis, immunotactoid glomerulopathy, and malignancies and secondary development. Also included are 24 new color illustrations

Gastrointestinal Pathology

1991-01-01

Cecilia M. Fenoglio‐Preiser , Patrik Lantz , Margaret B. Listrom +2 more

Fenoglio-Preiser, C.; Lantz, P.; Listrom, M.; Davis, M.; Rilke, F. . Author Information Fenoglio-Preiser, C.; Lantz, P.; Listrom, M.; Davis, M.; Rilke, F. . Author Information

Value of Adenosine Deaminase (ADA) in Ascitic Fluid for the Diagnosis of Tuberculous Peritonitis

2006-08-29

Arnoldo Riquelme , Mario Calvo , Felipe Salech +7 more

Adenosine deaminase (ADA) levels are used for diagnosing tuberculosis in several locations and although many studies have evaluated ADA levels in ascitic fluid. These studies have defined arbitrary cut-off points … Adenosine deaminase (ADA) levels are used for diagnosing tuberculosis in several locations and although many studies have evaluated ADA levels in ascitic fluid. These studies have defined arbitrary cut-off points creating difficulties in the clinical application of the results. The goals of this study are: to determine the usefulness of ADA levels in ascitic fluid as a diagnostic test for peritoneal tuberculosis (PTB) and define the best cut-off point.A systematic review was done on the basis of 2 independent searches. We selected prospective studies that included consecutive patients. Diagnosis of PTB had to be confirmed by bacteriologic or histologic methods and ADA levels determined by the Giusti method. Inclusion/exclusion criteria were applied by 2 independent reviewers. A receiver operating characteristic curve was constructed to establish the optimal cut-off point and the likelihood ratios (LRs) estimated using fixed-effect pooled method.Twelve prospective studies were found. Four of them met the inclusion criteria and were thus included in the meta-analysis. They included 264 patients, of which 50 (18.9%) had PTB. ADA levels showed high sensitivity (100%) and specificity (97%) using cut-off values from 36 to 40 IU/L. The included studies were homogeneous. Optimal cut-off point was determined at 39 IU/L, and LRs were 26.8 and 0.038 for values above and below this cut-off.This study supports the proposition that ADA determination is a fast and discriminating test for diagnosing PTB with an optimal cut-off value of 39 IU/L.

RADIOLOGIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS

1995-07-01

H. Page McAdams , Jeremy Erasmus , James A. Winter

A clinical dilemma: abdominal tuberculosis

2003-01-01

Oya Uygur‐Bayramiçli

To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.Thirty-one patients diagnosed as abdominal TB between March 1998 and … To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul, Turkey were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests, Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of ascites, upper gastrointestinal endoscopy, colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed.The median age of patients (14 females,17 males) was 34.2 years (range 15-65 years). The most frequent symptoms were abdominal pain and weight loss. Eleven patients had active pulmonary TB. The most common abdominal USG findings were ascites and hepatomegaly. Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2 %). Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients. Colonoscopy performed in 20 patients showed ulcers in 9 (45 %), nodules in 2 (10 %) and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one patient (5 %). Laparoscopy on 4 patients showed dilated bowel loops, thickening in the mesentery, multiple ulcers and tubercles on the peritoneum. Patients with abdominal TB were divided into three groups according to the type of involvement. Fifteen patients (48 %) had intestinal TB, 11 patients (35.2 %) had tuberculous peritonitis and 5 (16.8 %) tuberculous lymphadenitis. The diagnosis of abdominal TB was confirmed microbiologically in 5 (16 %) and histo-pathologically in 19 patients (60.8 %). The remaining nine patients (28.8 %) had been diagnosed by a positive response to antituberculous treatment.Neither clinical signs, laboratory, radiological and endoscopic methods nor bacteriological and histopathological findings provide a gold standard by themselves in the diagnosis of abdominal TB. However, an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of this insidious disease which primarily necessitate a clinical awareness of this serious health problem.

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Chemotherapy of tuberculosis

1964-12-01

William H. Feldman

[X-ray microscopy].

1986-01-01

Bru Villaseca L

WHO classification of tumours of the lung, pleura, thymus and heart

2015-01-01

William D. Travis

Extrapulmonary tuberculosis

2005-10-24

Michael Cotton

I read, with great interest, the documented advantages and cost-effectiveness of early discharge following breast surgery.In our Caribbean setting, bed shortages and cost implications have forced us to look into … I read, with great interest, the documented advantages and cost-effectiveness of early discharge following breast surgery.In our Caribbean setting, bed shortages and cost implications have forced us to look into early discharge for these patients.In 203 consecutive patients under going axillary clearance with either mastectomy or segmentectomy, the mean hospitalisation was 22 h (including 18 h postoperative stay).Because we have neither district nor hospital-based nursing care at home, a responsible relative (and/or the patient herself) is taught to empty and reseal the suction drain.All patients are afforded telephone contact with our surgical office.We have had 2 cases where the drain inadvertently dropped out at home -one on the 2nd and the other on the 7th postoperative day.The former required repeated aspiration as an out-patient; no patient needed re-admission.In another 2 cases, patients experienced leakage around the drain site; this only necessitated a change of dressing.In my view, not only is early discharge possible but there is little gain in keeping the patient beyond 24 h.Moreover, one can further reduce cost of home care by teaching the patient or a responsible relative how to manage the drain.

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Extrapulmonary Tuberculosis Revisited

1984-01-01

Salvador Álvarez , William R. McCabe

From the Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts 1 Chief of Infectious Diseases and Medical Microbiology, Instituto Nacional de Cardiologia, Mexico 22, … From the Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts 1 Chief of Infectious Diseases and Medical Microbiology, Instituto Nacional de Cardiologia, Mexico 22, DF 2 Director, Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital Professor of Medicine & Microbiology, Director of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.

Risk of cancer after tuberculosis disease among people with HIV in Denmark: a nationwide population-based cohort study

2025-06-26

Christian Kraef , Lars Haukali Omland , Anders Porskrog +7 more | The Journal of Infectious Diseases

Abstract Background The long-term cancer risk following TB disease in people with HIV remains unclear. We aimed to assess cancer risk following TB in a nationwide cohort of people with … Abstract Background The long-term cancer risk following TB disease in people with HIV remains unclear. We aimed to assess cancer risk following TB in a nationwide cohort of people with HIV in Denmark. Methods We conducted a population-based cohort study including all individuals enrolled in the Danish HIV Cohort Study from 1995–2020. TB and cancer diagnoses were identified through nationwide registries. Incidence rates (IRs) and adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for time-varying CD4 count, age, sex, and Charlson Comorbidity Index (CCI). Additionally, we calculated aIRRs stratified by age-group, sex, CCI and CD4-count. Results Among 6,135 people with HIV (median age: 37.1 years, 74.1% male), 319 had a TB diagnosis. During 62,878 person-years of follow-up (PYFU), 451 cancers were observed, including 55 lung cancers. The overall cancer IR among people with HIV without previous TB disease was 18.6 per 1,000 PYFU (95%confidence interval: 16.9–20.4), and 19.0 per 1,000 PYFU (95%CI: 10.4–25.6) among people with HIV following TB (aIRR: 1.1, 95%CI: 0.7–1.8). For lung cancer, the aIRR after TB was 1.7 (95%CI: 0.5–5.5). In stratified analyses, aIRRs were slightly higher among women (1.3, 95%CI: 0.6–2.9) and those aged ≥50 years (1.4, 95%CI: 0.8–2.4). Conclusion In this nationwide cohort of more than 6,000 people with HIV followed for up to 25 years, we observed no increased risk of cancer following TB disease. These findings do not support changes to continued standardized cancer surveillance in people with HIV and TB.

Pulmonary Tuberculosis and Lung Abscess: A Case Report

2025-06-24

Alifyah Alza Adawiya Latuconsina , Erlin Syahril , Dwi Anggita | The International Journal of Medical Science and Health Research

A 49-year-old woman presented to the hospital with a chief complaint of dyspnea that began in the morning. She reported a history of hemoptysis, initially manifesting as clots equivalent to … A 49-year-old woman presented to the hospital with a chief complaint of dyspnea that began in the morning. She reported a history of hemoptysis, initially manifesting as clots equivalent to approximately one tablespoon, which has since diminished to blood-streaked sputum. A notable episode of hemoptysis had occurred one year prior, for which she was prescribed Anti-Tuberculosis Treatment (ATT). The patient has experienced a chronic cough since the previous year, with associated dyspnea during severe coughing episodes. She also reported intermittent fever. A thoracic examination revealed a normochest configuration with symmetric respiratory movements. Palpation identified decreased tactile fremitus in the right hemithorax. Percussion was hyperresonant and dull over the medial aspect of the right hemithorax. On auscultation, vesicular breath sounds were present bilaterally (+/+), with additional rhonchi noted (+/+) but no wheezing (-/-). Cardiac sounds I/II were pure and regular, with no additional sounds. A chest X-ray revealed cloudy opacities across both lungs, with a distinct patch containing an air-fluid level in the right lung. The heart size was normal, both sinuses were clear, and the right diaphragm was well-defined, while the left diaphragm showed tenting. The skeletal structures appeared intact. The radiological impression was pneumonia, a right lung abscess, and old left-sided tuberculosis.

Syphilis as Rare Cause of Pyogenic Liver Abscess

2025-06-24

D. Meyer , Michele Granada | Emerging infectious diseases

Syphilis has a wide range of possible symptoms, making it difficult to diagnose. We report a rare case of liver abscess secondary to Treponema pallidum in a man in Minnesota, … Syphilis has a wide range of possible symptoms, making it difficult to diagnose. We report a rare case of liver abscess secondary to Treponema pallidum in a man in Minnesota, USA, who had well-controlled HIV infection. This case emphasizes the importance of appropriate screening for syphilis, especially in high-risk populations.

Esophageal Tuberculosis Mimicking Malignancy in an Immunocompetent Patient: A Case Report

2025-06-23

Soraya Gioftsiou , Maryam Faiz , Zineb Malki +1 more | Cureus

Tuberkulosis Paru Aktif Dengan Anemia Mikrositik Hipokrom Pada Remaja 16 Tahun : Sebuah Laporan Kasus

2025-06-22

Andi Muhammad Aqil Anwar , Muhammad Alfian Jafar , Floria Eva | The Indonesian Journal of General Medicine

Pendahuluan: Tuberkulosis (TB) merupakan penyakit infeksi menular yang masih menjadi beban kesehatan global, dengan Indonesia menempati peringkat kedua tertinggi jumlah kasus TB di dunia. Anak dan remaja termasuk kelompok rentan … Pendahuluan: Tuberkulosis (TB) merupakan penyakit infeksi menular yang masih menjadi beban kesehatan global, dengan Indonesia menempati peringkat kedua tertinggi jumlah kasus TB di dunia. Anak dan remaja termasuk kelompok rentan yang sering menunjukkan gejala tidak khas, sehingga diagnosis sering terlambat. TB paru sering disertai anemia, terutama anemia mikrositik hipokrom, yang dapat memperburuk kondisi klinis dan respons terapi. Laporan Kasus: Dilaporkan seorang remaja perempuan usia 16 tahun datang dengan keluhan demam naik turun, batuk, sesak napas, mual, muntah, serta penurunan berat badan 5 kg dalam sebulan. Riwayat kontak erat dengan penderita TB paru ditemukan. Pemeriksaan fisik menunjukkan konjungtiva anemis, ronki paru, dan retraksi dinding dada. Pemeriksaan penunjang menunjukkan infiltrat pada kedua lapang paru, serta anemia mikrositik hipokrom (Hb 7,8 g/dL, MCV 65,4 fL). Diagnosis ditegakkan sebagai tuberkulosis paru aktif dengan anemia mikrositik hipokrom. Hasil: Pasien diberikan terapi antituberkulosis sesuai pedoman WHO dan IDAI, yaitu HRZE selama 2 bulan diikuti HR selama 4 bulan. Anemia ditangani dengan pemberian transfuse PRC sebanyak 2 x 250 mL dengan interval 12 jam disertai 10mg/iv 30 menit sebelum transfusi untuk mencegah kelebihan cairan. Edukasi dan pemantauan terapi turut diberikan untuk meningkatkan kepatuhan. Kesimpulan: Kasus ini menegaskan pentingnya deteksi dini TB pada remaja, terutama pada pasien dengan riwayat kontak dan gejala sistemik. Penatalaksanaan terpadu terhadap TB dan anemia memberikan hasil klinis yang baik dan mencegah komplikasi jangka panjang.

Corrigendum to “Recombinant BCGΔBCG1419c protects outbred mice against M. tuberculosis challenge” [Vaccine 61 (2025) 127347]

2025-06-21

Sherry L. Kurtz , Victoria Gould , Mario Alberto Flores‐Valdez +1 more | Vaccine

Gastrointestinal Tuberculosis: Clinical Presentations and Diagnostic Approaches

2025-06-20

Timur Gonchar , Mauro Sidney De Robertis , Carola Güther +2 more | Journal of Clinical Medicine

Background: Gastrointestinal tuberculosis (GI TB) is a rare form of extrapulmonary TB that often mimics other conditions, such as Crohn’s disease (CD) or GI malignancies. Conventional diagnostics, like direct microscopy … Background: Gastrointestinal tuberculosis (GI TB) is a rare form of extrapulmonary TB that often mimics other conditions, such as Crohn’s disease (CD) or GI malignancies. Conventional diagnostics, like direct microscopy and culture, are often inconclusive or slow, delaying treatment. In Germany, a low-incidence country, GI TB is underrecognized. Rising migration has led to a resurgence of TB cases, increasing the likelihood of encountering extrapulmonary presentations. This study evaluates the performance and utility of various diagnostic tools and proposes a diagnostic approach to reduce delays and avoid unnecessary interventions. Methods: We retrospectively analyzed eight patients suspected of GI TB based on clinical presentation and testing. Two recent cases are described in detail to highlight diagnostic and therapeutic challenges. Results: GI TB was confirmed in five cases (62.5%), and all the patients presented with abdominal complaints, with the majority experiencing systemic symptoms such as weight loss or fever. Histopathology supported the diagnosis in all GI TB cases, while PCR testing was positive in four. Direct microscopy detected acid-fast bacilli in only one case. The remaining patients were diagnosed with latent genital TB, disseminated TB without GI involvement, or were ruled out clinically. Conclusions: GI TB remains a diagnostic challenge that often mimics other conditions, such as CD or malignancy. Early use of histopathology and PCR in patients with a high risk of GI TB is critical for timely diagnosis. In low-incidence settings like Germany, clinicians should maintain high suspicion in at-risk populations (e.g., migrants from areas or immunocompromised patients), especially when symptoms mimic CD or malignancy, to improve outcomes and avoid unnecessary procedures.

Analysis of the onset characteristics and diagnosis of 217 cases of renal tuberculosis

2025-06-20

Chongbin Li , Guiyun Zhu , Jianzhen Liu +7 more | European journal of medical research

To explore the latest characteristics and diagnostic methods of renal tuberculosis, and to improve the new recognition and diagnostic level of renal tuberculosis. We collected the medical records and postoperative … To explore the latest characteristics and diagnostic methods of renal tuberculosis, and to improve the new recognition and diagnostic level of renal tuberculosis. We collected the medical records and postoperative histopathological slides of 217 patients diagnosed and treated with renal tuberculosis in the Department of Urology of Hebei Provincial Chest Hospital from March 25, 2013 to February 6, 2024, and divided them into the typical group (145 cases) and the atypical group (72 cases) according to their onset characteristics, and analyzed the distribution of onset symptoms and the differences in the positive rates of different examination methods between these two groups. (1) Frequency, urgency and pain of urination were the main symptoms in the typical group (66.82%), and local or systemic atypical symptoms in the atypical group (33.18%), and the incidence rate of women in the atypical group was higher than that in the typical group (P < 0.05). (2) In both groups, the positive rate of CT diagnosis of renal tuberculosis was higher than that of ultrasound and urography (P < 0.05), and there was no statistically significant difference between the positive rates of T-SPOT.TB and PPD tests (P > 0.05). The CT positivity rate in the typical group was higher than that in the atypical group (P < 0.05). In the typical group GeneXpert MTB/RIF had a higher positive rate than that of PCR TB-DNA, acid-fast staining and tuberculosis culture (P < 0.05). However, in the atypical group and all patients in both groups, there was no statistical difference between the positivity rates of GeneXpert MTB/RIF and PCR TB-DNA (P > 0.05), both of which were higher than those of acid-fast staining and TB culture (P < 0.05). The positivity rate of acid-fast staining and tuberculosis culture was higher in the typical group than that in the atypical group (P < 0.05). In the typical group, the positivity rate of LAM antibody was higher than that of 38KDa and 16KDa (P < 0.05). However, in the atypical group, there was no statistically significant difference between the positivity rates of 38KDa and LAM antibodies (P > 0.05), and both were higher than that of 16KDa antibodies (P < 0.05). (3) There was no significant difference in pathological changes between the two groups, both of which were dominated by granulomas and caseous necrosis, and the positivity of tissue PCR TB-DNA was higher than that of antacid staining (P < 0.05), but there was no statistically significant difference in the positivity of tissue PCR TB-DNA between the two groups (P > 0.05). Cystoscopic biopsy was dominated by granuloma and necrosis in the typical group and chronic inflammation in the atypical group. (1) In addition to renal tuberculosis with bladder irritation as the main clinical manifestation, atypical renal tuberculosis is also an important part of renal tuberculosis, which is characterized by systemic or local atypical symptoms, and should be highly concerned. (2) CT, GeneXpert MTB/RIF, T-SPOT.TB (or PPD test) and LAM antibody have higher sensitivity both in typical and atypical renal tuberculosis, which can improve the diagnosis rate of renal tuberculosis. (3) There is no significant difference in the pathologic changes between typical and atypical renal tuberculosis, and PCR TB-DNA of the tissues may help to improve the pathologic diagnosis of renal tuberculosis. In atypical renal tuberculosis, bladder mucosal lesions are characterized by chronic inflammation, and cystoscopic biopsy alone is of low diagnostic value.

Breast Tuberculosis in a 21-Year-old Female Patient: A Case Report

2025-06-19

S R Vinutha , Saranya Ravi , B D Manjunath | Asian Journal of Case Reports in Surgery

Urinary lipoarabinomannan: A novel diagnostic tool for distinguishing gastrointestinal tuberculosis from Crohn’s disease

2025-06-19

Mukesh Kumar Singh , Manjeet Kumar Goyal , Himanshu Narang +7 more | Indian Journal of Gastroenterology

Abdominal tuberculosis in children: a systematic review on current advances

2025-06-18

Vinod Raj , Shilpa Sharma | Pediatric Surgery International

Abses Paru Pada Pasien Tuberkulosis Dengan Diabetes Melitus Yang Tidak Terkontrol

2025-06-14

Christy Efiyanti , Asysyukriati Prawiro , Khansa Kiasati Chandra Syahbunan +4 more | JUKEJ Jurnal Kesehatan Jompa

The coexistence of tuberculosis (TB) and diabetes mellitus (DM) increases the risk of severe lung complications such as pulmonary abscess. Aim: This study evaluates the outcomes of such cases, emphasizing … The coexistence of tuberculosis (TB) and diabetes mellitus (DM) increases the risk of severe lung complications such as pulmonary abscess. Aim: This study evaluates the outcomes of such cases, emphasizing the effectiveness of combined therapeutic approaches. Methods: This retrospective study reviewed 121 patients diagnosed with TB and DM treated at a hospital in Depok City between January 2023 and April 2024. The study included four patients with confirmed lung abscesses. Diagnosis was established using clinical and supporting examination analyses. We monitored the patients for up to nine months after initiating treatment. All patients received standard TB and DM therapy along with intravenous antibiotics for two weeks and continued with oral antibiotics for six weeks. Results: Radiological findings consistently showed lung cavities with fluid levels and thick walls. Clinical outcomes demonstrated substantial improvement in all cases, with resolution of abscesses and symptom alleviation. Patients with lung abscesses who received early, combination treatment with antibiotics and medication for TB and DM had positive results. Conclusion: In our study, the administration of antibiotics for eight weeks, alongside simultaneous treatment for TB and DM, led to significant clinical improvement. Further research is warranted to management of lung abscesses in patients with TB and DM and intravenous antibiotics as the first-line approach.

Frequency of Tuberculosis in End Stage Renal Disease (ESRD) Patients: A Cross Sectional Study

2025-06-12

Murik Rani Tanwani | Journal of the Dow University of Health Sciences

Case Report: Isolated hepatic tuberculoma mimicking malignancy in HBV-related chronic liver disease: a challenging case report

2025-06-11

Hajer Hassine , N. Krifa , Alia Zehani +7 more | F1000Research

<ns5:p>Hepatic tuberculosis is a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection. It can clinically and radiologically mimic primary hepatic malignancies, particularly in patients with underlying chronic liver disease. Herein, we … <ns5:p>Hepatic tuberculosis is a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection. It can clinically and radiologically mimic primary hepatic malignancies, particularly in patients with underlying chronic liver disease. Herein, we report the case of an 81-year-old man with a history of compensated advanced chronic liver disease secondary to hepatitis B virus infection, treated with Entecavir, who presented with rapid clinical decline, weight loss, and a newly discovered hepatic mass. Imaging revealed a heterogeneous, necrotic lesion in segment IV, classified LR-M on LI-RADS, highly suggestive of malignancy. However, histopathology from a liver biopsy showed granulomatous inflammation with caseating necrosis, confirming the diagnosis of hepatic tuberculosis. No evidence of extrahepatic tuberculosis $ was found. The patient received a full 9-month course of anti-tuberculous therapy with complete clinical and radiological resolution. This case highlights the diagnostic challenge of hepatic tuberculosis in cirrhotic patients, especially when mimicking hepatocellular carcinoma or cholangiocarcinoma. Liver biopsy remains essential in atypical instances to avoid unnecessary interventions.</ns5:p>

Isolated splenic tuberculosis in a patient with rheumatoid arthritis

2025-06-01

Y Toyota , Akihiro Ito , Tadashi Ishida | IDCases

Tuberculosis in pregnancy: a growing concern

2025-06-01

Muhammad jamshaid Khan , Syed Qamar Uddin , Omneya Elsayed Bioumy Ahmed | Journal of the Pakistan Medical Association

Tuberculosis (TB) remains one of the most prevalent diseases globally, with an estimated 10.6 million new cases reported in 2022.1 The causative agent is the bacterium Mycobacterium tuberculosis, and its … Tuberculosis (TB) remains one of the most prevalent diseases globally, with an estimated 10.6 million new cases reported in 2022.1 The causative agent is the bacterium Mycobacterium tuberculosis, and its classic symptoms include cough, fever, dyspnoea, chills, stabbing chest pain, and weight loss.2 Although TB is generally considered a curable disease, it can be fatal if left untreated, particularly if contracted during pregnancy. Tuberculosis can affect all stages of female reproduction.3 Therefore, screening and diagnosis are crucial in reducing morbidity and mortality. While pregnancy does not affect disease progression or susceptibility, the outcomes of pregnancy can be severely impacted by TB.4 A meta-analysis conducted by S Sobhy in 2017 demonstrated that active TB in pregnant women significantly increases the risk of maternal morbidity, antenatal admission, miscarriage, anaemia, perinatal death, birth asphyxia, and caesarean delivery.5 Another US-based study led by Erika M. Dennis et al. investigated the effects of active TB on pregnant and non-pregnant women. The study, which comprised 4058 cases, found that active TB in pregnancy resulted in an 80% higher risk of pregnancy complications in pregnant women compared to non-pregnant women. Moreover, the rate of in-hospital deaths among TB-infected pregnant individuals was 37 times higher than that of non-infected pregnant women. These complications included severe eclampsia, severe pre-eclampsia, and postpartum haemorrhage.6 These studies highlight a pressing concern and emphasize the need for measures to mitigate the effects of TB on pregnancy. As TB predominantly affects disadvantaged populations, it is prevalent in underdeveloped and developing countries, such as Pakistan. Consequently, physicians must be aware of how TB can impact diagnosis, prognosis, treatment, and pregnancy outcomes. Furthermore, physicians should educate the general population about TB during pregnancy and prioritize their efforts towards pregnant women who are highly susceptible, such as those residing in impoverished areas or with infected individuals. A more effective approach would involve collaboration between obstetricians, gynaecologists, healthcare providers, and infectious disease specialists. Pregnant women should undergo TB screening if they exhibit symptoms or live in close proximity to TB-infected individuals. These measures will contribute to eradicating the spread of TB and its adverse effects, as well as preventing the transmission of multidrug-resistant TB.

Extra-pulmonary Tuberculosis Diagnostic Dilemma in an Immunocompetent Patient – A Case Report

2025-06-01

Anjali Patond , Vijayshri Deotale , Ruchita Attal | Journal of Pure and Applied Microbiology

One of the biggest risks to public health is tuberculosis (TB), an infectious disease caused by the Mycobacterium tuberculosis bacteria. As one of the most communicable diseases in the present … One of the biggest risks to public health is tuberculosis (TB), an infectious disease caused by the Mycobacterium tuberculosis bacteria. As one of the most communicable diseases in the present day, tuberculosis has historically claimed more lives than any other infectious disease, leading to high rates of morbidity and mortality. Despite being present, it is still disregarded by clinicians as a cause of extrapulmonary tuberculosis. This case report focuses on an atypical presentation of an extrapulmonary tuberculosis (EPTB) infection in the form of a soft tissue mass presenting as a chest wall abscess in an immunocompetent person. This case was identified and managed appropriately. This atypical case presentation without lung involvement indicates that a complete case analysis is necessary. In this case, diagnosis was established using microbiological methods, molecular, imaging, and histopathological diagnosis. However, this example clarifies an essential lesson that the shift is beginning from pulmonary to extrapulmonary tuberculosis cases.

Chronic granulomatous cervicitis mimicking cervical cancer: A rare case diagnosed by single-port laparoscopy

2025-06-01

Junhan Liu , Ying Zheng | Asian Journal of Surgery

Preventing the risk of tuberculosis with teriflunomide: is pre-treatment screening necessary?

2025-06-01

Marlène Damin-Pernik , Erik Mayer , Anne Dautriche +3 more | Therapies

The Case of the Terribly Treatable Tumors! A Case Report

2025-06-01

Nisha Jose , Manish Lalwani , H Goldwin +5 more | Kidney Medicine

Aspects diagnostiques de la tuberculose péritonéale chez les patients hospitalisés dans le service de médecine interne du Centre Hospitalo-Universitaire de Kamenge au Burundi

2025-05-30

M Amani , AN Ishimwe , M Manirakiza +1 more | Journal of African clinical cases and reviews.

La tuberculose reste un problème de santé publique au Burundi. Nous rapportons une étude est descriptive rétrospective ayant inclus 58 patients hospitalisés pour suspicion d’une tuberculose péritonéale devant une ascite … La tuberculose reste un problème de santé publique au Burundi. Nous rapportons une étude est descriptive rétrospective ayant inclus 58 patients hospitalisés pour suspicion d’une tuberculose péritonéale devant une ascite lymphocytaire exsudative qui ont été amélioré et guéri après un traitement anti tuberculeux, recensés dans le service de méde-cine interne du Centre Hospitalo-Universitaire de Kamenge, entre Juillet 2019 et décembre 2022, soit une période de 42mois. Sur 397 qui ont été traités pour tuberculose toutes formes confondues et (58) 14,6% pour tuber-culose péritonéale. L’âge moyen des patients était de 37,7 ans, le sex ratio H/F de 0,4. (22/58)37,9% avaient un terrain d’immunodépression au VIH. La fièvre dans (47/58) 81%, l’augmentation du volume abdominal dans (26/58) 44,8% et les douleurs abdominales dans (25/58) 43,1%.La matité déclive des flancs dans (41/58) 70,7% des cas, était le signe le plus retrouvé. L’échographie a objectivé une ascite chez tous les patients, seules les ascites de moyenne et de grande abondance ont été explorées. Le liquide d’ascite était exsudatif dans (31/32) 96,8 % et lymphocytaire dans (31/32) 96,8 % des cas. La tuberculose péritonéale était isolée dans (13/58) 22,4% et associée à une ou plu-sieurs autre(s) localisation(s) tuberculeuse(s) dans (35/58) 77,6% de cas. L’hémogramme montrait une anémie inflammatoire dans (33/40) 82,5 %. La prise en charge thérapeutiques de nos patients a été constituée d’un traitement médical selon le programme na-tional de lutte anti tuberculeuse associée à la corticothérapie en cas d’atteinte péricardique. L’évolution était favorable dans tous les cas sous traitement anti tuberculeux Le but de ce travail est de décrire les aspects diagnostiques de la tuberculose péritonéale chez les patients hospitalisés dans le service de Médecine Interne au Centre Hospitalo-Universitaire de Kamenge. Mots-clés : tuberculose péritonéale, Ascite exsudative, ascite lymphocytaire.

Isolated biliary tuberculosis: a rare case report and diagnostic challenges

2025-05-29

Omer Usman , Muhammad Abdul Basit , Maryam Mazhar +6 more | Annals of Medicine and Surgery

Introduction and importance: Biliary tuberculosis is a rare form of Mycobacterium tuberculosis infection, accounting for only 0.0–0.1% of all TB cases in certain settings. Its preoperative diagnosis is difficult due … Introduction and importance: Biliary tuberculosis is a rare form of Mycobacterium tuberculosis infection, accounting for only 0.0–0.1% of all TB cases in certain settings. Its preoperative diagnosis is difficult due to nonspecific symptoms and the lack of specific imaging criteria. Often, it mimics other diseases like cancers and infections, complicating early detection. Case Presentation: A 51-year-old female with a past medical history of diabetes mellitus, hypothyroidism, and a biliary stricture following stent placement presented with nausea, vomiting, loss of appetite, and weight loss for 4 months. A CT scan revealed an indwelling common bile duct (CBD) stent, mild intrahepatic biliary ductal dilatation, and pneumobilia. An endoscopic retrograde cholangiopancreatography (ERCP) procedure was performed with stent exchange. Initial CBD biopsy showed chronic inflammation, but both biopsy and fine-needle aspiration (FNA) were negative for malignancy. A subsequent ERCP with additional biopsies also returned negative results for malignancy, though CBD brushing tested positive for M. tuberculosis . Clinical discussion: The diagnosis of biliary tuberculosis is challenging due to its nonspecific presentation. In this case, the positive result for M. tuberculosis in the CBD brushing led to the diagnosis, even after negative biopsy and FNA results. Early recognition of hepatobiliary tuberculosis is crucial as it enables conservative management with stents and anti-tuberculosis therapy (ATT). Conclusion: Biliary tuberculosis, although rare, should be considered in patients with unexplained biliary symptoms. Timely diagnosis through appropriate diagnostic procedures can lead to effective treatment with ATT and stenting, improving patient outcomes, and preventing more invasive treatments.

Laparoscopic combined nephroureterectomy with transurethral resection of the distal part of the ureter in the treatment of genitourinary tuberculosis

2025-05-29

O. N. Zuban , М. А. Прокопович , R. M. Chotchaev +1 more | Tuberkulez i socialʹno značimye zabolevaniâ

Purpose of the study . To conduct a comparative analysis of the results of laparoscopic and open combined nephroureterectomy with transurethral resection of the orifice (distal part) of the ureter. … Purpose of the study . To conduct a comparative analysis of the results of laparoscopic and open combined nephroureterectomy with transurethral resection of the orifice (distal part) of the ureter. Materials and methods . The results of surgical treatment of 61 patients for renal tuberculosis were analyzed. 30 patients underwent nephrectomy using laparoscopic access (main group), 31 patients underwent nephrectomy using open access (control group). Results . Removal of a kidney affected by tuberculosis along with the ureter, regardless of the chosen access, leads to a significant leveling of dysuria. The advantages of the laparoscopic method are: reduction in the volume of intraoperative blood loss, a more significant impact on all components of quality of life in comparison with the open technique.

CD39 REGULATES P2RX7-MEDIATED LUNG NECROTIC LESIONS IN SEVERE EXPERIMENTAL TUBERCULOSIS

2025-05-29

Gislane de Almeida Santos , Igor Santiago-Carvalho , Fabrício Moreira Almeida +7 more | bioRxiv (Cold Spring Harbor Laboratory)

Tuberculosis induces diverse lesions, such as necrotic pneumonia, contributing to disease progression and transmission. Despite advances in understanding the role of ATP-gated P2RX7 ion channels in developing severe forms of … Tuberculosis induces diverse lesions, such as necrotic pneumonia, contributing to disease progression and transmission. Despite advances in understanding the role of ATP-gated P2RX7 ion channels in developing severe forms of tuberculosis, the regulation of this important signaling pathway remains unclear. Herein, we show that the ectonucleotidase CD39 plays an essential regulatory role in TB progression by preventing lung tissue damage, bacterial dissemination, and excessive inflammatory responses. Mechanistically, through its enzymatic activity on the cellular surface, CD39 protects infected macrophages from undergoing necrotic death mediated by P2RX7 activation. We proposed that by protecting macrophages from P2RX7mediated cell death and bacterial dissemination, CD39 prevents the development of necrotic lesions. Altogether, these findings uncover a significant role for CD39 as an essential component of the molecular regulation underlying the development of severe tuberculosis

84-jährige Patientin mit ringförmigen Fremdkörpern auf der Röntgenaufnahme

2025-05-28

Klaus Muehlenberg , Niels Zorger , Oliver Pech

Diagnostic and Therapeutic Strategies for Solitary Pulmonary Nodules Mimicking Malignancy: Insights from Two Cases of Pulmonary Tuberculosis

2025-01-01

Xianlei Wang , Ying Zhang , Huan Zhang +2 more | IDCases