Diabetes mellitus (DM) has been reported to modify the presenting features of pulmonary tuberculosis (PTB), but data regarding the effect of diabetes on the presentation of PTB are highly variable.
To determine whether DM alters the demographic, clinical, and radiological manifestations of tuberculosis and whether the effect of diabetes varies with the age group of PTB patients.
Materials and Methods :
This prospective observational study was conducted on new smear-positive PTB patients with DM (PTB-DM group) and non-diabetic PTB patients (PTB group). Patients of both groups were again divided into six age groups (15–29, 30–39, 40–49, 50–59, 60–69, and >70 rears) to analyze and compare the impact of age on clinicoradiological presentations of PTB.
Patients in the PTB-DM group were significantly older (53.34 ± 14.06 year) in comparison to their nondiabetic counterparts (PTB group) (44.35 ± 18.14 year) (P < 0.001). The former group also had a lower male:female ratio, although the difference was not statistically significant (1.16:1 vs. 2.05:1, P = 0.101). Tuberculin positivity was significantly higher in the PTB group, compared with patients in the PTB-DM group (P < 0.004). The proportion of patients with lower lung field involvement (P = 0.003) and cavitations (P = 0.005) was also higher in the former group compared with the latter.
Diabetic patients with tuberculosis were relatively older, had lower tuberculin positivity, and higher proportion of lower lung field involvement and cavitation in comparison to nondiabetic patients.
Comparative study; diabetes mellitus; pulmonary tuberculosis; radiology
To assess the feasibility and results of screening diabetes mellitus (DM) patients for tuberculosis (TB) and TB patients for DM within the routine health care setting. Prospective observational study carried out within the Diabetes Centre and Pulmonary Medicine Department from February 2012 to September 2012. The screening for active TB in DM and DM in TB patients is followed as per the guidelines of the Revised National Tuberculosis Control Programme and national programmes in India. Total of 307 patients diagnosed with TB during the study period. Among the TB patients 9.77% were smokers, 19.54% were known cases diabetes, and 15.96% were newly diagnosed cases of diabetes. Total of 4,118 diabetes patients were screened for TB in which 111 patients found to have TB. The strengths of this study are that we implemented screening within the routine health system. It is feasible to screen DM patients for TB resulting in high rates of TB detection.
Diabetes mellitus; India; Prevalence; Tuberculosis
Hemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB.
We retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis.
The overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis.
BAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.
Aspergillosis; Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Tuberculosis
Emphysematous cystitis occurs mostly in diabetics with poor glycemic control or in immunocompromised patients. In most cases, diabetes mellitus correlates with the occurrence of emphysematous cystitis. The risk of relapse after tuberculosis cure or treatment completion is high among patients with diabetes mellitus.
A 64-year-old diabetic man suffering from high fever and lower abdominal pain was admitted to the emergency ward. Due to the results of radiographic examinations, he was diagnosed with an emphysematous cystitis. Although the emphysematous cystitis improved with urinary drainage and antibiotic therapy, the high fever recurred and respiratory symptoms appeared. This patient was diagnosed with a crisis of the pulmonary tuberculosis. He was started on the antituberculosis therapy, and he recovered.
This is the first report of a case of emphysematous cystitis that was complicated with pulmonary tuberculosis.
emphysematous cystitis; pulmonary tuberculosis
Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. We conducted a retrospective cohort study of patients with active, culture-confirmed tuberculosis (TB) in Maryland to determine the impact of DM on TB treatment outcomes. Of 297 TB patients, 42 (14%) had DM. Patients with diabetes had 2.0 times higher odds of death than patients without diabetes (95% confidence interval [CI] 0.74–5.2, P = 0.18). Adjusting for human immunodeficiency virus (HIV), age, weight, and foreign birth, the odds of death were 6.5 times higher in patients with diabetes than patients without diabetes (95% CI 1.1–38.0, P = 0.039). In pulmonary TB patients, time to sputum culture conversion was longer in patients with diabetes than patients without diabetes (median 49 versus 39 days, P = 0.09). Two-month culture conversion proportions were similar (70% and 69%). Treatment failure occurred in 4.1% of patients without diabetes and 6.7% of patients with diabetes (P = 0.51). In conclusion, DM was a risk factor for death in Maryland TB patients. There was a trend toward increased time to culture conversion; two-month culture conversion proportions, however, were similar.
Pulmonary tuberculosis is still the most common form of tuberculosis in HIV infected patients having different presentations according to the degree of immunosuppression. This study appraised the impact of HIV infection on clinical, laboratory and radiological presentations of tuberculosis.
The clinical, laboratory and radiological presentations of pulmonary TB in 56 HIV-infected patients were compared with 56 individually sex and age matched HIV-seronegative ones, admitted to Imam Hospital in Tehran (1999–2006) using paired t-test in a case control study.
All cases and the controls were male. Fever was found in 83.9% of the HIV positive patients compared to 80% of the HIV negative ones. Cough was the most common clinical finding in the HIV negative group (89.3% vs. 82.1% in HIV positive group). Among radiological features, cavitary lesions, upper lobe and bilateral pulmonary involvement were observed significantly less often in the HIV-infected group. On the contrary, lymphadenopathy was just present in the HIV positive group in this series of patients (12%) and primary pattern tuberculosis was more common, as well (71% vs. 39%, P= 0.02). The Tuberculin test was reactive in 29% of the HIV/TB patients.
The coexistence of both infections alters the picture of tuberculosis in many aspects and should be taken into account when considering a diagnosis of HIV infection and its potential for TB co-infection, and vice-versa.
Pulmonary Tuberculosis; HIV; TB and HIV; Iran
To determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM).
We conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection.
The prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred.
Given the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.
Prospective observation analysis to evaluate the cure in tuberculous cervical lymphadenopathy with directly observed treatment short course category III (DOTS CAT III) treatment as per revised national tuberculosis control program (RNTCP) at a tertiary care hospital in AP, India, from October 2007 to September 2009. These cases were followed up for period of 22 months.
Materials and Methods:
Total 1521 tuberculous cases were screened in KIMS both pulmonary and extra pulmonary cases out of which 146 cases were tuberculous lymphadenitis. Fifty cases of tuberculous cervical lymphadenopathy were included after diagnostic and treatment algorithm and fine needle biopsy or excision biopsy. Patients below 5 yrs, immunocompromised, having diabetes mellitus, pulmonary tuberculosis and with other co-morbid conditions were excluded from the study. All patients were put on DOTS CAT III as per RNTCP guidelines. Follow-up was done every 2 months till 6 months for 1) Constitution symptoms 2) Weight gain or loss 3) Appetite gain or loss 4) Regression of lymph nodes or increase 5) Compliance 6) Side effects 7) Failures by demonstration of organism by direct smear, culture or histopathological examination.
In this study, lymph node regression was found in 78% at the end of 2 months, 94% at the end of 4 months and 96% at the end of 6 months, 9 patients had regression in size though the nodes were palpable, 2 had no regression but fresh lymph nodes appeared on the same side and sinus discharge was present, culture was negative in these cases. Two cases had immune reconstitution syndrome, constitutional symptoms disappeared and showed clinical improvement. Four cases were subjected for surgical intervention.
DOTS CAT III is effective in the treatment of tuberculous cervical lymphadenopathy. Compliance was good with minimal, minor side effects, only two had immune reconstitution syndrome and two had sinus formation; they were referred for surgical intervention, and follow-up of 22 months did not show any relapses.
Biopsy; cervical lymphadenopathy; DOTS; immune reconstitution syndrome; tuberculosis
The association between pulmonary tuberculosis (PTB) and diabetes mellitus (DM) has been previously attracted much attention. Diabetes alters immunity to tuberculosis, leading to more frequent treatment failure in TB patients with DM. Moreover, TB and DM often coincide with micronutrients deficiencies, such as retinol and vitamin D, which are especially important to immunity of the body and may influence pancreas β-cell function. However, the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes, immune and nutrition state are still uncertain. We are conducting a randomized controlled trial of vitamin A and/or D in active PTB patients with DM in a network of 4 TB treatment clinics to determine whether the supplementation could improve the outcome in the patients.
This is a 2×2 factorial trial. We plan to enroll 400 active PTB patients with DM, and randomize them to VA (2000 IU daily retinol); VD (400 IU daily cholecalciferol); VAD (2000 IU daily retinol plus 400 IU cholecalciferol) or control (placebo) group. Our primary outcome measure is the efficacy of anti-tuberculosis treatment and ameliorating of glucose metabolism, and the secondary outcome measure being immune and nutrition status of the subjects. Of the first 37 subjects enrolled: 8 have been randomized to VA, 10 to VD, 9 to VAD and 10 to control. To date, the sample is 97.3% Han Chinese and 91.9% female. The average fasting plasma glucose level is 12.19 mmol/L.
This paper describes the design and rationale of a randomized clinical trial comparing VA and/or VD supplementation to active pulmonary TB patients with DM. Our trial will allow rigorous evaluation of the efficacy of the supplementation to active TB and DM therapy for improving clinical outcomes and immunological condition. This detailed description of trial methodology can serve as a template for the development of future treatment scheme for active TB patient with DM.
Pulmonary tuberculosis; Diabetes mellitus; Retinol; Cholecalciferol; Randomized controlled trial
Tuberculosis (TB) is an infectious disease which is still a major cause of morbidity and mortality throughout the world. People with diabetes mellitus (DM) have a three times higher risk of developing active TB than people without diabetes. However, there is not enough credible information on the burden of pulmonary tuberculosis (PTB) among DM patients in Ethiopia, in general, and in the city of Dessie, in particular. Therefore, this study aims to determine the prevalence and associated risk factors of smear positive PTB among diabetic patients at a referral hospital in Dessie.
A cross-sectional study was conducted from February 2012 to April 2012. Patient demographic characteristics were collected using a pre-tested standard questionnaire format. Spot-morning-spot sputum specimens were collected from the study participants and examined for acid-fast bacilli using direct microscopy by the Ziehl-Neelsen staining technique. Data was entered and analyzed using the SPSS version 16 statistical software and p-value <0.05 was considered as statistically significant.
Out of 225 TB suspected diabetic patients, 52% were males and 48% were females. Their ages ranged from 12 to 82 years, with a mean age of 47.2 years. Urban residence (AOR: 5.5; 95% CI: 1.07–28.20), history of TB (AOR: 13.4; 95% CI: 2.74–65.73), contact with TB patients in the family (AOR: 9.4; 95% CI: 1.822–48.50), and long duration of DM (AOR: 8.89; 95% CI: 1.88–58.12) were independently associated with the development of active TB in people living with DM.
The prevalence of smear positive PTB was 6.2% in TB suspected diabetic patients, which is higher compared with the general population (0.39%). Patients with a previous history of contact with TB patients, as well as those who had prolonged diabetes, were more prone to have PTB. Therefore, screening of diabetic patients for PTB infection during follow-up is necessary.
Dessie; Diabetic patients; Ethiopia; Pulmonary tuberculosis (PTB)
Chronic renal failure is a common sequel of renal inflammatory disease or diabetes mellitus. As a result of the immunosuppression that is induced by uremia, hemodialysis or posttransplant immunosuppressive medication, these patients are at a higher risk of opportunistic infections. Various viral, bacterial and mycobacterial infections have been reported. Tuberculosis is a common systemic opportunistic infection but reports of ocular involvement with pulmonary or disseminated tuberculosis are rare. We report the systemic and ocular findings in two postrenal-transplant patients with pulmonary or disseminated tuberculosis in whom detection of choroidal tubercles led to confirmation of the diagnosis in both patients and was the only specific premortem finding in one. Fundoscopy in this group of patients may help in the diagnosis of opportunistic tuberculosis, its earlier treatment and the consequent reduction of morbidity and mortality.
Ocular; opportunistic; renal allograft; tuberculosis
Diabetes mellitus (DM) is a major risk factor for tuberculosis (TB) but the defect in protective immunity responsible for this has not been defined. We previously reported that streptozotocin (STZ)-induced DM impaired TB defense in mice, resulting in higher pulmonary bacterial burden, more extensive inflammation, and higher expression of several pro-inflammatory cytokines known to play a protective role in TB. In the present study, we tested the hypothesis that DM leads to delayed priming of adaptive immunity in the lung-draining lymph nodes (LN) following low dose aerosol challenge with virulent M. tuberculosis (Mtb). We show that Mtb-specific IFN-γ-producing T cells arise later in the LN of diabetic mice than controls, with a proportionate delay in recruitment of these cells to the lung and stimulation of IFN-γ-dependent responses. Dissemination of Mtb from lung to LN was also delayed in diabetic mice, although they showed no defect in dendritic cell trafficking from lung to LN after LPS stimulation. Lung leukocyte aggregates at the initial sites of Mtb infection developed later in diabetic than in non-diabetic mice, possibly related to reduced levels of leukocyte chemoattractant factors including CCL2 and CCL5 at early time points post-infection. We conclude that TB increased susceptibility in DM results from a delayed innate immune response to the presence of Mtb-infected alveolar macrophages. This in turn causes late delivery of antigen-bearing APC to the lung draining LN and delayed priming of the adaptive immune response that is necessary to restrict Mtb replication.
The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.
Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent.
A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption.
The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.
In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.
We prospectively followed-up new patients of tuberculosis while on maintenance hemodialysis at a State Government-run tertiary care institute. Between 2000 and 2010, 1237 new patients were initiated on maintainence hemodialysis. The number of patients diagnosed with tuberculosis after initiation of hemodialysis was 131 (10.5% of 1237). The age was 46.4 ± 10.4 (range 8-85) years and there were 90 (68.7%) males. The number of patients diagnosed with tuberculosis on the basis of organ involvement were: Pulmonary-60, pleural effusion-31, lymph node-21, meningitis-8, pericardial effusion-7, peritoneum-2, latent tuberculosis-2. The incidence of tuberculosis in hemodialysis was found to be 105.9 per 1000 patient years. Male gender, diabetes mellitus, past history of tuberculosis, mining as an occupation, low serum albumin, and duration of hemodialysis more than 24 months, and unemployment were found to be significant risk-factors on univariate analysis.
Hemodialysis; latent tuberculous infection; tuberculosis; tuberculin skin test
Tuberculosis (TB) is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country.
Materials and Methods:
A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ≥15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV) infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients.
Among 715 registered TB patients, 375 (52.5%) patients were male; among those, 334 (53%) were in the alive group and 41 (54%) in the death group. Seventy-five (10.5%) of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5), positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6), smoking (AOR: 12.9, 95% CI: 3.9-27.3), drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7), diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0), drug use (AOR: 7.8, 95% CI: 2.4-25.5), and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3) were major risk factors for death in TB patients.
Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease mortality. Follow-up of patients with previous TB treatment is recommended.
Tuberculosis; mortality; risk factors
This article describes the clinical, epidemiologic, laboratory, and treatment characteristics of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Eastern North Carolina, a primarily rural area. The database was obtained for 1988-1992 from the University Medical Center of Eastern North Carolina-Pitt County and East Carolina University School of Medicine (the tertiary care referral center for this region). One hundred thirty-eight culture-positive patients were enrolled in the study; 56% were PTB and 44% were EPTB. African-American males constituted 59% of the population. Sixty-nine percent of the patient base were uninsured. There was a bimodal age distribution of < 40 and > 60 years of age. Factors associated with PTB (reported as odds ratios) were white males (2.5), diabetes mellitus (5.4), and cancer (5.1). Factors associated with EPTB (reported as odds ratios) were African-American females, positive human immunodeficiency virus (HIV) serology (8.7), low hematocrit (32.6), and elevated alkaline phosphatase (199). This study emphasizes that in the latest resurgence of tuberculosis, impoverished rural areas, which have been ignored in earlier and present control efforts, are important reservoirs of disease.
There is a documented increase of diabetes mellitus in Sub Saharan Africa, a region where tuberculosis is highly endemic. Currently, diabetes mellitus is one of the recognised risk factors of tuberculosis. No study has reported the magnitude of diabetes mellitus among tuberculosis patients in Uganda, one of the countries with a high burden of tuberculosis.
This was a cross-sectional study conducted among 260 consenting adult patients with a confirmed diagnosis of tuberculosis admitted on the pulmonology wards of Mulago national referral and teaching hospital in Kampala, Uganda to determine the prevalence of diabetes mellitus and associated clinical factors. Laboratory findings as well as the socio-demographic and clinical data collected using a validated questionnaire was obtained. Point of care random blood sugar (RBS) testing was performed on all the patients prior to initiation of anti tuberculosis treatment. Diabetes mellitus was diagnosed if the RBS level was ≥ 200mg/dl in the presence of the classical symptoms of diabetes mellitus.
The prevalence of diabetes mellitus among the admitted patients with tuberculosis was 8.5%. Only 5 (1.9%) patients with TB had a known diagnosis of diabetes mellitus at enrolment. Majority of the study participants with TB-DM co-infection had type 2 diabetes mellitus (n=20, 90.9%).
At bivariate analysis, raised mean ALT concentrations of ≥80 U/L were associated with DM (OR-6.1, 95% CI 1.4-26.36, p=0.032) and paradoxically, HIV co-infection was protective of DM (OR-0.32, 95% CI 0.13-0.79, P=0.016). The relationship between DM and HIV as well as that with ALT remained statistically significant at multivariate analysis (HIV: OR- 0.17 95%CI 0.06-0.51, p=0.002 and ALT: OR-11.42 95%CI 2.15-60.59, p=0.004).
This study demonstrates that diabetes mellitus is common among hospitalized tuberculosis patients in Uganda. The significant clinical predictors associated with diabetes mellitus among tuberculosis patients were HIV co-infection and raised mean serum alanine transaminase concentrations.
In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining seven patients (25%) had radiological changes consistent with pulmonary tuberculosis, but no miliary shadows. Of those who completed chemotherapy, only five (42%) received 18 months' treatment. Nine patients (32%) died from their miliary tuberculosis. Failure to consider the diagnosis, leading to a delay in starting chemotherapy, appeared to be a major problem.
The development and evaluation of rapid and accurate new diagnostic tools is essential to improve tuberculosis (TB) control in developing countries. In a previous study, the first release of a urine LAM-ELISA by Chemogen (Portland, USA) has been evaluated with a promising sensitivity and specificity for the diagnosis of pulmonary TB. In the present study, the now commercially available assay has been clinically assessed regarding its diagnostic value alone and in combination with clinical co-factors.
The test was applied to two urine samples from 291 consecutively enrolled Tanzanian patients with suspected pulmonary tuberculosis. The participants were subsequently assigned to classification groups according to microbiological, clinical and radiological findings at recruitment and during a maximum follow up period of 56 days.
Only 35 out of 69 pulmonary TB cases -confirmed by smear microscopy and/or solid culture and/or liquid culture- showed at least one positive LAM-ELISA result (sensitivity 50.7%). The sensitivity was noticeably higher in females (66.7%) and in HIV positive participants (62.0%). The specificity amounted to 87.8% and was determined in participants with negative results in all microbiological tests and with sustained recovery under antibiotic treatment at day 56. Correlation with urinalysis revealed that proteinuria was significantly and positively associated with LAM-positivity (P = 0.026).
This commercially available generation of LAM-ELISA does not appear to be useful as an independent diagnostic test for pulmonary tuberculosis. The question whether the assay is suitable as a supplemental device in the diagnosis of HIV-associated TB, requires further investigations.
Most cases of adult-onset tuberculosis (TB) result from reactivation of a pre-existing Mycobacterium tuberculosis infection. Mycobacterium tuberculosis usually invades the respiratory tract and most patients develop intrapulmonary TB; however, some patients develop concurrent pulmonary and extra-pulmonary TB. The purpose of the present study was to identify the demographic and clinical factors associated with an increased risk of concurrent extra-pulmonary diseases in patients with pulmonary TB. We compared patients who had isolated pulmonary TB with patients who had concurrent pulmonary and extra-pulmonary TB. We initially analyzed one-million randomly selected subjects from the population-based Taiwan National Health Insurance database. Based on analysis of 5414 pulmonary TB patients in this database, women were more likely than men to have concurrent extra-pulmonary TB (OR: 1.30, p = 0.013). A separate analysis of the Kaohsiung Medical University Hospital database, which relied on sputum culture-proven pulmonary TB, indicated that women were more likely than men to have concurrent extra-pulmonary TB (OR: 1.62, p = 0.039). There was no significant gender difference in extra-pulmonary TB for patients younger than 45 years in either database. However, for patients 45 years and older, women were more likely than men to have concurrent extra-pulmonary TB (insurance database: 9.0% vs. 6.8%, p = 0.016, OR: 1.36; hospital database: 27.3% vs. 16.0%, p = 0.008, OR = 1.98). Our results indicate that among patients who have pulmonary TB, older females have an increased risk for concurrent extra-pulmonary TB.
A young Caucasian adult presented to the Accident and Emergency department with small bowel obstruction, which necessitated an exploratory laparotomy. Multiple firm nodules were found with biopsies leading to a diagnosis of peritoneal tuberculosis (TB). Retrospectively, the patient was noted to have classical radiological pulmonary TB findings on a chest radiograph 3 months previously, and 2 weeks later had developed bony infiltration, paravertebral abscesses and likely TB skin lesions.
This case illustrates an unusual presentation in a patient with minimal risk factors yet widespread extra-pulmonary disease. It also highlights the importance of attentive reviewing of x-rays.
BACKGROUND: A study was undertaken to determine if there are differences in the radiological appearances at presentation between pulmonary infections caused by Mycobacterium kansasii and Mycobacterium tuberculosis. Correct recognition of the organism has important implications with regard to initial therapy and contact tracing. METHODS: The initial chest radiographs of 28 patients with pulmonary M kansasii infection were compared with those of 56 age, sex, and race matched patients with M tuberculosis infection. All patients in both groups were culture positive and none was known to be HIV positive. The radiographs were analysed independently by two radiologists who were unaware of the causative organism. RESULTS: Radiographic abnormalities in patients with M kansasii infection were more frequently unilateral and right side predominant, while those with tuberculosis more frequently involved a lower lobe. Air space shadowing involving more than one bronchopulmonary segment and pleural effusions were seen less frequently in M kansasii infection (four of 28 (14%) versus 30 of 56 (54%) and none of 28 versus 15 of 56 (27%)). Cavitation (21 of 28 (75%) versus 34 of 56 (61%) was seen to a similar extent in patients with M kansasii infection and in those with tuberculosis. Cavities tended to be smaller in patients with M kansasii infection (p < 0.01). CONCLUSIONS: Differences are seen in the radiographic appearances of pulmonary infection caused by M kansasii and M tuberculosis. These differences are not sufficient to allow a positive diagnosis on the basis of radiographic findings alone, but the presence of a pleural effusion or lower lobe involvement makes M kansasii infection very unlikely.
Tuberculosis is a disease with protean manifestations. We present a case which was initially suspected as bronchogenic carcinoma with lymphangitic carcinomatosis, based on radiological appearance but later diagnosed as pulmonary tuberculoma with military tuberculosis and silicosis after thoracotomy and open lung biopsy. The patient was treated successfully with Antituberculosis Therapy (ATT). Rarity of presentation in form of pulmonary tuberculoma co-existing with histological features of miliary tuberculosis and silicosis, led us to report this case.
Miliary tuberculosis; Pulmonary tuberculoma; Silicosis
Background: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare. A greater awareness of this rare clinical entity may prevent needless surgical intervention.
Aims: To help characterise this distinctly rare presentation of tuberculosis, five new cases are presented, together with a review of the world literature. The clinical, laboratory, radiological, and pathological features of these patients are described.
Methods: Polymerase chain reaction (PCR) assay of the liver tissue was carried out in all cases to confirm an aetiological diagnosis of Mycobacterium tuberculosis infection.
Results: All five patients (44–71 years old; two women, three men) underwent surgery, and had a preoperative diagnosis of malignant hepatic neoplasm and a postoperative histological diagnosis of chronic granulomatous inflammation, suggestive of tuberculosis. None of them had a known previous history of tuberculosis. All of them were positive for M tuberculosis by PCR analysis of the liver tissue.
Conclusions: This report illustrates the difficulty in reaching a correct preoperative diagnosis. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver, especially when it coexists with other malignancies. A high index of suspicion is required for diagnosis, which can be made only by histological and bacteriological studies, and PCR analysis.
Polymerase chain reaction; hepatic granulomatous inflammation; hepatic tuberculoma; hepatic tuberculosis