Search

Abstract: Tuberculosis (TB) remains a significant global health concern and kills millions of people every year. While TB can affect any organ in the body, breast TB is relatively uncommon. This study presents a comprehensive review of literature spanning 23 years, with a focus on cases of breast TB in Iran. Among the 96 cases found, the majority (89.6%) fell within the age range of 20-60, with a striking prevalence among women (98.9%). Common symptoms included pain and palpable mass, each presenting in approximately 60.4% of cases. Notably, only a quarter of patients had a confirmed history of exposure to a known TB case. Left breast involvement was more prevalent (58.3%), with ipsilateral lymph node enlargement observed in 40.6% of cases. Given the clinical presentation of breast TB, which often leads to misdiagnosis, a significant proportion of cases (68.7%) were diagnosed through excisional biopsy. Following a standard 6-month regimen of anti-TB drugs, relapse occurred in only 4.2% of cases. This study highlights the need for heightened awareness and vigilance in diagnosing breast TB, especially in regions with a high burden. Although breast TB poses diagnostic challenges, with prompt identification and treatment, the prognosis is generally favorable, with a low incidence of relapse., (Copyright © 2024 Copyright: © 2024 International Journal of Mycobacteriology.)

Background: Recent pandemic of coronavirus SARS-CoV-2 (COVID-19) caused limitations in the country's strategies to fight against mycobacterial infections. The aim of this study was to compare the suspected tuberculosis (TB) pulmonary patients before and during the COVID-19 pandemic (January 2018-December 2021) who were referred to the National Reference TB Laboratory (NRL TB), Tehran, Iran. The mycobacterial isolated strains were identified and compared with previous data., Methods: A total of 16,899 clinical samples collected from 7041 suspected pulmonary TB patients were received from 2018 to 2021. Primary isolation of Mycobacterium isolates was done on Löwenstein-Jensen medium. Then, the DNA was extracted from acid-fast bacillus culture-positive samples and identification was performed by IS6110, Hsp65, and 16S-23S rRNA genes using polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism, and nested PCR methods., Results: A total of 11679 specimens (69.1%) from 4866 suspected TB patients were collected in 2018-2019 and 5220 specimens (30.8%; from 2175 patients) in 2020-2021. Out of 11679 specimens, 2046 samples that belong to 852 patients were infected with Mycobacterium tuberculosis, and the remaining were non-TB Mycobacterium (NTM) species (n = 244) isolated from 102 patients. The cultures for 12894 specimens were either negative (76.3%) or contaminated (845/16899; 5%). A comparison of the total number of patients who were referred for diagnosis and treatment (954/666 patients, P > 0.05) showed a 30.1% reduction during the COVID-19 pandemic. Although, with these low number of patients, the significant increases of NTM species (P < 0.05) among suspected TB pulmonary patients were observed. Besides, new species of NTM, for example, Mycobacterium peregrinum and Mycobacterium montefiorense, were detected. For the past 20 years, these two species were not reported from pulmonary patients in Iran., Conclusions: During the pandemic of COVID-19, the TB diagnosis network became irregular, as a consequence, many patients could not reach the treatment center, and this could increase the circulation of mycobacterial diseases (TB and NTM). The study shows the emergence of new opportunistic NTM species also., Competing Interests: None

Introduction: Tuberculosis (TB) remains one of the most important infectious causes of death throughout the world. A wide range of technologies have been used for the diagnosis of TB. However, current diagnostic tests are inadequate. The aim of this study was to evaluate the expression of four genes, namely ASUN, NEMF, PTPRC and DHX29 as candidate biomarkers for the diagnosis of Latent tuberculosis infection (LTBI) and active TB and discrimination of active TB and LTBI. ; Materials and Methods: The expression of the mentioned four genes as well as ACTB as a housekeeping gene was evaluated by real-time PCR. Receiver operating characteristic (ROC) curve analysis was conducted to assess the specificity and sensitivity of each validated biomarker. ; Results: Our results showed that the expression of theASUN gene could discriminate between active TB cases and healthy BCG vaccinated volunteers with an AUC value of 0.76, combing with a sensitivity of 68% and a specificity of 67%. It should be noted that the PTPRC gene also has the potential for the diagnosis of active TB with an AUC value of 0.67 and a sensitivity of 64.5% and a specificity of 70%. The curve revealed that cases with LTBI could be distinguished from healthy BCG vaccinated volunteers according to their expression of the ASUN gene with an AUC value of 0.81. The cut-off value for diagnosing was 11, with a sensitivity of 73% and a specificity of 79%. Moreover, the expression of the NEMF gene might be considered as a diagnostic tool for the diagnosis of LTBI. The analysis showed an AUC value of 0.75. The highest sensitivity (60%) and specificity (81%) were obtained with a cut off value of 12. ; Conclusion: According to our results, the expression of ASUN and NEMF genes might be considered as a diagnostic tool for the diagnosis of LTBI. Our study showed that the expression of ASUN and PTPRC was obviously higher in active TB patients than those in healthy BCG vaccinated controls. On the other hand, DHX29 and PTPRC genes might be helpful in differentiating active TB and LTBI. However, our findings deserve further validation in larger studies., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Tuberculosis (TB) is one of the leading infectious causes of death worldwide and despite the progress recently made in TB control at a global level, the decline in its incidence is still slow. It is therefore crucial to evaluate the performance of new tools for monitoring of TB treatment. The aim of this study was to evaluate the response to tuberculosis treatment using the QuantiFERON-TB Gold Plus (QFT-Plus) kit. Blood samples of 100 patients with active TB were taken before treatment and after three months, if treatment was successful and sputum culture was negative. Whole blood was incubated in the presence or absence of the TB antigens, TB1 and TB2-specific antigens, and the production of IFN-γ was determined using the QuantiFERON-TB Gold Plus (QFT-Plus) test. The data were analyzed using SPSS 16 software and statistical significance was assessed at a two-tailed P value of 0.05. The median values of IFN-γ released following stimulation with TB1 peptides decreased slightly after treatment (2.5 IU/mL (IQR: 0.9-5.3), compared to the baseline (3.4 IU/mL (IQR: 0.5-6.6)). Also, with respect to the TB1 antigen, 38 out of 45 patients were positive for the QFT test before treatment (84.4%) and 37 cases after treatment (82.2%). On the other hand, the median values of IFN-γ determined with the TB2 test declined marginally after treatment (2.7 IU/mL; IQR: 0.95-5.8), as compared to pretreatment (3.0 IU/mL; IQR: 0.7-8.9). Thirty-nine out of 45 patients (86.7%) before initiation of treatment and 37 cases following a 3-month treatment (82.2%) were had positive values. Moreover, the median values of IFN-γ of TB2 minus TB1 before and after treatment were 0.17 (IQR: 0-1.0) and 0.03 (IQR: 0.0.48), respectively; however, these differences were not significant (p value=0.29). Conclusion: The results of this study show no significant differences between the IFN-γ release in TB patients prior to and after treatment. However, more extensive studies are needed in different populations with higher sample sizes to validate these results.

Introduction: Several studies have been conducted to find new biomarkers for the discrimination of Latent Tuberculosis Infection (LTBI) from active TB (ATB); however, their findings are inconsistent. The aim of the current study was to evaluate the potential of in vitro antigenspecific expression of Monocyte Chemotactic Protein (MCP)-2 for discrimination of ATB and LTBI after stimulation of whole blood with PE35 and PPE68 recombinant proteins., Materials and Methods: The recombinant PE35 and PPE68 proteins were evaluated at a final concentration of 5 µg/ml by a 3-day whole blood assay. Secreted MCP-2 from the culture supernatants were measured by commercially available Human MCP2 ELISA Kit. The diagnostic performance of MCP-2 was ascertained by Receiver Operator Characteristic (ROC) curve and measuring the Area Under the Curve (AUC) and their 95% Confidence Intervals (CI). Cut-offs was estimated at various sensitivities and specificities and at the maximum Youden's index (YI), i.e. sensitivity specificity-1., Results: The median MCP-2 response to both PE35 and PPE68 in those with LTBI was significantly higher than patients with ATB. The discrimination performance of MCP-2 response following stimulation of PE35 (assessed by AUC) between LTBI and patients with ATB was 0.98 (95%CI: 0.94-1.00). Maximum discrimination was reached at a cut-off of 86pg/mL with 100% sensitivity and 97% specificity. The highest sensitivity and specificity was obtained using cut off 58 pg/mL following stimulation with PPE68 (100% and 90%, respectively; AUC: 0.94, 95%CI: 0.85- 1.00)., Conclusion: MCP-2 induced by PE35 and PPE68 shows good discriminatory power for discrimination of ATB and LTBI. Additional studies with a larger sample size are needed to confirm the advantage of this marker, alone or combined with other markers; however, these findings present a promising method, which can discriminate between ATB and LTBI., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The objectives of this study were to determine the impact of diabetes mellitus (DM) on antituberculosis drug resistance in new cases of tuberculosis (TB). A case-control study was conducted on all newly diagnosed pulmonary TB adult patients with DM as cases and without DM as controls who were hospitalised from May 2013 to October 2013 in Iran. A molecular resistance test for rapid detection of resistance to isoniazid and rifampicin was done. Multivariate analysis was performed to determine the impact of DM on any anti-TB drug resistance. In total, 62 TB cases with DM and 64 TB cases without DM were included. TB cases with DM were more likely to be older (59 years vs. 43 years; P=0.001). Two TB-DM patients had multidrug-resistant TB (MDR-TB) (3.2%) compared with no cases of MDR-TB in the control group, and more TB-DM cases had isolates that were resistant to at least one drug (12.9% vs. 10.9%). DM [odds ratio (OR)=4.82, 95% confidence interval (CI) 1-23.57], age <40 years (OR=5.48, 95% CI 1.19-25.29) and history of TB contact (OR=5.86, 95% CI 1.69-20.36) remained significantly associated with any drug resistance in the multivariate analysis. In conclusion, new TB patients with DM are at increased risk of anti-TB drug resistance. More studies are needed to confirm these results., (Copyright © 2015 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Background: A significant link between diabetes mellitus (DM) and tuberculosis (TB) has been widely demonstrated. DM increases the risk of TB in all aspects. The aims of this study were to assess the prevalence of DM among newly diagnosed TB patients, to screen these patients for DM, and to determine the number needed to screen (NNS) to diagnose new cases of DM., Methods: A prospective cohort descriptive study was carried out in Iranian adults admitted to the National Research Institute of Tuberculosis and Lung Disease from 2012 to 2013 with a new diagnosis of TB. Glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) were measured for all patients., Results: Of the 293 patients included, 101 (34.5%) had DM. DM was newly diagnosed in 45 (19%) patients. The number needed to screen was 5 to identify one new DM case. Age ≥ 40 years was associated with DM in this population (odds ratio (OR) = 3.91, 95% confidence interval (CI) = 1.47-10.38)., Conclusion: Screening for DM should be performed routinely in patients with TB and may improve treatment outcomes.

Setting: National Referral Centre for Tuberculosis (TB), Tehran, Iran., Objective: To determine the impact of chronic renal failure (CRF) on TB treatment outcomes., Design: A retrospective study was conducted among adult TB patients with CRF and age- and sex-matched TB controls without CRF treated at the National Research Institute of Tuberculosis and Lung Disease from 2004 to 2011. Multivariate analysis was performed to determine the impact of CRF on drug-induced hepatitis (DIH), treatment failure and all-cause mortality., Results: A total of 55 TB cases with CRF and 165 TB cases without CRF were included in the study. Baseline demographic and clinical characteristics were similar, except that TB cases with CRF were more likely to be of Iranian nationality (94.5% vs. 83%, P = 0.04). During anti-tuberculosis treatment, 40 (18.2%) patients developed DIH, none failed treatment and 15 (6.8%) died. Patients with CRF were more likely to develop DIH (27.3% vs. 15.2%, P = 0.04) and to die during treatment (16.4% vs. 3.6%, P = 0.001). CRF remained significantly associated with all-cause mortality (HR 4.87, 95%CI 1.73-13.65) in multivariate analysis, whereas the relationship with DIH was not., Conclusion: TB patients with CRF are at increased risk of death. More intensive monitoring of patients with CRF should be considered by the National TB Programme.

The risk of death is significantly higher in HIV-infected patients with tuberculosis (TB). This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a tertiary TB centre in Iran. In total, 111 patients were recruited from 2004 to 2007. Mycobacteriological studies and demographic, clinical, and laboratory data from all patients were analysed and predictors of unsuccessful outcomes as well as mortality were determined. The mean age for all 111 TB-HIV patients was 38 ± 9 years (range 22-70) and 107 (96.3%) were men; 104 (93.7%) had a history of drug abuse and 96 (86.4%) had a history of imprisonment. The method of HIV transmission was intravenous drug use in 88 (79.3%). Twenty-three (20.7%) had a history of Category 1 (CAT I) TB treatment and six (5.4%) Category 2 (CAT II) treatment. Combination antiretroviral therapy (cART) was given to 48 (43.2%). No significant associations were found between treatment outcomes or mortality and gender, smoking, drug and alcohol abuse, imprisonment, method of transmission, history of CAT I and CAT II treatments, CD4 counts or adverse effects (P > 0.05). Administration of cART led to significantly better outcomes (P < 0.001). Lower serum albumin levels and low body weight were significantly associated with mortality.

Introduction: Several species of non-tuberculosis mycobacteria (NTM) can affect humans and can cause either symptomatic or asymptomatic infection.  This study aimed to determine the clinical and radiological manifestation, as well as the treatment, of M. simiae in patients in Masih Daneshvari Hospital, a TB referral hospital in Iran., Methodology: This retrospective study involved all patients presenting to our referral center from 2002 to 2009, with confirmation of M. simiae pulmonary infection. For all patients, sputum smear and culture for identification was performed, as was drug susceptibility testing. Additionally, PCR identification methods for NTM, and high-resolution CT scan were conducted. All patients were treated according to American Thoracic Society recommendations., Results: In total, 26 cases of M. simiae were identified in our center. The mean age of the patients was 58.23 ± 16.9years. Only one patient was HIV positive, and all but one were Iranian. The most frequent symptom was coughing (92.3%), and 100% of the patients had nodular lesions. In addition, bronchiectasis and cavitation were present in 84.6% and 88.5% respectively. All the patients were resistant to every first-line drug. Two patients failed the treatment, and twenty-four were cured, after which no recurrence of the disease was observed., Conclusion: M. simiae may present with clinical and radiological manifestations consistent with tuberculosis, and be resistant to anti-TB agents. A more efficient treatment for NTMs such as M. simiae is needed, to shorten the period of treatment and proved fewer adverse effects than current therapies.

Currently, the Category (CAT) II regimen is recommended for patients who have failed the CAT I regimen. We have determined before that prevalence of multidrug-resistant tuberculosis (MDR TB) is relatively high among these patients. On the other hand, the retreatment success rate with CAT II in CAT I treatment failures and defaults is nearly 50%. Therefore, we tried to find another strategy with a higher success rate. From January 2004 to November 2007, 105 patients with pulmonary TB, who failed a prior CAT I regimen or with more than one course of irregular anti-TB treatment, were included in this study, whereas five cases with nontuberculous mycobacteria were excluded. Drug susceptibility testing (DST), for first line anti-TB drugs, and polymerase chain reaction were performed. By the time of availability of DST that took 3 to 4 months, a pilot protocol consisted of isoniazid, rifampin, ethambutol, ofloxacin, cycloserine, and amikacin was started. Then therapeutic regimen was adjusted based on four categories of DST pattern: sensitive, non-MDR pattern, MDR pattern, and culture-negative. Sensitive patients received the standard CAT I regimen, non-MDR patients an individualized regimen based on DST, MDR patients a standard second-line regimen, and culture-negatives a standard CAT I plus a 6-month injectable agent. Treatment outcomes were categorized and analyzed. Forty-eight patients with prior CAT I treatment failure and 52 with more than one irregular treatment courses were included in the analysis. Six percent of subjects had confirmed HIV infection. Seventy-two percent of subjects were assigned to a good outcome and 28% were assigned to a poor outcome group. Seventeen percent were culture-negative. Regarding DST pattern, 13% isolated strains were completely sensitive to first-line drugs. 53% strains were MDR, 10% monodrug-resistant, and 7% polydrug-resistant. There was no significant association between DST pattern and outcome (P = 0.13). The irregular regimen was associated with MDR TB as twice as CAT I regimen failure (69.2% versus 35.4%, P = 0.004). Patients with MDR TB significantly experienced more side effects than non-MDR-TBs (47% versus 27%, P = 0.102). Of 100 patients, 72% were cured, 5% abandoned treatment, 12% died, 6% were classified as treatment failures, 1% relapsed, and 5% were transferred out. Of 53 patients with MDR TB, 33 subjects were cured and seven died. All together, successful outcome was achieved in 62.2%, 76%, and 76% of MDR TB, non-MDR TB, and completely sensitive cases, respectively. A retreatment strategy based on DST and replacing the Category II regimen with an intermediate regimen called revised CAT II may improve clinical outcomes among Category I treatment failures and defaults who found to have active, infectious MDR TB. This strategy significantly reduces delays to MDR TB diagnosis and to the initiation of MDR TB therapy. Success rate of this strategy is 62.2% and 72% in MDR TB and overall CAT I failure cases and defaulters, respectively., ((C) 2011 Lippincott Williams & Wilkins, Inc.)

A 33-year-old man was admitted in hospital due to fever, generalized lymphadenopathy, and hepatosplenomegaly. He had a history of anti-tuberculosis treatment in the previous 3 years. Despite normal chest radiograph, a sputum sample was smear-positive for acid-fast bacilli, and polymerase chain reaction was positive for Mycobacterium tuberculosis complex. Drug susceptibility test revealed resistance to isoniazid and rifampin. Evaluation of the patient's immune system revealed IL-12Rβ1 deficiency. The patient died of disseminated tuberculosis (TB), despite appropriate antibiotic treatment. This is the first IL-12 receptor-deficient patient presenting with disseminated TB in adulthood, without any previous relevant medical history. This diagnosis should be considered in selected adult patients with unexplained, overwhelming TB. IL-12Rβ1 deficiency is a genetic etiology of severe TB in adults and should be considered in adult patients with disseminated TB.

Background: Pneumothorax is a well known complication of pulmonary tuberculosis (TB), particularly in patients with advanced TB., Methods: At our national TB-referral hospital, we compared the medical records of 53 TB patients with pneumothorax and 106 TB patients without pneumothorax, seen in 2003 to 2008. We analyzed data on demographics; TB type (smear-positive, smear-negative, extrapulmonary); patient type (new patient, relapse, treatment default, treatment failure); clinical and radiological manifestations; surgeries; and outcomes., Results: Of the 53 pneumothorax patients, 34 (64%) were male. The pneumothorax group's mean age was 34 y (range 14-76 y). Thirty-six (68%) of the pneumothorax patients were new TB cases (ie, TB undiagnosed before they presented with pneumothorax). Pneumothorax was not significantly associated with sex, smoking, or drug use. Pneumothorax was significantly more common in patients < 30 years old (P < .001). In terms of radiological manifestations, 20 pneumothorax patients (38%) had cavitary lesions, and pulmonary infiltration and effusion were present in 19 (36%) and 17 (32%) patients, respectively. Cavitary lesion was significantly more common among the pneumothorax patients (P = .006). Overall, 47 (89%) of the pneumothorax patients were relieved with chest-tube insertion; the other pneumothorax patients were only observed., Conclusions: In patients < 30 years old or with cavitary lesions, worsening of the patient's respiratory condition should prompt consideration of pneumothorax.

Objective: Resistance to anti-tuberculosis (anti-TB) drugs is becoming a major and alarming threat in most regions worldwide., Methods: This was a descriptive cross-sectional study at a tertiary hospital in Iran, using patient medical records for 2000-2003. The findings were analyzed following the same framework as that used for previous reports from this center., Results: Among 1556 TB patients, drug susceptibility testing (DST) was performed for 548 culture-positive cases. Anti-TB drug resistance to both isoniazid and rifampin was identified in 10 (2.8%) of the new TB cases (multidrug-resistant TB; MDR-TB). Any resistance was detected in 228 (41.6%), showing an increasing trend in both new and retreatment cases. The data analysis revealed that drug-resistant TB had a statistically significant association with Afghan ethnicity, age>65 years, and the type of disease (retreatment vs. new TB case) (p<0.05). Also, assessment of the drug resistance trends showed a significant increase in resistance to any anti-TB agent, to isoniazid, and to streptomycin in new cases, and to all of the first-line anti-TB drugs in retreatment patients., Conclusions: There has been an increasing trend in drug resistance in recent years, particularly in retreatment cases. Hence, revision of the national TB control program, reevaluation of the role of the World Health Organization category II (CAT II) regimen, as well as the conducting of a nationwide drug resistance survey, are recommended.

The objective of this study was to determine the drug resistance prevalence and its pattern among tuberculosis (TB)-HIV patients in Iran. In this retrospective study, all admitted TB/HIV patients presenting to our tertiary centre during 2005-2007 were considered. After confirmation for TB-HIV, first-line DST was performed for culture-positive patients. The drug resistance patterns and the treatment outcomes were analysed. Of the total 92 TB/HIV patients, 27 were culture negative, and DST were available in 65. Intravenous drug abuse was seen in 59 (90.8%). Thirty-seven (57%) were 'sensitive' cases and 28 (43%) were 'any drug resistance' cases. Twenty-one (32.3%) were mono-drug, three (4.6%) poly-drug and four (6.1%) were multidrug-resistant TB patients. Previous anti-TB medication was significantly associated with any drug resistance (P = 0.041; 95% confidence interval =0.086-0.984); however, having any drug resistance did not affect the treatment outcome (P = 0.56). Streptomycin showed the highest resistance rate (27%) followed by isoniazid (20%), pyrazinamide (9.8%), rifampin (9.2%) and ethambutol (3%). Drug resistance to antitubercular agents in TB-HIV co-infected patients in Iran is high compared with other reports. Drug resistance is higher among those who have had prior anti-TB medication.

Socioeconomic problems limit the access of drug users to health-care services. This descriptive cross-sectional study was carried out by making use of the medical records of new case tuberculosis (TB) patients hospitalized at Masih Daneshvari Hospital, the national referral centre in Iran, from 2003 to 2006. Demographic and personal characteristics of the patients and type of disease were collected and categorized. Of the 944 patients with confirmed TB, 143 (15.1%) were drug users, among whom 140 (97.9%) were men with just three women drug users. The mean age of the drug users group was 43.04 +/- 13.81 years. The type of drug used was opium in 100 cases (69.9%), heroin in 29 (20.3%), opium and heroin together in four (2.8%) and all three, opium, heroin and crack, in two (1.4%). For 238 high-risk patients, an HIV test was performed and HIV infection was confirmed in 33 cases. Patient delay was longer in drug users (P = 0.000) against other patients, whereas diagnosis delay was shorter (P = 0.007). Drug susceptibility tests were performed for 515 patients with positive cultures. One hundred and thirty-three (14.1%) were found to have 'any resistance' to anti-TB drugs, and 10 (1.1%) individuals had multidrug-resistant TB. Twenty-six (19.5%) of the individuals who showed resistance to first-line agents were drug users. There was no significant relation between drug resistance and drug use (P = 0.4). In conclusion, it seems that active case finding for TB and HIV in addict cases must be contained in harm reduction packages. Moreover, the manifestations of the disease should be considered seriously regardless of attributing them to drug use.

Background: This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients. Methods: In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed. Results: Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups. Conclusion: The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma. [ABSTRACT FROM AUTHOR]

Background: The world is currently struggling with the COVID-19pandemic. Measures to control the COVID-19 pandemic have affected other health problems and diseases, including tuberculosis (TB) and its control. The present narrative review aimed at reviewing published literature on the impact of the COVID-19 pandemic on TB control. Materials and Methods: English language databases, including PubMed, ISI, Scopus, and Google Scholar, were searched using the keywords "Tuberculosis, COVID-19, and Coronavirus" to find relevant articles. Results: Problems and limitations in financial and human resources, as well as medical and laboratory services caused by the COVID-19 pandemic, contribute to the reduction in the number of newly diagnosed patients with TB. More effort in identifying patients with TB is of great importance, and if the global number of newly diagnosed patients with TB decreases by 25% for three consecutive months due to the COVID-19 pandemic, the TB mortality rate will increase by 13%. An increase in the TB mortality rate means the failure of TB control programs to reach the targets of the Global End TB Strategy. Conclusion: According to the latest statistics released by the Ministry of Health, the incidence of TB in Iran has not yet reached fewer than 100 cases per million population. On the other hand, being a neighbor with countries with a high risk of TB is a serious threat to Iran. Therefore, further effort to control TB during the COVID-19 pandemic is particularly important. [ABSTRACT FROM AUTHOR]

Introduction: Cytomegalovirus (CMV) is a leading cause of morbidity and mortality among the immunosuppressed population, and it is a common cause of opportunistic infections in human immunodeficiency virus (HIV)-positive patients. In this case series study, we describe our experience with nine HIV-positive patients suffering from pneumonia who demonstrated typical cyto-pathologic evidences of CMV pneumonitis. Material and methods: Clinical records of all HIV-infected patients with pneumonia who were admitted to National Research Institute of Tuberculosis and Lung Diseases (NRITLD), a tertiary center of tuberculosis and lung diseases in Iran, were prospectively reviewed. Results of micro-biological investigations of bronchoalveolar fluid (BAL) and trans-bronchial lung biopsy (TBLB) specimens were evaluated as well as their histological and cytological findings. All patients with cyto-pathologic evidences of CMV pneumonitis found in TBLB were extracted, characteristic of which was shown as enlarged cells with large pleomorphic nuclei, and intra-nuclear and cytoplasmic inclusions. Results: Of these cases, seven patients were diagnosed with concomitant CMV and Pneumocystis jiroveci pneumonitis. Five patients had thrush, two patients tested positive for active tuberculosis, and one patient reported a history of old tuberculosis. Laboratory data analysis revealed LDH ranging from 138 to 1,140, with average amount of 653.22. CD4+ counts ranged from 12 to 156, with average of 56.22. Six patients tested positive for CMV infection with plasma polymerase chain reaction (PCR) method. Conclusions: The differential diagnosis for CMV pneumonia in HIV-infected population is extensive and includes diseases, such as bacterial pneumonias, Mycobacterium tuberculosis infections, PCP, and other HIV-associated respiratory infections. Definitive diagnosis is based upon demonstration of CMV in pulmonary secretions or in lung tissue. [ABSTRACT FROM AUTHOR]

Background: The success of treatment strategies to control the disease relapse requires determining factors affecting the incident short-time and long-time of disease relapse. Therefore, this study was aimed to identify the factors affecting of short-and long-time of occurrence of disease relapse in patients with tuberculosis (TB) using a parametric mixture cure model. Materials and Methods: In this historical cohort study; the data was collected from 4564 patients with TB who referred to the Tuberculosis and Lung Diseases Research Center of Dr. Masih Daneshvari Hospital from 2005 to 2015. In order to evaluate the factors affecting of short-and long-time of occurrence of disease relapse, a parametric mixture cure model was used. Results: In this study, the estimation of the annual incidence of TB relapse showed that the probability of recurrence in the first year is 1% and in the third and tenth years after treatment is 3% and 5%, respectively. In addition, the results of this study showed that the variables of residence, exposure to cigarette smoke, adverse effects of drug use, incarceration, and pulmonary and extra-pulmonary tuberculosis were the factors affecting the short-time recurrence of TB. The variables of drug use, pulmonary and extra-pulmonary tuberculosis, and also incarceration affected the long-term recurrence of this disease. Conclusion: Cure models by separating factors affecting the short-time occurrence from the long-time occurrence of disease relapse can provide more accurate information to researchers to control and reduce TB relapse. [ABSTRACT FROM AUTHOR]

Background: Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis (Tb). Patients with TPE or malignant pleural effusions (MPE) frequently have a similar lymphocytic pleural fluid profile. Since the etiology of PE in various diseases is different, identifying the cellular components may provide diagnostic clues for understanding the pathogenesis. Objective: We determined the frequency of T helper (Th) subtypes in the PEs for differentiation of Tb and non-Tb patients. Methods: Thirty patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP), and 14 patients with parapneumonic effusion (PPE) were enrolled between December 2018 and December 2019. Five-milliliter fresh PE in tubes containing heparin as an anticoagulant was obtained from patients. The frequencies of CD4+IL-9+, CD4+IL-22+, CD+IL-17+, and regulatory T-cells CD4+CD25+ FOXP3+ (Treg) were determined by flow cytometry. Results: Treg cells have a lower frequency in TPE patients [4.2 (0.362–17.24)] compared with non-TPE patients [26.3 (3.349–76.93, p < 0.0001)]. The frequency of CD4+IL-9+ cells was significantly lower in TPE patients [3.67 (0.87–47.83)] compared with non-TPE groups [13.05 (1.67–61.45), p < 0.0001]. On the contrary, there was no significant difference in the frequency of CD4+IL-17+ and CD4+IL-22+ cells between TPE and non-TPE patients (p = 0.906 and p = 0.2188). Receiver-operator curve (ROC) analysis demonstrated that CD4+CD25+FOXP3+ T cells [optimal cutoff value = 13.6 (%), sensitivity 90%, specificity 75.86%] could be considered as predictor for TPE. However, adenosine deaminase [cutoff value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] levels had an even greater predictive capacity. Conclusion: ADA, Treg cells, and CD4+IL-9+ cells may differentiate TPE from non-TPE patients. However, these results need validation in an independent large cohort. [ABSTRACT FROM AUTHOR]

Despite the fact that about two years have passed since the onset of the COVID-19 pandemic, there is still no curative treatment for the disease. Most cases of COVID-19 have mild or moderate illness and do not require hospitalization. This guideline released by the National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital COVID-19 Expert Group to provide a treatment guide for outpatient management of COVID-19. [ABSTRACT FROM AUTHOR]

Medullary carcinoma of the thyroid should be considered in the differential diagnosis of miliary pattern of micronodules on chest imaging, irrespective of clinical features. [ABSTRACT FROM AUTHOR]

Background: The study aimed to evaluate the effectiveness and safety of BAE in TB patient with massive hemoptysis and evaluate the recurrence rate of hemoptysis after BAE. Materials and Methods: In this prospective study, 68 patients with moderate and severe hemoptysis due to active or old tuberculosis who underwent bronchial arteriography were included. CXR and CT scan were performed in all patients. Selective and nonselective bronchial artery angiography was performed in all patient and 62 patients underwent embolization. Results: Thirty-two patients (47.1%) had active TB and 36 patients (52.9%) had inactive TB (post-tuberculosis sequelae). Abnormality was detected in a single vessel in 30 (44.1%) patients, in two vessels in 23 (33.8%) and in more than two vessels in 13 (19.1%) patients. Embolization was performed in 62 patients and overall 95 abnormal arteries were embolized. Hemoptysis control rate was 82.3% at one month, 73.5% at three months, 69.1 % at 6 months, 63.2% at one year and 60.3% after two years. Conclusion: No major complication occurred as a result of BAE procedures. BAE is a safe and effective method for the management of hemoptysis in patient with tuberculosis. Only 20.6% of the patients need to repeat BAE during 2 years of follow up. [ABSTRACT FROM AUTHOR]