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Abstract Background Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen.

To report a case of disseminated TB presenting as ciliary body and thyroid mass lesions. A 17-year-old male patient presented with a thyroid mass and blurring of vision in the left eye. A diagnosis of ciliary body granuloma was made. Although the Mantoux was negative, the HRCT chest showed evidence of miliary TB, and the fine needle aspiration cytology from the thyroid mass revealed AFB. On initiation of Antitubercular therapy(ATT), a paradoxical worsening of ciliary body granuloma was noted which resolved on starting steroids. Involvement of thyroid gland and ciliary body although rare in tuberculosis, may be the presenting feature of disseminated TB. Paradoxical reactions seen after initiation of ATT in these cases may respond well to oral steroids. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods: New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results: Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion: The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) constitutes 15–20% of TB cases in general practice among HIV-negative adults in India. The head and neck region provides an impressive field of research because of its varied presentations and different sites of involvement. TB may often mimic malignancy and is misdiagnosed, which leads to an unnecessary delay in diagnosis. Through this study, we aim to draw focus on the various ways in which isolated extrapulmonary TB manifests in today's clinical practice in the head and neck region. Prospective analysis of 60 patients diagnosed with TB in a simple random sampling over 1 year. The period of study was from July 2022 to June 2023. All those patients who presented to the ENT OPD of Civil Hospital of Asarwa. Patients with complete clinical data were included in the study. In our study patients in the 3rd and 4th decade of life were most commonly affected and a male preponderance of the disease was seen. The most common presentation of EPTB in the head and neck region is cervical lymphadenitis, followed by tuberculous otitis media and laryngeal TB. Each of these has a characteristic clinical presentation that helps to identify this disease. Fine needle aspiration cytology is a very efficient cytopathological examination method that helps in the diagnosis of the disease. Special care should be taken in patients in whom other routine conventional medical and surgical therapy fail to show the desired outcome. Special care and a high degree of suspicion are needed to diagnose extrapulmonary TB. Once rightly diagnosed, it will prevent the progression of the disease and its complications. [ABSTRACT FROM AUTHOR]

Tuberculosis is a leading health problem worldwide, with India accounting for the majority of cases. Owing to the diverse clinical presentation and paucibacillary nature of extrapulmonary tuberculosis, it is tough to diagnosis by routine microbiological methods. Newer chip/cartridge based nucleic amplification tests (NAATs) like Truenat and Xpert have proved to be game changer in diagnosis of pulmonary tuberculosis. However, role of Truenat in extrapulmonary tuberculosis is still to be evaluated. This study was undertaken to evaluate the diagnostic yield of truant in various extrapulmonary tuberculosis. The study was conducted during 01 June 2021 to 31 July 2022. Of the total 1481 samples received during study, 761 (52%) were extrapulmonary samples. The highest yield of 36% was found in pus aspirate, followed by a 12% yield in pleural fluid. Overall yield of 12% in various extrapulmonary samples is encouraging. Further studies are required for evaluating Truenat role in rapid diagnosis of EPTB and rifampicin resistance detection for better patient care.

Tuberculosis is a leading health problem worldwide, with India accounting for the majority of cases. Owing to the diverse clinical presentation and paucibacillary nature of extrapulmonary tuberculosis, it is tough to diagnosis by routine microbiological methods. Newer chip/cartridge based nucleic amplification tests (NAATs) like Truenat and Xpert have proved to be game changer in diagnosis of pulmonary tuberculosis. However, role of Truenat in extrapulmonary tuberculosis is still to be evaluated. This study was undertaken to evaluate the diagnostic yield of truant in various extrapulmonary tuberculosis. The study was conducted during 01 June 2021 to 31 July 2022. Of the total 1481 samples received during study, 761 (52%) were extrapulmonary samples. The highest yield of 36% was found in pus aspirate, followed by a 12% yield in pleural fluid. Overall yield of 12% in various extrapulmonary samples is encouraging. Further studies are required for evaluating Truenat role in rapid diagnosis of EPTB and rifampicin resistance detection for better patient care. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Tuberculous otitis media (TOM) is an infrequent ailment. As an uncommon form of extra-pulmonary Tuberculosis, it is often underestimated, leading to a delay in diagnosis and start of appropriate treatment. Case Series: We describe 3 cases of TOM diagnosed and treated in our institute. The typical presentation was prolonged ear discharge not responding to culture sensitive antibiotics, hard of hearing, perforation of tympanic membrane, pale whitish granulation tissue. Pure Tone Audiogram (PTA) done to evaluate the hearing loss. The granulation tissue from all the patients sent for Histopathology examination (HPE) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) examination. CBNAAT results were positive in all three patients. HPE reported as chronic inflammatory pathology. PTA revealed sensorineural hearing loss in 2 patients and conductive hearing loss in 1 patient. Treatment with regular ATT 4FDC (Anti Tubercular Treatment- Four Drug Combination) regimen was started as per weight band for 6 months. Each of them was on follow up and symptomatically improving. Discussion: TOM requires recognition in refractory chronic otitis media. Early diagnosis and intervention are essential to prevent complications and optimise outcomes. The delay in initiating therapy may lead to complications such as facial nerve palsy. This case series aims to highlight the clinical presentation, effective diagnostic modalities and treatment of tuberculous otitis media and stresses the importance of awareness among otorhinolaryngologists regarding TOM and its timely management.

Elias Alehegn,1,2 Alganesh Gebreyohanns,1 Bereket Woldeab Berhane,3 Jayne A Wright,4 Gadissa Bedada Hundie,1 Rozina Ambachew Geremew,1 Kasahun Gorems,1 Zenebe Gebreyohannes,1 Misikir Amare,5 Yeshiwork Abebaw,5 Getu Diriba,5 Betselot Zerihun,5 Amanuel Wondimu Gebremichael,5 Melkayehu Kassa,1 Addisu Gize1,6 1Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Addis Ababa City Administration, Farmers and Urban Agriculture Development Commission, Addis Ababa, Ethiopia; 3Department of Pathology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4Jayne Wright Ltd, Pathology Consultancy, Ledbury, UK; 5Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 6CIHLMU Center for International Health, LMU University Hospital, Munich, GermanyCorrespondence: Elias Alehegn, Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, Email eluvet22@gmail.comBackground: Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa.Material and Methods: A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant.Results: From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes.Conclusion: Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.Keywords: extra pulmonary tuberculosis, Mycobacterium tuberculosis, drug resistance

Tuberculosis is one of the major health issues in developing countries, including Pakistan, causing significant morbidity and mortality. As far as extra-pulmonary sites of tuberculosis are concerned, pubic symphysis is a relatively uncommon site. We are reporting a unique case of tuberculosis at this rare site. A 42-year-old female reported complaints of groin pain, fever and numbness in their legs for one day. After all the investigations, the patient was put on a quadruple Anti-Tuberculosis Therapy(ATT) according to the National Institute of Health and Care Excellence (NICE) guidelines. The patient completed the ATTcourse for seven months and was symptom-free. She was advised to follow up on a CT scan after three months to look for a recurrence of the infection.

Mycobacterium bovis causes tuberculosis in cattle and when transmitted to humans typically causes extra-pulmonary tuberculosis (EPTB). Bovine tuberculosis (bTB) has a global distribution and is controlled in most countries to protect animal and public health. Recent studies revealed that bTB is established on dairy farms in Fiji where EPTB cases have been reported in people. The aims of this pilot investigation were to look for putative zoonotic TB (EPTB) cases in people and to evaluate practices that might contribute to the persistence and transmission of M. bovis between cattle and to humans. Existing data sets were shared between the Fiji Ministry of Agriculture and Ministry of Health and a questionnaire-based survey was implemented using One Health principles. Statistically significant co-location and close proximity of EPTB cases and bovine TB affected farms were identified. The bTB infection status of farms was significantly associated with unfenced water sources where cattle grazed. Of 247 households, 65 % shared drinking water sources with cattle and 36 % consumed raw milk without boiling, while 62 % of participants reported backyard slaughter of cattle. Several participants reported current symptoms potentially suggestive of TB (chronic cough) but the impact of smoking and history of previous TB treatment could not be evaluated. Farmers had limited understanding of the practices required to prevent bTB at farm level. Further study is recommended and should include an assessment of lifetime EPTB diagnoses, classification of farms based on more recent bTB test data and molecular typing of mycobacterial isolates from humans, cattle and the environment. A targeted awareness and education approach is required to reduce the future risk of zoonotic TB and to help ensure uptake of recommendations and practices aimed at controlling and preventing bTB.

Even in countries like India where the general dictum is to consider Tuberculosis as one of the differential diagnosis to any condition that is still under evaluation. Parotid Tuberculosis is a very rare entity. There are fewer than 200 cases reported in literature worldwide of Parotid gland Tuberculosis, a form of extrapulmonary Tuberculosis. We present an interesting case of Parotid Tuberculosis which presented as unilateral swelling in the parotid region of a four-year-old male child with an underlying abscess. [ABSTRACT FROM AUTHOR]

Even in countries like India where the general dictum is to consider Tuberculosis as one of the differential diagnosis to any condition that is still under evaluation. Parotid Tuberculosis is a very rare entity. There are fewer than 200 cases reported in literature worldwide of Parotid gland Tuberculosis, a form of extrapulmonary Tuberculosis. We present an interesting case of Parotid Tuberculosis which presented as unilateral swelling in the parotid region of a four-year-old male child with an underlying abscess.

Introduction: Tuberculosis, considered a major global and public health challenge, not only manifests in the lungs but also affects other sites. Tuberculosis primarily occurring in the nose, poses a diagnostic challenge, as the clinical presentations of other important pathologies such as infective and inflammatory diseases, granulomatous disorders and neoplastic conditions are similar, have an indolent course and are non-specific. Moreover, due to its rarity, it is often missed and not considered in differential diagnosis. It is hence felt that a series of three cases of Primary Nasal Tuberculosis, conclusively diagnosed within a year, merits reporting Case reports: A series of 03 cases, presented with complaints of nasal obstruction, crusting in nasal cavity, intermittent epistaxis, conclusively diagnosed as a case of primary nasal tuberculosis Conclusion: Primary nasal tuberculosis is rare. One should have a high index of suspicion in patients living in endemic areas not responding to routine treatment and presenting with nasal mass and crusting

Introduction: EPTB contributes to a significant burden of mortality and morbidity, due to its complex and sub clinical presentations, leading to a delay in their diagnosis. EPTB has negligible contagious potential and therefore never been prioritised in the campaigns undertaken by National TB Control Programs. Various methods can be used for the detection of EPTB of which microscopy, culture and identification of the organism’s DNA are known. Newer method known is CBNAAT. Present study was proposed to evaluate the effectiveness of CBNAAT in diagnosing EPTB in comparison with cytology. Materials and Methods: The study included 120 samples of lymph node, pus, pleural fluid, ascitic fluid and C.S.F. Samples were collected and subjected to AFB smear, FNAC and CBNAAT simultaneously. Results: Among total 120 cases, EPTB diagnosed by CBNAAT, FNAC, AFB stain were 40, 71 and 18 respectively. Conclusion: CBNAAT is a newer confirmatory test and adds an extra edge of simultaneous drug resistance. Still combining CBNAAT with other tests provide better diagnostic yield even at peripheral places. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) in pregnancy is a major health problem which possess a sustainable risk of morbidity to mother and fetus if not diagnosed and treated at correct time. The diagnosis in pregnancy is challenging, especially in the absence of lung involvement. It usually mimics other diseases as most of the patients with extra pulmonary TB present usually with nonspecific symptoms which misleads the diagnosis. Hence, it is very important to address even nonspecific symptoms in pregnancy as a neglected diagnosis and delayed treatment may lead to severe perinatal morbidity and mortality like fetal distress, preterm delivery, fetal growth retardation, seizures due to intra cranial space occupying lesion, perforation of intestinal lesions, pneumoperitonitis, high chances of intensive care unit admission for mother and neonate. Hereby, authors report two cases, one about a 29-year-old primigravida with numbness and paresthesia of unilateral limbs. She was diagnosed of intracranial tuberculoma and treated with Antitubercular Drugs (ATT) for nine months. She underwent a cesarean section in view of an intracranial space-occupying lesion. Another patient was a prima gravida who presented with persistent gastroenteritis symptoms like vomiting and diarrhea. She was diagnosed to have ileocecal mass with suspicion of malignancy or infectious aetiology. In view of deteriorating maternal condition, emergency cesarean section was done along with resection of ileocecal mass. On histopathological examination it was found to be ileocecal TB and she was started on ATT. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) in pregnancy is a major health problem which possess a sustainable risk of morbidity to mother and fetus if not diagnosed and treated at correct time. The diagnosis in pregnancy is challenging, especially in the absence of lung involvement. It usually mimics other diseases as most of the patients with extra pulmonary TB present usually with nonspecific symptoms which misleads the diagnosis. Hence, it is very important to address even nonspecific symptoms in pregnancy as a neglected diagnosis and delayed treatment may lead to severe perinatal morbidity and mortality like fetal distress, preterm delivery, fetal growth retardation, seizures due to intra cranial space occupying lesion, perforation of intestinal lesions, pneumoperitonitis, high chances of intensive care unit admission for mother and neonate. Hereby, authors report two cases, one about a 29-year-old primigravida with numbness and paresthesia of unilateral limbs. She was diagnosed of intracranial tuberculoma and treated with Antitubercular Drugs (ATT) for nine months. She underwent a cesarean section in view of an intracranial space-occupying lesion. Another patient was a prima gravida who presented with persistent gastroenteritis symptoms like vomiting and diarrhea. She was diagnosed to have ileocecal mass with suspicion of malignancy or infectious aetiology. In view of deteriorating maternal condition, emergency cesarean section was done along with resection of ileocecal mass. On histopathological examination it was found to be ileocecal TB and she was started on ATT.

Background: Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis. Methods: A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes. Results: A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment. Conclusion: Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results.

Objective: Tuberculosis (TB) is a significant public health problem that remains important worldwide. This study aimed to examine the demographic characteristics and clinical features of patients with extrapulmonary tuberculosis (EPTB) and also identify the comorbidities of EPTB. Our secondary aim was to compare tuberculous lymphadenitis (TBL) with other forms of EPTB. Patients and Methods: This single-center, retrospective, observational study was conducted on patients diagnosed with EPTB in a training hospital in Turkey between January 1, 2011 and December 31, 2020. The demographic characteristics and clinical features of the patients were examined. TBL cases were compared with other forms of EPTB cases. Results: The most common clinical form was TBL. Fever, night sweats, and accelerated erythrocyte sedimentation rate were significantly more common in the other forms of the EPTB group compared to TBL. The rate of tuberculin skin test positivity was significantly higher in patients with TBL. The complication rate was 3%, and mortality rate was 4% among all patients. Conclusions: Extrapulmonary tuberculosis should be considered in the differential diagnosis by evaluating the medical history of patients who present with organ-specific symptoms, especially in TB endemic countries. The clinic may differ according to the organ involvement. TBL may be seen with milder symptoms compared to other clinical forms. [ABSTRACT FROM AUTHOR]

Introduction: Rectovaginal fistulas (RVFs) can arise from various etiologies, the most common cause especially in developing countries is obstetric injury. Uncommonly, rectal tuberculosis can present as RVF, posing a diagnostic and treatment challenge especially in a patient without established risk factors. The first case of rectal tuberculosis was reported by Davis et al., in 1957, and a 2022 systematic review identified only 28 cases reported since then., Presentation of Case: we report the case of a 25-year-old college woman who presented with a 3-month history of lower abdominal pain and fecal passage per vagina. She had undergone a failed RVF repair attempt at another hospital. Examination revealed a single rectovaginal fistula with surrounding granulation tissue, despite the absence of prior TB history. Investigations revealed chronic granulomatous inflammation and acid-fast bacilli on biopsy, confirming rectal tuberculosis as the cause of RVF. She received a 6-month course of anti-tuberculous medication after which she underwent a successful surgical repair of the RVF via a transverse transvaginal approach., Discussion: Rectal tuberculosis is a rare condition, typically occurring in the third and fourth decades of life. The ileocecal junction is the most common site for gastrointestinal TB Risk factors include impaired immunity. It is usually secondary to pulmonary TB, Diagnosis can be challenging due to the varied symptoms, which can overlap with other conditions like rectal cancer. Treatment involves a 6-month course of antituberculosis medication, and surgery may be needed for complications like rectovaginal fistula., Conclusion: this case highlights the atypical presentation of tuberculosis and emphasizes the importance of considering tuberculosis as a cause of RVF especially in young patients without apparent risk factors living in TB-endemic areas. It also highlights the challenges in differentiating TB-induced RVF from other causes of RVF., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis. Methods: A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes. Results: A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment. Conclusion: Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of the time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis. Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy. Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values. Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy.

Extrapulmonary tuberculosis is rare even in endemic areas, and is dominated by lymph node involvement. Tonsillar tuberculosis is exceptional. The clinical examination and radiological explorations are non-specific. A 45-year-old woman presented with chronic odynophagia and otalgia. Examination revealed an enlarged left palatine tonsil with an irregular surface and a firm consistency. Radiologic exploration was not specific. The patient underwent a tonsillar biopsy. Histopathology was consistent with tuberculosis and the patient was put on antitubercular drugs. Tuberculosis is a global public health problem. Extrapulmonary tuberculosis is rare and mainly affects lymph nodes. Tonsillar tuberculosis is frequentely seen in individuals with immunodeficiency. Clinical features and imaging findings are non-specific. Diagnosis is based on histopathological and microbiological findings to rule out differential diagnoses especially cancer. Treatment is based on anti-tuberculosis drugs. Our case illustrates a rare presentation of primary tuberculosis and highlights the importance of considering tuberculosis as a potential cause of tonsillitis. • Extrapulmonary tuberculosis mainly affects the lymph nodes. • Tuberculosis is an uncommon cause of tonsillitis • Clinical examination and radiological explorations are usually non-specific. This raises the problem of differential diagnosis, especially with tonsillar carcinoma • The diagnosis is based on histopathological and microbiological findings • Early antitubercular therapy is essential for effective treatment [ABSTRACT FROM AUTHOR]

Objective: To determine the accurate ability to diagnose the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considered as gold standard the pleural biopsy. Materials & Methods: This study was a validation cross-sectional survey and it was conducted in the pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 years with exudative pleural effusion were included in the study. By implementing the process of the standard technique, closed needle pleural biopsy was executed by means of ABRAM'S needle. The collected samples of patients were sent to the pathology department of the Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to the National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: A total of 180 patients were included; 65.6% of patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and the -ve predictive value was 52.1%. The likelihood ratio was 8.25 and the ROC curve also showed similar values. Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy. [ABSTRACT FROM AUTHOR]

Mycobacterium tuberculosis infection is one of the oldest diseases of the human race. This bacteria can attack any organ in the human body. Extra Pulmonary Tuberculosis (EPTB) infection diagnosis are rarely straightforward, and in many cases, delayed due to various reasons. Tuberculous tenosynovitis (inflammation of the tendon and its capsule because of Mycobacterium tuberculosis complex infection) is a rare form of EPTB. Tuberculosis infection at sites of previous trauma have been reported consistently though rarely. We present the case of a 48 years old male with complains of lumps on his lower left arm (with prior history of blunt trauma on the location) and progressive inability to flex the fingers of his left hand. Early examinations suggest the diagnosis to be a soft tissue tumour. However, tissue biopsy later showed that the patient was actually suffering from tuberculosis infection. The patient later showed satisfying response to tuberculosis medication on subsequent follow ups. [ABSTRACT FROM AUTHOR]

Abstract Background Tuberculosis (TB) though primarily affects the lungs it may also affect the other parts of the body and referred as extra pulmonary (EPTB). This study is focused on understanding the genetic diversity and molecular epidemiology of Mycobacterium tuberculosis (M.tb) among tuberculous lymphadenitis (TBL), a form of EPTB patients identified in Chennai, Tamil Nadu. Methods The genetic diversity was identified by performing spoligotyping on the M.tb clinical isolates that were recovered from lymph node samples. A total of 71 M.tb isolates were recovered from extra pulmonary lymph node samples and subjected to Drug susceptibility testing and spoligotyping was carried out. In addition, immunological characterization from blood of same individuals from whom M.tb was isolated was carried out between the two major lineages groups East African Indian 3 (EAI3) and non-EAI3 strains by ELISA. The results of spoligotyping patterns were compared with the world Spoligotyping Database of Institute Pasteur de Guadeloupe (SpolDB4). Results We found 41 spoligotype patterns and their associated lineages. Out of 41 spoligotype pattern, only 22 patterns are available in the spoldB4 database with Spoligotype international Type (SIT) number and remaining patterns were orphan strains without SIT number. The most predominant spoligotype lineage that was found in lymph node sample in this region of India was EAI (36), followed by central Asian strain (CAS) (6), T1 (5), Beijing (3), Latin American & Mediterranean (LAM) (2), U (1), X2 (1) and orphan (22). In addition to EAI, CAS and Beijing, our study identified the presence of orphan and unique spoligotyping patterns in Chennai region. We observed six drug resistant isolates. Out of six drug resistant isolates, four were resistant to isoniazid drug and associated with EAI family. Moreover, we observed increased levels of type 2 and type 17 cytokine profiles between EAI3 and non-EAI family, infected individuals. Conclusions The study confirms that EAI lineage to be the most predominant lineages in EPTB patients with lymphadenitis and were found to have increased type 1 and type 17 proinflammatory cytokine profiles.

Background: Extrapulmonary tuberculosis is an emerging public health problem among diabetic patients. Diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Therefore, this study aimed to investigate the incidence and predictors of extra pulmonary tuberculosis among diabetic patients at Debre Markos referral hospital, Northwest Ethiopia. Methods: This institutionally-based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos compressive specialized hospital between January 2016 to December 2020. All eligible diabetic patients who full filled the inclusion criteria were included in the study. Data were entered using Epi-data Version 3.1 and analyzed using STATA Version 14. The survival time of diabetic patients was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables was compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients. Results: Among a cohort of 433 diabetic patients at Debre Markos compressive specialized hospital, 17(3.9%) developed extra pulmonary tuberculosis during the follow-up time. The total time allotted to follow up the study participants was 1101.5 person-years (PY). The overall extra pulmonary tuberculosis incidence rate was 1.5 per 100 PY with 95% CI. Using the multivariable Cox-regression analysis, age (AIR 4.8 (95% CI (1.2–20.7), 0.03), diabetic medication (AIR 1.4 (95% CI(1.24–16), 0.03), having past history of PTB before diabetic follow up initiation (AID 1.5(95% CI (3.2–6.9),0.01) and having history of alcohol (AIR (95%CI (4(1.2–13),0.02) were significantly increased the risk of extra pulmonary tuberculosis while BMI (18.5–25) AIR(95% CI (0.22 (0.06–0.76), 0.02) was associated with a rate reduction for the incidence of extra pulmonary tuberculosis. Conclusions: In this study, we found a high rate of extra pulmonary tuberculosis among diabetic patients. Factors significantly linked with increased risk of extra pulmonary tuberculosis included: age, using insulin as hypoglycemic medication, having past history of PTB before diabetic follow up initiation and alcoholic history while BMI was associated with a rate reduction of EPTB. Early screening and treatment for extra pulmonary tuberculosis is highly recommended at diabetes mellitus follow up for patients with the above risk factors.

Several studies have been reported the use of machine learning algorithms in the detection of Tuberculosis, but studies that discuss the detection of both types of TB, i.e., Pulmonary and Extra Pulmonary Tuberculosis, using machine learning algorithms are lacking. Therefore, an integrated system based on machine learning models has been proposed in this paper to assist doctors and radiologists in interpreting patients’ data to detect of PTB and EPTB. Three basic machine learning algorithms, Decision Tree, Naïve Bayes, SVM, have been used to predict and compare their performance. The clinical data and the image data are used as input to the models and these datasets have been collected from various hospitals of Jalandhar, Punjab, India. The dataset used to train the model comprises 200 patients’ data containing 90 PTB patients, 67 EPTB patients, and 43 patients having NO TB. The validation dataset contains 49 patients, which exhibited the best accuracy of 95% for classifying PTB and EPTB using Decision Tree, a machine learning algorithm.

Background and objective Lymph node tuberculosis (LNTB) is a common manifestation of extrapulmonary tuberculosis (EPTB). GeneXpert is a rapid diagnostic molecular test that simultaneously detects tuberculosis and rifampicin (RIF) resistance. In this study, we aimed to assess the epidemiology of LNTB and diagnostic performance parameters of the GeneXpert in routine ENT practice. Methods We conducted a cross-sectional prospective study from January to July 2019, in the Department of Otorhinolaryngology and Head Neck Surgery at the Hassan II University Hospital Center of Fez, Morocco. The samples were collected using lymph node biopsy and subjected to GeneXpert assay, culture, and histopathology. Diagnostic performance parameters of the GeneXpert were calculated and compared with culture. Results All patients with cervical adenopathy were included. Lymph node biopsies were performed for all patients. The performance of the GeneXpert was assessed according to culture findings. Among the 75 cases, the mean age was 21.6 ± 12.7 years with a female predominance (60%). GeneXpert was positive in 66.7% of specimens. The sensitivity and specificity of the GeneXpert assay were 78.6% and 40.4% respectively. GeneXpert accuracy was 54.6%. The positive predictive value (PPV) and negative predictive value (NPV) were found to be 44% (95% CI: 30.2-57.8) and 76% (95% CI: 59.3-92.7) respectively. Mycobacterium bovis was isolated in all samples, with no case of resistance to RIF found. Conclusions The performance of GeneXpert was found to be superior in terms of establishing the diagnosis of LNTB. It offers speedy and prompt results and clinicians should adopt it in routine clinical practice., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee for Biomedical Research (CERB) of the Faculty of Medicine and Pharmacy of Rabat issued approval 84/16. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Afellah et al.)

The burden of extrapulmonary tuberculosis (EPTB) is significant, constituting up to 20% of all TB cases in HIV-negative patients and 50% of new cases in HIV-positive individuals. However, diagnosing EPTB remains challenging due to its pauci-bacillary nature and the necessity for invasive sampling methods in many forms of the disease. Urogenital tuberculosis represents approximately 4% of the annual cases of extra-pulmonary tuberculosis in India, with isolated testicular tuberculosis being a particularly rare manifestation. In this report, we present three cases of testicular tuberculosis, diagnosed through tissue biopsy and Acid Fast Bacilli (AFB) smears., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Masilamani et al.)

Abstract Background Anterior cervical tuberculous abscess is a rare presentation of extrapulmonary tuberculosis even in endemic countries. Case presentation We report a case of a 14-year-old girl with a 5 day history of an anterior mass. The diagnosis of an infected fourth branchial cleft cyst was first evoked. Fine-needle aspiration cytology was suggestive of tuberculosis. Polymerase chain reaction analysis was the key to the diagnosis of a tuberculous abscess. Conclusions In endemic countries, abscesses occurring in uncommon sites should be dealt with a high degree of suspicion for tuberculosis. Early diagnosis is essential to initiate specific and effective treatment. Pre-operative diagnosis avoids invasive surgery and related complications.

Introduction: Siderophore, the low molecular weight ferric iron chelator, is secreted extracellularly by Mycobacterium tuberculosis, an obligate aerobe. The pathogenic mycobacteria need iron as co-factor for the extracellularly secreted enzyme Superoxide Dismutase (SOD) for its pathogenicity as well as it requires iron for its metabolic functions like reduction of oxygen for synthesis of Adenosine Triphosphate (ATP) etc. The termination of impulse conduction is endorsed by the rapid hydrolysis of Acetylcholine (ACh) by Acetylcholinesterase (AChE) in the central as well as peripheral nervous system (cholinergic pathway). The inhibitors to Cholinesterase (ChE) might lead to accumulation of ACh, hyper stimulation of nicotinic and muscarinic receptors and also disruption of neurotransmission. Possibility of an inhibitor substance for AChE in Tuberculosis (TB) patients interestingly correlates with the symptom of night sweating in those subjects. Aim: To assay the level of serum ChE in normal control, lung disease control and tubercular subjects;circumvent the serum ChE level as a diagnostic potential in TB at an early stage. Materials and Methods: The study was conducted on total 124 subjects, and were divided into three groups: Group 1: normal control (n=31), Group 2: lung disease control (n=31) and Group 3: patients suffering from TB {3A: pulmonary TB (n=31) and 3B: extrapulmonary TB (n=31)}. Serum ChE activity for all the subjects were measured according to the method of Hestrin S. Serum ChE level was assayed for group 3 subjects after additional one month's anti-TB drug treatment and also for group 2 subjects after one month with usual treatment. The level of significance was assessed using Student's t-test. Results: There was a significant inhibition of serum ChE activity in both pulmonary and extrapulmonary TB patients in comparison to that of in normal control as well as lung disease control subjects (p<0.01). With the anti-tubercular drug therapy for one month, there was significant recovery in the serum ChE activity in pulmonary as well as extrapulmonary tubercular subjects (p<0.01). Conclusion: It appears that the high level of hydroxamate type of siderophores (secreted by Mycobacterium tuberculosis for acquiring iron) might form ACh ferric hydroxamate complex binding more strongly with serum ChE resulting in inhibition of serum ChE activity in tubercular subjects. With anti-tubercular drug therapy, there was decrease in serum ACh ferric hydroxamate complex level resulting in recovery of serum ChE activity. [ABSTRACT FROM AUTHOR]

Introduction: Sputum negative pulmonary Tuberculosis (TB) is a major public health problem. So, the emergence of new techniques for a more precise and rapid microbiological identification of Mycobacterium tuberculosis in clinical samples is of great importance to improve the management of TB. Aim: To determine and compare the sensitivity and turnaround time for Mycobacterium tuberculosis detection by the BACTEC Mycobacteria Growth Indicator Tube (MGIT) 960 system, Lowenstein Jensen (LJ) medium and Ziehl-Neelsen (ZN) staining. Materials and Methods: An Institution based, observational, cross-sectional study was conducted at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, from July 2013-March 2016. Sputum, pericardial fluid, pleural fluid, peritoneal fluid, pus and endometrial tissue samples were collected from 80 patients of suspected TB cases. All were Acid-Fast stained by ZN staining method and cultured on solid culture LJ medium and on liquid medium (MGIT). Data was analysed using Statistical Package for the Social Sciences (SPSS) software, Version 20.0 (SPSS Inc, Chicago, IL, USA). Fisher’s-Exact test was used to show association of categorical variables. Non-parametric Mann-Whitney U test was used to show median difference of non-normally distributed continuous variables of two groups. Results: Out of the 80 samples, 41 cases were positive by either of the all methods. The positive specimen for ZN staining, LJ media and MGIT were 21, 29 and 41 cases respectively. The mean Time To Detection (TTD) was shorter for MGIT system than LJ media. Both LJ medium and MGIT 960 detected all cases of sputum smear positive cases and in addition significantly higher number than ZN stain in sputum smear negative cases. MGIT 960 detected significantly higher number of cases of sputum negative cases than LJ Media. The mean TTD was also significantly shorter in case of smear positive cases than the smear negative cases by both the solid and liquid culture mediums. Conclusion: The use of liquid media (MGIT) is more accurate and rapid method for the diagnosis of TB. The combination of more than one method is also highly recommended for rapid detection and early treatment of TB.

Introduction: Sputum negative pulmonary Tuberculosis (TB) is a major public health problem. So, the emergence of new techniques for a more precise and rapid microbiological identification of Mycobacterium tuberculosis in clinical samples is of great importance to improve the management of TB. Aim: To determine and compare the sensitivity and turnaround time for Mycobacterium tuberculosis detection by the BACTEC Mycobacteria Growth Indicator Tube (MGIT) 960 system, Lowenstein Jensen (LJ) medium and Ziehl-Neelsen (ZN) staining. Materials and Methods: An Institution based, observational, cross-sectional study was conducted at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, from July 2013-March 2016. Sputum, pericardial fluid, pleural fluid, peritoneal fluid, pus and endometrial tissue samples were collected from 80 patients of suspected TB cases. All were Acid-Fast stained by ZN staining method and cultured on solid culture LJ medium and on liquid medium (MGIT). Data was analysed using Statistical Package for the Social Sciences (SPSS) software, Version 20.0 (SPSS Inc, Chicago, IL, USA). Fisher's-Exact test was used to show association of categorical variables. Non-parametric Mann-Whitney U test was used to show median difference of non-normally distributed continuous variables of two groups. Results: Out of the 80 samples, 41 cases were positive by either of the all methods. The positive specimen for ZN staining, LJ media and MGIT were 21, 29 and 41 cases respectively. The mean Time To Detection (TTD) was shorter for MGIT system than LJ media. Both LJ medium and MGIT 960 detected all cases of sputum smear positive cases and in addition significantly higher number than ZN stain in sputum smear negative cases. MGIT 960 detected significantly higher number of cases of sputum negative cases than LJ Media. The mean TTD was also significantly shorter in case of smear positive cases than the smear negative cases by both the solid and liquid culture mediums. Conclusion: The use of liquid media (MGIT) is more accurate and rapid method for the diagnosis of TB. The combination of more than one method is also highly recommended for rapid detection and early treatment of TB. [ABSTRACT FROM AUTHOR]

Tuberculosis of the tonsils is a rare type of extra pulmonary tuberculosis. The secondary form is more common than the primary, usually caused by the contact with the infected sputum or saliva from a sputum smear positive case of tuberculosis. We report a primary form of tonsillar tuberculosis in 10-year-old boy, with no remote history suggestive of documented pulmonary tuberculosis. Local examination revealed Grade IV tonsillar hypertrophy and congestion of posterior pharyngeal wall. Management included, Coblation assisted adenotonsillectomy under general anaesthesia. Histopathological examination revealed features suggestive of chronic adenotonsillitis, multiple epithelioid granulomas with caseous necrosis, langhans type of giant cells with scant inflammatory infiltrate in the background.

Hussen Mohammed,1 Nega Assefa,2 Bezatu Mengistie2 1School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia; 2College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Background: The double burden of infectious diseases such as tuberculosis (TB) and HIV disproportionately affects Africa. Our objective was to summarize the prevalence of extrapulmonary TB (EPTB) among people living with HIV/AIDS (PLWHA) in sub-Saharan Africa (SSA).Methods: We searched PubMed and Google Scholar for studies done on the prevalence of EPTB among PLWHA which published in English from 1990 to 2017. We also searched bibliographic indices and browsed through reference lists of articles and journals. We critically appraised the quality of articles and abstracted the data with Joanna Briggs Institute (JBI) checklists. We used Review Manager Software (version 5.3) and Compressive Meta-analysis Software (version 2.2) for analysis. Finally, we summarized the effect estimate by using random-effects model and explored potential sources of heterogeneity by subgroup and sensitivity analyses. We assessed publication bias by funnel plot and statistical test. Finally, we used PRISMA format for reporting.Results: We included, in this review, 31 studies that fulfilled our inclusion criteria, with a total population of 28,659. The prevalence estimate of EPTB among PLWHA ranged from 6.4% (95% CI: 3.8, 9.0) to 36.8% (95% CI: 28.6, 45); random-effects pooled prevalence of EPTB among PLWHA was found to be 20% (95% CI: 17, 22; heterogeneity: τ2=0; χ2=509.09, degrees of freedom [df]=30, P

Background: In the era of increasing drug resistance in pulmonary tuberculosis (TB), it is prudent to assess causes of poor response to anti tubercular therapy (ATT) and drug sensitivity pattern (DSP) in osteoarticular TB. Materials and Methods: As a part of Bombay Orthopaedic society's research project, members were asked to refer non responders to ATT to our institute. Cases were enrolled from October 2010 to March 2014. Deep tissue samples were obtained in all but five cases and subjected to a battery of tests including histopathology (HPE) and TB culture and sensitivity. The DSP was compared with the study performed by the principle author from 2004 to 2007 and published in 2009. Results: 39 male and 50 female patients with a mean age of 24.85 years (2–66) were included and classified in four groups after results. (1) Culture and HPE positive-36. 24 had MDR and three XDR TB. Primary resistance to even second line drugs and deterioration of DSP since last study was noted, (2) culture negative and HPE positive-21. The cause of poor response was surgical in more than half cases, (3) non representative samples or lost to follow-up-15, (4) TB mimics-16. Conclusion: There is increasing incidence of primary resistance to second line drugs, primary resistance in children and worsening of resistance patterns as compared to older studies. ATT initiation is a fateful decision and every attempt should be made to rule out TB mimics and establish DSP before initiation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coexistence of non-Hodgkin lymphoma and Mycobacterium tuberculosis active infection is a rare condition. CLINICAL CASE: A 86-year-old woman with necrotic ulcerations on the neck and left underarm in the presence of active pulmonary tuberculosis. The skin lesions were classified as an extra-pulmonary tuberculosis manifestation; however, due to the lack of treatment response, histological assessment was performed, which led to the unveiled the coexistence of a T cells cutaneous lymphoma not otherwise specified. CONCLUSIONS: The concomitance of these conditions has been reported previously; however, this case shows the importance of the multidisciplinary assessment in presence of a complex situation and atypical presentation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coexistence of non-Hodgkin lymphoma and Mycobacterium tuberculosis active infection is a rare condition. CLINICAL CASE: A 86-year-old woman with necrotic ulcerations on the neck and left underarm in the presence of active pulmonary tuberculosis. The skin lesions were classified as an extra-pulmonary tuberculosis manifestation; however, due to the lack of treatment response, histological assessment was performed, which led to the unveiled the coexistence of a T cells cutaneous lymphoma not otherwise specified. CONCLUSIONS: The concomitance of these conditions has been reported previously; however, this case shows the importance of the multidisciplinary assessment in presence of a complex situation and atypical presentation. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis has been detected in some extra pulmonary ecological niches. Although extra pulmonary tuberculosis (EPTB) is less frequent than Pulmonary Tuberculosis (PTB), its incidence has increased worldwide. The aim of this study was to investigate the presence of EPTB and MDR-EXPT in Formalin-fixed, paraffin-embedded tissue blocks among different samples in Kermanshah, Iran. Methods: Among all the suspected tuberculosis cases referred to the pathology laboratories, 116 patients were included based on the diagnosis of the infectious disease specialist. DNA were extracted from formalin-fixed, paraffin-embedded tissue blocks using genomics extraction G-spin Total DNA Extraction kit and the presence of EPTB was examined by TB Resistant Modual Isoniazid, Rifampicin kit. Results: The frequency of EPTB in the paraffin-embedded block samples was 32% (37 cases), and lymph nodes had the highest frequency (44.5%) followed by Pleural fluid, breast and CSF with the frequencies of 34.6%, 33% and 27% respectively. Conclusions: In the present study we found a high and increasing frequency of EPTB in paraffin- embedded blocks of the participants and it is one of the highest frequencies reported around the world. Since EPTB cases constitute a large number of TB burden, serious attention of public health organizations is recommended.

Graphical abstract Highlights • The study provides insight into circulating genotypes of M.tb in Tehran, Iran. • URAL2 and CAS1-DELHI genotypes were predominant in EPTB and PTB, respectively. • Mode of TB transmission was mainly associated with reactivation of latent TB. Abstract Objectives Evaluation of the genetic diversity of Mycobacterium tuberculosis (M.tb) and determining if the association between a specific genotype and the site of infection is crucial. Accordingly, the current study aimed at comparing predominant M.tb genotypes in pulmonary (PTB) and extrapulmonary tuberculosis (EPTB) isolates circulating in the capital of Iran. Methods The genetic diversity of culture-confirmed PTB and EPTB isolates were evaluated by Spoligotyping and MIRU-VNTR (mycobacterial interspersed repetitive-unit–variable-number tandem-repeat) typing methods. Genotyping data were analyzed with SITVIT, MIRU-VNTRplus, and TBminer databases. To assess adjusted associations, chi-square/the Fisher exact test and multiple logistic regression model were applied. Results URAL2 (NEW-1) (28/88; 31.8%) and CAS1-DELHI (25/84; 29.8%) genotypes were predominant in EPTB and PTB strains, respectively. Based on MIRU-VNTR typing, 158 different MIRU-VNTR patterns were identified. Clustering rate and minimum estimate of the proportion of TB caused by recent transmission was 4.1% and 8.1%, respectively. Conclusions The current study provided new insight into circulating genotypes of M.tb in PTB and EPTB patients in Tehran, Iran. This low percentage of TB transmission rate, demonstrated that mode of TB transmission was mainly associated with reactivation of latent TB rather than recently transmitted infection in this region. There was no significant difference in the association between the genotypes of M.tb strains and the site of the disease. [ABSTRACT FROM AUTHOR]

Introduction: The global burden of Multi Drug Resistant Tuberculosis (MDR TB) is increasing worldwide. Smear microscopy has low sensitivity, culture based tests for identification of tubercle bacilli and drug susceptibility testing take weeks to give results. Molecular tests allow rapid detection of Mycobacterium tuberculosis Complex (MTBC) and drug resistance in 4-8 hours. Real-time-PCR based GeneXpert provides only RIF susceptibility. In this study newer GenoType MTBDRplus VER 2.0 assay is utilized which gives sensitivity of both the first line anti-tubercular drugs. Aim: To evaluate the performance of Line Probe Assay (LPA) for rapid identification and detection of drug resistance in MTBC in respiratory and non-respiratory samples. Materials and Methods: All the samples (respiratory and non-respiratory) received from clinically suspected cases of Tuberculosis (TB), admitted in various wards, ICUs and outdoor patients of Dayanand Medical College and Hospital during the study, were processed in the Department of Microbiology. Samples other than Cerebro Spinal Fluid (CSF) were digested and decontaminated by NALC-NaOH method. Microscopy by ZN (Ziehl-Neelsen) staining, liquid culture by MGIT (Mycobacterial Growth Indicator Tube, BD BBLTM), and LPA by the GenoType MTBDRplus assay, VER 2.0, HAIN Life Science) were performed on all the samples. Results: A total of 70 samples were considered which includes 34 respiratory samples and 36 non-respiratory samples. Out of the 70 samples, 13 (18.6%) were smear positive, 23 (32.8%) grown in culture and 29 (41.4%) were detected positive for MTBC by LPA. Considering culture as gold standard the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the LPA for diagnosis of TB in respiratory and non-respiratory samples were found as (83.33%, 72.73%), (72.73%, 80%), (62.5%, 61.54%) and (88.89%, 86.96%) respectively while sensitivity of LPA in smear positive and smear negative samples were found as 90% and 69.23% respectively. All the samples except two showed sensitivity to Isoniazid (INH) and Rifampicin (RIF). Two samples were found resistant to INH only. Conclusion: LPA performed directly on samples is a wonderful tool for fast detection of MTBC in the respiratory samples along with INH and RIF resistance. In comparison, the sensitivity of LPA is less in non-respiratory samples. Still, many patients can be diagnosed and can start appropriate treatment till the culture report is received.