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Tuberculosis of the breast, also referred to as tuberculous mastitis, represents an extremely rare presentation of tuberculosis. It constitutes < 0.1 % of all breast pathology in developed countries and <2 % of all tuberculous cases globally. It's an infrequent manifestation of extra-pulmonary tuberculosis. It is characterized by diagnostic challenges with majority of preliminary clinical diagnosis being breast carcinoma or pyogenic breast abscess. The diagnosis is challenging due to the nonspecific clinical and radiological findings, in addition to insufficient specimen with often negative microscopy and culture results. We report the case of tuberculosis of the right breast in a young multiparous woman, a healthcare worker who presented with clinical features suspected to be breast tuberculosis in whom diagnosis was made based on clinical, haematological parameters and tuberculin skin test only. She was commenced on anti-tuberculous medications with excellent clinical response after 6 months of therapy. This report highlights the importance of considering tuberculosis as a differential diagnosis in women with breast lumps and sinuses. In addition, this report also highlights the diagnostic challenges in breast tuberculosis and how a high index of suspicion and non-bacteriological investigation could be relied upon for its diagnosis. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of pediatric tuberculosis (TB) still remains a challenge due to the paucibacillary nature of the disease. Objectives: To assess the role of CB-NAAT in diagnosing pulmonary and extrapulmonary tuberculosis as compared to AFB smear and Mycobacterium tuberculosis culture in clinically diagnosed pediatric tuberculosis cases. Study design: Hospital-based prospective study. Methods: A total of142 patients with strong clinical suspicion of pulmonary or extra-pulmonary tuberculosiswere enrolled over a period of two yearsand then results of CB-NAAT were compared to conventional methods (culture/ AFB smear) on follow-up. Results: In subjects who had clinically diagnosed tuberculosis, culture was positive in 18.9% of cases, AFB smear was positive in only 12.1% whereas CB-NAAT was positive in 55.4% of subjects. The sensitivity, specificity, PPV, and NPV of CB-NAAT in patients with culture proven tuberculosis were100%, 83.3%, 47.5%, and 100% respectively with a diagnostic accuracy of 93.3%. and 60%, 100%, 100%, and 65.8% respectively with a diagnostic accuracy of 80.2% in clinically diagnosed pulmonary cases. Conclusion:CB-NAAT has true diagnostic potential with good sensitivity in confirmed cases and significantly better sensitivity than conventional methods in clinically diagnosed cases. [ABSTRACT FROM AUTHOR]

Simple Summary: Extra-pulmonary poorly differentiated neuroendocrine carcinoma is a rare tumour type with a limited evidence base for its treatment. Recent work has helped to clarify the optimum first-line chemotherapy regimen. However, in the second-line setting, data remain sparse. A more personalised approach is warranted, given the heterogeneity of this disease, and emerging translational approaches focused on mouse models, organoids, and comprehensive genomic profiling may guide future trial design. Extra-pulmonary poorly differentiated neuroendocrine carcinoma is rare, and evidence for treatment has been limited. In this article, the evidence behind the cytotoxic chemotherapy choices used for metastatic or unresectable EP-PD-NEC is reviewed. In the first-line setting, etoposide and platinum chemotherapy or irinotecan and platinum have been demonstrated to be equivalent in a large phase III trial. Questions remain regarding the optimal number of cycles, mode of delivery, and the precise definition of platinum resistance in this setting. In the second-line setting, FOLFIRI has emerged as an option, with randomized phase 2 trials demonstrating modest, but significant, response rates. Beyond this, data are extremely limited, and several regimens have been used. Heterogeneity in biological behaviour is a major barrier to optimal EP-PD-NEC management. Available data support the potential role of the Ki-67 index as a predictive biomarker for chemotherapy response. A more personalised approach to management in future studies will be essential, and comprehensive multi-omic approaches are required to understand tumour somatic genetic changes in relation to their effects on the surrounding microenvironment. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of pediatric tuberculosis (TB) still remains a challenge due to the paucibacillary nature of the disease. Objectives: To assess the role of CB-NAAT in diagnosing pulmonary and extrapulmonary tuberculosis as compared to AFB smear and Mycobacterium tuberculosis culture in clinically diagnosed pediatric tuberculosis cases. Study design: Hospital-based prospective study. Methods: A total of142 patients with strong clinical suspicion of pulmonary or extra-pulmonary tuberculosis were enrolled over a period of two years and then results of CB-NAAT were compared to conventional methods (culture/ AFB smear) on follow-up. Results: In subjects who had clinically diagnosed tuberculosis, culture was positive in 18.9% of cases, AFB smear was positive in only 12.1% whereas CB-NAAT was positive in 55.4% of subjects. The sensitivity, specificity, PPV, and NPV of CB-NAAT in patients with culture proven tuberculosis were100%, 83.3%, 47.5%, and 100% respectively with a diagnostic accuracy of 93.3%. and 60%, 100%, 100%, and 65.8% respectively with a diagnostic accuracy of 80.2% in clinically diagnosed pulmonary cases. Conclusion: CB-NAAT has true diagnostic potential with good sensitivity in confirmed cases and significantly better sensitivity than conventional methods in clinically diagnosed cases.

Objectives: Tuberculosis is the biggest health issue worldwide, with tuberculous lymphadenitis (TBL) being its most common extrapulmonary manifestation. Clinical diagnoses of TBL often pose challenges; thus, this study aimed to analyze the clinical, epidemiologic, and laboratory aspects of TBL in Debre Markos Specialized Comprehensive Hospital, northwest Ethiopia. Methods: The study was conducted at Debre Markos Specialized Comprehensive Hospital from October 2019 to March 2021. Patients with lymphadenitis displaying cytomorphologic features of tuberculosis were enrolled. A checklist was used to collect clinicodemographic data. Results: Among a total of 294 patients with TBL, 237 (80.61%) were adults aged 15-45 years. A fluctuant consistency (177; 60.20%; n = 294) with predominant involvement of cervical lymph nodes (229; 77.8%) was the most frequent presentation. Most patients did not have either HIV infection (235; 94.37%; n = 261) or known chronic medical illnesses (250; 95.8%). Constitutional symptoms (113; 41.85%; n = 270) and chronic cough (56; 20.74%; n = 270) were infrequent. The erythrocyte sedimentation rate (ESR) was increased in the majority of patients (133; 80%; n = 165), of whom extreme elevation (≥100 mm/hour) seen in 63 (38.18 %) patients and the mean ESR for our participants was 78.64 mm/hour. Conclusion: TBL typically presents as a fluctuant neck mass, predominantly in young adults. The majority of patients have no constitutional symptoms or cough. HIV infection or chronic medical illnesses are uncommon. The raised erythrocyte sedimentation rate is a fairly consistent finding.

Extra-pulmonary poorly differentiated neuroendocrine carcinoma is rare, and evidence for treatment has been limited. In this article, the evidence behind the cytotoxic chemotherapy choices used for metastatic or unresectable EP-PD-NEC is reviewed. In the first-line setting, etoposide and platinum chemotherapy or irinotecan and platinum have been demonstrated to be equivalent in a large phase III trial. Questions remain regarding the optimal number of cycles, mode of delivery, and the precise definition of platinum resistance in this setting. In the second-line setting, FOLFIRI has emerged as an option, with randomized phase 2 trials demonstrating modest, but significant, response rates. Beyond this, data are extremely limited, and several regimens have been used. Heterogeneity in biological behaviour is a major barrier to optimal EP-PD-NEC management. Available data support the potential role of the Ki-67 index as a predictive biomarker for chemotherapy response. A more personalised approach to management in future studies will be essential, and comprehensive multi-omic approaches are required to understand tumour somatic genetic changes in relation to their effects on the surrounding microenvironment.

Background: Around 26% of World’s tuberculosis (TB) cases are in India. In resource constrained settings, it is difficult to use diagnostic tests such as nucleic acid amplification technique and mycobacterial culture due to their complexity and expensiveness. Developing an assay using polyclonal antibody may help to solve this problem. Aims and Objectives: On the basis of this, we worked to detect tubercular antigen by developing Sandwich ELISA from the serum of TB patients. Materials and Methods: For this study, 50 cases, 50 disease controls, and 30 healthy control subjects were taken. Commercially available reagents were used for the development of Sandwich ELISA. The data were statistically analyzed with the help of software SPSS version 16.0. Results: Our effectively developed test had 82% area under the ROC curve. About 81% (n=35) patients of pulmonary TB cases with non-HIV infection detected by our Sandwich ELISA and 57% cases with the coinfection of HIV-TB. Developed test had 70.91% positive predictive value and 75.56% negative predictive value. Conclusion: We successfully developed Sandwich ELISA for tubercular antigen detection and to increase the specificity of the Sandwich ELISA, as per the WHO guidelines, further work is needed for the detection of tubercular antigen.

• Tuberculous lymphadenitis (TBL) often presents as a fluctuant neck mass with raised erythrocyte sedimentation rate. • Most TBL patients have no constitutional symptoms or cough. • HIV infection and chronic medical illness are infrequent in TBL patients. Tuberculosis is the biggest health issue worldwide, with tuberculous lymphadenitis (TBL) being its most common extrapulmonary manifestation. Clinical diagnoses of TBL often pose challenges; thus, this study aimed to analyze the clinical, epidemiologic, and laboratory aspects of TBL in Debre Markos Specialized Comprehensive Hospital, northwest Ethiopia. The study was conducted at Debre Markos Specialized Comprehensive Hospital from October 2019 to March 2021. Patients with lymphadenitis displaying cytomorphologic features of tuberculosis were enrolled. A checklist was used to collect clinicodemographic data. Among a total of 294 patients with TBL, 237 (80.61%) were adults aged 15-45 years. A fluctuant consistency (177; 60.20%; n = 294) with predominant involvement of cervical lymph nodes (229; 77.8%) was the most frequent presentation. Most patients did not have either HIV infection (235; 94.37%; n = 261) or known chronic medical illnesses (250; 95.8%). Constitutional symptoms (113; 41.85%; n = 270) and chronic cough (56; 20.74%; n = 270) were infrequent. The erythrocyte sedimentation rate (ESR) was increased in the majority of patients (133; 80%; n = 165), of whom extreme elevation (≥100 mm/hour) seen in 63 (38.18 %) patients and the mean ESR for our participants was 78.64 mm/hour. TBL typically presents as a fluctuant neck mass, predominantly in young adults. The majority of patients have no constitutional symptoms or cough. HIV infection or chronic medical illnesses are uncommon. The raised erythrocyte sedimentation rate is a fairly consistent finding. [ABSTRACT FROM AUTHOR]

Purpose: Tuberculosis is one of the dreadful infections and India contributes to substantial burden of TB cases globally. Though majority of cases are pulmonary, extra-pulmonary tuberculosis (EPTB) share significant burden, more in HIV-positive persons. Despite the striking burden, very few studies have been conducted in India and present study was undertaken to determine trends of EPTB at our tertiary care centre., Methods: This was a retrospective study conducted over a period of 4 years 3 months. Diagnosis of EPTB was based on suspected clinical features, with positive micobiological evidence with cartridge based nucleic acid amplification test (CBNAAT) with/without microscopy., Results: A total of 10,560 samples (pulmonary and extra-pulmonary) were received during the study period, of which 3972 were extrapulmonary. Of these, a total of 18% were noted to be positive for EPTB. Trend of positivity revealed highest burden in 2018 and a decline was noted over the years, however, rise in cases was noted in 2022. Pleural, meningitis, musculoskeletal, peritoneal and pericardial TB was more common in males, while lymphadenitis was more common in females (p value: <0.0001). Pleural TB (31%) was the most common presentation, followed by lymphadenitis. A gradual decline in lymphadenitis was noted with significantly increasing trend only for musculoskeletal TB. Rifampicin resistance was detected in 7.45% of positive samples, of which the maximum rate of resistance was noted in lymph node aspirates (11.11%), followed by musculoskeletal and pleural samples., Conclusion: The present study showed a gradual decline in positivity of EPTB cases over the years. Younger productive age group with more propensity to transmit infection was the most commonly affected, with pleural TB as the most common presentation. Rare presentations of EPTB also contributed major share. Higher rates of resistance underline requisite to strengthen ongoing programs, to achieve the End TB strategy by 2025., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Rapid detection of Mycobacterium tuberculosis complex and determination of drug resistance are essential for early diagnosis and treatment of tuberculosis (TB). Xpert MTB/RIF Ultra (Xpert Ultra), a molecular test that can simultaneously identify M. tuberculosis complex and resistance to rifampicin directly on clinical samples, is currently used. Xpert Ultra represents a helpful tool for rapid pulmonary TB diagnosis, especially in patients with paucibacillary infection. The aim of this review is to provide an overview of the diagnostic performance of Xpert Ultra in detection of extra-pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Around 26% of World's tuberculosis (TB) cases are in India. In resource constrained settings, it is difficult to use diagnostic tests such as nucleic acid amplification technique and mycobacterial culture due to their complexity and expensiveness. Developing an assay using polyclonal antibody may help to solve this problem. Aims and Objectives: On the basis of this, we worked to detect tubercular antigen by developing Sandwich ELISA from the serum of TB patients. Materials and Methods: For this study, 50 cases, 50 disease controls, and 30 healthy control subjects were taken. Commercially available reagents were used for the development of Sandwich ELISA. The data were statistically analyzed with the help of software SPSS version 16.0. Results: Our effectively developed test had 82% area under the ROC curve. About 81% (n=35) patients of pulmonary TB cases with non-HIV infection detected by our Sandwich ELISA and 57% cases with the coinfection of HIV-TB. Developed test had 70.91% positive predictive value and 75.56% negative predictive value. Conclusion: We successfully developed Sandwich ELISA for tubercular antigen detection and to increase the specificity of the Sandwich ELISA, as per the WHO guidelines, further work is needed for the detection of tubercular antigen. [ABSTRACT FROM AUTHOR]

Abstract Background Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. Methods In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. Results Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. Conclusions Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.

Rapid detection of Mycobacterium tuberculosis complex and determination of drug resistance are essential for early diagnosis and treatment of tuberculosis (TB). Xpert MTB/RIF Ultra (Xpert Ultra), a molecular test that can simultaneously identify M. tuberculosis complex and resistance to rifampicin directly on clinical samples, is currently used. Xpert Ultra represents a helpful tool for rapid pulmonary TB diagnosis, especially in patients with paucibacillary infection. The aim of this review is to provide an overview of the diagnostic performance of Xpert Ultra in detection of extra-pulmonary tuberculosis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis of small‐to‐medium‐sized vessels. Both eosinophilic infiltration and vasculitis are thought to contribute to multi‐organ damage. Some biologics have been used to reduce the required dose of corticosteroids in EGPA, but no single agent can ensure a complete control of this disease. Here, we describe a patient with anti‐neutrophil cytoplasmic antibodies‐negative relapsing EGPA whose asthma control was improved by omalizumab, but she continued to develop flares of abdominal and cutaneous vasculitis symptoms. After switching to mepolizumab therapy, her blood hypereosinophilia and extra‐pulmonary symptoms were significantly improved. Moreover, the dose of daily maintenance corticosteroid could be tapered off. The experience from our case suggests that biologics targeting interleukin‐5 may be more effective than omalizumab in the management of extra‐thoracic manifestations in EGPA. [ABSTRACT FROM AUTHOR]

Abstract Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis of small‐to‐medium‐sized vessels. Both eosinophilic infiltration and vasculitis are thought to contribute to multi‐organ damage. Some biologics have been used to reduce the required dose of corticosteroids in EGPA, but no single agent can ensure a complete control of this disease. Here, we describe a patient with anti‐neutrophil cytoplasmic antibodies‐negative relapsing EGPA whose asthma control was improved by omalizumab, but she continued to develop flares of abdominal and cutaneous vasculitis symptoms. After switching to mepolizumab therapy, her blood hypereosinophilia and extra‐pulmonary symptoms were significantly improved. Moreover, the dose of daily maintenance corticosteroid could be tapered off. The experience from our case suggests that biologics targeting interleukin‐5 may be more effective than omalizumab in the management of extra‐thoracic manifestations in EGPA.

Abstract Background Acute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes. Methods We performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n = 6), intratracheal hydrochloric acid (HCl; n = 6), intratracheal albumin (n = 10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv; n = 5). ARDS was defined when PaO2 was

Abstract Background This study aimed to establish and evaluate a simultaneous amplification and testing method for detection of extra-pulmonary tuberculosis (EPTB). Methods From January 2016 and December 2017 the pus or surgical excision from the lesions of inpatients admitted from Chongqing Public Health Treatment Center were collected. According to the clinical diagnosis, the samples were divided into two groups including EPTB (Group A) and other diseases excluded from tuberculosis diseases (Group B). Simultaneous detection of Mycobacterium tuberculosis (MTB) used Roche culture method, liquid culture method and simultaneous amplification and testing (SAT) method. The sensitivity and specificity of the SAT method were compared with culture methods and clinical diagnosis of EPTB. Results For 433 EPTB specimens and 49 non-TB specimens, the simultaneous amplification and testing tuberculosis (SAT-TB) results correlated with 80.5% (388/482 specimens) of the culture assay results. The sensitivity, specificity, and positive and negative predictive values of the SAT-TB test for the diagnosis of EPTB were 83.6, 79.4, 59.4, and 93.0%, respectively, compared to culture methods. Compared with the clinical diagnosis of patients, the sensitivity and specificity of the SAT-TB test were 41.6 and 100%, respectively, the cultures test were 29.3 and 98.0%. Conclusions SAT test is a simple and rapid test with high specificity which may enhance the detection of EPTB. SAT-TB is a higher clinical diagnosis value for EPTB in clinical microbiology laboratories.

Background: This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years).Methods: This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value <0.05 was considered statistically significant.Results: Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were <5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value < 0.001), rural residence (OR = 3.126, p-value < 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes.Conclusion: The study sites collectively reached the World Health Organization's target of treatment success (>85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran.Methods: In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model.Results: Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death.Conclusions: Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors. [ABSTRACT FROM AUTHOR]

Background: In the past 20 years four major viral infectious diseases outbreaks caused hundreds of thousands of deaths worldwide: SARS, Influenza H1N1, MERS, and COVID-19. They all present clinically initially as upper and lower respiratory tract infections and may progress to multi-organ failure. Methods: This study was a systematic review of literature conducted in September 2020 to study extra-pulmonary complications of SARS, FLU, MERS, and current COVID-19. We carried out a systematic search using the keywords in online databases of PubMed, EMBASE, and Google Scholar until June 2020. Objective: This article aims to review the most common extra-pulmonary manifestations of SARS, Influenza, MERS, and COVID-19. Discussion: Several studies have reported extra-pulmonary conditions in patients diagnosed with SARS, Influenza, MERS, and COVID-19, either by direct viral injury or from the systemic response to the initial infection. Conclusion: SARS, Influenza, MERS, and COVID-19 have all been associated with dysfunction of kidneys, endocrine system, neuromuscular symptoms, perinatal complications, and myocardial injury. Progression from pulmonary disease to a systemic condition has a poor outcome and can result in multi-organ failure. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystem idiopathic granulomatous disease. Lung is the most common organ involved but can involve any organ. The skin, eyes, joints, and heart are affected in a significant fraction of patients. Extrapulmonary sarcoidosis may be the major manifestation of the disease. Extrapulmonary disease may manifest before, concurrent with, or after the development of pulmonary disease or as isolated independent disease. We present three cases of isolated organ sarcoidosis involving the liver, lacrimal, and heart. Isolated organ involvement is difficult to diagnose and the treatment of Isolated organ is not defined.

Abstract Background Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea. Methods A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB. Results The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study. Conclusions Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.

Introduction: Rifampicin is one of the most effective components of anti‐tuberculous therapy (ATT). Since rifampicin is a hepatic enzyme (CYP3A4) inducer, in a post‐renal transplant recipient, the dose of calcineurin inhibitors needs to be up‐regulated and frequently monitored. In resource‐limited (low‐ and lower‐middle‐income countries) setting this is not always feasible. Therefore, we evaluated a non‐rifampicin‐based ATT using levofloxacin in kidney transplant recipients. Methods: We retrospectively studied the medical records of renal transplant recipients diagnosed with tuberculosis in our institute between 2014 and 2017. After a brief discussion with patients regarding the nature and course of ATT, those who opted for a non‐rifampicin based therapy due to financial constraints were included in the study and followed for a minimum of 6 months period after the completion of ATT. Results: Out of the 550 renal transplant recipients, 67 (12.2%) developed tuberculosis after a median period of 24 (1‐228) months following transplantation, of them, 64 patients opted for non‐rifampicin‐based ATT. The mean age was 37.6 years. Only 25% were given anti‐thymocyte globulin based induction, while the majority (56; 87.5%) of them were on tacrolimus‐based triple‐drug maintenance therapy. Extrapulmonary tuberculosis was noted in 33% of cases, while 12 (18.7%) had disseminated disease. The median duration of treatment was 12 months and the cure rate of 93.7% (n = 60) was achieved at the end of therapy. Conclusion: Levofloxacin based ATT appears to be a safe and effective alternative of rifampicin in kidney transplant recipients who cannot afford heightened tacrolimus dosage. SUMMARY AT A GLANCE: In this single‐centre study, the authors report their experience using levofloxacin instead of rifampicin for the treatment of tuberculosis after kidney transplantation. Therapy with levofloxacin appeared safe and effective, and may provide a more cost‐effective treatment for post‐transplant tuberculosis in financially constrained clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to review how did the first three COVID-19 waves affected the diagnostic of tuberculosis and to describe the extra-pulmonary Mycobacterium tuberculosis complex (TB) diagnosis., Materials and Methods: A retrospective observational study was done during the first three waves of pandemic to ascertain the impact on TB samples and to recover the extra-pulmonary TB cases we included the first two years of COVID-19. All relevant data was recovered from hospital and Clinical Microbiology records., Results: Prepandemic period showed an average of 44 samples per week for TB study; during the first three waves this number dropped to 23.1 per week. A reduction of 67.7% of pulmonary TB diagnosis was observed and an increase of 33.3% diagnosis of extra-pulmonary TB was noted when comparing pre-pandemic and pandemic period., Discussion: The number of declared cases and samples for TB diagnosis dropped during the first three COVID-19 waves due to the overstretched Public Health System which could lead to a delay in diagnosis, treatment and to the spread of TB disease in the general population. Surveillance programs should be reinforced to avoid this., (Copyright © 2022 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Tuberculosis involving organs other than the lungs is termed as ´extra pulmonary tuberculosis´. Tuberculosis remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

Background: Acute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes.Methods: We performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n = 6), intratracheal hydrochloric acid (HCl; n = 6), intratracheal albumin (n = 10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv; n = 5). ARDS was defined when PaO2 was < 15 kPa (112 mmHg) when ventilated with PEEP 10 cm H2O and FiO2 = 1.0. The effects on gas exchange were investigated by calculating the oxygenation index (OI) and the ventilation efficacy index (VEI) every 30 min for a period of 4 h. Post mortem lung lavage was performed to obtain broncho-alveolar lavage fluid (BALF) to assess lung injury and inflammation. Lung injury and inflammation were assessed by measuring the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, and interleukine-6 and -8 in the BALF. Histology of the lung was evaluated by measuring the mean alveolar size, alveolar wall thickness and the lung injury score system by Matute-Bello et al., as markers of lung injury. The concentration of interleukin-6 was determined in plasma, as a marker of systematic inflammation.Results: The OI and VEI were most affected in the LPS iv group and thereafter the HCl group, after meeting the ARDS criteria. Diastolic blood pressure was lowest in the LPS iv group. There were no significant differences found in the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, or interleukin-8 in the BALF, histology of the lung and the lung injury score. IL-6 in BALF and plasma was highest in the LPS iv group, but no significant differences were found between the other groups. It took a significantly longer period of time to meet the ARDS criteria in the LPS iv group.Conclusions: The LPS model caused the most severe pulmonary and cardiovascular insufficiency. Surprisingly, there were limited significant differences in lung injury and inflammatory markers, despite the different pathophysiological models, when the clinical definition of ARDS was applied. [ABSTRACT FROM AUTHOR]

Tuberculosis in London occurs at a rate of 19 cases per 100,000 population, with a significant proportion diagnosed as extra-pulmonary infection. At Barts Health NHS Trust, our TB rates are much higher than the London average and approximately 60% cases are extra-pulmonary in nature. We evaluated the BD MAX™ MDR-TB assay as a molecular tool for rapid diagnosis of TB. One hundred twenty-eight specimens, encompassing pulmonary (70) and extra-pulmonary (58) infection, were tested using the BD MAX™ MDR-TB assay and compared with smear and liquid culture results, to determine PCR performance. The BD MAX™ MDR-TB assay was also compared with the Xpert MTB/RIF assay, where applicable. TB was successfully detected in 50/66 Mycobacterium tuberculosis culture positive specimens, with additional detections in 2 of the culture negative specimens. The BD MAX™ MDR-TB assay demonstrated higher sensitivity with the pulmonary samples (92%) compared with the extra-pulmonary samples (52%), although the performance with fluids and biopsies demonstrated greater potential than the remaining extra-pulmonary samples. Rifampicin and/or isoniazid resistance was successfully detected by the BD MAX™ in 2/3 samples, where WGS susceptibility results were available. The BD MAX™ MDR-TB assay was comparable with the performance of the Xpert MTB/RIF assay. TB can successfully be diagnosed, in both pulmonary and extra-pulmonary samples, using the BD MAX™ MDR-TB assay. [ABSTRACT FROM AUTHOR]

Patients with extrapulmonary poorly differentiated neuroendocrine carcinomas (EP-PD-NECs) have a poor prognosis. Surgery is offered for those with localised disease, but the majority of patients present with advanced disease. Treatment strategies adopted are analogous to that of high grade NECs of the lung, with platinum/etoposide-based regimens advocated in the first-line setting for advanced disease. There is no standard second-line therapy. Research into their molecular and immune pathways may pave the way for novel drug discovery. The molecular drivers of NEC are best identified in small cell lung carcinoma, which present with near universal genomic alterations in TP53 and RB1. The genetics of EP-PD-NEC remain poorly understood; TP53, KRAS, PIK3CA/PTEN and BRAF mutations have been identified, with alterations in the BRCA pathway reported additionally in small cell NEC of the cervix and absence of argininosuccinate synthetase 1 expression in NEC of the urinary bladder. The use of cell lines and patient-derived xenografts (PDX) to predict response to treatment in NEC and the emergence of alternative biomarkers, such as circulating tumour cells and cell-free DNA, will also be explored. Despite limited published data on the immune microenvironment of EP-NEC, there are a number of clinical trials investigating the use of immune-targeted agents in this disease category, with conflicting emerging data from studies thus far. This review will summarise the treatment and available molecular and immune data in this under researched diagnosis and may stimulate the direction of future exploratory studies. [ABSTRACT FROM AUTHOR]

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study. [ABSTRACT FROM AUTHOR]

Background: This study aimed to establish and evaluate a simultaneous amplification and testing method for detection of extra-pulmonary tuberculosis (EPTB).Methods: From January 2016 and December 2017 the pus or surgical excision from the lesions of inpatients admitted from Chongqing Public Health Treatment Center were collected. According to the clinical diagnosis, the samples were divided into two groups including EPTB (Group A) and other diseases excluded from tuberculosis diseases (Group B). Simultaneous detection of Mycobacterium tuberculosis (MTB) used Roche culture method, liquid culture method and simultaneous amplification and testing (SAT) method. The sensitivity and specificity of the SAT method were compared with culture methods and clinical diagnosis of EPTB.Results: For 433 EPTB specimens and 49 non-TB specimens, the simultaneous amplification and testing tuberculosis (SAT-TB) results correlated with 80.5% (388/482 specimens) of the culture assay results. The sensitivity, specificity, and positive and negative predictive values of the SAT-TB test for the diagnosis of EPTB were 83.6, 79.4, 59.4, and 93.0%, respectively, compared to culture methods. Compared with the clinical diagnosis of patients, the sensitivity and specificity of the SAT-TB test were 41.6 and 100%, respectively, the cultures test were 29.3 and 98.0%.Conclusions: SAT test is a simple and rapid test with high specificity which may enhance the detection of EPTB. SAT-TB is a higher clinical diagnosis value for EPTB in clinical microbiology laboratories. [ABSTRACT FROM AUTHOR]

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Background: Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, despite being a treatable and preventable disease. The emergence of Multi Drug Resistant (MDR) TB had exacerbated the situation further. To prevent the spread of infection & to accelerate the administration of Anti-tubercular treatment, early detection of TB is required. Methodology: This Cross-sectional study was carried out on 236 samples clinically suspected cases of Pulmonary & Extra-Pulmonary Tuberculosis processed for Direct Ziehl-Neelsen Staining, Decontamination by NALC-NaOH and Culture in MGIT tubes & Lowenstein-Jensen Medium. Results: Out of 60 samples, 60(25.42%) were culture positive cases showed highest isolation rate by BACTEC MICRO MGIT as compared to LJ Medium 42(17.79%) with time of detection by BACTEC MICRO MGIT was 17 days and LJ Medium was 33.72 days. The Diagnostic accuracy of BACTEC MICRO MGIT when LJ Medium considered to be gold standard was also exhibited which showed sensitivity of 95.24%, Specificity of 89.69% while Negative Predictive value (NPV) & Positive Predictive value (PPV) was 98.86% and 66.67% respectively. The BACTEC MICRO MGIT detects mycobacteria early, with less contamination rates and has good sensitivity & specificity as compared to LJ Medium. Conclusion: So it can be concluded that BACTEC MICRO MGIT can be used as method of isolation of Mycobacterium tuberculosis either alone or in combination with LJ Medium. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the performance of Ziehl Neelsen (ZN) smearing, Lowenstein--Jensen (LJ) culture and real-time PCR analysis to detect Mycobacterium tuberculosis in pulmonary and extra-pulmonary specimens. Materials and Methods: A descriptive study conducted from January 2016 through December 2018, on a total of 293 clinical samples of patients suspected with pulmonary and extra-pulmonary tuberculosis at a tertiary hospital of Peshawar, Pakistan. Specimens were processed by ZN smearing, LJ culture and Real-time PCR technique for the detection of M.tuberculosis. The target for the amplification was a segment of IS6110 in the M.tuberculosis chromosome. Specificity and sensitivity were derived for each test and Fishers exact test was performed to examine significance of association between specimen types and each test. Results: Of the 293 samples, 165(56.3%) were from males and 128(43.7%) females. Mean age was 44 years (2-85 years). Specimen types included: CSF (30.4%), pleural fluid (4.1%), sputum (15%), urine (2.4%), synovial fluid (2.4%), other fluids (33.1%) and biopsies (12.6%). Using PCR as gold standard, ZN microscopy correctly identified 20.5% of total M.TB positive specimens and LJ culture detected 47.7%.Certain specimen types showed higher positivity rates of M.TB detection: synovial fluid (42.9%), pleural fluid (41.7%)by PCR analysis. ZN microscopy was associated with the low positivity rates for all specimens, the highest being 18.2% for sputum samples. Conclusion: Tuberculosis PCR is a more rapid and reliable test in the diagnosis and management of tuberculosis. Both Pulmonary and extra-pulmonary specimens exhibit greater positivity rates by PCR analysis than by LJ culture and ZN smearing. [ABSTRACT FROM AUTHOR]

Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered. [ABSTRACT FROM AUTHOR]

Objectives: The study determined tuberculosis (TB) treatment outcomes in Southern Ghana from 2012 to 2021., Methods: A retrospective analysis of service data on TB cases was conducted. Treatment success was defined as TB cure or completion of treatment course, whereas unsuccessful outcomes was defined as death, failure of treatment and lost to follow up. Bivariate and multivariate logistic regression was used to determine factors associated with treatment outcomes., Results: A total of 4106 adult TB cases were reported with a median age of 41 (interquartile range 32-52) years. Of these, 93.1% (n = 3823) were newly diagnosed. The treatment success rate declined from 71.0% in 2012 to 55.7% in 2021 (ktau-b = -0.56, P  = 0.0318). Clinically diagnosed TB and extra-pulmonary TB had 7.0% (adjusted prevalence ratio [aPR]: 0.93, 95% confidence interval [CI]: 0.88-1.00) and 24.0% (aPR: 0.76, 95% CI: 0.69-0.84) respectively, less successful treatment outcome compared to pulmonary TB patients. HIV negative status was associated with 22% higher successful treatment outcome compared with being HIV positive (aPR: 1.22, 95% CI: 1.12-1.33)., Conclusion: Tuberculosis treatment success rate declined over the period. There is a need for the TB Control Programme to review the national and sub-national TB data to ascertain poor performing TB treatment sites to identify and address context specific challenges with treatment interventions and system inadequacies to improve treatment success rates., Competing Interests: The authors have no competing interests to declare, (© 2023 The Author(s).)

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A definitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the prevalence of presumed ocular tuberculosis among diagnosed pulmonary tuberculosis patients. Method: It was a cross-sectional study in which 150 patients who were labeled to have active pulmonary tuberculosis underwent history and ocular examination prior to anti-tubercular therapy. The diagnosis of presumed ocular tuberculosis was made when clinical signs of tuberculosis (TB) uveitis were found in the participants. Lesions were documented and tallied, after which statistical analysis was performed. Results: 10 of the 150 pulmonary TB patients (6.8% prevalence: 95% CI 2.78% to 13.5%) included in the study showed signs of ocular inflammation. There was no sex and age predilection between those with presumed ocular TB and those without. Posterior uveitis alone was observed in three of the patients (two cases of retinal vasculitis and one case of choroidal tubercle). Non-granulomatous anterior uveitis with posterior synechiae alone was observed in two patients. One patient had combined non-granulomatous anterior uveitis with posterior synechiae and choroidal tubercle. One had combined granulomatous anterior uveitis with posterior synechiae and choroidal tubercle. Intermediate uveitis was not noted among the patients. Conclusion: Presumed ocular tuberculosis should be considered among patients with diagnosed pulmonary tuberculosis. Common ocular lesions found in the study include choroidal tubercle and non-granulomatous anterior uveitis with posterior synechiae. [ABSTRACT FROM AUTHOR]

Tuberculosis continues to be a problem in the entire world and can be confused with other diseases, when presented extra - pulmonary involvement. Cerebellar tuberculoma may present with symptoms of intracranial mass. A 53-years-old male patient was admitted with complaints of dizziness, nausea and vomiting. Cranial magnetic resonance imaging was observed mass in the posterior fossa and the patient was operated. Pathology of the lesion was reported as necrotizing granuloma. Patient diagnosed with tuberculos is meningoencephalitis and treated standard four drug anti tuberculosis regimen plus methylprednisolone. The symptoms of the patient were completely disappeared during treatment. Follow-up magnetic resonance imaging which taken 6 months after onset of the treatment shows cranial tuberculoma sequelae in the cerebellum. Central nervous system tuberculosis may be difficult to diagnose as it is an infrequent entity that can easily mimic an intracranial mass. Especially in tuberculosis endemic areas, in the patients who presenting with symptoms of intracranial lesion, tuberculosis diagnosis should be considered. [ABSTRACT FROM AUTHOR]

There has been reported increased incidence of ovarian tuberculosis in the tropics since the advent of HIV/AIDS disease. We report a case of bilateral ovarian tuberculosis associated with a single right kidney of uncertain origin in an immunocompetent 15-year-old generally healthy-looking girl. Abdominopelvic scan was equivocal about the diagnosis of the lesion as it failed to differentiate it from malignancy. Tuberculin and histopathology were necessary to confirm the diagnosis of ovarian tuberculosis. Antituberculous medical therapy successfully resolved the disease.

In order to assess the confusion attendant with current definitions of extrapulmonary tuberculosis, pleural and miliary disease, a set of 37 papers published which analyzed disease states were assessed for how the terms adhered to official definitions of the American Thoracic Society, the World Health Organization, and the Centers for Disease Control. The findings showed uncertainties in the classification of extrapulmonary disease, a frequent inconsistency in the inclusion of pleural disease within pulmonary rather than extrapulmonary disease, and the ambivalent use of the terms pleural and disseminated tuberculosis. Further attention by editors and authors is needed in the use of tuberculosis definitions.

The collectins family encompasses several collagenous Ca 2+ -dependent defense lectins that are described as pathogen recognition molecules. They play an important role in both adaptive and innate immunity. Surfactant proteins A and D are two of these proteins which were initially discovered in association with surfactant in the pulmonary system. The structure, immune and inflammatory functions, and genetic variations have been well described in relation to their roles, function and pathophysiology in the pulmonary system. Subsequently, these proteins have been discovered in a wide range of other organs and organ systems. The role of these proteins outside the pulmonary system is currently an active area of research. This review intends to provide a current overview of the genetics, structure and extra-pulmonary functions of the surfactant collectin proteins. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a common granulomatous disease especially in endemic regions. The rarity is further accentuated if the pathology arises primarily from the breast. The diagnosis is arduous even upon complete triple assessment. These conditions often give a diagnostic dilemma mimicking malignancy which ultimately requires surgical intervention. We report a series of six cases of TB-related breast pathology with a variety of unusual presentations, our management strategies and review of the literature. [ABSTRACT FROM AUTHOR]

Introduction: Carbapenems is on second line therapy of multidrug resistant Pseudomonas aeruginosa infections and are the last defense line in critical infections Enterobacteriaceae family but Carbapenems resistance is increased so there are some problems when Carbapenems resistance is increased. Therefore, a new study about carbapenem resistance is necessary. Materials and Methods: This study collected 196 isolated bacteria of Pseudomonas aeruginosa and Enterobacteriaceae family from Hospitals patient of Tehran and evaluates them by phenotypic and biochemical methods. Also, the researcher studies the disk diffusion method and use it to determine antibiotic sensitivity of all bacteria according to the CLSI standard table. Results: From the total of 196 bacteria collected, the resistance to Meropenem is %39.79 and Imipenem is %45.91 and 30.10 percent to Meropenem and Imipenem resistance so that the percent resistance of bacteria is as follows: Pseudomonas aeruginosa resistance to Meropenem is %39.62 and Imipenem is %43.39. Meropenem and Imipenem resistance in Enterobacteriaceae family are as follows: Salmonella resistance to Imipenem and Meropenem is %0 and %50, Citrobacter koseri the resistance to Imipenem and Meropenem %0 and %50, Citrobacter freundii Meropenem resistance of %28.57 and Imipenem %28.57, Escherichia coli resistance to Meropenem %39.70 and Imipenem %47.05, Klebsiella oxytoca resistance to Meropenem %46.6 and %40 Imipenem and Meropenem resistance Klebsiella pneumoniae %34.14 and Imipenem %53.65, respectively. Conclusion: There is an increasing resistance to Meropenem and Imipenem antibiotics in treatment of Pseudomonas aeruginosa and Enterobacteriaceae family in our country. Hence, it should be properly and reasonably use these antibiotics. [ABSTRACT FROM AUTHOR]

Children are more likely than adults to develop extra-pulmonary tuberculosis (EPTB), which often presents as cervical lymphadenopathy. The role of surgery in management is uncertain. We reviewed all head and neck EPTB cases presenting to our tertiary care pediatric institution over a twelve-year period. All children 18 years of age and younger with EPTB involving the head and neck were included. We recorded clinical data and age at diagnosis, birth country, BCG vaccination status, as well as radiographic, surgical, histological, and microbiological results. All 16 patients presented with cervical lymphadenopathy. Fourteen were born outside of Canada in TB endemic areas and all had foreign-born parents. Diagnosis was confirmed microbiologically from lymph node biopsies in 14 cases. Multi-drug resistant TB was identified in two cases: both had previous excisional node biopsies that had not been cultured. Two patients had culture negative suppuration despite adequate anti-tuberculous treatment that required surgery for cure. Ongoing suppuration despite appropriate drug therapy is seen in a minority of patients. We found that excisional lymph node biopsy of diseased cervical lymph nodes is diagnostic, and also therapeutic in some cases with ongoing suppuration despite appropriate drug therapy. Mycobacterial culture of lymph nodes is important for diagnosis and determination of drug resistance patterns. [ABSTRACT FROM AUTHOR]

The incidence of Tuberculosis (TB) is high especially in developing countries but primary para-nasal TB is still a rarity. The latter often remains quiescent until it reaches an advanced stage and offers a diagnostic challenge. In the present case report maxillary sinus TB mimicked a destructive periodontitis induced space infection, thus causing a delay in treatment. The present case report describes clinical presentation, diagnosis, management and outcome of a 50-year-old diabetic/HIV seronegative patient with histopathologically confirmed case of maxillary sinus TB.

Hepatic tuberculosis presents one of the rare forms of extra-pulmonary tuberculosis. It is usually secondary to infection in the lung or the gut. Tuberculous liver abscess is the rarer manifestation even in endemic areas of Mycobacterium tuberculosis. Hepatogastric fistula secondary to tuberculous liver abscess has never been reported in literature. We herein report a case of a disseminated tuberculous liver abscess complicated by hepatogastric fistula, which posed a considerable diagnostic challenge. It was treated successfully with anti tubercular drugs. Liver abscess with atypical features and non responsive to antibiotics should raise the suspicious of tuberculosis or fungal infections.