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Background/Purpose The diagnosis of TB in the head & neck region is challenging due to diverse presentations and due to changing clinical pictures. The aim of this article is to report three unusual primary cases of head and neck tuberculosis in immunocompetent patients presenting to our hospital with description of their clinical presentation, appropriate diagnostic methods used and treatment response of these patients. Methods Three clinical cases were of primary tuberculosis of the lacrimal system, the thyroid gland and of the temporal space were clinically worked up. The aspirate from the swellings were sent for Cytology and Gene Xpert tests. Results The Gene Xpert tests were positive in these unusual cases and aided the Cytology in promptly confirming the diagnosis which otherwise would be missed if staining for AFB is negative. ATT was started and responded well to the treatment. Conclusion These cases demonstrate the importance of having a high index of suspicion for tuberculosis as a cause of head and neck swellings, especially in developing countries. It also illustrates the value of needle aspiration in such swellings and sending it for cytology and Gene Xpert for early diagnosis of tuberculosis.

Tuberculosis of the wrist joints is an uncommon clinical entity that most frequently presents with insidious pain and swelling. Isolated carpal bones involvement due to tuberculosis is a relatively uncommon event. In this report, the authors describe the case of a 36-year-old female patient presenting with fracture of the scaphoid bone. The diagnosis of tuberculosis was suspected based on the ultrasound and magnetic resonance imaging findings of the wrist joint, and confirmed by joint fluid culture. Introducing anti-tuberculous drugs under appropriate supervision resulted in clinical improvement and optimal regain of function. No reactivation of the disease was noted after 2 years of follow‑up. This case report describes a rare presentation of wrist joint tuberculosis.

Introduction: Of the largest series on osteoarticular tuberculosis (TB) by Tuli et al. involving 1074 cases, only seven involved clavicle. It is also noted that the lateral end of the clavicle has been less frequently involved by tubercular disease than the medial end. We present a case of primary tubercular involvement of the lateral end of the clavicle and discuss its management by an innovative modification of the Weaver-Dunn procedure. Case Report: Twenty-five-year-old working women came with complaints of swelling in her left shoulder for the past 2 months. On examination, swelling with restricted shoulder movements was noted. Radiological evaluation revealed an osteolytic lesion with a pathological fracture in the lateral end of the clavicle. With a provisional diagnosis of giant cell tumor, we proceeded with fine-needle aspiration cytology which was inconclusive. Blood parameters were within normal limits. We proceeded with the excision biopsy of the lateral end of the clavicle and stabilization with a modified Weaver-Dunn procedure involving the reconstruction of the coracoclavicular ligament and augmentation with an Endobutton loop. Biopsy reported the lesion to be of tuberculous etiology. The patient made a good recovery without any complications. Conclusion: Primary TB of the clavicle is a rarity that mimics other diseases like a tumor; hence, clinicians should be aware of a wide range of presentations to diagnose such an entity. Although antitubercular treatment remains the mainstay of treatment, surgical resection is justified in cases of uncertain diagnosis or disease not responding to conservative lines of management and in cases that need the removal of the sequestrum. Keywords: Primary tuberculosis, clavicle, modified Weaver-Dunn procedure, osteoarticular tuberculosis, pathological fracture.

The objective of the article: to demonstrate the peculiarities of tuberculosis in young children and the high probability of the transition of primary tuberculosis in a child from a sociopathic family to a chronic process due to the absence of medical supervision after chemotherapy. The article describes a clinical case demonstrating the influence of dysfunctional social risk factors on the development of chronic primary tuberculosis in a child. The authors provide a detailed information of medical care to the child, including surgery.

Tubercular appendicitis is the appendicular infection with tubercular bacillus, which develops as an extension of ileocecal infection. Tuberculosis is either primary or secondary. Primary tuberculosis of the appendix is uncommon. Diagnosis is made by histopathological examination of the resected appendix. We report a rare case of tubercular appendicitis diagnosed on histopathology. Primary Tuberculosis of the appendix is a clinical rarity. Hence, it is being reported. The case report in this study emphasizes the importance of submitting all appendectomy specimens for histopathological examination and the occurrence of primary tuberculosis at a rare site, such as the appendix.(NCI-2019-0069.R2)

Tuberculosis of the tongue is a very rare event even in a areas and countries in which tuberculosis is endemic. The disease can present itself in a variety of clinical appearances, most of which may mimic malignant lingual neoplasm’s clinically. Here we report a case of lingual non healing ulcer in a 44 years female which was clinically suspected as malignant ulcer. The diagnosis of lingual tuberculosis was made by histopathology. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 199-202

Введение: Туберкулезная инфекция представляет собой сложное взаимодействие микобактерии и факторов резистентности организма. Особенности иммунного реагирования при рецидивирующем течении туберкулеза изучены недостаточно. В статье анализируются особенности антиген-специфической продукции интерферона-γ и интерлейкина-2 при первичном туберкулезе и рецидиве заболевания. Цель: оценить особенности антигенспецифической продукции интерферона-γ и интерлейкина-2 на антигены ESAT-6, SFP-10 и TB7.7 при первичном ТБ и при его рецидивах. Материалы и методы. Было проанализировано 208 проб крови от больных туберкулезом. Диагноз туберкулеза был подтвержден молекулярно-генетическими (GeneXpert/Hain-test) или бактериологическими (BACTEC) методами. Больных с первичным туберкулезом было 125 (60,1%), больных с рецидивом заболевания 83 (39,9%). Анализ антиген-специфической продукции цитокинов проводился с использованием стандартных тест-платформ, основанных на высвобождении цитокинов после стимуляции антигенами M. tuberculosis. Для сравнения полученных результатов использовались стандартные методы непараметрической статистики (критерий Манна-Уитни, медиана и межквартильный размах). Результаты: Сравнительный анализ продукции антиген-специфических IFN-γ и IL-2 показал, что уровень IFN-γ достоверно повышен у больных рецидивом туберкулеза по сравнению с больными первичным туберкулезом (22±0,45 МЕ/мл против 0,09±0,21 МЕ/мл соответственно, р - 0,004), при отсутствии различий в уровне антиген-специфического IL-2 между первичным туберкулезом и ТБ рецидивом. При этом, анализ распределения концентраций выявил, что уровень антиген-специфического IFN-γ у больных впервые диагностированным ТБ (медиана ± SE = 0,03 ± 0,019 МЕ/мл, диапазон 0,10–1,81 МЕ/мл) был значительно ниже, чем у больных с рецидивом ТБ (медиана ± SE = 0,07 ± 0,049 МЕ/мл, диапазон - 0,36-3,17 МЕ/мл. р=0,004). Выводы: Антиген-специфические IFN-γ и IL-2 продуцируются с различной интенсивностью при первичном туберкулезе и рецидиве. Уровень продукции IFN-γ при первичном туберкулезе ниже по сравнению с IL-2. При этом, при рецидиве отмечается значительное повышение IFN-γ по сравнению с первичным туберкулезом и оба цитокина синтезируются с одинаковой интенсивностью., Introduction. Tuberculosis infection is a complex interaction between mycobacterium and host resistance factors. Features of the immune response in the recurrent course of tuberculosis have not been studied enough. The article analyzes the features of antigen-specific production of interferon-γ and interleukin-2 in primary tuberculosis and relapse of the disease. Aim: to assess the features of antigen-specific production of interferon-γ and interleukin-2 for ESAT-6, SFP-10 and TB7.7 antigens in primary and relapsed TB. Materials and methods. A total of 208 blood samples from TB patients were analyzed. The diagnosis of tuberculosis was confirmed by molecular genetic (GeneXpert/Hain-test) or bacteriological (BACTEC) methods. There were 125 (60.1%) patients with primary tuberculosis, 83 (39.9%) patients with relapse of the disease. Analysis of antigen-specific cytokine production was performed using standard test platforms based on cytokine release after stimulation with M. tuberculosis antigens. To compare the obtained results, standard methods of nonparametric statistics (Mann-Whitney test, median and interquartile range) were used. Results. Comparative analysis of the production of antigen-specific IFN-γ and IL-2 showed that the level of IFN-γ was significantly increased in patients with recurrent tuberculosis compared with patients with primary tuberculosis (22±0.45 IU/ml versus 0.09±0, 21 IU/ml, respectively, p - 0.004), in the absence of differences in the level of antigen-specific IL-2 between primary and recurrent TB. At the same time, analysis of the distribution of concentrations revealed that the level of antigen-specific IFN-γ in patients with newly diagnosed TB (median ± SE = 0.03 ± 0.019 IU/ml, range 0.10–1.81 IU/ml) was significantly lower than in patients with recurrent TB (median ± SE = 0.07 ± 0.049). IU / ml, range - 0.36-3.17 IU / ml. p=0.004). Conclusions.Antigen-specific IFN-γ and IL-2 are produced with different intensity in primary tuberculosis and relapse. The level of production of IFN-γ in primary tuberculosis is lower compared to IL-2. At the same time, there is a significant increase in IFN-γ during relapse compared with primary tuberculosis and both cytokines are synthesized with the same intensity., Кіріспе. Туберкулездік жұқпа микобактерия мен ағзаның резистенттілік факторлары арасындағы күрделі өзара байланыс болып табылады. Туберкулездің қайталама ағымы барысындағы иммунды жауап қайтарудың ерекшеліктері жеткілікті зерттелмеген. Бұл мақалада біріншілік туберкулез бен аурудың қайталануы кезінде интерферона-γ мен интерлейкин-2-нің антиген-спецификалық өнімінің ерекшеліктері талданады. Мақсаты: біріншілік ТБ мен оның қайталануы кезінде интерферона-γ мен интерлейкин-2-нің ESAT-6, SFP-10 мен TB7.7 антигендеріне қарсы антиген-спецификалық өндірілу ерекшелігін бағалау. Материалдар мен әдістер: Туберкулезбен науқастардың 208 қан үлгісі талданды. Туберкулез диагнозы молекулалық-генетикалық(GeneXpert/Hain-test) немесе бактериологиялық (BACTEC) әдістерменрасталды. Біріншілік туберкулезбен науқастар саны 125 (60,1%), ал аурудың қайалануымен науқастар саны 83 (39,9%) болды. Цитокиндердің антиген-спецификалық өндірілуін талдау M. tuberculosisантигендерімен ынталандырудан соң цитокиндердің синтезіне негізделген стандартты тест-платформалар көмегімен жүргізілді. Алынған нәтижелерді салыстыру үшін параметрлік емес стандартты статиска әдістері (Манна-Уитни критерийі, медиана мен квартильаралық ауқым) қолданылды. Нәтижелер. IFN-γ мен IL-2-нің антиген-спецификалық өндірілуін салыстырмалы талдау IFN-γ деңгейі туберкулездің қайталануы кезінде біріншілік туберкулезбен салыстырғанда жоғары (22±0,45 ХБ/мл қарсы 0,09±0,21 ХБ/мл сәйкесінше, р - 0,004) екенін көрсетті. Ал антиген-спецификалық IL-2 деңгейі бойынша біріншілік туберкулез бен оның қайталануы арасында айырмашылық анықталған жоқ. Бұл ретте концентрацияның үлестірілуін талдау антиген-спецификалық IFN-γ деңгейі ТБ бірінші рет анықталған науқастарда(медиана ± SE = 0,03 ± 0,019 ХБ/мл, диапазон 0,10–1,81 ХБ/мл) ТБ қайталануы барысындағы деңгейімен (медиана ± SE = 0,07 ± 0,049 ХБ/мл, диапазон - 0,36-3,17 ХБ/мл. р=0,004) салыстырғанда әлдеқайда төмен екенін көрсетті. Қорытынды. Антиген-спецификалық IFN-γ мен IL-2 біріншілік туберкулезбен оның қайталануы кезінде әр түрлі қарқындылықпен өндіріледі. Біріншілік туберкулез кезінде IFN-γ өнім деңгейі IL-2 деңгейімен салыстырғанда төмен болып табылады. Бұл ретте аурудың қайталануы кезінде біріншілік ТБ-мен салыстырғанда IFN-γ деңгейі әлдеқайда жоғарылайды және екі цитокин де бірдей қарқындылықпен өндіріледі., Наука и здравоохранение, Выпуск 4 (24) 2022, Pages 79-85

Research on the pathogenesis of tuberculosis in recent years has focused largely on the granulomatous stage of primary tuberculosis. However, post-primary tuberculosis that accounts for 80% of clinical disease is seldom studied because of the paucity of animal models and human tissues. The early lesion of post-primary tuberculosis is a subclinical obstructive lobular pneumonia that develops asymptomatically for months accumulating secreted mycobacterial antigens in alveolar macrophages and highly sensitized T cells before onset of clinical disease. Here we demonstrate antigen of M. tuberculosis in the cytoplasm of ciliated bronchiolar epithelium and alveolar pneumocytes in association with elements of the programmed death ligand 1 (PD-L1), cyclo-oxygenase (COX)-2, and fatty acid synthase (FAS) pathways in the early lesion. This suggests a new synthesis of the pathogenesis of post-primary tuberculosis in which M. tuberculosis use its secreted antigens and cord factor to direct prolonged subclinical development of the early lesions in preparation for a sudden necrotizing reaction sufficient to produce a cavity and/or granulomas. Available evidence indicates that most successful human and animal vaccines and host directed therapies of post-primary tuberculosis target the early lesion, not granulomas. Recognition of this will facilitate design and evaluation of improved vaccines and therapies for tuberculosis.

Tuberculosis of the parotid gland is uncommon in ENT practice. If not associated with sinus/abscess formation, it becomes difficult to differentiate it from neoplasm of the gland. In cases where it involves only the gland (Primary Tuberculosis), then the diagnosis mainly depends on high index of suspicion of the treating physician. Radiological support, FNAC or HPE are the other helping modes to arrive on a diagnosis. FNAC is a simple process with less morbidity for the patient. We treated a patient successfully with medical treatment after FNAC. Keywords: Parotid gland, Tuberculosis, FNAC.

Tubercular osteomyelitis of zygomatic bone is extremely rare. Here we have reported a rarest case of primary tuberculosis (TB) of zygomatic bone in a 20 year male who presented with discharging sinus over right zygomatic region. Anti-tubercular chemotherapy given and patient improved well. Keywords: Zygomatic bone, Tuberculosis, Discharging sinus, Anti-tubercular chemotherapy

Tuberculosis is one of the major causes of ill health and death worldwide. Primary tuberculosis of the oral cavity and oropharynx is usually uncommon. Among tuberculosis of oral cavity and oropharynx, primary tuberculosis of tonsil in the absence of active pulmonary tuberculosis is a very rare clinical entity which presents difficulties in diagnosis because of similarity of presentation of carcinoma tonsil. Diagnosis mainly relies on the treating surgeon having a high index of suspicion. Although rare, tuberculosis should be kept in mind and considered in the differential diagnosis of any patient presenting with ulcer over tonsil.

Objective To compare the diagnostic performance of the manual BACTEC™ Mycobacteria Growth Indicator Tube (MGIT™) system (M-MGIT) with the automated BACTEC™ MGIT™ 960 system (A-MGIT) and Löwenstein-Jensen (L-J) culture method in detecting mycobacteria in sputum specimens from patients with suspected pulmonary tuberculosis (TB). Methods For this cross-sectional study, sputum samples were taken from patients aged ≥18 years attending a TB clinic in Beijing, China between July 2015 and October 2016. Processed sputum samples were inoculated into the MGIT systems and L-J medium for up to 6 and 8 weeks, respectively. Results The M-MGIT and A-MGIT methods detected significantly more Mycobacterium tuberculosis complex (MTC) isolates than L-J culture from the 565 sputum samples (39%, 40% and 32%, respectively). Using a positive result from any of the three culture systems as reference, the sensitivity of M-MGIT, A-MGIT and L-J methods were 92%, 94%, and 74%, respectively. The time-to-detection of mycobacteria was 12.9±4.2 days for M-MGIT, 11.8±5.2 days for A-MGIT and 24.2±8.7 days for L-J. Conclusions M-MGIT has a similar diagnostic performance to A-MGIT, and is a fast and reliable alternative to conventional culture methods in the diagnosis of pulmonary TB in a developing country.

The diagnosis of tuberculosis must be made in the face of any cervical swelling, and the treatment is essentially medical.

Primary tuberculosis (TB) of the graft presenting as multiple liver abscesses is previously unreported. A 14-month-old male child in the early post liver transplant (LT) period presented with high-grade fever spikes and on evaluation was found to have multiple pyogenic liver abscesses (PLA) in the CT abdomen. His fever was not responding to intravenous antibiotics and liver biopsy was done which showed numerous acid fast bacilli. Genetic analysis confirmed the bacilli as Mycobacterium tuberculosis (MTB). Timely diagnosis and prompt introduction of antituberculosis therapy were lifesaving.

Anton Ghon is well known in the field of childhood tuberculosis, and the tuberculosis primary focus and complex are frequently called the Ghon focus and complex; this is largely the result of the wide publication of the English translation of his monograph “Der primäre Lungenherd bei der Tuberkulose der Kinder.” Ghon’s studies are frequently quoted, but precise details of his monograph are neglected, his results often misquoted, and his later publications virtually unknown. This review highlights aspects of Ghon’s anatomical pathology studies in children and adults not necessarily dying of tuberculosis but with signs of tuberculosis infection. Ghon found a single primary tuberculosis focus in approximately 80% of tuberculosis-infected children situated close to the pleura in two-thirds of cases. Cavitation of the focus was common, and lymphatic spread involved lymph nodes in the abdomen and neck in many children. Studies amongst adults and children frequently found the healed primary tuberculosis focus to be completely calcified without histological signs of tuberculosis activity; however, particularly in the presence of pulmonary tuberculosis, histological signs of tuberculosis activity were often found in the lymph nodes of the angulus venosus, despite apparent healing with extensive calcification. Both earlier studies and more recent investigations, with molecular biological tools, unavailable to Ghon and earlier researchers, have confirmed the presence of viable mycobacteria in apparently normal or healed thoracic nodes and also found molecular biological indications of viable mycobacteria in these nodes. As suggested by Ghon, lympho-haematogenous spread of tuberculosis may be more common than is usually appreciated.

Tuberculosis (TB) continues to be a major public health problem in India. With an annual incidence rate of 2.8 million new cases, India accounts for a quarter of the global TB burden. Primary thyroid TB still remains a rare entity even in this era of global TB pandemic. Here we discuss a case of primary thyroid TB in a 22-year-old immunocompetent male patient presenting with a thyroid swelling followed by non-healing sinus tract after fine-needle aspiration cytology (FNAC) procedure. TB is a known common cause for development of chronic sinuses and ulcers. However, the primary involvement of thyroid gland along with formation of non-healing sinus tract post FNAC make it a most unusual case posing a diagnostic challenge to the unsuspecting physician.

Tuberculosis (TB) is a very common health problem in developing nations such as India. It can present as its primary form or as secondary forms (extrapulmonary TB). Maxillofacial manifestations of TB compose nearly 10% of all extrapulmonary manifestations of the disease. Extrapulmonary TB involving the maxillofacial region is very rare and can present in any tissues in this region. These infections generally involve the head and neck through hematogenous or lymphatic routes. Very few cases of primary TB of the temporomandibular joint (TMJ) have been reported in the literature. The presentation of TB infection of the TMJ can resemble arthritis, osteomyelitis, or any other kind of chronic joint disease. It is very important to diagnose this disease at an early stage. If left untreated, it can prove fatal within 5 years in more than half the cases. Therefore, early diagnosis and management of these cases is critical. This article describes a case of primary TB of the TMJ that presented as a preauricular swelling.

Breast tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic countries. Its frequency is low both in tuberculosis localization (0.06 to 0.1%) as well as in breast disease (0.025 to 4.5%)

Tuberculosis poses a real public health problem inTunisia.We report an 80-year old patient, immunocompetent, who has initial presentation of a painless ulcerative lesions of the glans penis. A history of pulmonary tuberculosis was not present.The physical examination revealed an indurated glans penis covered with blackish crusts and small ulcerations. A biopsy of the lesion was undertaken and histological examination was confirmed the diagnosis of tuberculosis of glans.Others investigations was performed without finding any abnormalities He responded well to anti-tubercular treatment with complete resolution of lesions in six months., Highlights • Tuberculosis poses a real public health problem in endemic countries. • Tuberculosis of the glans penis is an uncommon presentation of tuberculosis.This is the first case to be reported in Africa. • Clinical presentation is extremely varied. • Diagnostic confirmation is based on histological study aided by culture. • Antibiotic therapy for tuberculosis is the basis of treatment.