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Background: Granulomatous lymphadenitis, a histopathological diagnosis, often indicates infections, such as those caused by mycobacterial and fungal agents., Methods: We conducted an analysis of 1098 granulomatous lymphadenitis cases, examining age distribution, lymph node locations, and laterality. Molecular detection of Bacillus Calmette-Guérin (BCG) was performed on archived formalin-fixed paraffin-embedded tissue specimens., Results: Our analysis revealed a bimodal age distribution, notably with a minor peak in infants. These infantile cases predominantly featured axillary involvement, frequently occurring on the left side. Positive rates of BCG identification decreased with age: <1 year, 71%; 1-2 year, 33%; 2-3 year, 13%; 3-4 year, 0%. Remarkably, only one of the 14 cases with molecularly confirmed BCG lymphadenitis had comments regarding BCG in the pathological report. Compared with patients born after 2016 (BCG at 5-8 months), those born before 2016 (BCG at birth) developed BCG lymphadenitis at a wider age range with right skewness (before 2016, 13 ± 11 months [range, 3-33 months] vs. after 2016, 10 ± 2 months [range, 8-13 months]). Four of the 14 BCG-positive cases had congenital heart disease. Seven patients received anti-tuberculosis drugs following surgical excision. No surgical complications were reported., Conclusions: BCG lymphadenitis constitutes a distinctive minor peak within the spectrum of granulomatous lymphadenitis in Taiwan. Pathologists should consider the possibility of BCG infection, especially in cases of infantile axillary, supraclavicular, neck lymphadenopathies on the left side. Moreover, BCG administration at 5-8 months may reduce delayed-onset BCG lymphadenitis., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: To investigate the clinical epidemiological and drug resistance (DR) characteristics of lymph node tuberculosis (LNTB) in Hunan Province which locates in South-central China, and to provide scientific clues for effective prevention and treatment of LNTB., Methods: We retrospectively collected LNTB patients with Mycobacterium tuberculosis culture positive at Hunan Chest Hospital, the biggest TB reference hospital in South-central China, from January 2013 to December 2021. The multiple demographic, clinical and drug susceptibility data of patients were collected from the hospital's electronic patient records. Descriptive statistical methods, Chi-square test and logistic regression analysis were employed as statistical methods., Results: Of the 577 LNTB cases, 373 (64.64%) were males, 352 (61.01%) were farmers; majority (161, 33.10%) aged at 20-29 years old; 147 (25.48%) had simple LNTB, 350 (60.66%) had LNTB combined with pulmonary TB (PTB) (defined as LNTB-PTB), and 80 (13.86%) had LNTB combined with other extrapulmonary TB (EPTB) (defined as LNTB-EPTB). A total of 345 (59.79%, 345/577) LNTB patients had cervical node infection, and the simple LNTB patients (81.63%, 120/147) had higher proportion of this infection than LNTB-PTB (51.71%, 181/350) and LNTB-EPTB (55.00%, 44/80) (both p values <0.017), respectively. LNTB-EPTB was more inclined to have abdominal tuberculous LNs (20%, 16/80) and at least four tuberculous lesions (22.50%, 18/80) than simple LNTB and LNTB-PTB. Seventy-seven (13.34%) and 119 (20.62%) were resistant to rifampicin (RIF) and isoniazid (INH), respectively; 72 (12.48%) were multi-drug resistant (MDR), and a total of 150 (26.00%) were DR (resistant to at least one of RIF, INH, ethambutol and streptomycin). LNTB patients aged 30-34 and 50-54 years old (compared to those aged <30 years) were independent predictors of RIF resistance (RR) (ORs were 3.47 and 2.83, respectively; 95% CIs were 1.64-7.35 and 1.08-7.46, respectively)., Conclusion: Our study disclosed the epidemiological and DR characteristics of LNTB in Hunan Province, China. High LNTB prevalence was found in younger people while high RR LNTB prevalence was found in older ones, suggesting that we should conduct further studies to clarify the occurrence of RR in LNTB, meanwhile, strengthen the diagnoses and treatments of LNTB to prevent the emergence of RR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fang, Xiang, Li, Liu, Liu, Wu, Xu, Li, Yang, Li, Yu, Zhao, Zhao, Wan, Yuan, Tan and Li.)

Background: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan., Methods: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018., Results: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB., Conclusion: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan., Competing Interests: Conflict of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Introduction: Lymphadenopathy is usually due to benign or malignant conditions. It can also be local or systemic in distribution and can involve peripheral or deep-seated lymph nodes. This study aimed to determine the prevalence of lymphoma and the distribution pattern of lymph node pathologies among adult patients who presented with lymphadenopathy and its relationship with age and sex., Methods: A retrospective study was conducted, and a record of all cases of lymphadenopathy with histological diagnosis over 5-year period (January 2017 to December 2021) was extracted from Departments of Anatomical Pathology of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data generated were analyzed using Statistical Package for Social Sciences (SPSS) software, version 26., Results: One hundred and ninety results were extracted with an age range of 18 to 94 years and a mean age of 41 ± 16 years. They were made up of 75 (39.5%) males and 115 (60.5%) females, with a male-to-female ratio of 1:1.5. The prevalence of lymphoma was 50.0% (95/190). Thirty-five (18.4%) were Hodgkin's lymphoma (HL), while 60 (31.6%) were non-Hodgkin's lymphoma (NHL). Other pathologies manifested by cases of lymphadenopathy include metastatic tumor deposits (38 (20%)), reactive lymphoid hyperplasia (29 (15.3%)), and tuberculous lymphadenitis (18 (9.5%)). Others include sinus histiocytosis (4 (2.1%)), dermatopathic lymphadenitis (5 (2.6%)), and Castleman's disease (1 (0.5%))., Conclusion: About half of all patients who presented with lymphadenopathy were lymphoma with a high prevalence of 50%, and the majority were NHL. Other major causes of lymphadenopathy were metastatic tumor deposits, reactive lymphoid hyperplasia, and tuberculous lymphadenitis. Any case of lymphadenopathy should be properly investigated early for effective management., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Background: Head and neck lesions of tuberculosis, though not uncommon are often difficult to diagnose and require a unique management protocol. These lesions are often misdiagnosed as bacterial infections, malignancies or other granulomatous diseases. Hence in our study we endeavor to gain a better understanding of the diagnostic and management protocols of tuberculosis in otorhinolaryngology., Methods: We have performed an observational study at our institute, the patient's details were obtained from patient record forms and noted in a standard proforma. Results were calculated as percentage and Chi square analysis was performed., Results: We found cervical tuberculous lymphadenitis to be the most common manifestation 76.97%, with a significant association with pulmonary tuberculosis. Neck swelling was the most common presenting complaint, 65.35%. 26-50 years of age was the most commonly involved age group., Conclusion: FNAC, PCR and histopathology are the modalities for bacteriological diagnosis for tuberculosis of Head and Neck. Anti-tuberculous therapy is uniformly found to be useful in all the patients, with surgical intervention used as and when required., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Mycobacterium tuberculosis complex has an impact on public health and is responsible for over one million deaths per year. Substantial numbers of people infected with M. tuberculosis can develop tuberculosis lymphadenitis; however, there is a limited study in Adama, Ethiopia. The aim of this study was to determine the magnitude of Tuberculosis lymphadenitis, its predictors, and rifampicin-resistance gene-positive M. tuberculosis. A total of 291 patients with enlarged lymph nodes were recruited from May 2022 to August 30 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). GeneXpert, Ziehl-Neelsen staining, and cytology were used for the diagnosis of TB lymphadenitis from the Fine Needle Aspirate (FNA) specimen. Rifampicin-resistant gene was detected using GeneXpert. For data entry and analysis, Epi Data version 3.0 and SPSS version 25 were used respectively. A binary logistic regression model was used to identify predictors of TB lymphadenitis. A p < 0.05 with a 95% confidence interval (CI) was taken as a cut point to determine the significant association between dependent and independent variables. The prevalence of TB lymphadenitis using GeneXpert, Ziehl-Neelsen staining, and cytology were 138 (47.4%) (95% CI 41.70-53.10), 100 (34.4%) (95% CI 28.94-39.85), and 123 (42.3%) (95% CI 36.63-47.00) respectively. Nine (3.1%) participants were infected with rifampicin-resistant gene-positive M. tuberculosis. Out of the total M. tuberculosis detected by GeneXpert (n = 138), 9 (6.5%) were positive for rifampicin resistance-gene. Participants with a chronic cough had 2 times odds of developing TB lymphadenitis (AOR: 2.001, 95% CI 1.142-3.508). Close to half of patients with enlarged lymph nodes were positive for M. tuberculosis by the GeneXpert method in the study area. Chronic cough was significantly associated with TB lymphadenitis. Rifampicin-resistant gene-positive M. tuberculosis was relatively prevalent among patients with enlarged lymph node in the study area., (© 2023. The Author(s).)

Background: Tuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide, caused by species of the Mycobacterium tuberculosis complex (MTBC), with Mycobacterium tuberculosis being the dominant pathogen in humans and Mycobacterium bovis in cattle. Zoonotic transmission of TB (zTB) to humans is frequent particularly where TB prevalence is high in cattle. In this study, we explored the prevalence of zTB in central Ethiopia, an area highly affected by bovine TB (bTB) in cattle., Method: A convenient sample of 385 patients with pulmonary tuberculosis (PTB, N  = 287) and tuberculous lymphadenitis (TBLN, N  = 98) were included in this cross-sectional study in central Ethiopia. Sputum and fine needle aspirate (FNA) samples were obtained from patients with PTB and TBLN, respectively, and cultures were performed using BACTEC ™ MGIT ™ 960. All culture positive samples were subjected to quantitative PCR (qPCR) assays, targeting IS 1081 , RD9 and RD4 genomic regions for detection of MTBC, M. tuberculosis and M. bovis , respectively., Results: Two hundred and fifty-five out of 385 sampled patients were culture positive and all were isolates identified as MTBC by being positive for the IS 1081 assay. Among them, 249 (97.6%) samples had also a positive RD9 result (intact RD9 locus) and were consequently classified as M. tuberculosis . The remaining six (2.4%) isolates were RD4 deficient and thereby classified as M. bovis . Five out of these six M. bovis strains originated from PTB patients whereas one was isolated from a TBLN patient. Occupational risk and the widespread consumption of raw animal products were identified as potential sources of M. bovis infection in humans, and the isolation of M. bovis from PTB patients suggests the possibility of human-to-human transmission, particularly in patients with no known contact history with animals., Conclusion: The detected proportion of culture positive cases of 2.4% being M. bovis from this region was higher zTB rate than previously reported for the general population of Ethiopia. Patients with M. bovis infection are more likely to get less efficient TB treatment because M. bovis is inherently resistant to pyrazinamide. MTBC species identification should be performed where M. bovis is common in cattle, especially in patients who have a history of recurrence or treatment failure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ayalew, Habtamu, Melese, Tessema, Ashford, Chothe, Aseffa, Wood, Berg, Mihret and The ETHICOBOTS Consortium.)

Background: The serum lipid and immunohematological values of tuberculosis lymphadenitis (TBLN) patients is poorly documented relative to pulmonary tuberculosis (PTB) cases. Therefore, the aim of this study was to investigate the serum lipid and immunohematological values of patients with TBLN in comparison with PTB (PTB) patients., Methods: An institution-based comparative cross-sectional study was conducted in Northwest Ethiopia from March to December 2021. The study participants were bacteriologically confirmed PTB (n = 82) and TBLN (n = 94) cases with no known comorbidity and whose ages was greater than 18 years and with no current pregnancy. Independent sample t-test, one-way ANOVA, box plot, and correlation matrix were used to analyze the data., Results: The body mass index (BMI), CD4 + T cell count, and high-density lipoprotein-Cholesterol (HDL-C) values were significantly higher among TBLN cases compared with PTB cases. Additionally, the total white blood cell (WBC) count, hemoglobin (Hb), total Cholesterol (CHO) and creatinine (Cr) values were relatively higher among TBLN than PTB (P > 0.05). On the reverse, the platelet count and triacylglycerol (TAG) values were relatively higher among PTB than in TBLN cases. While the mean days of culture positivity were 11.6 days for TBLN, the mean days of culture positivity were 14.0 days for PTB. Anemia and serum lipid values showed no correlation with sputum bacilli load and time to culture positivity., Conclusion: Tuberculous lymphadenitis patients were well-endowed with serum lipid, immunological and nutritional status compared with PTB cases. Hence, the high incidence rate of TBLN in Ethiopia could not be explained by low peripheral immunohematological values, malnutrition, Anemia, and dyslipidemia. Further study for identifying the predictors for TBLN in Ethiopia is highly desirable., (© 2023. The Author(s).)

Background: This article is to review cervical lymphadenitis due to tuberculosis (TB), their presentation, their aetiology, the methods used to diagnose them, the treatment modalities offered and the response to treatment., Methods: 1019 patients were diagnosed and treated for TB of the lymph nodes of the neck from 1st November 2001 to 31st August 2020 at a tertiary ENT hospital, Nadiad, Gujarat, India. Study consisted about 61% males and 39% females with the mean age being 37.3 years., Result: Commonest factor or habit among those diagnosed for tuberculous cervical lymphadenitis was consumption of unpasteurized milk. HIV and diabetes were the most common co-morbid conditions found with this disease. Swelling in the neck was most common clinical feature followed by loss of weight, formation of abscess, fever and fistula. Rifampicin resistance was found in 1.5% of patients among those tested for the same., Conclusion: The most commonly affected site for extra pulmonary TB is posterior triangle of neck than the anterior triangle. Patients with HIV and diabetes are at higher risk for the same. Testing for drug susceptibility has to be done due to increased resistant of drugs for extra pulmonary TB. GeneXpert and histopathological examination are important for its confirmation., Competing Interests: Conflict of interests All authors have none to declare., (Copyright © 2022 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Objectives: Extrapulmonary tuberculosis (EPTB) is not a notifiable infectious disease in China but is a heavy burden on public health. However, the epidemic situation of EPTB nationwide is unclear. This study aimed to investigate the magnitude and main subtypes of EPTB in China., Methods: We conducted a national cross-sectional study with multistage, stratified cluster random sampling during 2020-2021. We calculated proportions of EPTB in all patients with TB by organs. Logistic regression models were used to estimate odds ratios by characteristics., Results: A total of 6843 patients with TB were included. Of them, 24.6% were patients with EPTB, and the proportion of EPTB solo was 21.3%. Higher EPTB burden was observed in children, female patients, clinically diagnosed patients, provincial-level and prefectural-level health facilities, and Central and West China. EPTB occurred most frequently in respiratory (35.5%), musculoskeletal (15.8%), and peripheral lymphatic (15.8%) systems with top three subtypes, including tuberculous pleurisy (35.0%), spinal TB (9.8%) and cervical tuberculous lymphadenopathy (7.9%). With the increase of age, proportion of peripheral lymphatic TB decreased, and proportion rank of genitourinary TB rose., Conclusion: It is essential to strengthen the diagnosis and treatment capacity for EPTB in primary medical facilities. EPTB should be added to the National Tuberculosis Program as a notifiable disease., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2022. Published by Elsevier Ltd.)

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., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2022. Published by Elsevier Ltd.)

Background and Purpose: abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB., Methods: seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB., Results: eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates., Conclusions: the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings.

Classic Rosai-Dorfman-Destombes disease (RDD) is a rare histiocytic disorder with bilateral massive painless cervical lymphadenopathy. It is a mysterious disease and there is little knowledge of its pathogenesis, clinical features, radiological findings, laboratory investigations, effective treatments and prognosis. Some of its clinical presentations may overlap with those of Mycobacterium tuberculosis infection. Just like tuberculosis infection, RDD may involve many other organs, for example, skin, kidney, bone, brain and spine. The diagnosis can easily be overlooked, especially in communities hyperendemic to tuberculosis infection. We report our experience in diagnosing and managing a patient with spinal RDD with concurrent tuberculosis infection, who was treated empirically for cervical tuberculous lymphadenitis without a conclusive laboratory finding prior to her spinal condition. In view of her acute neurological deficit, emergency spinal decompression was performed. Her intraoperative spinal samples had shown classic histopathological features of RDD. We believe the lymphadenopathy was part of the clinical presentation of RDD. She showed favourable neurological recovery throughout the follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Lymph node tuberculosis (LNTB) frequently affects peripheral cervical lymph node body sites. We aimed to study epidemiology and diagnostic and therapeutic characteristics of LNTB patients in ENT routine practice., Methods: We conducted a cross-sectional prospective study in the ENT and cervicofacial surgery department at the Sourô Sanou University Hospital of Bobo Dioulasso, Burkina Faso, for a period of 36 months., Results: There were 68 cases with LNTB, of which 54.4% were mostly men. The mean age and the median age were calculated at 37 ± 6.8 and 42 years, respectively. The patient's age ranged between 3 and 81 years, and the most represented age group was from 30 to 60 years (62%). According to geographical origin, most patients (79%) originated from rural areas. In 6 cases (9%), patients reported diabetes and 12 patients were HIV positives (18%). Most clinical features leading to the ENT consultation were cervical lymph nodes (82%) and cervical scrofuloderma (18%). For the multiple locations, the lymphadenopathies involved mostly the transversal cervical chain (56%) and spinal chain (50%). Histopathology examination was the mostly diagnosed methods used in 68%. A 6-month anti-tuberculous treatment was given with a follow-up of 6 months without any relapse in 62 cases (97%)., Conclusion: The frequency of 68 cases of LNTB in 3 years is underappreciated. Among all lymph node sites, transversal cervical chain and cervical spinal chain were mostly affected. Further advanced studies are recommended to determine the prevalence and contributing factors of LNTB in the study area., (© 2022 S. Karger AG, Basel.)

Tuberculosis (TB) remains in 2022 a significant public health issue as it remains endemic in some areas of the globe, with a high prevalence in underdeveloped countries (Pujani, Khan, Hassan, Jetley, Raina, Breast Dis., 35(3): 195-198, 2015. doi:10.3233/BD-150405. PMID: 26406543). Pulmonary TB is the most common form, but TB can also have extrapulmonary manifestations like tubercular lymphadenopathy. Tuberculous lymphadenitis is the most extrapulmonary tuberculosis. It used to be called scrofula in the past coming from the Latin meaning breeding sow (Kokosali, Lloyd, Dent Update, 33(5): 306-308, 311, 2006. doi:10.12968/denu.2006.33.5.306. PMID: 16841612; Oberhelman, Watchmaker, Phillips, JAMA Dermatol, 155(5): 610, 2019. doi:10.1001/jamadermatol.2018.5651. PMID: 30942835). It is a common cause of peripheral lymphadenitis, seen mostly in the developing countries, but also reemerging among intravenous drugs users and immunocompromised population. Cervical nodes are the most commonly detected nodes in tuberculous lymphadenitis, accounting for 63% of the cases, followed by mediastinal (27%) and axillary nodes (8%) (Ahuja, Ying, Evans, King, Metreweli, Clin Radiol, 50(6): 391-395, 1995. doi:10.1016/s0009-9260(05)83136-8. PMID: 7789023). Tuberculous lymphadenitis affects predominantly the young population and children. There is also a slight female predilection. As to our knowledge, there have not been any reported cases as post-menopausal axillary tuberculous lymphadenitis, and it is the focus of this article.

Objective: To evaluate changing trends in patient collectives, age-related patterns of manifestation, and diagnostic pathways of patients with extrapulmonary head and neck tuberculosis (TB), and to provide strategies to fasten diagnosis in these patients., Study Design: Case control study., Methods: A 10-year retrospective analysis of 35 patients diagnosed with extrapulmonary TB in the head and neck at a tertiary university institution from 2009 to 2019, with special focus on the influence of the patient's age on consideration of TB and clinical patterns., Results: The vast majority of patients younger than 40 years had their origin in countries with high TB burden (P = .0003), and TB was considered very early as a differential diagnosis (P = .0068), while most patients older than 40 years were domestic citizens initially suspected for a malignancy, who more often had an underlying immunosuppressive condition (0.0472). Most frequent manifestations in both groups were the lymph nodes, larynx, and oropharynx. Surprisingly, no differences in the rates of open TB or history of TB infection in the family anamnesis were found., Conclusion: The two groups of patients found most often are younger patients migrating from regions with high TB burden and elderly domestic patients suffering from immunosuppressive conditions, with the latter often being misdiagnosed as malignancies. TB remains an important but difficult differential diagnosis, due to the initially unspecific symptoms and the great variety in the presentation of manifestations in the head and neck., Level of Evidence: 4 Laryngoscope, 131:2701-2705, 2021., (© 2021 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Tuberculosis (TB) remains a global problem and a diagnostic challenge, especially in pediatrics. The aim of this study was to describe the clinical, microbiological, radiological, and histopathological data of TB in children. A 7-year retrospective and descriptive cohort study that included 127 patients under 18 years of age with diagnosis of active TB was conducted from 2011 to 2018 in a pediatric hospital. Tuberculosis was microbiologically confirmed using Ziehl-Neelsen (ZN) staining, culture or polymerase chain reaction (PCR) in a total of 94 (74%) cases. Thirty-three cases were defined as probable TB based on tuberculin skin test result and epidemiological evaluation. The TB forms found were lymph node (39.3%), bone (15.7%), lung (13.6%), and meningeal TB (8.6%). The most common symptoms were fever (48.8%) and adenopathy (45.6%). History of contact was established in 34.6%. Positive ZN staining (sensitivity 30%) and culture (sensitivity 37%) were found in 29% and 37.7% of subjects, respectively. About 64.5% depicted abnormal chest X-ray. Xpert MTB/RIF® (PCR) was positive in 9.4% and biopsy was compatible in 52.7% of these samples. It is fundamental to have laboratory and epidemiological evaluation that support the diagnosis of the disease in children and thus, define its management; since, in most cases, early microbiologic confirmation is lacking.

Background: Diagnosis of extrapulmonary tuberculosis including tuberculous lymphadenitis (TBLN) is challenging because of its atypical clinical presentation, paucibacillary nature of mycobacteria at the infected sites, variation in sensitivity of a test to specimens collected by different methods and from different infected tissues., Methods: In the present study, suspected individuals for lymph node tuberculosis irrespective of age were enrolled prospectively and specimens were collected aseptically by fine needle aspiration (FNA). After the implementation of exclusion criteria, FNA specimens from a total of 278 cases of suspected TBLN were evaluated for cytomorphology (FNAC), presence of acid-fast bacillus (AFB) in smear microscopy and specific detection of mycobacterial DNA in cartridge-based nucleic acid amplification test (CBNAAT)., Results: The results showed high prevalence of Type II (59.71%), followed by Type I (34.53%) and Type III (5.75%) pattern in FNAC. Non-type II patterns were significantly high in regions outside of the head and neck region (P = 0.031; OR = 2.125) and had an increasing trend of their occurrences with progression of age. The most affected age group was between 16 and 30 years with female preponderance documented in individuals below 45 years, whereas male preponderance was observed in higher age group patients, majority of whom had infected lymph nodes outside of HAN region (P = 0.063, OR = 1.998). The results also showed high sensitivity of CBNAAT (83.04%) method followed by FNAC (72.17%) with AFB smear exhibiting the disappointing results (sensitivity of 10.86%) compared to the CRS. High percentage of positivity was observed in Type III (AFB:25% vs CBNAAT: 100%) followed by Type II (AFB:10.2 vs CBNAAT: 76.5), while low detection was observed from samples with Type I (AFB:4.2 vs CBNAAT: 50). Interestingly, CBNAAT detection of TB was shown to be unaffected by gender, age and site of infection., Conclusion: The study suggests a possible contributary role of age and gender for cytomorphological pattern distribution of TBLN at various body parts. Although FNAC detected TB in 77.1% of cases which were identified positive by CBNAAT and/or AFB, it is being solely based on cytomorphology cannot be used alone as a reliable diagnostic method for TBLN detection. Further, the negative results in CBNAAT for FNAC positive cases may not necessarily be non-TB cases and must be evaluated by other diagnostic modalities. We recommend for both cytomorphological investigation and CBNNAT for the fine needle aspirates from suspected TBLN and subsequent treatment to reduce the disease burden., Competing Interests: Declaration of competing interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Universal Bacillus Calmette-Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies., (© 2021. The Author(s).)

Background: Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia., Methods: Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis., Results: From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]., Conclusion: Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors., Competing Interests: The authors have declared that no competing interests exist.

The outcome of lymph node tuberculosis (LNTB) management with conventional anti-tubercular treatment alone is unsatisfactory. We conducted a randomised open-label controlled clinical trial in the Department of Respiratory Medicine in Government Institute of Dhaka, Bangladesh from April 2017 to March 2019. Compared with controls, 54 patients of LNTB received category 1 anti-tubercular treatment with additional prednisolone after randomisation. Complete resolution in 21/54 (75%) and 7 (26.9%), symptomatic improvement in 26 (92.9%) and 22 (84.6%) and complications in 11 (39.28%) and 16 (61.53%) were observed in the treatment and control group, respectively. Thus, we recommend the use of steroids in this setting.

Background: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia., Methods: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05., Results: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007)., Conclusion: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision., (© 2021 Yohannes Zenebe, et al.)

Background: Tubercular lymphadenitis (TBLN) remains the most frequent manifestation for extrapulmonary TB despite advancements in diagnostics and management over the years. Our study intends to explore five-year trend of TBLN in a tertiary care centre from south India, and aims to study clinico-demographic and diagnostic factors in the management of TBLN., Methods: All the adult patients (≥18 years) diagnosed and confirmed for TB lymphadenitis between January 2015 to December 2019 were retrospectively evaluated. Demographic factors, clinical manifestations, and different diagnostic approaches used in the management of TBLN were analysed using SPSS ver. 16., Results: A total of 164 patients with confirmed TBLN were included. Patients aged 18-45 years were the most affected (63.41%) with female dominancy. The most affected lymph nodes were cervical lymph nodes (84.1%) presenting with single palpable enlarged lymph node (80.5%). Majority (78.7%) of the lymph nodes were non-matted and 68.9% of enlarged lymph nodes were >3cm size. Excisional biopsy was performed for the majority of the patients 99 (60.4%) and 60.4% of the cases were managed with a combination of surgical excision and anti-tubercular treatment (ATT)., Conclusions: The declining trend of TBLN observed in this study highlights the outcome of good public health policies; however, young females and high-risk groups like HIV infected or AIDS (affected more in the study) demand further attention. Overall, the advanced diagnostic tools along with surgical management and ATT can lead us to earlier diagnosis and successful treatment outcomes., Competing Interests: None

Our study describes the epidemiology and aetiology of cervical lymphadenopathy in children diagnosed between 2003 and 2017 at the pathology laboratory of Lomé, Togo. A total of 221 cases were collected. The average age of diagnosis of the study population was 9.8 ± 0.3 years and consisted of 118 (53.4%) boys. HIV was confirmed by indirect ELISA test in 69 (31.2%) cases. The cohort consisted of infections (n = 128, 57.9%), tumours (n = 85, 38.5%) and others (n = 8, 1.6%). The main infectious aetiology was tuberculosis (n = 84). Tumour aetiology consisted of 79 primary malignancies and three metastatic cases. Primary tumours consisted predominantly of lymphoma (n = 74), with Burkitt's lymphoma (n = 44) being the most common. Tuberculosis on a background of HIV infection remains the dominant cause of cervical lymphadenopathy in the tropical region of Togo.

Background: Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia., Methods: We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients' medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases., Results: Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases., Conclusions: Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia., Competing Interests: The authors have declared that no competing interests exist.

Background: Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis. This study was primarily designed to assess clinical characteristics of Peripheral tubercular lymphadenitis and incidence of Paradoxical reaction., Materials & Methods: It is a prospective observational study for 130 peripheral Lymph node tuberculosis patients diagnosed and treated between 1st Jan 2018 to 31st Dec 2019. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc, Chicago, USA). A P value of <0.05 is considered significant., Results: Out of 130 study patients, 54 were male, and 76 were female, with a sex ratio of 1:1.4. The mean age of the patients was 28.01 years (±12.41). Almost one-fourth of study patients (25.38%) had symptoms for more than one years before the diagnosis of tubercular lymphadenitis. Of the 130 patients, 62 (47.69%) were classified as having confirmed TB based on AFB positivity in FNAC sample. More than half of study patients (55.38%) received homoeopathic treatment before initiation of anti-tubercular treatment. The most common Lymph node involved was cervical (66.15%). Forty-six (35.38%) patients developed Paradoxical reaction, and most of this occurred in the first two months of the initiation of Anti-tubercular treatment. Fifty-eight patients (44.61%) had a residual Lymph node of size more than one centimetre after six months of treatment. Only 9 patients out of 54 patients had significant reduction in the size of the lymph node with 9 months of treatment., Conclusion: Significant number of patients had residual lymph node at the end of 6 months of treatment, but extending the treatment to 9 months was not beneficial. More than half of patients had history of homoeopathic treatment that could lead to delayed presentation. The paradoxical reaction is very common but most of it subsided spontaneously., Competing Interests: Declaration of competing interest The authors have none to declare., (Copyright © 2020 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Tuberculous lymphadenitis (TBLA) is the most common extrapulmonary manifestation of tuberculosis (TB) in Denmark. However, the clinical features of patients with TBLA have never been systematically studied in this setting., Methods: Patients treated for TBLA in Central Region Denmark from 2007 to 2016 were identified using the national TB surveillance register and The Danish Hospital Patient Registry. Data of clinical characteristics and treatment were extracted from hospital records., Results: Eighty-three TBLA patients were identified. The median age was 32 years (IQR 23-42); 71 (85.5%) were migrants; 58 (69.9%) presented with cervical lymphadenopathy; and 45 (54.2%) had one or more systemic TB symptom such as fever, chills, night sweats, fatigue, and weight loss. Sixty-five patients had no comorbidities (78.3%). HIV co-infection was seen in five (7.2%) of the 69 who were tested for HIV. Abscesses and/or draining sinuses were noted in 13 (15.7%) patients and 15 (18.1%) had concurrent pulmonary infection. The median time from first hospital contact to treatment initiation was 42 days (IQR 16-82) and admitted patients were hospitalised for a median of 7 days (IQR 3-13.5). For 24 patients (28.9%), lymph node material was not sent for mycobacterial culture and 52 (62.7%) had microbiologically confirmed TB. Treatment outcome was successful for 70 patients (84.3%)., Conclusion: In Denmark, TBLA is mainly seen among young and previously healthy migrants presenting with cervical lymphadenopathy and sparse systemic symptoms. The diagnosis is often considerably delayed and not microbiologically verified, implying diagnostic difficulties. Treatment outcome needs to be improved., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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., Competing Interests: The authors declare no competing interests., (Copyright: Shilpam Sharma et al.)

Background: This study aimed at highlighting some demographic and clinical features of tuberculosis (TB) at Leon Bernard TB unit, Algeria., Methods: This was a retrospective and descriptive study based on TB data extracted from TB patient records during 2009-2019 at Leon Bernard TB unit., Results: Of the total 1375 TB patients, 602 (43.8%) had extrapulmonary TB (EPTB), 482 (35.1%) had new sputum smear-positive pulmonary TB (PTB), 42 (3.1%) had sputum smear-negative with culture-positive PTB, and 97 (7%) EPTB patients had concomitant pulmonary involvement. The male-to-female ratio was 1.07. A total of 116 (8.4%) TB relapses were reported with predominance among ETPB cases (54.3%). Lymphadenitis TB was the most common manifestation of EPTB with 301 cases (39.6%), followed by pleural TB with 237 cases (31.2%). The number of bacteriologically not confirmed EPTB was 22.6% more than half (53.3%) of whom were pleural TB. Among patients with new sputum smear-positive PTB, 71.2% were males, whereas the reverse was observed among patients with EPTB where 62.3% were female. Two-third of recorded cases were between 15 and 45 years old. Nearly all children had EPTB (64/69). The results revealed that most of the patients who passed away were affected by PTB (15/18), and the most frequent cmorbidities were diabetes (9/18) and high blood pressure (6/18)., Conclusion: Specific attention needs to be given to an examination of the risk factors of PTB among male population and of EPTB among female population and children and to diagnosis of pleural TB and primary PTB., Competing Interests: None

Introduction: Although pancreatic tuberculosis (TB) is traditionally considered to be a rare clinical entity, in recent times, an increase in the number of reports of pancreatic TB has been noted. We conducted a systematic review in order to summarise currently available data on pancreatic TB., Methods: A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted in order to identify papers reporting cases of pancreatic TB. The eligibility criteria for inclusion in the review required that the studies reported patient(s) affected by pancreatic TB and that individual data on age, sex, clinical presentation and outcome were available., Results: In total, 116 studies reporting data on 166 patients were included in the analysis. The majority of patients were males (62.1%) diagnosed at a mean age of 41.61 ± 13.95 years. Most cases were diagnosed in Asia (50.0%), followed by North America (22.9%), Europe (20.5%), Africa (4.2%) and South America (2.4%). Human immunodeficiency virus (HIV) infection was diagnosed in 25.3% of those affected. Pancreatic TB most frequently presented itself in the form of a pancreatic mass (79.5%) localised mainly in the head (59.0%) and less frequently in the body (18.2%) and tail (13.4%). Extrapancreatic TB involvement most frequently affected the peripancreatic lymph nodes (47.3%). More than half of patients (55.2%) were subjected to laparotomy, while 21.08% underwent endoscopic ultrasound fine-needle aspiration biopsy. The presence of TB was identified most frequently through histological analysis (59.6%), followed by culture (28.9%), staining (27.7%) and, in a smaller number, by polymerase chain reaction (9.6%) and cytology (6.6%). Almost all patients received anti-tubercular pharmacological therapy (98.2%), while 24.1% underwent surgery. Despite treatment, 8.7% of patients died., Conclusion: Increased awareness of pancreatic TB is needed, not only in endemic areas but especially in relation to HIV infection and other clinical conditions associated with immunoincompetence.

Background: Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan., Method: We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling., Findings: Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9-31.0) compared to 27.9% (95%CI; 27.3-28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate., Conclusions: The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management., Competing Interests: The authors have declared that no competing interests exist.

Poverty, high population density and unhealthy dwellings in Siena's historic district accounted for the spread of tuberculosis in its various forms between the mid-nineteenth century and the first three decades of the twentieth century. In this paper, the author relies on statistical data relating to a time span between 1898 and 1935 to discuss the high incidence of scrofula, or tuberculosis of the lymphatic glands, among Siena's infant population.The result is a description of the most important actions implemented at city level to prevent tuberculosis and to assist and treat sick children: stays in seaside hospices promoted by Carlo Livi in order prevent and treat poor and malnourished children, the establishment of a Preventorium to accommodate children from families that included members infected with pulmonary tuberculosis, the realization of activities in the green areas of the Fortress on advice of Achille Sclavo. Furthermore, the author recalls the work of great hygienist Sclavo to raise awareness of the hygienic practices among Siena's population, which was fundamental in the prevention of epidemic diseases such as tuberculosis.

In countries of the European Union, tuberculosis (TB) mainly affects marginalised people, including asylum seekers. Migratory flows from high-incidence countries to Italy have increased up to 2017, posing challenges to the national health system. This study sought to assess TB and latent TB infection (LTBI) prevalence among asylum seekers in Milan during the biennium 2016-2017 and to evaluate interventions in place.A two-level active surveillance and screening system was developed for both TB and LTBI. Asylum seekers underwent an initial screening with a tuberculin skin test (TST) and a questionnaire at the receiving sites. At the Regional TB Reference Centre, those with a positive result underwent chest radiography. People aged <35 years with negative chest radiography results underwent further testing by interferon-γ release assay. If results of the assay were positive, LTBI treatment was offered. TB and LTBI prevalence were compared with literature data.A total of 5324 asylum seekers, mostly young (10-39 years; 98%), male (84%) and from sub-Saharan Africa (69%), were enrolled in the study. 69 active TB cases were diagnosed and 863 LTBI-positive individuals were detected. TB prevalence was high (1236 per 100 000 population) and LTBI prevalence was 28%. Despite losses (41%) during the transition from initial screening sites and the diagnostic centre, a good TB cure rate (84%) and optimal LTBI treatment completion (94%) were achieved.Our study shows that TB incidence is high among asylum seekers in Milan and that well-coordinated screening measures are critical for early diagnosis and treatment. It also proves that rolling out successful at-scale interventions for both prophylaxis and disease management is feasible., Competing Interests: Conflict of interest: S. Villa has nothing to disclose. Conflict of interest: L.R. Codecasa has nothing to disclose. Conflict of interest: M. Faccini has nothing to disclose. Conflict of interest: M.M. Pontello has nothing to disclose. Conflict of interest: M. Ferrarese has nothing to disclose. Conflict of interest: P.F. Castellotti has nothing to disclose. Conflict of interest: S. Senatore has nothing to disclose. Conflict of interest: A. Lamberti has nothing to disclose. Conflict of interest: E. Mazzola has nothing to disclose. Conflict of interest: C.F. Perno has nothing to disclose. Conflict of interest: D. Campisi has nothing to disclose. Conflict of interest: M. Saporiti has nothing to disclose. Conflict of interest: M.C. Raviglione has nothing to disclose., (Copyright ©ERS 2019.)

Background: Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes., Methods: A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes., Results: There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006-2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231-1.028]; p = 0.05). On multivariate analysis, age group 56-65 years (1.658 [1.157-2.376]; p = 0.006), relapse cases (7.078 [1.585-31.613]; p = 0.010), EPTB-DM (1.773 [1.165-2.698]; p = 0.008), patients with no formal (2.266 [1.254-4.095]; p = 0.001) and secondary level of education (1.889 [1.085-3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311-1.746]; p <  0.001), Malays (1.251 [1.056-1.482]; p = 0.010) and Indians (1.450 [1.142-1.842]; p = 0.002), TB-HIV (3.215 [2.347-4.405]; p <  0.001), EPDM-HIV (4.361 [1.657-11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785-5.987]; p <  0.001), those living in urban areas (1.272 [1.109-1.459]; p = 0.001) and no formal education (1.361 [1.018-1.820]; p = 0.037)., Conclusion: The findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.

Background: Tuberculosis (TB) is a public health problem worldwide. Characterizing its trends over time is a useful tool for decision-makers to assess the efficiency of TB control programs. We aimed to give an update on the current chronological trends of TB in Southern Tunisia from 1995 to 2016 and to estimate future trajectories of TB epidemic by 2030., Methods: We retrospectively collected data of all notified TB new cases by the Center of Tuberculosis Control between 1995 and 2016 in South of Tunisia. Joinpoint Regression Analysis was performed to analyze chronological trends and annual percentage changes (APC) were estimated., Results: In the past 22 years, a total of 2771 cases of TB were notified in Southern Tunisia. The annual incidence rate of TB was 13.91/100,000 population/year. There was a rise in all forms of TB incidence (APC = 1.63) and in extrapulmonary tuberculosis (EPTB) (APC = 2.04). The incidence of TB increased in children and adult females between 1995 and 2016 (APC = 4.48 and 2.37, respectively). The annual number of TB declined in urban districts between 2004 and 2016 (APC = -2.85). Lymph node TB cases increased (APC = 4.58), while annual number of urogenital TB decreased between 1995 and 2016 (APC = -3.38). Projected incidence rates would increase to 18.13 and 11.8/100,000 population in 2030 for global TB and EPTB, respectively., Conclusions: Our study highlighted a rise in all forms of TB and among high-risk groups, notably children, females and lymph node TB patients in the last two decades and up to the next one., Competing Interests: The authors have declared that no competing interests exist.

Background: There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0-4 versus 5-14 years in rural Ethiopia., Methods: For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5-14 years., Results: We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5-14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5-14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5-14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5-14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5-14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002)., Conclusions: We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success.

Introduction: Tuberculosis (TB) is an infectious and curable disease caused by Mycobacterium tuberculosis complex; it affects both men and women at any age., Objective: To characterize cases of TB presented at the Michoacán Local Office of IMSS (Mexican Institute of Social Security), from 2015 to 2018., Material and Methods: Cross-sectional, observational and analytical study. Cases with a clinical file with complete information and registered in the Epidemiological Surveillance Information System, from 2015 to 2018, at the Michoacán Local Office were included. Descriptive statistics, frequency and association measures were obtained by using XMH and chi squared., Results: 328 cases of TB were found, 56% were male; the most affected age group was the one of 65 years and above with 20%; 28% were housewives; 32% had primary education; 30% were from Lazaro Cardenas jurisdiction; 70% presented pulmonary TB; 88% got cured; 25% were associated with diabetes. The association of pulmonary TB with some risk factors was 1.24 times greater in retired: XMH = 2.02, OR = 2.74, chi squared: p = 0.03 (95% CI, 1.03 7.30); 1.15 times greater in males: XMH = 1.97, OR = 1.61, chi-squared: p = 0.04 (95% CI, 1.00 2.60), and 1.21 times greater in the age group of 65 years and above: XMH = 2.34, OR = 2. 21, chi-squared: p = 0.01 (95% CI: 1.12 4.35)., Conclusion: The results of this study are a starting point to prevent, diagnose, control and follow up TB cases at the local office level at IMSS.

Background: Head and neck tuberculosis (HNTB), including cervical lymphadenopathy, is the most common extrapulmonary manifestation of TB. The proposed study investigated the epidemiologic and clinical characteristics of HNTB., Materials and Methods: A literature search was conducted via PubMed, Embase, Cochrane Library and Wanfang for keywords (tuberculosis, head and neck, laryngeal, pharyngeal, tongue, oropharyngeal, nasopharyngeal, and oral cavity). Scientific articles published from January 1990 through July 2017 were selected and reviewed to assess the epidemiology, presentation, diagnosis and treatment of HNTB disease., Results: Results from the included 57 studies revealed that the majority of HNTB cases were age<40 years and female. The most common HNTB sites were cervical lymph nodes (87.9%), followed by larynx (8.7%). Involvement of other HN-regions was rare (3.4%). Multidrug resistant TB was not common among the majority of studies. Given the paucibacillary nature of HNTB, sputum tests did not have a good performance on HNTB diagnosis. Most of HNTB cases were diagnosed by fine-needle aspiration, cytology and excision biopsies in combination with clinical presentations., Conclusion: HNTB disease is an important manifestation in the diagnostic process in an otolaryngologist practice. The developments of rapid, ultrasensitive, simple and cost-effective high-throughput methods for early diagnosis of HNTB are urgently needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Head and neck tuberculosis (HNTB) especially cervical lymphadenopathy are the most common extrapulmonary indications of TB, but remain a diagnostic challenge. In this study, we describe and analyze the epidemiologic characteristics of HNTB on a population-level., Materials and Methods: We retrospectively assessed 547 HNTB cases reported to the Centers for Disease Control and Prevention's TB Genotyping Information Management System in Texas from 2009 to 2016 and compare and contrast differences between diagnosed exclusively HNTB and HNTB with concurrent pulmonary tuberculosis (PTB)., Results: The majority of patients with HNTB were diagnosed with cervical lymphadenopathy (96.9%), age 25-44 (47.3%) and female (52.7%). Co-infection with human immunodeficiency virus, being homeless, excessive alcohol use within the past 12 months and drug use were more frequently seen for HNTB with concurrent pulmonary involvement compared to reported patients with exclusively HNTB. The highest prevalence of Mycobacterium tuberculosis lineage in exclusively HNTB was Euro-American L4 (52.3%), followed by Indo-Oceanic L1 (21.5%) and East-Asian L2 (13.1%). One multidrug resistant TB case was identified. Seven deaths were reported during treatment., Conclusion: Our findings provide a better understanding of the epidemiology of HNTB and characteristics associated with the disease at the population-level, which is important in managing HNTB patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Tuberculous lymphadenitis is the most frequent form of extra-pulmonary TB (EPTB) and accounts for a considerable proportion of all EPTB cases. We conducted a systematic review of articles that described the epidemiological features of TBLN in Africa., Methods: Any article that characterized TBLN cases with respect to demographic, exposure and clinical features were included. Article search was restricted to African countries and those published in English language irrespective of publication year. The articles were retrieved from the electronic database of PubMed, Scopus, Cochrane library and Lens.org. Random effect pooled prevalence with 95% CI was computed based on Dersimonian and Laird method. To stabilize the variance, Freeman-Tukey double arcsine root transformation was done. The data were analyzed using Stata 14., Results: Of the total 833 articles retrieved, twenty-eight articles from 12 African countries fulfilled the eligibility criteria. A total of 6746 TBLN cases were identified. The majority of the cases, 4762 (70.6%) were from Ethiopia. Over 77% and 88% of identified TBLN were cervical in type and naïve to TB drugs. Among the total number of TBLN cases, 53% were female, 68% were in the age range of 15-44 years, 52% had a history of livestock exposure, 46% had a history of consuming raw milk/meat and 24% had history of BCG vaccination. The proportion of TBLN/HIV co-infection was much lower in Ethiopia (21%) than in other African countries (73%) and the overall African estimate (52%). Fever was recorded in 45%, night sweating in 55%, weight loss in 62% and cough for longer than two weeks in 32% of the TBLN cases., Conclusions: TBLN was more common in females than in males. The high prevalence of TBLN in Ethiopia did not show directional correlation with HIV. Population based prospective studies are warranted to better define the risk factors of TBLN in Africa., Competing Interests: The authors have declared that no competing interests exist.

Background: Extra-pulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs. It is frequently a diagnostic and therapeutic challenge with paucity of data available. The aim of this study was to assess the prevalence of bacteriologically confirmed EPTB; to determine the most affected organs and to evaluate the therapeutic outcome of EPTB patients treated under program conditions in the littoral region of Cameroon., Methods: A descriptive cross-sectional laboratory-based epidemiological survey was conducted from January 2016 to December 2017 and 109 specimens from 15 of the 39 diagnosis and treatment centers in the littoral region were obtained. Two diagnostic methods (Gene Xpert MTB and culture (LJ and MGIT) were used for EPTB diagnosis. Determine HIV1/2 and SD Biolinewere used for HIV diagnosis. Confirmed EPTB cases were treated following the national tuberculosis guide., Results: The prevalence of bacteriologically confirmed EPTB was 41.3% (45). All 45 cases were sensitive to rifampicin. Males were predominately more infected [26 (57.8%)] likewise the age group 31-45 years with 15 (33.3%) cases. The overall prevalence for HIV was 33.6% (36). HIV infection was present in 28.9% (13) of patients with EPTB. The most affected sites with EPTB were: Lymph nodes (66.5%), pleural cavity (15.6%), abdominal organs (11.1%), neuromeningeal (2.2%), joints (2.2%) and heart (2.2%). Overall, 84.4% of the study participants had a therapeutic success with males responding better 57.9% (p = 0.442). Therapeutic success was better (71.7%) in HIV negative EPTB patients (p = 0.787)., Conclusion: The prevalence of bacteriologically confirmed EPTB patients treated under program conditions in the littoral region of Cameroon is high with a therapeutic success of 84.4% and the lymph nodes is the most affected site.

Background: India accounts for one fourth of the global tuberculosis (TB) burden. In 2015, an estimated 28 lakh cases occurred and 4.8 lakh people died due to TB and proportion of children among new TB patients was 6% in 2016. The clinical presentation of childhood TB is extremely variable, therefore the study attempted to understand, the socio-demographic profile of pediatric tuberculosis patients, and the treatment outcomes under Revised National Tuberculosis Control Program (RNTCP)., Methods: It was a prospective study carried out from January 2015 to December 2015. A predesigned, pretested and semi-structured questionnaire was used to interview caregivers of pediatric TB patients and they were followed up at two more occasions i.e. at the end of intensive phase at the end of continuation phase., Results: A total of 141 study subjects were enrolled. Majority of the subjects (51.8%) belonged to 11-14 years of age group were females (63.8%) and from lower middle class families (48.9%). Extra pulmonary TB (70.2%) was almost three times more prevalent than pulmonary TB. During follow up visits symptoms like chest pain, breathlessness and eye redness were disappeared by the end of intensive phase and fever, cough and skin lesion improved by the end of continuation phase. Mean weight gain in malnourished children (2.6 kg) was lesser as compared to normal children (3.0 kg) at the end of 3rd visit. Treatment success rate in category 1 was 96.2% and in category 2 was 90%., Conclusion: Treatment success rate under RNTCP is good but still need to improve, to make it 100 percent., (Copyright © 2018. Published by Elsevier B.V.)

Patients with chronic kidney disease have impaired immunity that increases their risk of infection. Increased incidence of mycobacterial infections, in particular Mycobacterium tuberculosis, is described in patients undergoing hemodialysis and peritoneal dialysis as well as after kidney transplantation in low-prevalence and high-prevalence settings. Diagnosis of this infection can be challenging because of atypical presentations that may lead to treatment delay and, consequently, increased mortality; however, recent advances in molecular testing have improved diagnostic accuracy. It is imperative to try to identify those patients at increased risk and offer adequate prophylaxis. There are controversies and insufficient data regarding treatment agents, duration, and dosages. Most studies in nontuberculous mycobacteria are based on case series and retrospective studies., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Tuberculosis (TB) is a major health problem and a leading cause of illness and death from infectious disease. Tuberculosis in pregnancy has been associated with increased risks of prematurity and small for gestational age (SGA)infants.The present study is aimed to examine obstetrical and perinatal outcomes among women who had extra-pulmonary tuberculosis., Material and Methods: It was retrospective study involving patient who presented with extra pulmonary tuberculosis over a period of ten years (2008-2017)was reviewed. Diagnosed women were compared with controls in the ratio of six controls for each case. Data included age, parity and complications in the antenatal, intrapartum and postpartum periods. The mean birth weights of infant and the frequency of small for gestation age, neonatal depression and still births were used for perinatal outcome., Results: During the period of study 30 pregnant women were booked for extra -pulmonary TB. 22/30(73.3%) were diagnosed having extra pulmonary -TB prior to pregnancy and were taking ATT (anti-tubercular therapy) during the pregnancy, in 8/30(26.6%) it was diagnosed during pregnancy. Age, parity were similar in two groups. There was significantly increased incidence of oligoamnios and preterm rupture of membrane (P = 0.001). Mean gestation age of delivery in TB cases was 36.15 ± 1.8 weeks as compared to37.5 ± 0.5 weeks in low risk patients (P = 0.001). The mean birth weight of the infants of mother with extra pulmonary TB was 2324.26 ± 379.5 grams and 2712.3 ± 635.7 for control group(P = 0.001)., Conclusion: This study emphasize on the need for early diagnosis and treatment of tuberculosis preferably before pregnancy, regular medical follow up and good perinatal care., (Copyright © 2018. Published by Elsevier B.V.)

Background: Sewage management is hazardous due to chronic exposure to chemical gases, bioaerosols and micro-organisms through inhalation; accidental oral intake and penetration through skin or mucous membranes through injuries or breech in personal protective equipment. While there has been some research on isolated infections and multisystem symptom profiling of sewage workers, there is little research on the burden of chronic illnesses like Tuberculosis and Non Communicable Diseases (NCDs)., Methods: A cross sectional observational study was conducted on chronic comorbidity profile of sewage workers with more than five years of occupational experience and employed in three contiguous districts of NCT of Delhi., Results: The study sample consisted of 104 sewage workers with mean age of 50.71 (±8.43) years, an average of 7.35 (±3.75) years of formal education and an average occupational exposure to sewage work of 21.28 (±10.54) years. 21.15% sewage workers had Tuberculosis and 92.31% had at least one of the chronic respiratory diseases (COPD, Asthma or ACOS). 85.6% of participants were smokers. The most common NCD was Hypertension (67.3%) followed by Dyslipidaemia (50%) and Diabetes Mellitus (43.3%). There was clustering of NCDs with 53.85% subjects having three or more chronic disorders. Less than 5% of study participants were free from all the investigated chronic diseases., Conclusion: The sewage workers have an adverse chronic morbidity profile for both Tuberculosis and NCDs. There is an urgent need for epidemiological research and targeted screening and public health intervention for Tuberculosis and other NCDs in sewage workers as an occupational group., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Early detection and treatment of tuberculosis (TB) is essential to achieve the goals appointed in the WHO End TB Strategy. Tuberculous lymphadenitis (TBLA) is the most common manifestation of extrapulmonary TB, but the diagnosis can be challenging in low-incidence countries due to sparse and inconsistent clinical features, resulting in delay. We aimed to summarize and discuss the current literature on patient delay, health care delay, and total delay (i.e., time to first health care contact, diagnosis, and treatment) in patients with TBLA in TB low-incidence countries. A systematic review using PubMed was conducted, searching for studies set in TB low-incidence countries (defined as <20 per 100,000 citizens) that reported on health care seeking behaviour, patient delay, health care delay, and/or total delay. Studies were categorized by type of delay and compared. We identified 11 heterogeneous studies with highly variable observations. Mean patient delay varied from 55 to 154 days (range, 14-1,461), mean health care delay from 44 to 94 days (range, 7-224) and median total delay from 77.5 to 122 days (range, 0-2,820). Evidently, more comprehensive insights into the diagnostic pathway and delay in TBLA patients are warranted., (© 2019 S. Karger AG, Basel.)

Extrapulmonary tuberculosis accounts for 15-20 % of all clinical presentations of tuberculosis. Peripheral tuberculous lymphadenitis is the second most common presentation of extrapulmonary tuberculosis in children, after pleural tuberculosis, in Argentina. We analyzed 92 patients with peripheral tuberculous lymphadenitis seen at the Department of Tisiology of Hospital de Niños "Dr. Ricardo Gutiérrez" between August 2000 and September 2015. The patients' mean age was 8.7 ± 5 years. Nodal sites corresponded to single peripheral (31.5 %), multiple peripheral (20.6 %), and peripheral associated with deep nodes (47.8 %). Cervical lymph nodes were the most common site of involvement (80 %). In 80 % of patients previous antibiotic therapy had been administered, without response. The tuberculosis source was known in 56 %; 69 % had a positive tuberculin skin test; and 54 %, a pathological chest X-ray. Tuberculosis treatment was started on all patients based on clinical criteria, exposure and/or positive tuberculin skin test, prior to microbiological or histological confirmation. The clinical course was either healing (81.5 %), referral to a facility near home (8.7 %) or dropout (8.7 %). One patient died., (Sociedad Argentina de Pediatría.)

Introduction: Lymph node tuberculosis remains widespread in Cameroon. Our goal was to compare the diagnostic agreement between the hematein-eosin coloration technique and the Ziehl-Neelsen technique., Methods: This study is a retrospective and comparative study realized in the Yaounde University Teaching Hospital over a period of 5 years. We needed to specify the diagnostic agreement for tuberculosis, first inter observer and secondly between the standard and special colorations. The data we collected allowed us to determine the agreement rates observed and the kappa (k) coefficients with linear weighting., Results: The 186 samples of the 1726 cases of tuberculosis of all locations represented a proportion of 10.78%. There were more male patients (65.05%) with a sex ratio (M:F) of 1.30. The average age was 24.21 ± 15.5 with the extremes from 5 to 68 years. The most represented age group was from 10 to 39 years. The two observers agreed in 93 cases using hematein eosin coloration (P 0 = 83.87 %; k = 0.8109) and on 73 samples using the Ziehl-Neelsen coloration (P 0 = 89.78 %; k = 0.7734). The two coloration techniques presented an agreement on 104 samples (P 0 = 88.17 %; k = 0.8783)., Conclusion: The routine choice of the hematein eosin coloration technique not paired with the coloration technique of Ziehl-Neelsen can effectively alleviate the program for fighting tuberculosis in an environment of limited resources.