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A framework for Computer-Aided Diagnosis (CAD) to diagnose Cavitary TB and Miliary TB from chest Computed Tomography (CT) slices has been designed and implemented. The lung tissues from the CT slic...

Background: Few studies have explored the relative burden and trends in pulmonary (PTB) vs. extra-pulmonary (EPTB) tuberculosis in the United States using a nationally representative sample. Methods: This study examined trends in hospitalization rates, length-of-stay (LOS), in-hospital mortality and inflation-adjusted charges, for PTB vs. EPTB using the Nationwide/National Inpatient Sample (NIS) from 1998 to 2014. Descriptive and multivariable analyses (linear, negative binomial and logistic) were utilized adjusting for demographics, co-morbidity and hospital characteristics. Results: During the study period there were a survey-adjusted, estimated 258,631 PTB (75.5%), 76,476 EPTB (22.3%) and 7552 concurrent PTB and EPTB (2.2%) discharges. Whites accounted for 27.6% of PTB, 21.9% of EPTB and 17.6% of concurrent discharges; and self-pay or no insurance accounted for 22.2%, 18.4%, and 25.9%, respectively. EPTB was more common among blacks (22.5%), and combined TB more common among Hispanics (24.8%). Mean LOS was 11.4 days, 13.2 days, and 19.5 days; with mean nominal charges of $48,031, $62,255, and $89,364 for PTB, EPTB and combined TB respectively. Inpatient mortality for all three groups was approximately 5.7%. Miliary TB and TB of meninges and central nervous system were positively associated with mortality (odds ratios of 2.44 and 2.11, respectively), as was alcohol abuse (OR 1.21). Trend analyses showed decreased hospitalizations for all TB types, no change in LOS trends, decreased mortality for PTB and ETB and increased charges for PTB and ETB from 1998 to 2014. Increased utilization, higher charges and higher risk of mortality (to some extent) among the EPTB cases warrant improved methods for screening, diagnosis and treatment. Conclusion: Though rates of TB hospitalization are declining, EPTB is becoming relatively more common and is more costly compared to pulmonary TB. Screening methods that focus on identification of ETB contrary to current practice guidelines are needed to aid ETB case finding. Keywords: Tuberculosis, Epidemiology, Health care utilization, Alcohol, Health care disparities

Background Wallgren's tuberculosis (TB) timetable demonstrated co-occurrence of miliary TB and tuberculous meningitis in children. To verify the same in immunocompetent adults, we prospectively evaluated the prevalence and spectrum of central nervous system (CNS) involvement in patients with pulmonary miliary TB. Materials and Methods This was a tertiary care, University hospital-based, prospective evaluation performed from December 2018 to June 2020. Newly diagnosed patients with pulmonary miliary TB were subjected to a detailed clinical, laboratory and MRI-based evaluation. All patients received treatment as per WHO guidelines. Results Out of 342 patients with pulmonary TB, 53 patients met the eligibility criteria. The median age at presentation was 32 y and approximately two-thirds of patients were female. Clinically, only two-fifths of patients had features of CNS involvement. Cerebrospinal fluid (CSF) and imaging abnormalities were noted in 46 patients each. Twelve (23.5%) patients were diagnosed with definite-category tuberculous meningitis. Presence of an infarct significantly correlated with neurological features. Mantoux positivity correlated significantly with the presence of choroid tubercles, CSF changes and brain tuberculomas. Conclusion This is the first study to endorse Wallgren's observations in immunocompetent adults. A high index of suspicion, even in asymptomatic patients, may uncover tuberculous lesions involving the CNS and guide optimal monitoring of patients.

Children and adolescents represent an important component of the overall tuberculosis (TB) epidemic. Following exposure to an infectious case of TB and subsequent infection, young children and pubertal adolescents have a high risk of progression to TB disease. The disease manifestations change with age; the youngest children often have paucibacillary disease, either localised to lymph nodes or disseminated through the body as miliary TB or TB meningitis. As children enter adolescence, they are more likely to develop multibacillary disease and have typical features of adult TB, such as cavities. The diagnosis of TB in young children can be challenging, and microbiological confirmation is frequently not possible, due to the paucibacillary nature of the disease as well as the challenges in obtaining respiratory specimens. The clinician must therefore assemble pieces of evidence to support the diagnosis, including symptoms, signs, immunological tests, and radiology. The treatment of TB infection and disease in children and adolescents are broadly similar to adults. However, important differences include drug dosages, the need for child-friendly formulations, specific issues for adherence support and other areas such as impact on schooling, and child protection. Childhood TB needs to be addressed as part of any TB programme and services need to be tailored to the specific needs of children and adolescents of all ages. If this is undertaken, the potential for a future TB-free generation is possible.

Three teaching hospitals in Ghana.To elucidate trends in demographics, clinical characteristics and treatment outcomes in extrapulmonary TB (EPTB) patients.This was a retrospective study involving the review and comparison of EPTB and pulmonary TB (PTB) data from 1 January 2008 to 31 December 2017 in TB registers and treatment cards.Of 15,392 TB cases, 4607 (30%) were EPTB, including 4477/4607 (97%) new cases. There were 2,679/4607 (58%) males and the age range was 0.3 to 96 years. Pleural TB (1021/4607, 22%) was the most common. Treatment success rates for EPTB and PTB were respectively 72% and 84%. HIV positivity was high among patients with disseminated/miliary TB (429/779, 55%) and TB meningitis (242/526, 46%). To note, disseminated/miliary TB (χThere is male preponderance for both EPTB and PTB in Ghana. Increasing age, disseminated/ miliary TB, TB meningitis and HIV are risk factors for mortality among EPTB patients. This emphasises the need for public education on the risk factors for EPTB and preventive strategies.Trois centres hospitalières universitaires au Ghana.Elucider les tendances démographiques, les caractéristiques cliniques et les résultats du traitement de patients atteints de TB extrapulmonaire (EPTB) au Ghana.Ceci est une étude rétrospective de revue et de comparaison des données de EPTB et de TB pulmonaire (PTB) du 1e janvier 2008 au 31 décembre 2017 dans les registres de TB et les cartes de traitement.Sur 15 392 cas de TB, 4607 (30%) étaient des EPTB dont 4477/4607 (97%) étaient de nouveaux cas. Les hommes représentaient 2679/4607 (58%) et leur âge allait de 0,3 à 96 ans. Une TB pleurale 1021/4607 (22%) était la plus fréquente. Le taux de réussite du traitement de la EPTB et de la PTB a été de 72% et 84%, respectivement. La positivité au VIH était élevée parmi les patients atteints de TB disséminée/miliaire (429/779 ; 55%) et de méningite tuberculeuse (242/526 ; 46%). Il est significatif que la TB disséminée/miliaire (χIl y a une prépondérance masculine à la fois de la EPTB et de la PTB au Ghana. Un âge croissant, une forme disséminée/ miliaire, une méningite TB et le VIH sont des facteurs de risque de mortalité pour les patients EPTB. Ceci met l’accent sur le besoin d’éducation du public relative aux facteurs de risque et aux stratégies de prévention.

We report a case of tuberculosis (TB) meningitis after allogeneic hematopoietic stem cell transplantation (HSCT) for relapsed acute myeloid leukemia. The patient was 52‐year‐old woman who had relapsed leukemia with a remission duration of 7 months, and she received re‐induction with consolidation, allogeneic HSCT. After 4 days of engraftment, she had headache with fever and cerebrospinal fluid (CSF) analysis presented increased intracerebral pressure, white blood cell counts with dominant neutrophils, elevated glucose and protein level. Brain imaging showed diffuse leptomeningeal enhancement with scattered miliary TB lesions suggesting disseminated TB disease. Mycobacterium tuberculosis was detected in CSF and sputum anti‐TB medication was started. She was IGRA positive before transplantation but did not receive treatment for LTBI prior or during the transplant. Unfortunately, she expired because of intracerebral hemorrhage. TB meningitis is a rare but important complication of HSCT as it can cause serious neurologic sequelae, even death. So in transplant recipients having high risk of TB reactivation, LTBI treatment is recommended before or along with transplantation. If latent TB is not treated, vigilant suspicion and early diagnosis of TB meningitis could improve the transplant outcome.

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is more common in developing countries. Isolated splenic TB is typically found in trauma, miliary TB and immunocompromised status. We present a very rare case of an immunocompetent child with an isolated primary TB in the spleen. The child only had fever of unknown origin (FUO), and mild anaemia. The diagnosis was not made until splenectomy was performed. The patient took the quadruple therapy for TB, and follow-ups showed no recurrence. This case is unique because this child was immunocompetent with no history of trauma or active TB. TB diagnosis should never be ignored in FUO as this might prevent unnecessary procedures to the patient. Although the child was vaccinated with Bacillus Calmette–Guérin that usually protects against severe TB in first 5 years of life, it did not prevent from affecting the spleen.

Paradoxical reaction (PR) after initiating anti‐tuberculous therapy (ATT) is a well‐recognized immune phenomenon. Less recognized, however, is a pulmonary reaction that is associated with miliary tuberculosis (TB), which can be a source of diagnostic confusion and progress to respiratory failure and acute respiratory distress syndrome (ARDS). We report an elderly patient who developed PR associated with respiratory failure following ATT for miliary TB, with radiological and pathological documentation. He responded to corticosteroids, but relapsed twice when the dose was reduced. It is imperative to be familiar with this form of PR to avoid diagnostic pitfalls and initiate appropriate therapy., Worsening of miliary tuberculosis after initiation of anti‐tuberculous therapy is uncommon but is potentially serious and can cause diagnostic confusion. It is, therefore, prudent to recognize this phenomenon and manage it appropriately with corticosteroid therapy.

Background Hepatitis in young children with tuberculosis (TB) outside miliary TB is not well described and represents a challenge because of the hepatotoxicity associated with first-line anti-TB treatment. Case presentation We report an antibiotic naïve 13-month-old male from Nepal with pulmonary TB and hepatitis, who improved after TB treatment. We also performed a literature review for TB-associated hepatitis in children. Conclusions Liver function tests should be considered, when feasible, in infants and young children with pulmonary TB. Testing could help to identify and manage patients with TB-associated hepatic abnormalities, and also to establish a baseline for detection and management of liver injury associated with anti-TB therapy.

Aim and Objectives. To describe the patient characteristics, clinical-epidemiologic-microbiologic profile, and treatment outcomes, and to draw attention to tuberculosis (TB) in Turkey. Methods. A retrospective, descriptive study was undertaken of 93 children aged 0 to 18 years who were admitted to Hacettepe University Pediatric Pulmonology Department for treatment from January 2005 to December 2015. Review of hospital records was performed for all children diagnosed as having TB. Results. Pulmonary TB was detected in 51.6% of the patients, extrapulmonary involvement in 33.3%, and pulmonary TB with extrapulmonary involvement in 15.1%. The history of contact with an adult with TB was found in 29% of cases. The most common extrapulmonary TB was TB lymphadenitis. The most common symptom was cough followed by fever and night sweats. One fifth of the patients had normal physical examinations at the time of diagnosis. One fifth (20.4%) of the patients had culture, 17.2% had polymerase chain reaction, and 15% had acid-resistant bacillus positivity. In 21.4% of patients with culture growth, at least one anti-TB drug resistance was found. The mean duration of treatment of patients treated according to the national guideline was 8.6 months (range = 6-36 months). Recovery was seen in 91.4% of patients. Conclusion. The most important way to prevent childhood TB is to fight adult TB through early diagnosis and effective treatment. The presence of contact history must direct us to search for TB. While evaluating children with persisted nonspecific symptoms, TB must be kept in mind even if physical examinations are normal.

Background In this study, we aimed to describe the prevalence, clinical presentation and risk factors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) cases in China. Methods We performed a descriptive analysis of demographic and clinical data of HIV/TB coinfected patients receiving ART at Beijing Ditan Hospital between January 2014 and October 2018. Results Of 199 patients included, 45 (22.6%) developed paradoxical TB-IRIS, and 19 (9.5%) TB-IRIS cases presented miliary TB. The pre-ART CD4 count lower than 50 cells/mm3 was found to be significantly associated with development of TB-IRIS. Similarly, patients with higher than 4-fold increase in CD4 cell count after antiretroviral therapy (ART) had significantly higher odds of having TB-IRIS. When patients aged 25–44 years were utilized as the control group, youths ( Conclusions In conclusion, our data demonstrate that approximate one quarter of patients coinfected with TB and HIV develop paradoxical TB-IRIS after initial of ART therapy in China. Lower baseline CD4 count and rapid increase in CD4 count are the major risk factors associated with the occurrence of paradoxical TB-IRIS.

The UK has one of the highest rates of tuberculosis (TB) in Western Europe.1 If current trends continue, with over 7500 cases per year,2 England will overtake the whole of the USA in the annual number of TB notifications within the next 2 years.3 TB disease in UK children is relatively rare with

While tuberculosis (TB) in pregnant women is reported globally, clinical data is unavailable in China. To describe clinical features and identify difficulties in the diagnosis of pregnancy-related TB, we performed a retrospective study of 28 TB inpatients at Beijing Chest Hospital. The results were presented in terms of interquartile range (IQR) for age, and medians and percentages with respect to the categorical variables. One patient (3.6%) was immediately diagnosed; for 27 patients (96.4%), the median interval from the initial onset of symptoms to diagnosis was five weeks. Eight cases (28.6%) were microbiologically confirmed. 22 (78.6%) were pulmonary TB (PTB), while six (21.4%) were extrapulmonary TB (EPTB). In addition, eight (28.6%) were miliary TB and six (21.4%) were cerebral TB. 27 (96.4%) were cured and one (3.6%) died. 15 neonates were identified, nine of which were healthy. Two were small for the gestational age (SGA) and one was a stillbirth. Three had neonatal TB, one of which died. Nine were legal abortions and four were spontaneous abortions. Indeed, there was a substantial delay in the diagnosis of TB in the pregnant women and a high incidence of both miliary and cerebral TB was evident. With timely treatment, prognosis is positive.

Multiple Myeloma (MM) is a malignant neoplasm arising from a single plasma cell clone. It mainly affects older people. It forms localised osteolytic lesions. It secretes a single monoclonal immunoglobulin of constant isotype with light-chain restriction (paraprotein). MM cells may express, an adhesion molecule. This molecule is not present on normal plasma cell. In addition, immunoglobulin light-chain may be detected in urine (Bence jones proteins). Rarely, one of the isotypes may switch to another type during high-dose chemotherapy. In addition, Isotype Switch (IS) may occur spontaneously without any treatment. The present case relates about an 87-year-old man who complained of pain in dorsal thoracic region. X-ray examination showed fractures of thoracic vertebra eighth to tenth. Sternal puncture was done. Bone marrow examination showed large number of plasmacytoid cells. Moreover, serum protein electrophoresis revealed moderately raised M band proteins in gamma globulin region (M band protein concentration was 2.03 gm/dL). The patient was diagnosed as a case of MM. Initially, he was treated with Thalidomide 100 mg daily for one month. Later, he was treated with Lenalidomide 10 mg daily for 30 days followed by a drug-free period of 15 days. After eight cycles of Lenalidomide therapy light-chain IS was detected. Initially, tumour produced lambda (λ) light-chain for one year as seen in first, second and third serum specimens. Later, light-chain switch was detected in fourth serum specimen from lambda (λ) to kappa (k) light-chain. IS was accompanied with high level of M band proteins (5.4 gm/dL). In addition, the patient developed Miliary Tuberculosis. Subsequently, the patient was treated with Phaglomide (Pomalidomide) instead of Lenalidomide.

Background: A paradoxical reaction (PR) during anti-tuberculosis treatment is a phenomenon that is poorly studied in immunocompetent children. It is defined as a clinical or radiological worsening of preexisting tuberculosis (TB) disease.Methods: A retrospective descriptive study of children younger than 14 years of age was performed; these children developed PR during the years 2009 to 2014, following a diagnosis of TB. Demographic characteristics, microbiological results, treatment and outcome data were collected.Results: Of 51 children diagnosed with TB, five (9.8%) developed a PR; four of these children had pulmonary TB and the remaining patient had miliary TB with central nervous system involvement. The PR occurred at a median of 42 days (range 23-53 days) after initiating therapy. Corticosteroids were started when PR was suspected, at a median dose of 1 mg/kg/day. Clinical and radiological improvement was noted in all cases, with a median clinical regression time of 10.5 days (range 3-15 days) and a median radiological regression time of 45 days (range 26-105 days). No sequelae were described in any patient.Conclusions: PR in immunocompetent children during anti-tuberculosis treatment is not such an unusual reaction. Treatment with corticosteroids may be useful for the resolution of PR. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license.

Miliary tuberculosis (TB) is characterized by a multitude of small nodular opacities on chest radiography. Despite ultrasound of the chest gaining wider acceptance as a diagnostic tool of lung infections, sonographic changes of pulmonary miliary TB have not yet been reported. Here, we describe B-lines and comet-tail artifacts disseminated throughout multiple lung areas and a pattern of sub-pleural granularity as consistent changes seen in lung ultrasound of ten patients with pulmonary miliary TB diagnosed by chest radiography.

Miliary tuberculosis is a severe form of tuberculosis resulting from dissemination of Mycobacterium tuberculosis bacilli. Since symptoms appearing in patients due to miliary TB are diverse and atypical, depending on the site of invasion, early diagnosis and treatment are important. A paradoxical response of tuberculosis is a rare phenomenon and it can be a clinical difficulty to treatment especially when involving the central nervous system. We present a case report with a review of related literature about the patient who developed sudden hearing loss due to tuberculosis infection in vestibulocochlear area.

We report a case of miliary tuberculosis (TB) found in one of the commercial dairy farms in Mekelle, Tigray, Ethiopia. The case history of the cow indicated weight loss, emaciation and chronic cough. Antibiotic treatment was not successful and there was also repeated death of cows in the farm. Postmortem (PM) examination showed tuberculous lesions in the lung, liver, mediastinal lymphnodes, mesenteric lymphnodes, pleural cavity, reproductive tract, lymphnodes of the head and bone marrow suggesting miliary form of TB. This was confirmed by bacteriological examination and histopathology. The farm where the present case was reported is one of the dairy farms in Mekelle city that supplies milk to the community. As the pasteurization facility is weak in the area, it is suspected that this farm may serve as one of the major transmitters of TB in humans. The lack of control policy in the country worsens the occurrence and spread of TB in animals. In this case, the owner of the Farm was advised to conduct tuberculin skin testing and segregate TB positive cows. Moreover, the owner was advised that it is advantageous to slaughter the reactors under the supervision of the local veterinarian so as to reduce spread of bovine TB in the farm. Keywords: Bovine tuberculosis; Dairy cattle; Exotic; Mekelle; Miliary TB

Increasing incidences of tubercular infections in developing countries has become a cause of concern. The extra-pulmonary tuberculosis is more commonly seen in malnourished and immuno-compromised susceptible individuals. We report a case of young female who worked as a commercial sex worker suffering from disseminated miliary TB with secondary involvement of mid facial skeleton. This case report highlights a lack of healthcare facilities and general apathy of society for these neglected sections of society.

In the present case, we report a false positive result for the detection of rifampicin (RIF) resistance by the Xpert® MTB/RIF assay, version G4.Miliary Mycobacterium tuberculosis infection (miliary TB) was suspected in a 50-year old Angolan woman. Imaging of the thorax and abdomen displayed diffuse lesions. The Xpert® MTB/RIF assay conducted on the broncho-alveolar lavage (BAL) fluid was positive for TB and positive for RIF resistance. Confirmatory molecular tests and the phenotypic drug susceptibility determination supported the diagnosis of TB but not RIF resistance. The patient was treated successfully with a conventional therapeutic scheme. Because, the Xpert® MTB/RIF assay allows the simultaneous detection of TB and RIF resistance, the World Health Organisation (WHO) recommends its use as initial diagnostic test, over microscopy, culture and phenotypic drug susceptibility testing. Even though specificity of the Xpert® MTB/RIF assay version G4 is high, false positive test results remain possible and have to be considered for the interpretation of the RIF resistance detection by Xpert® MTB/RIF assay.

The BCG vaccine was introduced in 1921 and remains the only licensed vaccine for the prevention of TB worldwide. Despite its extensive use, the BCG vaccine lacks the ability to fully control the TB-endemic and -pandemic situations. The BCG vaccine is most effective in preventing pediatric TB, in particular, miliary TB and tuberculous meningitis. However, it has a limited effect in preventing pulmonary TB, which occurs more frequently in adults. BCG vaccination has now been implemented in more than 157 countries worldwide. For various countries, the benefits of vaccination are only limited and potentially not cost effective. The International Union Against Tuberculosis and Lung Diseases had set the criteria for discontinuation of BCG vaccination in 1994. This decision, however, was not based on economic considerations. Many developed countries have met the criteria set by the International Union Against Tuberculosis and Lung Disease and stopped universal BCG vaccination. For developing countries, the BCG vaccine is still an effective intervention in protecting young children from TB infection. A lot of effort has been spent on R&D of new TB vaccines, the first of which are expected to be available within 5-7 years from now. Novel TB vaccines are expected to be better and more effective than the current BCG vaccine and should provide a viable strategy in controlling TB morbidity and mortality. In this review, the aim is to explore economic evaluations that have been carried out for vaccination against TB worldwide. In addition to epidemiological evidence, economic evidence can play a crucial role in supporting the governments of countries in making proper public health decisions on BCG vaccination policies, in particular, to implement, continue, or discontinue.

Tuberculous (TB) conjunctivitis was not an uncommon condition before the early 20(th) century but is currently a rare occurrence, especially in the developed countries. We report a 27-year-old Saudi female who underwent enucleation of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary TB that was treated at the age of 22. She was presented with chronic purulent discharge from her right an anophthalmic socket for 2 months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and steroids. Direct microscopic examination of conjunctival scrapings with the Ziehl-Neelsen staining revealed no microorganisms. Histopathological examination revealed epithelioid granulomas. Polymerase chain reaction was negative for Mycobacterium tuberculosis DNA. TB conjunctivitis was suspected from the history of miliary TB and presence of epithelioid granulomas. The definitive diagnosis was made after prompt resolution of the ocular signs with no recurrence only after systemic anti-TB therapy.

Tuberculosis (TB) remains an important public health problem worldwide. Ocular involvement in patients with systemic TB has traditionally been considered uncommon. Diagnosing ocular TB is challenging and often delayed, especially in the absence of pulmonary signs or symptoms typical of TB. Here we describe a case of paradoxical reaction after antituberculosis therapy in an immunocompetent patient with ocular TB.