Extra Pulmonary Tuberculosis

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Smear positive extra pulmonary tuberculosis disease at University of Gondar Hospital, Northwest Ethiopia

Smear positive extra pulmonary tuberculosis disease at University of Gondar Hospital, Northwest Ethiopia

Tuberculosis can involve any organ system in the body. Although pulmonary tuberculosis is the most common presentation, extra pulmonary tuberculosis (EPTB) is also an important public health problem in this era of HIV/ AIDS [8]. Review from Pittsburgh revealed that the in- crease in pathology associated with HIV/M. tuberculosis co-infection is caused by a functional disruption of the local immune response within the granuloma. These dis- ruptions presumably decrease the ability of the granuloma to contain M. tuberculosis, leading to increased bacterial growth with more mycobacterial dissemination and severe pathology [9]. In developed countries, 10-15% of TB cases have extra-pulmonary involvement, but in patients from high-incidence countries the rate is much higher [10]. People who are HIV positive and infected with TB develop EPTB much more frequently, about 50% of cases [10]. In countries with comprehensive diagnostic and reporting systems, EPTB accounts for 20–25% of reported cases [11]. Extra pulmonary tuberculosis has the reverse epi- demiological trend of pulmonary tuberculosis (PTB). Over the last several years, reported EPTB was increas- ing in absolute numbers and proportion of all reported TB cases [12]. Several studies confirmed that extra pul- monary TB is increasing from time to time. Retrospect- ive study from Nigeria showed that, the proportion of EPTB notified remained consistently below 3% but dur- ing 2007 to 2009 it has risen to 5% [13]. Another study from Kenya demonstrated that EPTB rises from 6.4% to
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Therapy duration and long term outcomes in extra pulmonary tuberculosis

Therapy duration and long term outcomes in extra pulmonary tuberculosis

6 months, with the exception of tuberculous meningitis which is treated with 9 to 12 months of therapy [5]. In general, extra-pulmonary tuberculosis in adult patients has been lumped aside in a wastebasket category. Menin- gitis is a notable exception [6-10]. Dutt, Moers and Stead studied the outcomes over an average period of 3 years post treatment in 219 EPTB the early 1980s [11]. However, this cohort of patients was treated with a regimen of iso- niazid and rifampin alone, not the standard four drug regi- men used today. In a second study, Kwara et al examined data on 126 patients with EPTB at the dawn of the AIDS pandemic, and found that the short-term mortality during treatment of EPTB was associated with HIV-infection, meningeal tuberculosis and disseminated disease [12]. Long-term outcomes were not reported. Thus, the long- term outcome in EPTB patients “adequately treated” with the current standard regimen is unknown, so that it is un- clear if standard short course therapy is effective in redu- cing long-term mortality. We have developed methods to use the Texas electronic database to examine long-term outcomes such as death in tuberculosis patients [6]. This study is focused on the evaluation of long-term outcomes in patients with EPTB, and the demographic and therapy factors predictive of poor long-term outcome.
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A study of extra-pulmonary tuberculosis and its outcome

A study of extra-pulmonary tuberculosis and its outcome

Methods: Data was collected from cases of tuberculosis patients diagnosed and treated under DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). We evaluated extra-pulmonary cases and recorded sites of involvement in order of frequency. We also studied treatment outcome by recording as per definitions given by the WHO and also evaluated any difference in outcome of extra-pulmonary tuberculosis disease with HIV co-infection. Results: Extra-pulmonary cases accounted for 30.5% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Most common site of extra-pulmonary tuberculosis was pleura (29.9%) followed by meninges (22.5%), abdomen (19.6%) and lymph node (10.7%) tuberculosis. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 8 HIV reactive patients, 5 patients completed treatment and the remaining 3 patients died during the course of treatment. Conclusions: Extra-pulmonary Tuberculosis accounts for 30.5% of the total cases studied. Pleura is most common site of extra-pulmonary TB in our study. Treatment irregularities and alcohol abuse are the two most common reasons for default. Co-infection with HIV seems to have a poor outcome on patients with extra-pulmonary TB and needs to be studied in large number of samples.
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Clinical, molecular and drug sensitivity pattern of mycobacterial isolates from extra pulmonary tuberculosis cases in Addis Ababa, Ethiopia

Clinical, molecular and drug sensitivity pattern of mycobacterial isolates from extra pulmonary tuberculosis cases in Addis Ababa, Ethiopia

sub lineages. Accordingly, the T1, H, CAS, ETH2/U and T3 cover more than 60 % of the EPTB isolates; the T1 is the dominant, widely distributed and isolated from dif- ferent parts of the body whereas CAS strains are clus- tered with close similarity and isolated from cervical and axillary samples only. Out of the total 59 isolates 10 were categorized under CAS1 family, of these 9 were found in lymph node tuberculosis. Showing there is dominance of CAS1 high in TBLN. In line with this, studies from Pakistan showed that these strains were also prevalent and accounted for 39 % of isolates form both pulmonary and extra pulmonary cases [51]. Simi- larly, Lari et al. (2009) reported that there is association between the CAS strains and extra-pulmonary TB [52] which might in part explained by the long established link of extra-pulmonary tuberculosis TB with South Asian of African origin patients that has been also re- ported earlier. On the other hand, two strain families, LAM3/F11 and W-Beijing, predominated in the South African study [53]. However, in our study we found only a single isolate of Beijing strains which is similar to stud- ies conducted on the same area [54].
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Diagnostic dilemma in extra-pulmonary tuberculosis:  PCR a convenient tool

Diagnostic dilemma in extra-pulmonary tuberculosis: PCR a convenient tool

This is a one year prospective study aimed at detecting the presence of Mycobacterial tuberculosis complex (MTBC) by MTB DNA PCR in clinically suspected cases of extra-pulmonary tuberculosis and also comparing the results with conventional Ziehl-Neelsen stained smears. The study was conducted in the Department of Microbiology and Molecular biology at Krishna Institute of Medical Sciences Limited, Secunderabad. Various samples (CSF, Fluids, Tissue, Urine, etc.) from patients suspected of having EPTB; received for PCR during the period from March 2017 to February 2018 were included in the study. Samples received were processed according to standard microbiological guidelines. Smears were prepared from the samples and subjected to Ziehl-Neelsen (ZN) staining for detection of acid fast bacilli (AFB).
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Extra Pulmonary Tuberculosis: Retrospective Review of 83 Confirmed Cases, Observed in Radiology in Lomé (TOGO)

Extra Pulmonary Tuberculosis: Retrospective Review of 83 Confirmed Cases, Observed in Radiology in Lomé (TOGO)

The abdominal tuberculosis location in frequency order is the 6 th location of extra-pulmonary tuberculosis af- ter pleural location, ganglionic, genito-urinary, osteoaricular, military and meningeal [8], it represents the fourth location in our study. This position is related to the large number of peritoneal tuberculosis cases in our series which accounted for 11.2% of all locations. Peritoneal tuberculosis is the most common form of abdominal tu- berculosis [16]; it represented 7.2% of extra-pulmonary TB in a study in one of pathological rooms at the Teaching Hospital of Lomé [4]. This difference between our study and that of Darré et al. [4] could be explained by the low proportions of other locations including ganglionic, genitor-urinary and gastrointestinal diseases that were not often explored by imaging or when the radiological exploration is made, the levy for bacteriological or histological confirmation is not easy. In medical imaging, ultrasonography is the first examination to be carried out in presence of ascites. It is completed by CT-Scan in search of signs to guide the diagnosis, especially to dis- tinguish tuberculous ascites from carcinomatous ascites and other causes including cirrhosis ascites. Although some authors believe that the distinctive elements provided by ultrasonography and CT-scan have little orienta- tion value [17] [18], these two means remain essential in exploring ascites. Hepatic TB location is very rare [19], it was 0.9% in our series. As N’goran et al. reported [20] it was the ultrasonography that allowed evoking the diagnosis, ultrasonography-guidedbiopsy and pathological examination had enabled to confirm the origin of tu- berculosis by displaying the giant cellgranuloma, with necrosis central caseous. The splenic tuberculosis loca- tion is also rare [21]. No gastrointestinal location was mentioned in this study while it represented between 3% and 5% of extra-pulmonary tuberculosis according to Chong and Lim [22]. This lack of cases cannot be ex- plained by the absence of suspected cases by imaging, but rather by the difficulties in swabbing the samples for histological confirmation.
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To Assess the Burden of and Trends in Extra Pulmonary Tuberculosis at a Tertiary Care Hospital in India

To Assess the Burden of and Trends in Extra Pulmonary Tuberculosis at a Tertiary Care Hospital in India

Extra pulmonary tuberculosis is seen in a substantial number of the suspects. Disease was found to be more common in young adults and females. Peripheral lymph node tuberculosis was the predominant type. A combination of diagnostic methods especially direct microscopy and culture by use of liquid and solid media helps in enhancing the isolation rates and confirming the etiology. Rapid identification test for M.tb. complex like MPT64 antigen detection test finds place for confirming the type species involved with good sensitivity and specificity. It is wiser to read cytology and biochemical findings in light of bacteriological results as alone they are less specific. Resistance is emerging to anti tuberculosis drugs even in extra pulmonary form of disease. Hence the use of anti tuberculosis drugs has to be justified as per the laboratory results of drug susceptibility pattern. The authors deeply thank the management of Deccan College of medical sciences, Princess Esra Hospital and the technical staff of all the central laboratories for providing timely help.
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PCR could be a method of choice for identification of both pulmonary and extra pulmonary tuberculosis

PCR could be a method of choice for identification of both pulmonary and extra pulmonary tuberculosis

Total 766 specimens from patients with a high clinical suspicion of pulmonary or extra-pulmonary tuberculosis were received at Division of Molecular Diagnostics CEMB, University of the Punjab from July 2004 to October 2010 for the detection of MTB including Serum (n = 41), Blood (n = 88), Urine (n = 225), Cere- bro Spinal Fluid (CSF) (n = 76), Ascitic Fluid (n = 133), Pleural Fluid (n = 98), Pericardial Fluid (n = 10), pus (n = 44), Bone Marrow (n = 5), Sputum (n = 36) and Bronchoalveolar Lavage (BAL) (n = 10). All these sam- ples were smearing negative. Pulmonary tuberculosis was defined as tuberculosis of lungs, pleura, and med- iastinal lymph nodes whereas extra-pulmonary TB is disease outside these sites. In Pakistan tuberculosis is highly endemic. Several TB clinics and surveillance cen- ters in Pakistan offer free diagnostic facility mostly based on smear examination will all the limitation of low sensitivities. None of these Centers has the modern molecular techniques for the diagnosis of TB. Ethical approval was not needed for the current study as all the samples from the subjects were received for clinical diagnosis from tertiary collection points and we had not disclosed any identification of the subjects.
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Comparative Study between Fluorescent Microscopy, Mycobacterial Growth Indicator Tube (MGIT) and Gene Xpert for the Detection of Mycobacterium Tuberculosis from Clinical Suspects of Smear Negative Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis Pa

Comparative Study between Fluorescent Microscopy, Mycobacterial Growth Indicator Tube (MGIT) and Gene Xpert for the Detection of Mycobacterium Tuberculosis from Clinical Suspects of Smear Negative Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis Patients

In majority Tuberculosis affects the lungs, with features of persistent cough with or without expectoration, evening rise of temperature, loss of appetite, weight loss, chest pain and hemoptysis 50 . But there are 10 to 15 %&upto 40% 22 of cases with extra pulmonary involvement in developed & low incidence countries 7 , but the prevalence is even more higher in developing countries like India with higher incidence of Tuberculosis. Extra pulmonary tuberculosis involves lymph nodes, pleura, bone and joints, abdominal, genitourinary, neurological, laryngeal, meningeal, ocular and serosal membranes 7 .
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Utility of cartridge based nucleic acid amplification test in the diagnosis of extra pulmonary tuberculosis

Utility of cartridge based nucleic acid amplification test in the diagnosis of extra pulmonary tuberculosis

Background: Tuberculosis is one of the top 10 cause of death globally. Extra-pulmonary tuberculosis is an important clinical problem. Extra-pulmonary tuberculosis range from 30%-53% in India. Diagnosis of extra-pulmonary tuberculosis is still challenging despite many investigations. World Health Organization recommends Gene-Xpert Mycobacterium Tuberculosis/Rifampicin (Cartridge Based Nucleic Acid Amplification Test-CBNAAT) over conventional tests for diagnosis of extra-pulmonary tuberculosis which permits rapid tuberculosis diagnosis through detection of the genetic sequence of DNA of mycobacterium tuberculosis and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of multi-drug resistant tuberculosis.
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Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center

Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center

It’s an observational study done in the Department of Pathology, Andhra Medical College, Visakhapatnam over a period of 12 months (April 2017 to March 2018) With a Sample size of 289 cases.We have included all presumptive cases (clinically suspicious) of extra pulmonary tuberculosis, Purulent aspirates on FNA from the various sites between the age group of <1yr to 60 years and excluded cases that were already diagnosed, recurrent, follow up cases of extra pulmonary tuberculosis.

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Nitric Oxide, Carbonyl Protein, Lipid Peroxidation and Correlation Between Antioxidant Vitamins in Different Categories of Pulmonary and Extra Pulmonary Tuberculosis

Nitric Oxide, Carbonyl Protein, Lipid Peroxidation and Correlation Between Antioxidant Vitamins in Different Categories of Pulmonary and Extra Pulmonary Tuberculosis

The study was undertaken in subjects between 16 and 60 years of age, of lower socio- economic status, from different categories of pulmonary and extra-pulmonary tuberculosis, diagnosed by newly cultured positive sputum pulmonary category I (n = 100; 50 male and 50 female). Extra-pulmonary patient category (n = 35; 19 males and 16 females), before and after treatment of six months, untreated category II (n = 100), untreated category III (n = 100), and normal control subjects (n = 100), were selected from the pulmonary tuberculosis and chest diseases department, outpatient department, and inpatient department of Sir J.J. Group of Hospitals, Gokuldas Tejpal Government Hospital, and the Municipal Corporation Group of Tuberculosis Hospitals in Shewri Mumbai Maharashtra, India. Approval of the medical ethical committees of the institutes was obtained for the study (No – IEC/Pharm/379/07, dated 30/8/2007). Informed consent was taken from the subjects. Statistical analysis using software Mini-tab 16 for student’s t test, ‘correlation’ was significantly different from zero (two-sided P < 0.01).
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Prevalence of pulmonary and extra-pulmonary tuberculosis among HIV patients receiving ART at tertiary care centre

Prevalence of pulmonary and extra-pulmonary tuberculosis among HIV patients receiving ART at tertiary care centre

. Moreover, the infection is poorly contained following reactivation, resulting in widespread dissemination causing extra pulmonary disease. This is corroborated by experimental findings that when peripheral blood lymphocytes of patients with HIV-TB are exposed to M. tuberculosis invitro, they produce decreased amounts of Th1 type cytokines, as compared with HIV-negative patients with TB (12) .

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Previous Pulmonary Fibrosis in Dermatomyositis/Polymyositis: A Predictive Factor for Pulmonary and Extra Pulmonary Tuberculosis

Previous Pulmonary Fibrosis in Dermatomyositis/Polymyositis: A Predictive Factor for Pulmonary and Extra Pulmonary Tuberculosis

DOI: 10.4236/ojra.2018.84011 105 Open Journal of Rheumatology and Autoimmune Diseases months (rifampicin and isoniazid to 7 months) and 1/3 had levofloxacin asso- ciated with the regimen (1/2 of them replacing isoniazid) with variable duration of treatment. Eleven out of 12 patients were cured, whereas one died during treatment (pulmonary thromboembolism complications). Moreover, during fol- low-up, there was no DM/PM disease relapsing.

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Treatment outcomes and risk factors of extra pulmonary tuberculosis in patients with co morbidities

Treatment outcomes and risk factors of extra pulmonary tuberculosis in patients with co morbidities

Numbers of EPTB with diabetes mellitus EPTB-DM, EPTB with human immunodeficiency virus EPTB-HIV and EPTB and hepatitis EPTB-HEP cases were frequently seen among 35–55 years age whereas t[r]

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The high prevalence of Mycobacterium tuberculosis Beijing strain at an early age and extra-pulmonary tuberculosis cases

The high prevalence of Mycobacterium tuberculosis Beijing strain at an early age and extra-pulmonary tuberculosis cases

mine the threshold cycle (CT) for the amplification curves. A positive result was defined when a typi- cal sigmoid fluorescence curve was observed for each sample and the final fluorescence intensity was above a CT, which was determined by comparing the fluorescence intensity between the Beijing and/or non-Beijing reference genotypes and the background noise. M. tuberculosis H37Rv (the non-Beijing con- trol), a wild type of the Beijing strain (verified by spoligotyping), and a Milli-Q water (Merck Milli- pore, Germany) were included as controls.

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Clinical Profile of Pulmonary and Extra Pulmonary Tuberculosis: A Study of 210 cases

Clinical Profile of Pulmonary and Extra Pulmonary Tuberculosis: A Study of 210 cases

Pleural tuberculosis mainly results from penetration into the pleural space by tubercle bacilli, usually from rupture of a sub pleural focus. Other mechanisms by which tuberculosis involves the pleura are reactive, in which a immunological reaction to bacilli proteins leads on to pleural inflammation without bacilli entering the pleural cavity and rupture of a tuberculous cavity in to the pleural space which causes tuberculous empyema. Pleural effusion can occur along with primary lesion or as a post primary phenomena 6 – 12 months after primary infection. This commonly occurs in younger age group and tuberculous empyema occurs in elderly individuals. They commonly present as pleuritic type of chest pain which may later become dull aching. Sometimes they may have fever and mild irritative cough. If pleural effusion is massive , it can cause breathlessness.
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Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

In present study, most common age group of the children affected in both pulmonary and extra pulmonary tuberculosis was 5-9 years which is consistent with observations in many other studies also. In contrast a study conducted by Marais BJ et al reported 1-5 years as the most common group in his study and male children were more commonly affected than females with a ratio of 1.7:1 which is different from the findings in present study. In present study females outnumbered the male children with a ratio of 0.7:1. This can be due to high care taken in Indian scenario with regard to male children than female due to traditional beliefs. 11
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Tuberculous Osteomyelitis of the Zygoma

Tuberculous Osteomyelitis of the Zygoma

droplets are generated by coughing sneezing or talking. After the infection is established, symptomatic individuals mostly show pulmonary manifestations of the disease. The most common expression of extrapulmonary tuberculosis is tuberculous lymphadenitis, which presents as asymptomatic enlargement of cervical or supraclavicular lymph nodes. 3 Extra pulmonary tuberculosis involving head and neck is rare

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Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status

Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status

Present study was carried out to investigate whether lower serum 25(OH)D might be associated with higher prevalence of pulmonary or extra pulmonary tuberculosis which might provide an evidence for a role of vitamin D in the comorbidity of these two diseases and does it have any correlation with glycemic status.

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