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Extrapulmonary tuberculosis (TB) represents 10%–15% of TB cases, with lymph nodes being the most frequent site in India. Genital TB is uncommon, and testicular TB is rarer, still accounting for only 3% of genital TB cases. Isolated testicular TB is extremely rare and often mimics other testicular conditions, such as malignancy, complicating diagnosis. We present a case involving a 49-year-old male with diabetes and a history of smoking, who experienced bilateral scrotal swelling and pain over 3 months, accompanied by weight loss. He had no history of respiratory complaints, fever, TB, or significant medical history. Physical examination revealed bilateral scrotal swelling (3 cm × 3 cm) and multiple inguinal lymph nodes. Scrotal ultrasound demonstrated bilateral heterogeneously hypoechoic masses, while magnetic resonance imaging of the scrotum and testis identified solid cystic lesions with heterogeneous enhancement. Serum alpha-fetoprotein and lactate dehydrogenase levels were within normal limits. Fluorodeoxyglucose positron emission tomography–computed tomography revealed metabolically active lesions in both testes and several lymph nodes. Chest X-ray was normal. With a strong suspicion of malignancy, the patient underwent bilateral high inguinal orchiectomy. Histopathological analysis of the excised tissue showed dense epithelioid granulomas with caseous necrosis, indicative of TB. The patient was commenced on antitubercular therapy, with plans for continued monitoring. Although rare, isolated testicular TB should be included in the differential diagnosis of testicular masses. Prompt recognition and appropriate treatment are essential to prevent unnecessary surgical procedures and ensure optimal management.

Diagnosis of drug reaction syndrome with eosinophilia and systemic symptoms (DRESS), which is a rare condition, can be observed in patients undergoing therapy for tuberculosis. This particular side effect, associated with the consumption of an Anti-tuberculosis Drug (ATD), has been known to lead to fatal outcomes. A 19-year-old male individual was diagnosed with pulmonary tuberculosis and started a 4-day treatment regimen comprising a fixed combination of ATD. Subsequent to the administration of the drugs, the patient experienced a severe skin reaction characterized by widespread erythematous macules with well-defined borders. The patient's condition improved after administration of Methylprednisolone at an intravenous daily dosage of 62.5 mg. A preliminary assessment was conducted based on a previous report, indicating red patches on the body, increased white blood cell count, and elevated eosinophils after anti-tuberculosis medication. These findings align with a probable case of DRESS as per the Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) scoring system. Steroids show efficacy in treating DRESS when anti-tuberculosis drug therapy starts. [ABSTRACT FROM AUTHOR]

Pulmonary tuberculosis (TB) is rampant in developing countries, whereas the reported incidence of pulmonary embolism is low in such patients. Hemoptysis occurs in both conditions, leading to the possibility of missing one diagnosis. We report two patients with TB and pulmonary thromboembolism: the first developing embolism during the evaluation and treatment of disseminated TB and the second presenting with coexistent TB and pulmonary embolism at admission. In developing and underdeveloped countries, respiratory symptoms and signs of pulmonary embolism may be attributed to TB per se alternatively, diagnostic facilities may not be available to confirm pulmonary embolism. In addition, owing to drug interactions, anticoagulation with warfarin becomes a problem with simultaneous rifampicin and isoniazid therapy. Newer oral anticoagulants, as an alternative, lead to increased costs and an increased probability of reduced compliance. [ABSTRACT FROM AUTHOR]

Spinal Tuberculosis (Pott’s Spine) infection during pregnancy poses significant challenges in early diagnosis, as it often resembles typical back pain experienced during pregnancy. Delayed diagnosis has resulted in maternal and foetal complications, including paraplegia, premature labor, preterm delivery, and foetal growth restriction. Treatment approaches are tailored to individual clinical presentations and may involve conservative or surgical intervention. Surgical decompression should be considered when there is a neurological deficit that could complicate the delivery process. The standard Antituberculous Therapy (ATT) regimen for 12 months is an accepted treatment protocol according to the World Health Organisation (WHO) guidelines during the antenatal period. The present case series comprises four middle-aged pregnant women (two aged 19 years, one aged 21 years, and one aged 35 years, all primigravida) diagnosed with Pott’s spine at various trimesters, exhibiting a range of clinical presentations from mild back pain to acute neurological deficits. One patient in the late trimester with a neurological deficit required surgical decompression, while the remaining patients were successfully managed with appropriate ATT.

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Tuberculosis is prevalent throughout the world and is a major public health problem in most developing countries. Standardized and directly observed treatment under NTEP (National Tuberculosis Elimination Programme) is currently recommended for drug-sensitive pulmonary tuberculosis in India. It is generally well tolerated, with few minor side effects. Severe side effects necessitating discontinuation of therapy are rare with standard TB treatment regimens. Drug-resistant tuberculosis (DR-TB) has become more common in recent years, posing a challenge to global efforts to control the disease. Therapy for DR-TB has been associated with many adverse effects. Therefore, close monitoring of patients on DR-TB therapy is necessary to ensure that adverse effects of drugs are recognized early by healthcare personnel and treated accordingly. This will improve drug compliance and, hence, treatment goals. Here we report three cases of tuberculosis who had unusual adverse effects while receiving anti-tuberculous medication, prompting drug discontinuation.

Spinal Tuberculosis (Pott's Spine) infection during pregnancy poses significant challenges in early diagnosis, as it often resembles typical back pain experienced during pregnancy. Delayed diagnosis has resulted in maternal and foetal complications, including paraplegia, premature labor, preterm delivery, and foetal growth restriction. Treatment approaches are tailored to individual clinical presentations and may involve conservative or surgical intervention. Surgical decompression should be considered when there is a neurological deficit that could complicate the delivery process. The standard Antituberculous Therapy (ATT) regimen for 12 months is an accepted treatment protocol according to the World Health Organisation (WHO) guidelines during the antenatal period. The present case series comprises four middle-aged pregnant women (two aged 19 years, one aged 21 years, and one aged 35 years, all primigravida) diagnosed with Pott's spine at various trimesters, exhibiting a range of clinical presentations from mild back pain to acute neurological deficits. One patient in the late trimester with a neurological deficit required surgical decompression, while the remaining patients were successfully managed with appropriate ATT. [ABSTRACT FROM AUTHOR]

Spinal tuberculosis is the most common form of skeletal tuberculosis, and it can be destructive and devastating to the patient. Most of the spinal tuberculosis cases involve thoracic spine, and cervical involvement is unusual and rare. This case series is about different presentation and treatment approaches of cervical spine tuberculosis in four healthy young girls without any comorbidities. Among them, three girls presented with severe neurological complications. All of them had a history of severe neck pain and stiffness. None had constitutional symptoms or tuberculosis exposure. Diagnosis was made with the help of magnetic resonance imaging (MRI) spine and histopathological and microscopy of biopsied skeletal segments. The three girls with neurological complications were treated with surgical debridement and cervical spine stabilization surgery along with antitubercular treatment (ATT). All the three girls remarkably improved neurologically with a combined approach. The one without significant neurological deficits was started on ATT alone and advised to follow up with serial neuroimaging.

Introduction: Tuberculous Meningitis (TBM) is a common infection in patients with Human Immunodeficiency Virus (HIV) and it shows significant differences in clinical profile, treatment response, and outcome compared to patients without HIV infection. Aim: To describe the clinical presentation, laboratory parameters, and radiological findings of TBM patients with and without HIV coinfection and to observe differences between them in treatment response, complications, and mortality. Materials and Methods: This was a prospective observational study, conducted on 80 TBM patients with (n=40) and without (n=40) HIV co-infection at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India, from from March 2016 to August 2017. Demographic, clinical, laboratory data, and various imaging findings were noted at the start of the study and at three and six months follow-up, for any changes from baseline to know the treatment response. Appropriate statistical tests were applied, and p-value less than 0.05 were considered statistically significant. Results: Mean age of HIV patients was 36.75 years and that of the non HIV patients was 29.35 years. Altered sensorium (90% in HIV and 72.5% in non HIV), seizures (50% in HIV and 20% in non HIV) were common in HIV patients, and weight loss (95% in non HIV and 87.5% in HIV) was common in non HIV patients. Common signs noted were nuchal rigidity (90% in HIV and 87.5% in the non HIV group), focal neurological deficit (50% in HIV and 22.5% in non HIV), and cranial nerve palsy (37.5% in HIV and 12.5% in non HIV). Anaemia was seen in 56.3% (87.5% in HIV and 25% in non HIV) and raised Erythrocyte Sedimentation Rate (ESR) was seen in 56.3% (25% in HIV and 87.5% in non HIV) patients. Tuberculoma was the most common (32.5%) Magnetic Resonance Imaging (MRI) brain finding. Adverse drugs reactions due to Antitubercular Treatment (ATT) (other causes ruled out) were seen in 22.5% of HIV patients (none in non HIV), and Antiretroviral Therapy (ART)-induced Adverse Drugs Effects (ADE) was noted in 10% of patients. Patient survival was better among non HIV (65%) compared to HIV (55%) patients. Multidrug-resistant Tuberculosis (MDR-TB) was more prevalent in HIV (7.5%) than non HIV (2.5%) cases. Conclusion: TBM involves a younger population, has a worse prognosis in HIV co-infection patients with more adverse reactions to treatment. [ABSTRACT FROM AUTHOR]

Addison's disease was first described by Thomas Addison in 1855. He demonstrated the destruction of bilateral adrenal gland by tuberculosis (TB) in six patients. Since then, the incidence of TB has declined in the Western world, but in developing countries, it is still the most common cause of adrenal insufficiency. Because of the introduction of antituberculous chemotherapy, the incidence of adrenal TB has been declined in the past decades. The most common symptoms are nonspecific; therefore, diagnosis is often delayed, and patients may first present with a life-threatening adrenal crisis. The most commonly identified organism for adrenal failure in adrenal TB is Mycobacterium tuberculosis infection. Adrenal TB involves bilateral adrenal glands more frequently than unilateral glands. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful investigations to differentiate between tuberculous Addison's disease and the other causes of adrenal insufficiency. In CT scans or MRI, features of adrenal TB are bilateral adrenal enlargement and peripheral rim enhancement with or without calcifications. Antituberculous drugs, biochemical monitoring of adrenal function, and steroid therapy are essential for the management of adrenal TB and adrenal insufficiency. Here, we describe a case of adrenal TB with abscess formation followed by a review of the current literature of adrenal TB for better diagnosis and management of this condition.

Eosinophilic enteritis is a rare entity affecting human gastrointestinal tract. The exact etiology is unknown, and some drugs are implicated in causing this condition. We report a case of drug-induced eosinophilic enteritis, caused by antituberculous therapy (ATT). The cessation of ATT-induced clinical remission and symptoms were reproduced on drug re-challenge, which corroborated our diagnosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is the major problem being faced worldwide, particularly in developing countries, and therefore, it is important to recognize the unusual presentations of the disease. Although TB is primarily lung disease, it can affect several other organs such as bone, brain, liver, and intestine etc. Liver involvement in TB is not uncommon but isolated liver TB is the rarest form of TB. A common observation is that the mortality rate is higher in intra-abdominal TB as compared to pulmonary TB, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. We present a case of primary hepatic tuberculoma in an immuno-competent host and illustrate how these cases can be managed non-surgically.

Tuberculous meningitis (TBM) is a medical emergency. It is the most devastating manifestation of tuberculosis (TB). The outcome depends on early diagnosis and appropriate treatment. Empirical antituberculous therapy should be started if clinical suspicion is high. All patients should be tested for HIV. The choice of antituberculous drugs is extrapolated from pulmonary TB regimen, and many drugs have poor cerebrospinal fluid penetration. More evidence is required to guide on drug therapy in TBM. Steroids should be used as adjunctive therapy and response may be modulated by host genotype. Active monitoring should be done for complications such as hydrocephalus, hyponatremia, and stroke.

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Worldwide, tuberculosis (TB) is still a serious and significant health concern, more so with the emergence of multidrug-resistant-TB. The inability of mankind to control this infection stems from the fact that the vaccines and drugs that were once effective against TB are no longer efficacious. This has led to a search for new antituberculous agents and adjuvant therapy. Vitamins are being revisited for their role in pathogenicity as well as for their antimycobacterial properties. Vitamins such as biotin and thiamin are essential for Mycobacterium tuberculosis and are required for establishment of infection. On the other hand, vitamins such as Vitamin C and Vitamin D have been shown to possess antimycobacterial properties. To combat M. tuberculosis, innovative strategies need to be devised, keeping in mind the efficacy of the agent to be used. Vitamins can prove to be useful agents capable of modifying the life cycle and biology of M. tuberculosis. We present here a brief overview of the available knowledge on thiamin, biotin, Vitamin C, and Vitamin D, keeping TB treatment and control in perspective.

This case report presents a 35-year-old female who presented with HIV-associated multidrug-resistant tuberculosis. Resistant tuberculosis in HIV-infected patients with immunodeficiency is extremely difficult for effective treatment. Nevertheless, our clinical case showed that the cure of tuberculosis is possible in the late stages of HIV infection with the correct choice of treatment tactics, taking into account the resistance of MBT with the subsequent use of antiretroviral therapy. The progression of HIV infection, against the background of the effective antituberculous therapy, was associated with the patient's refusal to treat the underlying disease.

Introduction: Meningitis is the most severe manifestation of tuberculosis, resulting in death or disability in over 50% of those affected, with even higher morbidity and mortality among patients with HIV or drug resistance. Antimicrobial treatment of Tuberculous meningitis (TBM) is similar to treatment of pulmonary tuberculosis, although some drugs show poor central nervous system penetration. Therefore, intensification of antibiotic treatment may improve TBM treatment outcomes. Areas covered: In this review, we address three main areas: available data for old and new anti-tuberculous agents; intensified treatment in specific patient groups like HIV co-infection, drug-resistance, and children; and optimal research strategies. Expert commentary: There is good evidence from preclinical, clinical, and modeling studies to support the use of high-dose rifampicin in TBM, likely to be at least 30 mg/kg. Higher dose isoniazid could be beneficial, especially in rapid acetylators. The role of other first and second line drugs is unclear, but observational data suggest that linezolid, which has good brain penetration, may be beneficial. We advocate the use of molecular pharmacological approaches, physiologically based pharmacokinetic modeling and pharmacokinetic-pharmacodynamic studies to define optimal regimens to be tested in clinical trials. Exciting data from recent studies hold promise for improved regimens and better clinical outcomes in future. [ABSTRACT FROM AUTHOR]

Background: Granulomatous lobular mastitis (GLM) is a rare chronic inflammatory condition of the breast. The purpose of this study was to describe antituberculous treatment of GLM and the long-term follow-up outcome. Methods: This retrospective study included 22 patients who had been histopathologically diagnosed with GLM at the Second Hospital of Shandong University from January 2011 to March 2015. Clinical characteristics, ultrasonography and mammography findings, laboratory tests, treatment regimens, follow-up information, and recurrences were recorded. Results: All patients were female with a median age of 29 (range 23-44) years. The most common symptom was a breast mass with or without pain. Large irregular hypoechoic masses could be found in the breast ultrasounds of 13 patients. All patients received triple antituberculous therapy. During a median follow-up period of 40 months, 3 patients were lost to follow-up; of the remaining 19 patients, 18 achieved clinical complete remission and no recurrences were observed. Conclusion: GLM is an unusual benign breast condition that mimics breast carcinoma in its clinical and imaging presentation. Antituberculous therapy seems to be an effective alternative option in the treatment of GLM. [ABSTRACT FROM AUTHOR]

Worldwide, tuberculosis (TB) is still a serious and significant health concern, more so with the emergence of multidrug-resistant-TB. The inability of mankind to control this infection stems from the fact that the vaccines and drugs that were once effective against TB are no longer efficacious. This has led to a search for new antituberculous agents and adjuvant therapy. Vitamins are being revisited for their role in pathogenicity as well as for their antimycobacterial properties. Vitamins such as biotin and thiamin are essential for Mycobacterium tuberculosis and are required for establishment of infection. On the other hand, vitamins such as Vitamin C and Vitamin D have been shown to possess antimycobacterial properties. To combat M. tuberculosis, innovative strategies need to be devised, keeping in mind the efficacy of the agent to be used. Vitamins can prove to be useful agents capable of modifying the life cycle and biology of M. tuberculosis. We present here a brief overview of the available knowledge on thiamin, biotin, Vitamin C, and Vitamin D, keeping TB treatment and control in perspective. [ABSTRACT FROM AUTHOR]

The Central nervous system can be affected in extrapulmonary tuberculosis. The intracranial tuberculoma occurrence is a rare entity occurrence; most often occur in the form of discrete small multiple lesions. Rarely a large sized tuberculoma is observed with mass effects and usually managed surgically to provide rapid relief of mass effect, histopathological confirmation of diagnosis, reduction of pathological mass thereby increasing efficacy of medical therapy. Author reports an extremely rare case of giant tuberculoma occurring in a pediatric patient, which was managed with antituberculous medication along with cerebral decongestant. The patient was also advised surgical therapy in view of giant size of tuberculoma associated with significant mass effect; however, the parents were unwilling for any form of surgical intervention and finally choose to continue medical treatment alone. After 6 months of antitubercular medical therapy, magnetic resonance imaging brain showed completely vanishing of lesion and also amelioration of mass effect with marked subsidence of perilesional edema correlated very well with marked improvement in the clinical status. He received antituberculous therapy for 24 months. To the best knowledge of authors, the current case represents first case of its kind in the pediatric age group with giant intracerebral tuberculoma responding favorably with medication. Management of such rare case and pertinent literature is reviewed briefly. [ABSTRACT FROM AUTHOR]

Optic nerve tuberculomas are rarely reported and their natural history, prognosis, and duration of required treatment remain unclear. A 40-year-old immunocompetent male presented with complete loss of vision in his right eye, which had evolved over 6 weeks. He had optic atrophy on examination. Initial imaging showed right optic nerve swelling and thickening suggesting an infiltrative inflammatory optic neuropathy (infectious or noninfectious). Serial imaging revealed appearance of ring enhancement with a necrotic centre. Biopsy and culture of the coexistent parietal lobe lesion revealed Mycobacterium tuberculosis. Persistent optic nerve granuloma with evidence of radiological improvement was noted at 18 months follow-up with antituberculous therapy (ATT). Visual recovery could not be achieved. The salient features in this case include the clinical presentation initially mimicking an infiltrative or compressive optic neuropathy, rapid radiological evolution into a tuberculoma, subtle paradoxical radiological worsening after initiation of ATT and persistence of granuloma on follow up scan. The challenges involved in early diagnosis and during the treatment course will be discussed.

Purpose. The predictive factor of response to antituberculous therapy has not been fully elucidated. Airway acidity has been thought to be a potential indicator of the bactericidal activity. Therefore, we hypothesized that monitoring airway acidity by measuring sputum pH could predict response to therapy.Methods. A total of 47 patients having newly diagnosed, smear-positive, active pulmonary tuberculosis were enrolled between October 2011 and March 2014. Sputum samples were serially analyzed before and after treatment. Eligible patients who initiated a standard 6-month treatment were monitored for the length of time to sputum smear and culture conversion.Results. There were 39 patients who completed a 2-month intensive phase of isoniazid, rifampicin, pyrazinamide, and ethambutol therapy followed by a 4-month continuation phase of isoniazid and rifampicin. Although factors including age, cavitation, sputum grade, and use of an acid-suppressant were associated with initial low sputum pH in univariate analysis, multivariate analysis revealed that only age ≥61 years was a statistically important factor predicting low pH value (p = 0.005). Further outcome analysis showed that initial low sputum pH before treatment was the only factor significantly associated with shorter length of time to both sputum smear and culture conversion (p = 0.034 and 0.019, respectively) independent of the effects of age, sputum bacterial load, extent of lung lesion, and cavitation. Thus, initial low sputum pH indicated favorable response to anti-tuberculosis therapy.Conclusions. Measuring sputum pH is an easy and inexpensive way of predicting response to standard combination therapy in patients with pulmonary tuberculosis.

Tracheoesophageal fistula and bronchoesophageal fistula (BEF) usually result from malignancy. BEF caused due to benign conditions is rare. Here, we report a case of BEF due to tuberculosis. A 65-year-old lady presented with 15 days history of dysphagia, cough, and fever. Esophagoscopy revealed an ulcerated lesion at 22 cm. Further evaluation with contrast-enhanced computed tomography revealed mid-esophageal wall thickening, mediastinal and supraclavicular lymphadenopathy, along with BEF. Endoscopic tissue biopsy from ulcer revealed tuberculosis. The patient was put on antituberculous drugs and showed good response to therapy.

Background :To assess monocyte lymphocyte ratio (M/L ratio) as a biomarker to see the outcome of therapy and progress of tuberculosis. Methods: In this descriptive study 45 newly diagnosed cases of tuberculosis and 45 age and sex matched healthy controls, were enrolled. The study was designed to determine the baseline, initiation phase and 2-months maintenance phase treatment values of M/L ratio in newly diagnosed active TB cases. Blood complete counts were performed in automated haematology analyzer. Manual differential leukocyte count was done by microscopy to determine M/L ratio. Results: The pre-treatment lymphocyte and monocyte count in the study group were significantly different from the control group, while M/L ratio was similar in both the groups. The mean M/L ratio in cases and controls were 0.24 ± 0.14 and 0.24 ± 0.07 respectively. The M/L ratio significantly decreased after initiation phase and two months of maintenance phase of treatment from baseline 0.24 ± 0.14 to 0.20 ± 0.10 to 0.19 ± 0.10 with p value of 0.006. Conclusions: Tuberculosis is associated with increased M/L ratio, which declines and returns to normal with antituberculous therapy.

Objective: To describe the clinical presentation, radiological findings, management details, and outcome in nine cases of tuberculous brain abscess (TBA).Materials and Methods: Nine patients (5 females, 4 males) harboring a TBA, as defined by the Whitener's criteria, were managed over a span of one and a half decade by the authors. All, except one patient, underwent contrast-enhanced magnetic resonance imaging scans, followed by surgical excision of the abscesses due to the failure of complete resolution of the lesion after its drainage using a burr-hole.Results: The infra-tentorial location (n = 4) in TBAs was as common as the supra-tentorial location (n = 4). All large TBAs (more than 3 cm in diameter) failed to resolve after tapping of the purulent material and required surgical excision for a favorable long-term outcome. Two patients expired, while seven patients survived with Karnofsky Performance scale of 90 for 3, 80 for 3, and 70 for 1 patient. The follow-up ranged from 2 to 12 years (mean = 5.7 years).Conclusion: TBAs should be considered in the list of differential diagnoses for pyogenic abscesses, especially in developing countries, as it is difficult to differentiate between them on the basis of clinical or radiological findings. Hence, all pus samples should be sent for Ziehl-Neelsen staining and culture for Mycobacterium tuberculosis. Surgically excised and pathologically evaluated specimens remain the gold-standard for diagnosing TBAs. Larger abscesses warrant surgical excision, while concomitantly associated smaller lesions tend to resolve with prolonged antituberculous therapy. [ABSTRACT FROM AUTHOR]

Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis. [ABSTRACT FROM AUTHOR]

Optic nerve tuberculomas are rarely reported and their natural history, prognosis, and duration of required treatment remain unclear. A 40-year-old immunocompetent male presented with complete loss of vision in his right eye, which had evolved over 6 weeks. He had optic atrophy on examination. Initial imaging showed right optic nerve swelling and thickening suggesting an infiltrative inflammatory optic neuropathy (infectious or noninfectious). Serial imaging revealed appearance of ring enhancement with a necrotic centre. Biopsy and culture of the coexistent parietal lobe lesion revealed Mycobacterium tuberculosis. Persistent optic nerve granuloma with evidence of radiological improvement was noted at 18 months follow.up with antituberculous therapy (ATT). Visual recovery could not be achieved. The salient features in this case include the clinical presentation initially mimicking an infiltrative or compressive optic neuropathy, rapid radiological evolution into a tuberculoma, subtle paradoxical radiological worsening after initiation of ATT and persistence of granuloma on follow up scan. The challenges involved in early diagnosis and during the treatment course will be discussed. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to outline the clinicoradiological features of central nervous system (CNS) tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3years (range=17–43years), and the average disease duration at presentation was six months (range=1–19months). The tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with headache and consciousness disturbance, and two patients had a history of pulmonary Koch’s disease. Five patients had a history of tuberculous meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received conservative treatment; all patients received anti-tuberculosis therapy for 18months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90–100). Patients presenting at an advanced disease stage had a poorer outcome. CNS tuberculoma is a benign condition with a good prognosis and effective therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early surgical decompression is recommended for intramedullary tuberculoma. Craniotomy is indicated for patients with intracranial hypertension, while more conservative therapy is appropriate for patients who have intracranial tuberculomas without intracranial hypertension. [Copyright &y& Elsevier]

Summary: Background: Epilepsy is relatively common in CNS tuberculomas, but its natural course is unclear. Aim: To determine the prevalence and prognosis of epilepsy in patients with seizures related to CNS tuberculomas. Methods: We retrospectively reviewed the charts of patients with CNS tuberculomas who presented at our institution between 1983 and 2001. Results: Seizures occurred in 22 of 93 (23.6%) of the patients with CNS tuberculomas. These patients were treated with standard antituberculous therapy for a period varying between 6 and 20 months. Sixty-three out of 93 patients were cured of tuberculosis, and 21 of the 63 (33%) who had concomitant epilepsy became seizure-free. TB recurred in 3 patients, and 1 out of 22 who had concomitant epilepsy continued to have seizures; 3 died and 24 were lost to follow-up. Anti-epileptic medications were discontinued after completion of the anti-TB course. Conclusion: Seizures are commonly associated with CNS tuberculomas and most often resolve after successful treatment of the underlying CNS tuberculosis. [ABSTRACT FROM AUTHOR]

Abstract: Clinicoradiological presentation and management of patients with sellar and suprasellar tuberculomas (SST) were reviewed. The SSTs of eight patients were divided into five radiological subgroups: a sellar–suprasellar mass (n =3); multiple coalescing ring enhancing granulomas (n =2); an intrasellar abscess (n =1); pachymeningitis with suprasellar extension (n =1); and skull-base lesion involving the sella (n =1). The predominant endocrinopathies were hypogonadism, hypothyroidism and diabetes insipidus. The management options included surgery utilizing the frontotemporal, transylvian approach (n =4) or the transsphenoidal approach (n =1), stereotactic biopsy and ventriculoperitoneal shunt (n =1); endoscopic transsphenoidal biopsy (n =1); and antituberculous therapy (ATT) without surgery (n =1). All patients received ATT for 15–18 months. Patients with rapid visual deterioration (n =2) or with associated intramedullary tuberculoma (n =2) also received steroids for 2 weeks. At follow-up (range 10 months to 5.5 years; mean 3.2 years), the radiological response to ATT was evaluated. MRI after ATT showed resolution of SST in all except two patients with solid lesions. However, these lesions were smaller and had reduced contrast enhancement on imaging. Thus, SST may present with five radiological subtypes. Surgery is useful in obtaining histology. Short-term steroid therapy with ATT may reduce edema and adhesions around the optic nerve when rapid visual deterioration occurs and relieve symptoms of raised intracranial pressure. The often-associated hypopituitarism indicates the requirement for preoperative hormonal evaluation. [Copyright &y& Elsevier]

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Tuberculosis (TB) is an airborne communicable disease. It is a new major health problem worldwide, with an increasing incidence in both developing and industrialized nations. The WHO reports that there are 2 million deaths related to TB per year. Ocular TB presents with varied manifestations, such as tubercular anterior uveitis, choroidal tubercle, subretinal abscess, multifocal choroiditis, retinal vasculitis or even panophthalmitis. The incidence of ocular complications due to TB has increased due to the coexistence of AIDS in those patients. Treatment of ocular TB should be concomitant with the management of systemic status. Multidrug-resistant TB has emerged as a new problem in the management of TB. Recognition of the correct diagnosis and specific therapy avoids recurrences and prevents ocular morbidity due to complications of TB. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is the commonest infection detected in HIV-infected individuals worldwide.Aim: The aim of this study is to describe the clinical, bacteriologic and radiological spectrum of tuberculosis (TB) in the setting of human immunodeficiency virus (HIV) infection in a tertiary care centre in Mumbai.Methods: A total of 8640 HIV-infected individuals were screened for tuberculosis routinely from January 1998 to December 2003, using clinical examination, chest X-ray and abdominal ultrasonography, sputum smears for acid-fast bacilli (AFB) and culture on Lowenstein-Jensen medium.Results: TB was detected in 8078 (93.5%) patients of whom 3393 (42%) had pulmonary, 3514 (43.5%) had extrapulmonary TB and 1171 (14.5%) had disseminated disease. One thousand two hundred thirty eight patients (36.5%) showed AFB in sputum, while 1154 (34%) showed growth on culture medium and 4174 had radiographic involvement. In 781 (67%) individuals disseminated disease coexisted with pulmonary involvement. All 8078 coinfected patients were treated with anti-TB therapy (ATT), of whom 6422 patients (79.5%) showed one or more adverse events. Gastritis was the commonest complaint followed by hepatitis and skin rashes. ATT resistance was detected in 482 individuals.Conclusion: Tuberculosis is the commonest opportunistic infection (OI) in HIV positive patients in India, showing a higher prevalence of extrapulmonary and disseminated TB and adverse events due to ATT. Early recognition of concurrent OIs and their adequate treatment and prophylaxis is essential. [ABSTRACT FROM AUTHOR]

The incidence of tuberculosis (TBC) in patients undergoing maintenance hemodialysis is reported to be higher than that in the general population. We report an 8-year-old boy receiving such treatment for chronic renal failure who developed mediastinal lymph node TBC. He showed only intermittent fever, recurring every 2 weeks, with no other symptoms suggesting TBC. Although staining and culture of pharyngeal swab and gastric juice specimens failed to provide evidence of TBC, a lymph node biopsy specimen disclosed typical pathologic findings of tuberculoma, including caseating granulomas. Antituberculous therapy with isoniazid (INH), rifampicin, pyrazinamide, and ethambutol was given for 12 months, resulting in complete resolution of the TBC, with no subsequent recurrence. To our knowledge, mediastinal lymph node localization of TBC is relatively rare, in a patient on maintenance hemodialysis, especially in a child. [ABSTRACT FROM AUTHOR]

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Allogeneic stem cell transplant (ASCT) recipients have severely impaired cell-mediated immunity as a result of their conditioning regimen, immunosuppressive therapy, and graft-versus-host disease (GVHD). Accordingly, they are susceptible to bacterial, viral, and fungal infections. Mycobacterial infections can also occur in these patients, although the incidence is not high, even in countries where tuberculosis (TB) is common. We describe four patients from our hospital who developed pulmonary T tuberculous infection in the post-transplant period over a 3-year period. During that time a total of 127 patients have undergone an ASCT, representing an incidence of TB of 2.3%. The pretransplant diagnosis was acute myeloid leukemia in three patients and chronic myeloid leukemia in one case. All four patients were treated with a combination of cyclosporine and corticosteroids for acute and/or chronic GVHD. Three of the four patients were born outside Australia, each from an area where TB is endemic. Two patients died within 2 weeks of the commencement of antituberculous therapy, the third is alive and well, and the fourth died of multi-organ failure and sepsis after 4 months in hospital. A higher index of suspicion of previous TB exposure and infection is required in the assessment of ASCT recipients, particularly in those born in areas where TB is common or endemic. [ABSTRACT FROM AUTHOR]

Background: The radiographic changes of Mycobacterium avium complex (MAC) pulmonary disease during therapy have not been studied well. Objective: To assess the efficacy of antituberculous drug therapy against MAC pulmonary disease using computed tomography (CT). Method: We analyzed chest CT scans before and after antituberculous therapy in 30 patients (21 women, 9 men) with MAC pulmonary disease. To evaluate radiographic changes during therapy, we defined a 'degree of improvement' (DI) that is calculated according to the CT appearance. Results: DI was better (1.35 ± 0.21) in patients who had converted sputum culture than in those who had not (0.44 ± 0.25) (p < 0.05). In patients who were diagnosed by bronchial washing, DI was better (1.60 ± 0.22) than in patients who were diagnosed by sputum (0.67 ± 0.20) (p < 0.01). We categorized the CT appearance into 6 types: small nodules, cavities, bronchial wall thickening, infiltration, pleural thickening and atelectasis. Patients who showed pleural thickening had a significantly worse DI (0.12 ± 0.40) than those who did not (1.23 ± 0.18) (p < 0.01). Most of the lesions that disappeared after therapy were small nodules. Conclusion: These results indicate that chest CT might be a useful tool for the prediction or assessment of drug therapy for MAC pulmonary disease. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a common public health problem in Pakistan. It can affect any part of the body but generally spares skeletal muscles, thyroid, pancreas and myocardium. Here we report an unusual case of tuberculous myocarditis in a young female who was treated with antituberculous therapy and steroids. [ABSTRACT FROM AUTHOR]

A case of tuberculous brain infection following tuberculous meningitis in a 67-year-old man is presented. It was located in an old cerebral infarct associated with left internal carotid artery occlution. CT demonstrated capsule enhancement in the left temporal area after iodinated contrast medium. Chemotherapy with INH, RFP and SM diminished the lesion and the capsule disappeared thirteen months later. It is suggested that a relatively long clinical history together with the appearance of a thick-walled abscess-like lesion on the CT scan is consistent with the diagnosis of tuberculous brain infection, perhaps an abscess. [ABSTRACT FROM AUTHOR]

Single oral doses of rifampicin (10 mg/kg body weight), p-aminosalicylic acid (0.2 g/kg), isoniazid (10 mg/kg), or rifampicin and either p-aminosalicylic acid or isoniazid, were given to 69 tuberculous patients with normal renal and hepatic function. Ten-fold interindividual differences were observed in the peak serum concentrations and half-lives of rifampicin; its half-life was reduced from 4.3 h after the first dose to 3.1 h after the third dose, possibly due to self-induction of its own metabolism. No effect on its serum concentration or half-life, nor on those of isoniazid, were found after simultaneous oral administration of the two drugs. After treatment with rifampicin and p-aminosalicylic acid, the peak serum level of the former was delayed from 2 to 4 h, it was reduced from 8.0 to 3.8 µg/ml, and the mean area under the serum concentration curve throughout the entire 8 h study period was also lowered by about half. Individual patients did not attain therapeutically effective peak serum concentrations of rifampicin if also treated with p-aminosalicylic acid. The interaction observed between the two drugs is probably due to impaired gastrointestinal absorption of rifampicin, either by alteration of its physico-chemical properties or by a decrease in the gastric emptying rate combined with more rapid intestinal transit. The combination of these two drugs is unsuitable for the routine chemotherapy of tuberculosis. [ABSTRACT FROM AUTHOR]

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During the last 8 years, the diagnosis of tuberculous colitis has been made radiologically in 22 cases. Twelve were confirmed by histological or bacteriological evidences. The X-ray findings are classified into three types as follows: Type A, showing an extensive scarred area in the ileocecum and ascending colon. Type B, showing annular stricture in the ascending colon and dilatation of its oral side. Type C, showing pouchformation (pseudo-diverticulum) and deformity in the cecum. We emphasize that histological examination and culture of the biopsy specimens by endoscopy were useful for the diagnosis of tuberculous colitis. Furthermore, radiologie changes of the colon by administration of antituberculous drugs were observed. [ABSTRACT FROM AUTHOR]

We present a case of human immunodeficiency virus 2 (HIV- 2) infection with acquired immune deficiency syndrome with immune reconstitution and inflammatory syndrome due to disseminated tuberculosis. We address here the drug interactions between antiretroviral therapy and antituberculous treatment (ATT), choice of ATT, and duration of ATT when rifampicin is omitted as in our case. Though this problem is encountered rarely, we felt that it is important to report the issue to counter drug resistance in tuberculosis and HIV. [ABSTRACT FROM AUTHOR]

Abstract: This case report concerns a 21-year-old man developing left leg paresis. Evaluation with magnetic resonance imaging (MRI) showed an intramedullary tumor in the conus region. He was planned for surgery but preoperative investigation indicated he had tuberculosis and the tumor was presumed to be a tuberculoma. Antituberculous therapy was started and the patient improved neurologically. The patient was followed clinically and with consecutive MRI during 2 years and the last MRI showed that the lesion had disappeared completely. Intramedullary tuberculomas are rare but important differential diagnosis in patients with spinal cord mass lesions. The role of medical and surgical treatment of intramedullary tuberculomas is discussed. [Copyright &y& Elsevier]

Abstract: We report a 65-year-old man with tenosynovitis of the wrist and finger caused by Mycobacterium intracellulare. The diagnosis was made after subsequent recurrence, when a specimen of synovial fluid was subjected to specific polymerase chain reaction and mycobacterial culture. Synovectomy and susceptibility-guided antituberculous therapy permitted complete healing of tenosynovitis. [Copyright &y& Elsevier]