Reintroduction regimens in anti-tubercular therapy-induced hepatitis in extra-pulmonary tuberculosis patients – A pilot study

Abstract Background The association of tuberculosis and motor neuron disease-like illness has not been described previously. We present a case of co-existent pulmonary and extra-pulmonary tuberculosis in a young man whose clinical presentation was suggestive of a motor neuron disease-like illness and was subsequently diagnosed with tubercular infection. This case provokes our thought as to whether the association between tuberculosis and motor neuron dysfunction was just a co-incidence, given the high prevalence of tuberculosis in our set-up, or does it point towards a possible causative role of infection in motor neuron disease. Case presentation A 31-year-old man presented with progressive thinning of bilateral upper and lower limbs with associated pain and twitching sensation in upper and lower limb muscles. He had a history of loss of appetite and unintentional weight loss. On clinical examination, there was evidence of fasciculations in bilateral quadriceps, bilateral biceps, and paraspinal muscles which was further confirmed with electrophysiology. The work-up for underlying autoimmune, toxic and metabolic aetiology, and paraneoplastic aetiology was found to be negative. CT scan of the chest was suggestive of consolidations in bilateral upper lobes with multiple tree-in-bud nodules in both the lungs. Hybrid 18-Flourine-flourodeoxyglucose positron emission tomography and magnetic resonance imaging (F-18-FDG PET/MRI) imaging was also suggestive of pulmonary and extra-pulmonary tuberculosis. Imaging of the brain revealed atrophy along bilateral motor cortices with reduced tracer uptake. Diagnosis of tubercular infection was confirmed with nucleic acid amplification test and the patient was put on anti-tubercular therapy. On follow-up after 6 months, the patient reported improvement in the symptoms and the muscle power in bilateral upper and lower limbs. Conclusion We have described a very rare association of pulmonary and extra-pulmonary tuberculosis with motor neuron-like illness. It may be debated that such an association may just be co-incidental; however, given the improvement in the symptoms and signs of the motor neuron disease-like illness on follow-up while the patient was on anti-tubercular therapy, it may point towards a causative relationship between tubercular infection and motor neuron dysfunction. Further epidemiological studies should be sought for in order to reach a conclusive answer.

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TO STUDY OF DISTRIBUTION EXTRA-PULMONARY TUBERCULOSIS PATIENTS ACCORDING TO SITES TREATED UNDER RNTCP IN KARAD TUBERCULOSIS UNIT

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/541 ◽

2015 ◽

Vol 4 (22) ◽

pp. 3752-3756

Author(s):

Anil Bhoi ◽

Vandana Bhoi

Keyword(s):

Pulmonary Tuberculosis ◽

Extra Pulmonary Tuberculosis ◽

Tuberculosis Patients ◽

Extra Pulmonary

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Treatment Outcome of Pulmonary and Extra Pulmonary Tuberculosis Patients in TB and Chest Disease Hospital DOT Centre, Goa, India

International Journal of Current Microbiology and Applied Sciences ◽

10.20546/ijcmas.2016.504.051 ◽

2016 ◽

Vol 5 (4) ◽

pp. 437-441 ◽

Cited By ~ 4

Author(s):

A.L. Da Costa ◽

Sanjivani J. Keny ◽

Durga Lawande

Keyword(s):

Treatment Outcome ◽

Pulmonary Tuberculosis ◽

Extra Pulmonary Tuberculosis ◽

Tuberculosis Patients ◽

Chest Disease ◽

Extra Pulmonary ◽

Disease Hospital

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A 5-year experience characterizing the demographic and clinical profile and directly observed treatment short-course treatment outcome in National Tuberculosis Center of Duhok province, Iraqi Kurdistan

SAGE Open Medicine ◽

10.1177/2050312120921055 ◽

2020 ◽

Vol 8 ◽

pp. 205031212092105

Author(s):

Muayad Aghali Merza

Keyword(s):

Treatment Outcome ◽

Pulmonary Tuberculosis ◽

Treatment Outcomes ◽

Clinical Profile ◽

Patient Treatment ◽

Extra Pulmonary Tuberculosis ◽

Tuberculosis Patients ◽

National Tuberculosis Program ◽

National Tuberculosis ◽

Extra Pulmonary

Background: The objectives were to describe the demographic and clinical profile and treatment outcomes in the National Tuberculosis Program Center of Duhok governorate. Methods: This was a descriptive retrospective study of all forms of drug-susceptible tuberculosis cases in the National Tuberculosis Program Center of Duhok. The Electronic Nominal Recording Reporting System data of tuberculosis cases were reviewed during 2014–2018. Information on the demographic, clinical, and laboratory characteristics of the patients were analyzed. Tuberculosis trends and treatment outcomes were determined. Results: A total of 1063 tuberculosis patients visited the National Tuberculosis Program Center, of whom 905 were from Duhok. The estimated tuberculosis notification rate per 100,000 people in Duhok governorate was 14.06, 16.16, 10.43, 11.05, and 10.34 for the years 2014, 2015, 2016, 2017, and 2018, respectively. The most affected age group was 15–24 years. The male cases were predominant. Most patients (97.3%) were native Iraqi. There were 718 (67.5%) pulmonary tuberculosis cases and 345 (32.5%) extra-pulmonary tuberculosis cases; tuberculosis lymphadenitis was the most common presentation. The majority of extra-pulmonary tuberculosis patients were females aged 15–24 years (p = 0.019), and patients aged ⩾65 years were associated with pulmonary tuberculosis and extra-pulmonary tuberculosis in males (p ⩽ 0.001). The highest tuberculosis incidence occurred in winter (288 patients). The patient treatment outcomes were as follows: 90.7% successful treatment, 1.6% lost to follow-up, 6.7% death, 0.3 transferred out, and 0.8 treatment failure. Conclusion: There was a high frequency of extra-pulmonary tuberculosis, which may reflect overestimation in its diagnosis. Therefore, meticulous evaluations should be provided. The treatment outcome was satisfactory in the center. Hence, we should maintain the favorable work to attain tuberculosis control objectives. Performing GeneXpert for all tuberculosis cases and introducing culture and drug susceptibility testing should be an urgent plan to strengthen the diagnosis of susceptible and drug-resistant tuberculosis cases.

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