scholarly journals 781. Non-Tuberculous Mycobacterium: Often a Missed Entity

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S280-S280
Author(s):  
Sairam B ◽  
Atul Gogia ◽  
Atul Kakar ◽  
S P Byotra
Keyword(s):  
Pulmonary Infection ◽  
Clinical Presentation ◽  
Mycobacterial Infection ◽  
Molecular Techniques ◽  
Drug Resistant ◽  
First Line ◽  
Diagnostic Dilemma ◽  
Mycobacterial Diseases ◽  
Back Ache ◽  
Anti Tubercular Therapy

Abstract Background Initially referred to as Lady Windermere syndrome, the prevalence of Non-Tuberculous Mycobacterium (NTM) is on the rise globally. In India, the TB capital of the world, these infections still go unrecognized, as the clinical presentation of all mycobacterial diseases are similar. This is of clinical relevance as misdiagnosis may lead to unwarranted or inappropriate therapy. Methods We conducted a retrospective study of adults suspected of having mycobacterial infection. Records of patients admitted with suspected TB from January 2015 to December 2017 were reviewed; clinicoradiological features were correlated with the organism isolated; treatment given and outcomes were recorded. Results Out of 877 suspected patients, 245 patients had microbiologically proven Mycobacterium tuberculosis and 34 had NTM (3.8%). Pulmonary infection was seen in 19 cases (56%), rest were extra pulmonary (34%). Fever was the commonest symptom (62%) others being cough (50%), breathlessness (41%), hemoptysis (15%), weight loss (3%), chest pain (3%), and back ache (12%). Symptoms were prolonged (>1 month) in 65% of cases. Radiologically, cavitations (42%), lung nodules (32%), and infiltrates (32%) were commonly seen. Upper zone predilection was noted in 68% of cases. Past tuberculosis was the major risk factor seen in 42% of cases while 26% were immunocompromised. Macrolide resistance was noted in none of our patients. Twenty-four out of 34 cases were AFB smear positive (71%), but MTB gene Xpert was negative. Our series includes four patients who did not respond to first-line anti-tubercular therapy (ATT) and were suspected to have multi-drug-resistant (MDR) tuberculosis. Cultures later grew NTM and the patients improved with macrolide regime. Conclusion NTM is an underreported infection in a developing country like India with a high TB prevalence. Similar clinical features and morphology create a greater diagnostic dilemma. Usage of molecular techniques and AFB culture should be made mandatory in all suspected cases of tuberculosis. NTM should always be considered in ATT nonresponders before starting them on MDR regime. Disclosures All authors: No reported disclosures.

scholarly journals Parotid gland tuberculosis-presentation of 4 case variants

2021 ◽  
Vol 8 (3) ◽  
pp. 984
Author(s):  
Samir Paruthy ◽  
Shivani B. Paruthy
Keyword(s):  
Parotid Gland ◽  
Clinical Presentation ◽  
Pulmonary Involvement ◽  
Clinical Suspicion ◽  
Treatment Modalities ◽  
Residual Deformity ◽  
Diagnostic Dilemma ◽  
Parotid Neoplasm ◽  
Low Incidence ◽  
Anti Tubercular Therapy

Pulmonary tuberculosis is a necrotizing granulomatous disease with diverse presentation. Nevertheless, extra pulmonary involvement although rare even in endemic regions, is associated with diagnostic dilemma for confirmation and treatment modalities. Contextually, parotid gland tuberculosis is a rare surgical presentation because of nonspecific signs, symptoms and allegedly low incidence; it is often misdiagnosed as parotid neoplasm, and therefore remains a diagnostic paradox. However, clinical suspicion alongside pathological evidence and imaging helps in diagnosing indecisive questionable cases. We present 4 cases of parotid tuberculosis each with different clinical presentation along with clinical suspicion and pathological diagnosis. Parotid tuberculosis is a rare clinical entity and completely curable by category-I anti-tubercular therapy. It has no residual deformity if diagnosed timely followed by conservative treatment management.

Role of routine nephrectomy for non-functioning kidneys due to genitourinary tuberculosis: Data from an Indian subcontinent

2021 ◽  
pp. 205141582098766
Author(s):  
Pradeep Prakash ◽  
Prabhjot Singh ◽  
Amlesh Seth ◽  
Rishi Nayyar ◽  
Brusabhanu Nayak
Keyword(s):  
Indian Subcontinent ◽  
Disease Recurrence ◽  
Drug Resistant ◽  
Second Line ◽  
Sensitivity Testing ◽  
Level Of Evidence ◽  
Lower Blood ◽  
Anti Tubercular Therapy ◽  
Open Nephrectomy

Objective: To evaluate the role of routine nephrectomy for tuberculous non-functioning kidney (TNFK) after receiving anti-tubercular therapy (ATT) by demonstrating whether live tubercle bacilli persist in nephrectomy specimens after treatment or not. Materials and methods: Patients with TNFK who underwent nephrectomy after completion of at least 6 months of ATT were included in this prospective cohort study. We sent tissue/pus from a nephrectomy specimen for acid-fast bacilli (AFB) staining, polymerase chain reaction (PCR) and culture to look for live bacilli. Bacilli were considered alive only if AFB culture was positive. Results: Twenty-four patients underwent nephrectomy for TNFK between April 2015 and October 2017 (18 laparoscopic and 6 open nephrectomy). Laparoscopic nephrectomy was associated with lower blood loss (225 ml versus 408 ml, p = 0.0003) and shorter hospital stay (3 versus 3.8 days, p = 0.06) compared with open nephrectomy; however, mean operative time and overall complications were similar. Eight specimens were AFB smear and/or tuberculosis PCR positive, out of which three showed viable bacilli upon culture. Drug sensitivity testing showed multi-drug resistant strain in all three patients who were treated with second-line ATT. Conclusion: It is preferable to do routine nephrectomy for TNFKs as they are more likely to harbour live bacilli and lead to disease recurrence. Viability testing for AFB must be performed on all operated specimens to identify drug resistant bacilli so that patients may be treated with second-line therapy if required. Level of evidence: 4.

scholarly journals Real world cost and health outcomes of patients presented with chest pain in England: which is the most cost-effective first-line test?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tsiachristas ◽  
H West ◽  
E.K Oikonomou ◽  
B Mihaylova ◽  
N Sabharwall ◽  
...  
Keyword(s):  
Chest Pain ◽  
Health Outcomes ◽  
Diagnostic Tests ◽  
Clinical Presentation ◽  
Cost Effective ◽  
Funding Source ◽  
First Line ◽  
Nice Guidelines ◽  
Exercise Ecg ◽  
Stable Chest Pain

Abstract Background The National Institute for Health and Care Excellence (NICE) updated their guidance for the management of patients with stable chest pain and recommended that all patients undergo computed tomography coronary angiography (CTCA). This update has sparked a great deal of debate, and was followed by upgrade of CTCA into a Class I indication in the recent ESC guidelines. The cost-effectiveness of using CTCA as first line investigation is still unclear. Purpose To describe the current clinical pathway of patients with stable chest pain presented to outpatient clinics, assess the compliance with the updated NICE guideline, and explore the costs and health outcomes of different non-invasive diagnostic tests in real-world clinical setting. Methods We used data of 4,297 patients who attended chest pain clinics in Oxford between 1 January 2014 and 31 July 2018. Data included clinical presentation (e.g. age and previous cardiovascular conditions), diagnostic tests, outpatient visits, hospitalization, and hospital mortality and was compared between 6 alternative first-line diagnostic tests. Multinomial regressions were performed to estimate the probability of receiving each alternative and the associated cost after adjusting for clinical presentation. A decision tree was developed to describe the clinical pathway for each alternative first-line diagnostic in terms of subsequent diagnostic tests and treatments and to estimate the associated costs and life days. Results The proportion of patients who received CTCA as first line diagnostic test increased from 1% in 2014 to 17% in 2018, while the publication of the updated NICE guidelines in 2016 led to a threefold increase in this proportion. CTCA is less likely to be provided as a first-line diagnostic to patients who are younger age, males, smokers, and have angina, PVD, or diabetes. The standardised rate of hospital admission was the lowest in the exercise ECG cohort (0.35 admissions per 1,000 life-days) followed by the CTCA cohort (0.40 admissions per 1,000 life-days) while the latter cohort had the lowest standardised rate of cardiovascular treatment (2.74% per 1,000 life days). Stress echocardiography and MPS were associated with higher costs compared with CTCA, other ECG, and exercise ECG after adjusting for clinical presentation and days of follow-up. CTCA is the pathway most likely to be cost-effective, even compared to exercise ECG, while the other diagnostic alternatives are dominated (i.e. they cost more for less life-days). Conclusions Currently, the updated NICE guidelines for stable chest pain are implemented only to a fifth of the cases in England. Our findings support existing evidence that CTCA is the most-cost effective first-line diagnostic test for this population. Hopefully, this will inform the debate around the implementation of the guidelines and help commissioning and clinical decision processes worldwide. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research Oxford Biomedical Research Centre

scholarly journals Biology and Management of Dedifferentiated Liposarcoma: State of the Art and Perspectives

2021 ◽  
Vol 10 (15) ◽  
pp. 3230
Author(s):  
Jun Nishio ◽  
Shizuhide Nakayama ◽  
Kazuki Nabeshima ◽  
Takuaki Yamamoto
Keyword(s):  
Standard Treatment ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Single Agent ◽  
Dedifferentiated Liposarcoma ◽  
Cyclin Dependent Kinase ◽  
First Line ◽  
First Line Therapy ◽  
Well Differentiated ◽  
Genetic Events

Dedifferentiated liposarcoma (DDL) is defined as the transition from well-differentiated liposarcoma (WDL)/atypical lipomatous tumor (ALT) to non-lipogenic sarcoma, which arises mostly in the retroperitoneum and deep soft tissue of proximal extremities. It is characterized by a supernumerary ring and giant marker chromosomes, both of which contain amplified sequences of 12q13-15 including murinedouble minute 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) cell cycle oncogenes. Detection of MDM2 (and/or CDK4) amplification serves to distinguish DDL from other undifferentiated sarcomas. Recently, CTDSP1/2-DNM3OS fusion genes have been identified in a subset of DDL. However, the genetic events associated with dedifferentiation of WDL/ALT remain to be clarified. The standard treatment for localized DDL is surgery, with or without radiotherapy. In advanced disease, the standard first-line therapy is an anthracycline-based regimen, with either single-agent anthracycline or anthracycline in combination with the alkylating agent ifosfamide. Unfortunately, this regimen has not necessarily led to a satisfactory clinical outcome. Recent advances in the understanding of the pathogenesis of DDL may allow for the development of more-effective innovative therapeutic strategies. This review provides an overview of the current knowledge on the clinical presentation, pathogenesis, histopathology and treatment of DDL.

scholarly journals The Effects of Oral Liposomal Glutathione and In Vitro Everolimus in Altering the Immune Responses against Mycobacterium bovis BCG Strain in Individuals with Type 2 Diabetes

2021 ◽  
Vol 12 (1) ◽  
pp. 16-26
Author(s):  
Kimberly To ◽  
Ruoqiong Cao ◽  
Aram Yegiazaryan ◽  
James Owens ◽  
Kayvan Sasaninia ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Immune Cells ◽  
Mycobacterial Infection ◽  
Drug Resistant ◽  
Tnf Α ◽  
Resistant Strains ◽  
Ifn Γ ◽  
Drug Resistant Strains

Abstract Tuberculosis (TB) caused by Mycobacterium tuberculosis (M. tb) still remains a devastating infectious disease in the world. There has been a daunting increase in the incidence of Type 2 Diabetes Mellitus (T2DM) worldwide. T2DM patients are three times more vulnerable to M. tb infection compared to healthy individuals. TB-T2DM coincidence is a challenge for global health control. Despite some progress in the research, M. tb still has unexplored characteristics in successfully evading host defenses. The lengthy duration of treatment, the emergence of multi-drug-resistant strains and extensive-drug-resistant strains of M. tb have made TB treatment very challenging. Previously, we have tested the antimycobacterial effects of everolimus within in vitro granulomas generated from immune cells derived from peripheral blood of healthy subjects. However, the effectiveness of everolimus treatment against mycobacterial infection in individuals with T2DM is unknown. Furthermore, the effectiveness of the combination of in vivo glutathione (GSH) supplementation in individuals with T2DM along with in vitro treatment of isolated immune cells with everolimus against mycobacterial infection has never been tested. Therefore, we postulated that liposomal glutathione (L-GSH) and everolimus would offer great hope for developing adjunctive therapy for mycobacterial infection. L-GSH or placebo was administered to T2DM individuals orally for three months. Study subjects’ blood was drawn pre- and post-L-GSH/or placebo supplementation, where Peripheral Blood Mononuclear Cells (PBMCs) were isolated from whole blood to conduct in vitro studies with everolimus. We found that in vitro treatment with everolimus, an mTOR (membrane target of rapamycin) inhibitor, significantly reduced intracellular M. bovis BCG infection alone and in conjunction with L-GSH supplementation. Furthermore, we found L-GSH supplementation coupled with in vitro everolimus treatment produced a greater effect in inhibiting the growth of intracellular Mycobacterium bovis BCG, than with the everolimus treatment alone. We also demonstrated the functions of L-GSH along with in vitro everolimus treatment in modulating the levels of cytokines such as IFN-γ, TNF-α, and IL-2 and IL-6, in favor of improving control of the mycobacterial infection. In summary, in vitro everolimus-treatment alone and in combination with oral L-GSH supplementation for three months in individuals with T2DM, was able to increase the levels of T-helper type 1 (Th1) cytokines IFN-γ, TNF-α, and IL-2 as well as enhance the abilities of granulomas from individuals with T2DM to improve control of a mycobacterial infection.

scholarly journals Abdominal Tuberculosis

2017 ◽  
Vol 28 (1) ◽  
pp. 39-45
Author(s):  
Md Ismail ◽  
Golam Azam
Keyword(s):  
Clinical Presentation ◽  
Imaging Study ◽  
Abdominal Tuberculosis ◽  
Clinical Feature ◽  
Ascending Colon ◽  
Diagnostic Dilemma ◽  
Mdr Tb ◽  
Colon And Rectum ◽  
Frequent Site ◽  
High Index Of Suspicion

Abdominal tuberculosis constitute up to 12% of extrapulmonary TB and is sixth frequent site of extrapulmonary involvement. The most common sites of involvement is the ileocaecalregion. Other site of involvement in descending order are ascending colon jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon and rectum. Abdominal TB has diagnostic dilemma due to its diverse and non-specific clinical presentation and has no single most specific, sensitive diagnostic test. A high index of suspicion, common and rare clinical feature, adequate imaging study, endoscopy, enteroscopy, laparoscopy, laparotomy, biopsy with histopathology, Mycobacterial isolation, Quantiferon-TB Gold, GeneXpert Assay, MULTIPLEX PCR and clinical response to anti TB therapy are considered for early diagnosis to reduce morbidity and mortality. Six month antiTB regime is effective as nine or 12month therapy. MDR TB and frequent interruption of therapy should considered in nonresponder to standard therapy. Surgery is required for minority cases that developed complications not responding to medical therpy.Medicine Today 2016 Vol.28(1): 39-45

scholarly journals Prevalence of primary drug resistant tuberculosis in a tertiary care hospital, Nepal

2015 ◽  
Vol 4 (4) ◽  
pp. 36-38
Author(s):  
R Khunjeli ◽  
U R Mohsin ◽  
S K Shrestha ◽  
S Adhikari ◽  
B Srivastava ◽  
...  
Keyword(s):  
Armed Forces ◽  
Care Hospital ◽  
Drug Resistant ◽  
Newly Diagnosed ◽  
First Line ◽  
Sensitivity Testing ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Resistant Strains ◽  
Primary Drug

 Background & objectives: Tuberculosis is a transmissible disease mainly due to inhalation of infected droplet nuclei. The burden of drug resistant tuberculosis is very high in our neighboring countries India and China. Prevalence of primary drug resistant disease is difficult to estimate in our country because culture and sensitivity is not done routinely. This study was an attempt to find out the prevalence of drug resistant in newly diagnosed tuberculosis patients serving in the Nepalese Armed Forces. Methodology: Medical records of patients serving in the Nepalese Armed Forces who had the provisional diagnosis of pulmonary tuberculosis for the first time from July 2012 to June 2014 were analyzed. They had their sputum subjected for both smear and culture with sensitivity testing. Out of 134 patients, 62 had culture positive for Mycobacterium tuberculosis and drug sensitivity was done for the first line 4 antitubercular drugs. Results: Drug resistant strains were found in 5 cases (8.1%) of which 2 (3.2%) were resistant to 4 first line drugs - rifampicin, isoniazid, ethambutol and streptomycin. Prevalence of isoniazid resistance was the highest, found in 3 cases (4.8%). Conclusion: Primary drug resistant tuberculosis in newly diagnosed cases was high even in young healthy adults, and isoniazid resistant strains were the commonest.DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11970

Atom based 3D QSAR and Fingerprint based 2D QSAR of Novel Molecules as MmpL3 receptor inhibitors for Mycobacterium tuberculosis

2021 ◽  
pp. 6321-6329
Author(s):  
Poojita K ◽  
Fajeelath Fathima ◽  
Rajdeep Ray ◽  
Lalit Kumar ◽  
Ruchi Verma
Keyword(s):  
Health Care ◽  
Mycobacterium Tuberculosis ◽  
3D Qsar ◽  
Cross Resistance ◽  
Drug Resistant ◽  
Urea Derivatives ◽  
2D Qsar ◽  
Qsar Models ◽  
Inhibition Property ◽  
Anti Tubercular Therapy

Tuberculosis is one of the leading cause of increase in mortality rate in today’s health care scenario. Due to increase frequency of drug resistant TB it is prudent to find new targets and promising targets for anti-tubercular activity. MmpL3 (Mycobacterial Membrane Protein Large 3) is one of the most effective and promiscuous targets for development of new drug for anti-tubercular therapy due to its cross resistance inhibition property. In this study we have presented atom based 3D QSAR and finger print based 2D QSAR models to study different structural and functional groups of Adamantyl urea derivatives and their action in MmpL3 inhibitory activity which will provide us the insight for designing better and far more effective anti TB drugs.

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