scholarly journals Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217190
Author(s):  
Rebecca Nightingale ◽  
Beatrice Chinoko ◽  
Maia Lesosky ◽  
Sarah J Rylance ◽  
Bright Mnesa ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Tuberculosis ◽  
Respiratory Symptoms ◽  
Treatment Completion ◽  
First Year ◽  
Tb Treatment ◽  
Effective Interventions ◽  
Hiv Coinfection ◽  
History Of ◽  
Chest X Ray

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.

scholarly journals Pulmonary aspergilloma on transthoracic ultrasound

Infection ◽  
2021 ◽  
Author(s):  
Lisa C. Ruby ◽  
Rajagopal Kadavigere ◽  
Shubha Sheshadri ◽  
Kavitha Saravu ◽  
Sabine Bélard
Keyword(s):  
Pulmonary Tuberculosis ◽  
Point Of Care ◽  
Computed Tomography Imaging ◽  
Imaging Tool ◽  
Irregular Border ◽  
History Of ◽  
Chest X Ray ◽  
Previously Treated ◽  
Pulmonary Aspergilloma ◽  
Transthoracic Ultrasound

Abstract Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

Molluscum-Like Papules as a Presentation of Early Papulonecrotic Tuberculid in Association with Nodular Tuberculid in a Male with Asymptomatic Active Pulmonary Tuberculosis

2015 ◽  
Vol 19 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Rachel Asiniwasis ◽  
Maha T. Dutil ◽  
Scott Walsh
Keyword(s):  
Pulmonary Tuberculosis ◽  
Early Stage ◽  
Induced Sputum ◽  
Simultaneous Occurrence ◽  
Antituberculous Therapy ◽  
X Ray ◽  
Active Pulmonary Tuberculosis ◽  
History Of ◽  
Chest X Ray ◽  
Histopathologic Findings

Background/Objectives The clinical and histopathologic findings of a rare simultaneous occurrence of papulonecrotic tuberculid and nodular tuberclid in a patient with active but asymptomatic pulmonary tuberculosis are presented. Papulonecrotic tuberculid was observed at a very early stage, presenting as molluscum-like lesions. This has been described once in the literature. This was observed in conjunction with lesions compatible with the rare clinicopathologic variant of nodular tuberculid. Critical to the diagnosis of active pulmonary tuberculosis was the use of induced sputum testing, which confirmed the diagnosis despite the lack of a cough and a chest x-ray negative for active tuberculosis. Methods/Results A 40-year-old male presented with a 2-week history of fever and a skin eruption consisting of molluscum-like papules on the ears, arms, and abdomen and nodules on his legs. Biopsies from both lesions were consistent with papulonecrotic and nodular tuberculid, respectively. Despite the lack of any respiratory symptoms, induced sputum grew Mycobacterium tuberculosis, and the lesions resolved on antituberculous therapy. Conclusions and Relevance Tuberculids are rare in Western countries but must be considered in the differential diagnosis of eruptions in patients from endemic countries. An active tuberculous focus must be sought out.

scholarly journals Role of gene Xpert test in clinical TB suspect in children

2018 ◽  
Vol 5 (4) ◽  
pp. 1657
Author(s):  
Sheenu Gupta ◽  
Veerana Kotrashetti ◽  
Rizwan Ahmed
Keyword(s):  
Diagnostic Tests ◽  
Clinical Manifestations ◽  
Childhood Tuberculosis ◽  
Mantoux Test ◽  
Gastric Aspirate ◽  
X Ray ◽  
Tb Treatment ◽  
Childhood Tb ◽  
History Of ◽  
Chest X Ray

Background: Tuberculosis (TB) is a major global health problem. Childhood tuberculosis (TB) is common in our community but it is relatively neglected, due to greater challenges in diagnosis. Clinical manifestations of childhood TB differ from adults. The diagnosis in most cases is based on clinical evidence but chest X-ray, Mantoux test, history of Kochs contact, malnutrition and sputum/gastric sample microscopy are important supporting investigations. WHO recommended use of newer diagnostic tests like Gene Xpert in pediatric cases where TB is mostly paucibacillary and identification of TB bacilli is difficult for confirmation of diagnosis.Methods: This prospective study was conducted among admitted and OPD patients in the department of Pediatrics over a period of 1and half year. Clinically suspected cases of TB in the age group 0-12 years who met the diagnostic criteria made the study group. Refusal of consent by parent and children already on TB treatment were excluded from this study. Investigations like chest X-ray, Mantoux test, sputum/gastric aspirate microscopy and Gene Expert were done to confirm the clinical diagnosis.Results: Pulmonary tuberculosis was more common (28%), TB lymphadenitis 22%, TB meningitis 14%, Tubercular Pleural effusion 12 %. and rest were no TB. BCG scar was present in 90%. History of contact was present in 76% and Mantoux test was positive in 76%. Gene Expert was positive only in one case in our study rest 49 cases were negative. The most common symptoms were fever (72%), cough (52%) and weight loss (40%).Conclusions: This study supports that detailed history, clinical evaluation and active investigative workup in addition to newer diagnostic tests like Gene Xpert has a major role in diagnosing childhood tuberculosis.

scholarly journals A rare case of left lung agenesis in a female teenager.

2012 ◽  
Vol 11 (4) ◽  
pp. 350-352
Author(s):  
Md Ankan Bandyopadhyay ◽  
Debabrata Saha ◽  
Kaushik Saha ◽  
Debraj Jash ◽  
Arnab Maji ◽  
...  
Keyword(s):  
Medical Science ◽  
Left Lung ◽  
Pulmonary Angiography ◽  
First Year ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Lung Agenesis ◽  
First Year Of Life ◽  
Routine Chest

Pulmonary agenesis is a rare congenital anomaly. History of recurrent chest infection in first year of life is the presenting symptom although patient may be asymptomatic and detected on routine chest x-ray. Our patient presented with recurrent chest infections since childhood. CT scan thorax revealed absence of lung tissue on left side with mediastinal shifting and herniation of right lung to left side. Pulmonary angiography confirmed the diagnosis of left lung agenesis. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12610 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12  

Wheezing Is Associated with Increased Rates of Acute Chest Syndrome and Pain Episodes In Adults with Sickle Cell Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2647-2647
Author(s):  
Robyn T. Cohen ◽  
Anusha R. Madadi ◽  
Morey A. Blinder ◽  
Michael R. DeBaun ◽  
Robert C. Strunk ◽  
...  
Keyword(s):  
Lung Function ◽  
Respiratory Symptoms ◽  
Acute Chest Syndrome ◽  
Shortness Of Breath ◽  
Cell Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Function Table ◽  
Physician Diagnosis

Abstract Abstract 2647 Rationale: Among children with sickle cell disease (SCD), a physician diagnosis of asthma has been associated with increased rates of acute chest syndrome (ACS), pain and mortality. Respiratory symptoms, including wheezing, occur in individuals with SCD independent of an asthma diagnosis. Few studies have evaluated the significance of asthma or respiratory symptoms in adults with SCD. Objective: The primary objective of this study was to determine whether adults with SCD and a physician-diagnosis of asthma have more ACS and pain episodes compared to adults with SCD but without asthma. A secondary objective was to evaluate the relationship between asthma-like symptoms and ACS and pain among adults with SCD. Methods: This was an observational cohort study of adults (≥ 19 years) with SCD who received care exclusively in the Washington University/Barnes Jewish Hospital system and completed baseline questionnaires including the ATS-DLD respiratory symptom survey. The questionnaires documented the frequency, severity and precipitants of symptoms such as wheezing, cough and shortness of breath. Enrollment into the study began August 2006. Hospitalizations for ACS and pain were determined from retrospective and prospective review of electronic medical records from January 1, 2004 to March 1, 2010 and analyzed using adjusted negative binomial regression models. Cox proportional hazards models were used to determine survival rates from date of consent through March 1, 2010. Spirometry was obtained from 69% of the study cohort. Results: Of 114 adults with SCD, those with a physician diagnosis of asthma (n=34) were more likely to have classic features of asthma including cough and wheeze, history of eczema, parental history of asthma, and an IgE level >150 kU/L (all p<0.05); however, there were no differences in rates of ACS or pain (table 1), lung function (table 2), or risk of death between adults with and without asthma. In contrast, those adults who reported recurrent episodes of severe wheezing (defined as ≥ 2 episodes of wheezing that progressed to shortness of breath) (n=34), with or without a diagnosis of asthma, had twice the rates of ACS and pain (table 1), significantly decreased lung function (table 2), and a trend towards increased risk of death (unadjusted HR 4.2, p=.046; adjusted HR 3.5, p=.09) compared to adults without a history of recurrent, severe wheezing. Notably, of 80 patients without a diagnosis of asthma, 30 reported multiple, persistent asthma-like symptoms at least monthly including nighttime cough/wheeze, daytime cough/wheeze even in the absence of exercise, and recurrent episodes of severe wheezing progressing to shortness of breath. Conclusions: While a physician diagnosis of asthma was not associated with an increased risk of morbidity/mortality or decreased lung function in this cohort of adults with SCD, a history of recurrent, severe wheezing was associated with an increased rate of ACS, pain and decreased lung function. These findings may represent a misclassification of asthma diagnoses or SCD-associated wheezing, a clinical observation that is not well-defined. This study highlights the need for careful assessment of respiratory symptoms by physicians caring for adults with SCD. Disclosures: Blinder: Novartis: Honoraria, Research Funding, Speakers Bureau. Field:Novartis: Honoraria.

scholarly journals 1648. CD4 T Lymphocyte and Monocyte Activation within One Year After Treatment Completion for Pulmonary Tuberculosis: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S812-S812
Author(s):  
Moises A Huaman ◽  
Anissa Moussa ◽  
Kris I Orsborn ◽  
Eduardo Ticona ◽  
Jorge Sanchez ◽  
...  
Keyword(s):  
T Cell ◽  
Immune Activation ◽  
Treatment Completion ◽  
Research Support ◽  
Activation Markers ◽  
Tb Treatment ◽  
Hla Dr ◽  
History Of ◽  
Previously Treated ◽  
One Year

Abstract Background Persons with active tuberculosis (TB) have increased immune activation, which declines with TB treatment. Whether residual immune activation is present after completion of TB treatment is unknown. We conducted immunophenotyping of T cells and monocytes from individuals who had completed TB treatment, and compared them to controls without history of active TB. Methods Cross-sectional study of HIV-uninfected individuals 40 to 70 years old recruited in Lima, Peru. For this analysis, we included 6 individuals who had completed treatment for pulmonary TB within the past year, and 10 healthy controls without history of active TB (6 QuantiFERON®-TB positive; 4 QuantiFERON®-TB negative). Participants provided blood for T cell and monocyte immunophenotyping using multi-parameter flow cytometry, including expression of cell surface activation markers. Results There were no significant differences in age, sex, or comorbidities between patients previously treated for TB and controls without history of active TB. Median time since TB treatment completion was 4 months (range, 2 – 9) for the previously treated group. Compared to controls, persons previously treated for TB had increased CD4+ to CD8+ ratio (2.4 vs. 1.3; p=0.03), increased proportion of CD4+ T cells co-expressing HLA-DR and CD38 activation markers (5.8% vs. 3.1%; p=0.02), increased CD4+ T cell ICAM-1 expression (56.3% vs. 33.2%; p=0.03), as well as increased density of HLA-DR in monocytes (HLA-DR MFI; 7572 vs. 3917; p=0.03). Conclusion In this pilot study, individuals who recovered from pulmonary TB exhibited increased CD4+ T cell and monocyte activation phenotypes within one year of TB treatment completion. These results suggest residual immune activation after clinical TB cure. Disclosures Carl Fichtenbaum, MD, Amgen (Grant/Research Support, outside the submitted work)Clinical Care Options (Other Financial or Material Support, outside the submitted work)Cytodyn (Grant/Research Support, outside the submitted work)Gilead Sciences (Grant/Research Support, outside the submitted work)Janssen (Grant/Research Support, outside the submitted work)Merck (Grant/Research Support, outside the submitted work)ViiV Healthcare (Research Grant or Support, outside the submitted work)

scholarly journals Efficacy of GeneXpert in Diagnosing Smear Negative Pulmonary Tuberculosis and Comparison to Culture

2021 ◽  
pp. 6-12
Author(s):  
Muhammad Kashif Munir ◽  
Iftikhar Ali ◽  
Ahsan Sattar Sheikh ◽  
Arif Malik ◽  
Asif Hanif ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Sputum Sample ◽  
Target Population ◽  
P Value ◽  
Tb Treatment ◽  
Lowenstein Jensen ◽  
History Of ◽  
Smear Negative ◽  
The University ◽  
Medical University

Objectives: Aim of present study is to observe the efficiency of GeneXpert MTB/RIF Assay in comparison to MTB culture on Lowenstein Jensen media in diagnosis of smear negative pulmonary tuberculosis cases. Methods: This descriptive study was carried out in The University of Lahore in collaboration with King Edward Medical University/Mayo Hospital Lahore 11th September, 2020 to 10th April 2021. Smear negative for acid fast bacilli patients enrolled for anti TB treatment were the target population. After taking informed consent, patients were asked to submit first morning sputum sample for culture on Lowenstein Jensen Medium and GeneXpert. Results: A total of 345 smear negative TB patients were diagnosed clinically and/or on the basis of radiological findings with mean age of 38.28±17.93,consisting of 47.5% male and 52.5% females  recruited in this study. History of TB contact was present among 41.4% patients whereas history of smoking and diabetes remained to be 27.2% and 17.4% respectively. Culture showed significantly higher rate (35.1%) (p-value <0.05) of detection of MTB as compared to GeneXpert (21.5%). A sensitivity of 56.01% was calculated for GeneXpert whereas for culture on LJ medium it was 60.63%. Conclusion: Sensitivity of GeneXpert MTB/RIF Assay is a bit low in diagnosing the SNPT patients as compared to the culture but still registers itself as a handsome tool in terms of promptness and definite detection of MTB complex. Further provision of rifampicin susceptibility is bonus in same time.

scholarly journals Protracted Respiratory Findings in Children Post-COVID-19 Infection

2021 ◽  
Author(s):  
Shoshana Leftin Dobkin ◽  
Joseph Collaco ◽  
Sharon McGrath-Morrow
Keyword(s):  
Lung Function ◽  
Respiratory Symptoms ◽  
Pediatric Patients ◽  
Acute Infection ◽  
Retrospective Chart Review ◽  
Exercise Intolerance ◽  
Prior History ◽  
Exertional Dyspnea ◽  
History Of ◽  
The Mean

Introduction: Although prolonged respiratory symptoms following SARS-CoV-2 infection have been reported in adults, there is a paucity of literature describing post-acute symptoms in pediatric patients following COVID-19. In this study we describe health data and respiratory findings in pediatric patients presenting with complaints of persistent respiratory symptoms following acute COVID-19 infection. Methods: This study included patients referred to Pulmonary Clinic at the Children’s Hospital of Philadelphia between December 2020 and April 2021 (n=29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected. Results: The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months post-acute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) of the patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.7% of subjects. Many subjects were overweight or obese (62.1%) and eleven subjects had a prior history of asthma. Lung function was normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of children tested. Conclusion: Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with post-acute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Lung function, however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.

scholarly journals Cerebral tuberculomas in a 6-year-old girl causing central diabetes insipidus

2018 ◽  
pp. bcr-2018-226590 ◽  
Author(s):  
Shavindra Chellen ◽  
Elizabeth Whittaker ◽  
Michael Eisenhut ◽  
Louis Grandjean
Keyword(s):  
Diabetes Insipidus ◽  
Pulmonary Infection ◽  
Central Diabetes Insipidus ◽  
X Ray ◽  
Csf Analysis ◽  
Tb Treatment ◽  
History Of ◽  
Ct Head ◽  
Chest X Ray ◽  
Strong Suspicion

A 6-year-old girl presented acutely with worsening frontal headaches. She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. A chest X-ray showed a left upper lobe consolidation, and a CT head showed multiple enhancing lesions with significant surrounding oedema in both cerebral hemispheres. Due to the strong suspicion of tuberculosis (TB), she was admitted and treated with anti-TB therapy and steroids. Following this, pulmonary infection with Mycobacterium tuberculosis was confirmed by a positive PCR from induced sputum. Cerebral spinal fluid (CSF) analysis was normal and tested negative for M. tuberculosis on PCR. During her first week of treatment, she developed polyuria, nocturia and polydipsia and was diagnosed with central diabetes insipidus. She was started on desmopressin which rapidly improved her symptoms, and she was continued on desmopressin for 3 months. Currently, she remains well and has shown a good response to TB treatment.

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