Acid Fast Bacilli
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Majid Ali Sarfraz ◽  
Apurva Raina ◽  
Deepjyoti . ◽  
Arti .

<p class="abstract"><strong>Background:</strong> Tuberculosis (TB) of head and neck is a rare form of extrapulmonary TB but still poses a significant clinical and diagnostic challenge. Rare occurrence and unspecific symptoms of extrapulmonary tuberculosis often leads to misdiagnosis. The aim of the study was to evaluate the various otolaryngological manifestations of extrapulmonary TB and make otolaryngologist aware of these manifestations.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 40 cases who presented to us at a tertiary hospital with various symptoms of head and neck TB. Detailed history with ear, nose throat examination was carried out on all patients. Fine needle aspiration cytology (FNAC), histopathology and Acid-fast bacilli (AFB) staining were done to confirm the diagnosis. After confirmation, patients were started on anti-TB therapy and showed good response to the treatment.  </p><p class="abstract"><strong>Results:</strong> The study included 40 cases who presented to us at a tertiary hospital with various symptoms of head and neck tuberculosis. The majority of these cases had cervical lymphadenopathy (55%) followed by deep neck abscess (20%), laryngeal TB (15%), tubercular otitis media (7.5%) and nasal TB (2.5%). Majority of the cases (65%) belonged to lower socio-economic status. 42.5% of cases had family history of pulmonary TB. Six out of 40 subjects had co-existing pulmonary TB.</p><p class="abstract"><strong>Conclusions:</strong> Otorhinolaryngeal TB can involve any site with unspecific symptoms. The most commonly site involved is cervical lymph node presenting as neck swelling. Variable nature of its manifestations makes it necessary to have high degree of clinical suspicion to make early diagnosis.</p>

2021 ◽  
Vol 13 (4) ◽  
pp. 917-923
Prenilla Naidu ◽  
Rahul Sharma ◽  
Jamil N. Kanji ◽  
Vilma Marks ◽  
Arienne King

Autochthonous leprosy was reported in the Southern USA in 2011 and has comprised an average of 34% of new cases from 2015 to 2020 in that country. We report a similar case in a patient from Western Canada. A 50-year old male patient presented with a four-year history of a chronic rash. Pathology stains revealed acid-fast bacilli prompting specialist referral. Examination was suspicious for leprosy, which was confirmed on slit skin smears and molecular testing. The patient responded well to treatment. Genotypic testing mapped the organism to the 3I-2 SNP type, which is of European origin and is the type found in implicated armadillo species in North America.

2021 ◽  
Vol 21 (1) ◽  
Yin Huang ◽  
Bo Chen ◽  
Dehong Cao ◽  
Zeyu Chen ◽  
Jin Li ◽  

Abstract Background Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. Methods Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. Results Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). Conclusions We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

Guangyu Shao ◽  
Bakari Chitechi ◽  
Gamze Demireli ◽  
Karoline Ornig ◽  
Matthias J. Neuböck ◽  

Summary Background Gastrointestinal tuberculosis (TB) is a rare manifestation in low TB-incidence countries such as Austria. It is usually seen in immunocompromised patients or in migrants being more susceptible for extrapulmonary disease manifestations. Case description We report a very rare manifestation of severe gastrointestinal TB in a 49-year-old previously healthy man from Upper Austria. Endoscopy showed a large tumor mass obstructing about 2/3 of the lumen of the cecum. Positron emission tomography/computed tomography scan revealed not only a high metabolic activity in the tumor mass, but also active pulmonary lesions in both upper lung lobes. Bronchial secretion showed acid-fast bacilli in the microscopy and polymerase chain reaction was positive for M. tuberculosis complex. Phenotypic resistance testing showed no resistance for first-line anti-TB drugs. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Based on therapeutic drug monitoring, the standard treatment regime was adapted to rifampicin high dose. TB treatment was well tolerated and the patient achieved relapse-free cure one year after the end of treatment. Conclusion Gastrointestinal involvement mimicking an intestinal tumor is a very rare TB manifestation in previously healthy Austrians. However, it should be kept in mind due to increasing migration from countries with higher rates of extrapulmonary TB and due to an increasing number of immunocompromised patients. TB telephone consultations can support medical professionals in the diagnosis and the management of complex TB patients. TB management is currently at a transitional stage from a programmatic to personalized management concept including therapeutic drug monitoring or biomarker-guided treatment duration to achieve relapse-free cure.

2021 ◽  
Vol 25 (10) ◽  
pp. 839-845
M. Ejo ◽  
A. Van Deun ◽  
A. Nunn ◽  
S. Meredith ◽  
S. Ahmed ◽  

OBJECTIVES: To assess the performance of the GenoType MTBDRsl v1, a line-probe assay (LPA), to exclude baseline resistance to fluoroquinolones (FQs) and second-line injectables (SLIs) in the Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB 1 (STREAM 1) trial.METHODS: Direct sputum MTBDRsl results in the site laboratories were compared to indirect phenotypic drug susceptibility testing (pDST) results in the central laboratory, with DNA sequencing as a reference standard.RESULTS: Of 413 multidrug-resistant TB (MDR-TB) patients tested using MTBDRsl and pDST, 389 (94.2%) were FQ-susceptible and 7 (1.7%) FQ-resistant, while 17 (4.1%) had an inconclusive MTBDRsl result. For SLI, 372 (90.1%) were susceptible, 5 (1.2%) resistant and 36 (8.7%) inconclusive. There were 9 (2.3%) FQ discordant pDST/MTBDRsl results, of which 3 revealed a mutation and 5 (1.3%) SLI discordant pDST/MTBDRsl results, none of which were mutants on sequencing. Among the 17 FQ- and SLI MTBDRsl-inconclusive samples, sequencing showed 1 FQ- and zero SLI-resistant results, similar to frequencies among the conclusive MTBDRsl. The majority of inconclusive MTBDRsl results were associated with low bacillary load samples (acid-fast bacilli smear-negative or scantily positive) compared to conclusive results (P < 0.001).CONCLUSION: MTBDRsl can facilitate the rapid exclusion of FQ and SLI resistances for enrolment in clinical trials.

2021 ◽  
Vol 15 (09) ◽  
pp. 1299-1307
Yared Merid ◽  
Elena Hailu ◽  
Getnet Habtamu ◽  
Melaku Tilahun ◽  
Markos Abebe ◽  

Introduction: Understanding the epidemiology of tuberculosis is limited by lack of genotyping data. We sought to characterize the drug susceptibility testing patterns and genetic diversity of M. tuberculosis isolates in southern Ethiopia. Methodology: A cross-sectional study was conducted among newly diagnosed sputum smear positive patients with tuberculosis visiting nine health facilities in southern Ethiopia from June 2015 to May 2016. Three consecutive sputum samples (spot-morning-spot) per patient were examined using acid-fast bacilli smear microscopy with all smear positive specimens having acid-fast bacilli cultures performed. M. tuberculosis isolates had drug susceptibility testing performed using indirect proportion method and were genotyped with RD9 deletion analysis and spoligotyping. Mapping of strain was made using geographic information system. Results: Among 250 newly diagnosed patients with tuberculosis, 4% were HIV co-infected. All 230 isolates tested were M. tuberculosis strains belonging to three lineages: Euro-American, 187 (81%), East-African-Indian, 31 (14%), and Lineage 7 (Ethiopian lineage), 8 (4%); categorized into 63 different spoligotype patterns, of which 85% fell into 28 clusters. M. tuberculosis strains were clustered by geographic localities. The dominant spoligotypes were SIT149 (21%) and SIT53 (19%). Drug susceptibility testing found that 14% of isolates tested were resistant to > 1 first line anti- tuberculosis drugs and 11% to INH. SIT 149 was dominant among drug resistant isolates. Conclusions: The study revealed several clusters and drug resistant strains of M. tuberculosis in the study area, suggesting recent transmission including of drug resistant tuberculosis. Wider monitoring of drug susceptibility testing and geospatial analysis of transmission trends is required to control tuberculosis in southern Ethiopia.

2021 ◽  
Michael Abel Alao

Abstract BackgroundThe GeneXpert MTB/RIF assay for the diagnosis of tuberculosis (TB) and its uptake has been limited in most developing countries. This may lead to under-diagnosis, ineffective treatment and high mortality. We determine the prevalence of Mycobacterium tuberculosis (MTB) and Rifampicin-resistant TB using a nucleic acid–based test and AFB-smear in a Nigerian population.MethodsWe analyzed a single early morning sputum and extrapulmonary specimen from suspected cases of TB. Smear microscopic and real-time PCR for the detection of MTB and mutation on the rpoB gene using a molecular beacon was performed. ResultsThe median age of the participants was 40 years (range: 6 weeks to 120 years). The incidence of MTB and RR-TB determined using GeneXpert were 620 (16.6%) and 59(1.6%), respectively. Acid-fast bacilli (AFB) smear identified AFB only in 2 out of 59(3.4%) cases with RR-TB. The agreement between the paired test of GeneXpert and AFB smear was poor (Kappa = 0.009, p = 0.01; McNemar’s p < 0.0001). AFB sensitivity, specificity positive and negative predictive value were 2.4%, 98.2%, 1.9 and 98.1 respectively. The distribution of the RR-TB are more prominent among new TB-AFB-negative cases, those residing in densely populated semi urban communities and migrants at border towns. Conclusion The GeneXpert test shows a high detection for MTB in the paediatric population but a lower RR-TB than the national average. There is a need for aggressive escalation of the nuclei acid based test in low middle-income-countries in order to achieve the end TB strategy in a global village.

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Khizar Hamid ◽  
Swaminathan Perinkulam Sathyanarayanan ◽  
Touba Naim ◽  
Muhammad Hamza ◽  
Mirza Omer Mahmood Baig ◽  

Hantavirus Cardiopulmonary Syndrome (HCPS) can occur after infection with Hantavirus which can occur by inhaling aerosolized rodent urine, feces, and saliva contaminated with the virus. It presents with the rapid development of pulmonary edema, respiratory failure, and cardiogenic shock with the hallmark being microvascular leakage. We report a patient with a history of alcohol abuse and recent exposure to mice and sick kittens who presented with cough with sputum production, shortness of breath, orthopnea, and new-onset lower extremity edema. Imaging revealed bilateral infiltrates more common on the left with an unremarkable echocardiogram. Testing for COVID-19, Human Immunodeficiency Virus (HIV), influenza, bacterial pneumonia including tuberculosis and methicillin-resistant Staphylococcus aureus (MRSA), aspergillosis, histoplasmosis, Blastomyces, and Coccidiodes was negative. Bronchoscopy and bronchoalveolar lavage revealed diffuse alveolar hemorrhage (DAH) and were negative for acid-fast bacilli and Nocardia cultures. He was further tested for Hantavirus, Q fever, leptospirosis, toxoplasmosis, and empiric treatment with doxycycline initiated. His Hantavirus IgM antibody came back positive. Human Hantavirus infection occurs after inhalation of infected rodent excreta; fortunately, human-to-human transmission has not been documented. HCPS most commonly occurs due to the Sin Nombre virus (SNV), has a case fatality rate of 50%, and is a notifiable disease in the United States. It has 3 distinct phases, prodromal, cardiopulmonary, and convalescent/recovery. The cardiopulmonary phase occurs from increased permeability of pulmonary capillaries and in severe cases can progress to cardiogenic shock. Diagnosis is based on the presence of IgM and IgG Hantavirus antibodies. Treatment is mainly supportive; however, patients are usually treated with broad-spectrum antibiotics while workup is underway. In animal models, ribavirin and favipiravir are only effective when administered in the prodromal phase. If suspicion of Hantavirus infection exists, early mobilization to the intensive care unit for treatment is recommended. Extracorporeal membrane oxygenation (ECMO) has been suggested to improve outcomes in severe HCPS with refractory shock.

Shahrizan Majid Binti Allapitchai

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, predominantly affecting the skin and peripheral nerves. Lucio phenomenon is a rare reactional state presenting in patient with lepromatous leprosy and described as acute cutaneous necrotising vasculitis. We discussed the case of a 38-year-old male patient presenting with oedematous and dusky discolouration of bilateral hands and feet associated with diffuse facial involvement. His skin condition gradually worsened to form multiple ulcers with bizarre shaped purpuric lesion over bilateral upper and lower limbs, trunk, and face. Histopathological examination of the skin biopsy showed multiple acid-fast bacilli and diagnosis of Lucio’s phenomenon was made in the background of lepromatous leprosy. He was treated with multi drug therapy (MDT) as recommended by the WHO guidelines. A better understanding of rarer manifestation of this illness is important for early diagnosis and to prevent significant morbidity associated with it.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S20

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