Extrapulmonary Tuberculosis Manifests as Middle Ear Tuberculosis: A Rare Case Report from Secondary Health Care Center at Sub-Himalayan Region

Tuberculosis of ear is a rare entity. Early diagnosis and prompt treatment can prevent many serious complications. Here we report a case of 45 year old female with middle ear tuberculosis which was cured with mastoid exploration followed by anti tubercular treatment. Keywords: Tuberculosis, TB, Extrapulmonary Tuberculosis, Middle Ear Tuberculosis, Sub-Himalayan Region

Occupation and Treatment Outcome of Multi-drug resistant tuberculosis Patients

Background: Tuberculosis is a contagion from ancient times comprising around one 3rd of global population on the wedge of infection with Mycobacterium tuberculosis complex where under developed and developing countries is coping with high burden of the disease. Aim: To observe the most prevalent occupation and treatment outcome in both Genders of MDR TB patients. Methodology: Health Research Institute-National Institute of Health TB Research Centre in collaboration with Department of Pulmonology, King Edward Medical University/Mayo Hospital Lahore from january 2014 to December 2020. A pre-designed questionnaire was used to collect data from MDR Tb patients after verbal informed consent. Patients were followed to see the final outcome on completion of anti-tubercle treatment. Data was entered and analyzed by using SPSS. Results: Out of total 450 MDR TB patients analyzed in this study a higher proportion of 54.9% were males and 45.1% were females with an overall mean age of patients as 39.64±17.52 years. Most of 159(35.4%) patients had no skills and were labors whereas most of 145 (28.2%) females were house wives. Almost 71% of the patients successfully completed the treatment including 45% cured on the basis of availability of final smear and culture reports.. Conclusion: A high mortality rate of MDR TB patients was observed while most of the TB patients in this study belong to labor class while most of the women were housewives. Keywords: Tuberculosis, MDR TB, Occupation, Treatment outcome, loss to follow up.

Cancer and tuberculosis: A lethal duo

Cancer patients are at an increased risk of developing active Tuberculosis (TB) disease. Immunosuppression because of cancer or its treatment modalities, including chemo-radiotherapy, places these patients at an increased risk of developing active TB. We describe the case of a fifty-eight-year-old male patient who was diagnosed and treated for carcinoma larynx but later succumbed to pulmonary TB. Active screening and treatment for Latent TB Infection (LTBI) at the start of cancer treatment in these patients may potentially help reduce the reactivation risk of active TB disease among them. Keywords: tuberculosis; TB; cancer; malignancy; mortality; LTBI; chemo-radiotherapy

Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01). Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years. Keywords: Tuberculosis; screening; community; Uganda.

Analysis of interaction mechanisms between main objects of tuberculosis-target therapy and corresponding selective inhibitors

Aim. Search for new inhibitors of the mitotic apparatus of mycobacterium and a number of enzymatic targets. Methods. 3D models of key targets reconstruction and geometry optimization and analysis of biologically active conformations of inhibitors were performed according to a previously developed technique. Results. A revision of mycobacterial inhibitors, which exhibit antimicrobial action against representatives of the genus Mycobacterium, was carried out, which made it possible to create an appropriate reference library of compounds. The complete spatial structure of a number of the main targets of targeted therapy for tuberculosis was reconstructed and verified, and the features of their interaction with selective inhibitors were established. Chemogenomic profiling was performed, which made it possible to draw conclusions regarding the uniqueness of the studied sites and the potential toxicity of compounds related to these sites for humans. Conclusions. A well-developed search algorithm for known inhibitors of proteins with M. tuberculosis allows further study of the features of their interaction with the corresponding homologues of M. bovis and the development of new, more selective compounds using molecular dynamics and docking methods. Keywords: tuberculosis, in silico, anti-tuberculosis drugs.

Primary oral tuberculosis in an immunocompetent patient

Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment. Keywords: Tuberculosis; oral; immunocompetence; ulcer.

Mycobacterium tuberculosis Infection of the Spine Secondary to Oxygen – Ozone Therapy for Prolapse Intervertebral Disc: A Scoping Review

Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimally invasive treatment option in the management of herniated disc in the cervical and lumbar spine. It causes the decrease in the volume of herniated disc by dehydration. Case Report: We hereby present the first reported case of Mycobacterium infection of the spine secondary to ozone therapy with the aim to caution the surgeons regarding the complications of intradiscal ozone therapy. Conclusion: Lack of proper, adequate, and recommended precautions if not taken can inoculate the varied microorganisms into the intradiscal space leading to devastating and unforeseen complications. Keywords: tuberculosis, ozone therapy, infection.

Frequency of Pre-Extensively Drug Resistant Tuberculosis and Extensively Drug Resistant Tuberculosis

Aim: To determine the frequency of pre-extensively drug resistant tuberculosis, extensively drug resistant tuberculosis in patients with multi-drug resistant tuberculosis. Study design: Retrospective/observational Place and duration of study: Department of Medicine, Bolan Medical College Quetta from 1st July 2019 to 31st December 2020. Methodology: One hundred and eighty patients of both genders presented with multi drug resistant tuberculosis were enrolled in this study. Patient’s detailed information including age between 20-70 years, sex, body mass index were recorded. Sputum samples were taken from all the patients and then drug sensitivity testing (DST) for 1st and 2ndline drugs. Frequency of pre-XDR TB and XDR tuberculosis were recorded. Results: There were 100 (55.56%) males and 80 (44.44%) patients were females and mean age was 37.38±10.75 years. Mean body mass index was 24.18±2.41 kg/m2. Among all the multi-drug resistant tuberculosis patients, pre extensively drug resistant tuberculosis was found in 62(34.44%) patients and extensively drug resistant tuberculosis was found in 8(4.44%) patients. All 62(100%) patients of pre-XDR tuberculosis were resistant to fluoroquinolone while among XDR tuberculosis patients 4 were resisted to amikacin, 2 were resisted to kanamycin and fluoroquinolone, 1 patient was resisted to amikacin and kanamycin. Conclusion: Frequency of pre-extensively tuberculosis among multi drug resistant tuberculosis was high while only 4% patients had extensively drug resistant tuberculosis. Keywords: Tuberculosis, Multi-drug resistant, Pre-extensively drug resistant, Extensively drug resistant

Diabetes Mellitus among Newly Diagnosed Tuberculosis Patients during COVID-19 Pandemic Period in a Secondary Health Institution

Introduction: Tuberculosis is one of the major public health problems worldwide and it is a major cause of morbidity and mortality. The risk of TB infection not only rises in diabetes patients, but is also associated with a higher risk of an increased number of diabetes complications. This study was conducted to determine the prevalence of Diabetes Mellitus (DM) among patients with newly diagnosed TB in Civil hospital Dehra, district Kangra (HP) a secondary health institute. AIM: To study the prevalence of DM in newly diagnosed pulmonary tuberculosis patients. Materials and Methods: Total 40 newly diagnosed patients with pulmonary tuberculosis (TB) who came in medicine OPD, Civil hospital Dehra from August 2020 to April 2021 during COVID -19 pandemic period were enrolled in the study. Their fasting blood glucose (FBG) was done. Screening and diagnosis of DM was done according to American diabetes association (ADA) guidelines. Results: The prevalence of DM and impaired fasting glucose (IFG) in newly diagnosed tubercular patients was 10% and 12.5% respectively in our study. Conclusion: The prevalence of FBS was found to be higher in patients with TB than the general population. Hence it is very important to screen these patients timely to prevent further complications. Keywords: Tuberculosis (TB), diabetes mellitus (DM), impaired fasting glucose (IFG), fasting blood glucose (FBG).

Application of optimal control to tuberculosis model with parameter estimations: Bayesian approach

In this paper, one-strain tuberculosis (TB) model with two control mechanisms, education campaigns and chemoprophylaxis of TB-infected patients, was studied to determine their effects on the reduction of latent and active TB cases. In the case of analysis, boundedness and positivity of the model solutions were carried out to determine the biological feasibility of the study. Besides, the calibration of the parameters by utilizing the identifiability technique through the Markov chain Monte Carlo (MCMC) was thoroughly analysed. The optimum conditions for controlling TB were derived from the Pontryagin Maximum Principle. The numerical simulations were carried out using the forward-back sweep method with the help of the Runge-Kutta fourth-order numerical schemes. Simulation results showed that the education campaigns strategy is more effective in reducing TB infections than the chemoprophylaxis of TB-infected individuals. The combination of the two control strategies reduces a significant number of infections than when each strategy is used on its own. To minimize the transmission of TB from the community, we recommend the education campaigns strategy be a focal point and treatment of latent TB to be paired with the treatment of active TB cases. Keywords: Tuberculosis, Education campaigns, Chemoprophylaxis, MCMC