Field changes on automated Humphrey’s field analyzer in tuberculosis following ethambutol therapy

This study was conducted to evaluate the visual field changes in tubercular patients on anti-tubercular therapy and to assess the reversibility of these changes after the discontinuation therapy. This study was conducted as a prospective analytical study at tertiary care centres in Bhopal and Jabalpur on all newly detected tuberculosis patients. Ocular history, relevant history was recorded and detailed ocular examination was done at the time of presentation, before initiating ATT. All the patients were followed up periodically till the cessation of treatment and three months thereafter. A total of 40 cases of newly diagnosed tuberculosis were registered with mean age of 38.4±13.99 years. We documented significant deterioration in visual acuity after 3 months of initiation of therapy. Once the ATT was stopped, the improvement in visual acuity was statistically significant 3 months after the cessation of ATT as compared to visual acuity 3 months after initiation of ATT (p<0.05). But residual visual impairment even after stoppage of ATT was observed. Color vison and visual field defects were observed in higher proportions of eyes following initiation of ethambutol which improved significantly after 3 months of cessation of ATT (p<0.05). Ethambutol, even in recommended dose according to DOTS, has been associated with ocular toxicity which manifests in the form of painless progressive loss of vision, color vision defects and visual field defects. Though these changes are usually reversible, few patients have irreversible damage. Thus, patients receiving ethambutol must be explained regarding these effects and followed up periodically.

A Review of Blastomycosis in Indian Subcontinent

This study traces the earliest cases of blastomycosis reported from India. Four authentic cases of blastomycosis from India including one each from Arunachal Pradesh, Himachal Pradesh, Kerala, and one each from Bangladesh and Nepal, and five misdiagnosed cases have been reported in India after 2013. The clinical and diagnostic features of all cases are reviewed. The authentic cases from India originate from widespread locations in the country. The incidence of blastomycosis in dogs is known to be eight to ten times higher than that in humans. There is only one case of canine blastomycosis from India manifesting as a fatal pulmonary infection in a Mongrel dog. It is suggested additional canine cases should be looked for in different parts of India to facilitate the detection of endemic foci of B. dermatitidis for human and animal infections in the country. Mycological investigation of cases of pulmonary tuberculosis negative for culture and AFBs mear, and not responding to anti-tubercular therapy may reveal some cases of blastomycosis. A recently developed real-time PCR for identification of B. dermatitidis in culture and tissue may facilitate correct diagnosis of blastomycosis in suspected cases. Antigen testing in urine or serum is also recommended for diagnosing clinical infection and monitoring antifungal therapy in blastomycosis.

Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

Polymerase Chain Reaction Confirmed Mycobacterium Tuberculosis Intermediate Uveitis – Analysis of 22 Eyes of 14 Cases From a Tertiary Care Centre in South India.

Background: To report the role of Polymerase Chain Reaction in confirming the diagnosis of presumed mycobacterium Tuberculous Intermediate Uveitis. Method: Retrospective analysis of 22 eyes of 14 cases of presumed tubercular intermediate uveitis wherein intraocular fluid was tested for MTB DNA by Nested & Real time PCR, based on clinical suspicion of tubercular aetiology. QuantiFERON TB gold test and High Resolution CT Chest were done. Patients were treated with anti-tubercular therapy with oral steroids & immunomodulators. In the study, eleven were male (79%) and three female (21%). The median age was 34 years. Nested PCR for both IS 6110 & MPB 64 was positive in 64% of the cases, IS 6110 positive in 23% and MPB 64 positive in 15%. Real time PCR was positive in 48% of the cases. Vision improved in 33% cases, maintained in 57% cases and worsened in 10 % of cases. Conclusion: Presumed Tubercular intermediate uveitis can be confirmed by PCR of intraocular fluids. Anti-tubercular therapy with immunosuppression can improve vision and prevent recurrences in such cases.

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

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.

Spectrum of mycobacterial pathogens responsible for head and neck tuberculosis-like presentation

Tuberculosis (TB) of the head and neck can be contained in the lymph nodes, larynx, oropharynx, salivary glands, nose and paranasal sinuses, ear, skin and skull. Head and neck TB presentations are varied in nature and thus difficult to diagnose. The clinical features, radiological findings, microbiological diagnostic modalities, surgical and medical management and outcomes of nine cases of head and neck TB are discussed in detail here, together with a thorough review of the literature. Patients presented with atypical symptoms such as discharging sinus, ear lobule swelling, otitis media, vision loss and facial weakness, long refractory otorrhoea and granulation tissue in the ear canal. We diagnosed tubercular skull base osteomyelitis (one case) and laryngeal tuberculosis (two cases), mastoid tuberculosis (one case) and non-tubercular mycobacterial infection involving the temporal bone (two cases), sino-nasal region (one case), maxilla (one cases) and ear lobule (one case) over a period of 8 months. All patients were managed successfully with a combination of surgery and a well-planned treatment regimen for non-tuberculous mycobacteria (NTM) or anti-tubercular drugs for TB. All had successful outcomes except one patient with tubercular skull base osteomyelitis who expired before the initiation of anti-tubercular therapy (ATT). High clinical suspicion followed by thorough diagnostic work-up for both TB and NTM would enable early diagnosis and complete treatment.

A Systematic Review on Anti-tubercular Therapy Induced Hepatotoxicity

Tuberculosis is the leading cause of major morbidities and mortalities around the globe. One in every three persons suffers from tubercular infection in their lifetime. Antitubercular therapy-induced hepatitis occurs due to toxicity from the primary compound, metabolite, or an immunologically mediated response. Risk factors associated with hepatotoxicity are age, sex, low BMI, hypoalbuminemia, alcohol consumption, HIV, hepatitis B, and C. There are 6 major pathways by which anti-TB drugs are involved in hepatotoxicity including hampering of intracellular calcium homeostasis, derangement of actin fibril assembly that occurs next to the canaliculus, the drug binds to the heme-containing cytochrome p-450 and forms enzyme-drug adduct and produces an immune response, The enzyme- drug addict when gets incorporated to vesicle acts as antigen for the production antibodies, some drugs also inhibit the ? oxidation and respiration and hence reduction in ATP production hence damaging cell and mitochondrial DNA, and some directly leads to apoptosis. Isoniazid is being metabolized to acetyl-isoniazid followed by hydrolysis to acetyl hydrazine via cytochrome P450 enzyme which produces toxic metabolites responsible for hepatotoxicity. Rifampicin activates the cytochrome enzyme and hence stimulates the production of harmful toxic materials leading to ATT-induced hepatotoxicity. It is the duty of the he pharmacist / medical staff has to provide the patient with adequate education about diseases and to inform them about their therapy regarding possible side effects and side effects. Pharmacists / medical staff must also train patients to comply with medication.

Unmasking of miliary tuberculosis in COVID-19: A case report

Both coronavirus disease-19 (COVID-19) and pulmonary tuberculosis (PTB) are transmitted through the respiratory route and are related to various risk factors. The index case was a 45-year-old female who presented to a tertiary care hospital in North India with complaints of dry cough, loss of weight, and appetite for twenty days followed by fever and dyspnea for five days. RT-PCR for COVID-19 turned out positive. Chest-roentgenogram revealed bilateral homogenous micronodules. She was started on COVID-19 treatment according to the Ministry of Health and Family Welfare guidelines. She was not clinically improved so CECT-thorax was performed which revealed bilateral homogenous millet-shaped micronodular opacities. Mantoux test was twenty-five millimeters in size but sputum analysis for acid-fast bacilli was negative. The patient was started on anti-tubercular-therapy (ATT). The patient got improved clinically and is being followed. This case focuses on the need for prompt diagnosis of PTB in COVID patients for the appropriate management and early recovery.

A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

Zinc-responsive acral hyperkeratosis as a mimicker of cutaneous tuberculosis

Zinc-responsive acral hyperkeratosis is regarded as a novel entity masquerading numerous skin disorders, such as psoriasis, acral necrolytic erythema, and tuberculosis. Tuberculosis itself is a great imitator and so is its cutaneous form. Herein, we present the case of a female misdiagnosed as a case of tuberculosis verrucosa cutis due to clinical, biochemical, and histopathological features. The patient completed a full course of anti-tubercular therapy without an improvement and showed a dramatic response after a therapeutic trial of oral zinc. Thus, the patient was diagnosed as a case of zinc-responsive acral hyperkeratosis. In any form of acral hyperkeratotic lesions, zinc-responsive acral hyperkeratosis must be considered as a differential diagnosis.