Tuberculosis and the Heart

Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET‐Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.

Treatment of patients with isoniazid-resistant pulmonary tuberculosis using an adjuvant therapy

The purpose of the study was to assess the efficacy of glutamyl-cysteinyl-glycine disodium (Glu) as adjuvant therapy in patients with isoniazid resistant pulmonary tuberculosis. Methods. This was a randomized placebo-controlled blind study. The study involved 67 patients who was randomly assigned to the treatment with Glu and antituberculosis cchemotherapy (group 1; n = 23), or placebo (group 2; n = 10), or antituberculosis chemotherapy (group 3; n = 34). All patients were positive for M.tuberculosis (MBT). The treatment included a standard intensive chemotherapy in a hospital (DOTS strategy) during 5 months (2S 3–5HRZE/5RSE). Glu was administered intramuscularly in the dose of 60 mg once daily during 10 days followed by 60 mg once daily every other day during 20 days; the total course included 20 doses. Results. Single-drug resistant MBT was detected in 26.1%, 20.0%, and 8.8% of patients in groups 1, 2, and 3, respectively. Multiple drug resistance was detected in 73.9%, 77.8%, and 91.2%, respectively. Sputum conversion was achieved in 26.1%, 52.2%, and 21.7% of group 1 patients in one, two and three months of the treatment, respectively. Sputum conversion in group 2 was achieved over 3 months of the treatment only (n = 3 at 3 months, n = 4 at 4 months, and n = 2 at 5 months); two patients were still MBT-positive to the end of the treatment. In group 3, sputum conversion was achieved in 18 patients (53.0 %) at 3 months, in 6 patients (18%) at 4 months, and in 5 patients (14.7%) at 5 months; 5 patients remained MBT-positive to the end of the treatment. Median time to sputum conversion was 62, 114, and 100 days in groups 1, 2, and 3, respectively. Conclusion. The adjuvant treatment with Glu in patients with isoniazid-resistant pulmonary tuberculosis was associated with earlier sputum conversion. This strategy can shorten the duration of the intensive treatment.

Tuberculous Distal Biceps Tendon Rupture: Case Report and Review of the Literature

Tuberculous distal biceps tendon rupture is a rare condition in orthopedics. Musculoskeletal tuberculosis usually presents with bursitis, synovitis, myositis, and osteomyelitis, conditions which demonstrate an excellent response to antituberculosis chemotherapy. Tendon rupture is often associated with delayed diagnosis and treatment. We report a rare manifestation of musculoskeletal tuberculosis in the distal biceps tendon with delayed diagnosis.

An OCT Study of Anterior Nodular Episcleritis and Scleritis

Anterior scleritis and episcleritis are a well-known presentation in tuberculosis. The case of a female patient with presumed tuberculous anterior scleritis and episcleritis is discussed in this article. Anterior segment OCT was efficient in diagnosis and evaluation of the therapeutic outcome. Antituberculosis chemotherapy was sufficient to achieve clinical remission.