Extra-Pulmonary Tuberculosis: Retrospective Review of 83 Confirmed Cases, Observed in Radiology in Lomé(TOGO)

Background: Tuberculosis primarily affects lungs, but all organs may be affected. Extra-pulmonary forms of tuberculosis cause a big public health problem as it is diagnosed late. This delay in diagnosis is not only due to the delay in the examination, but also due to difficulties related to extra-pulmonary tuberculosis diagnostic. Aim: To describe the different locations of extra-pulmonary Tuberculosis and its aspects in Togo. Patients and Methods: A retrospective analysis of all extra-pulmonary tuberculosis cases diagnosed by imaging over five years (January 2010 to December 2015) was done. All the cases were confirmed either by direct examination of biological fluids or by histological analysis of biopsy and surgical samples or by culture on specific area. Data were collected from the Department of Radiology, from Microbiology Laboratory of the Pneumo-phthisiology unit and from Pathology Laboratory of Sylvanus Olympio Teaching Hospital of Lomé. Results: A total of 83 cases of extra-pulmonary Tuberculosis had been taken into account: 45 men and 38 women, with a maximum number of cases (66.3%) in the age group between 20 to 40 years old. An HIV infection was known in 51 patients (61.4%). Pulmonary damage was associated in 21 patients (25.3%). A total of 116 extra-pulmonary tuberculosis locations were recorded. Damages were pleural in 37.1% (43), ganglion in 24.1% (28), osteo-articular in 15.5% (18), abdominal in 12.9% (15), military represented 8.6% (10), a case of testicular damage, and a case of mammary tuberculosis. Conclusion: The medical scanning based on conventional radiography, ultrasonography and TDM is indispensable for the diagnosis and the care taking of extra-pulmonary tuberculosis since some locations may be confused with many other diseases and lead to misdiagnosis errors and delay the treatment.

Extra-Pulmonary Tuberculosis in the Uterine Cervix: A Case Report

Tuberculosis of the uterine cervix is grouped under genital tuberculosis. Other sites for genital tuberculosis include the Fallopian tubes and the endometrium. Genital tuberculosis and other types of tuberculosis outside the lungs are referred to as extra-pulmonary tuberculosis (EPTB). Genital tuberculosis presents with unspecific symptoms and signs;and because of this, most often, the diagnosis is made incidentally during investigations for other conditions that present with similar clinical pictures. Therefore, misdiagnosis and wrong treatment are not uncommon. We present a case of tuberculosis of the uterine cervix which was incidentally diagnosed when the patient was being investigated for cervical cancer, and successfully treated with a 6-months rifampicin regimen, 2RHZE/4HRE. Health providers have a duty to highly suspect tuberculosis of the cervix among women who present with abnormal vaginal discharge, abnormal vaginal bleeding and post-coital bleeding especially in countries where HIV and TB are endemic. If properly diagnosed and correctly treated, tuberculosis of the uterine cervix is curable.

Life Threatening Stridor Due to Primary Laryngeal Tuberculosis

Tuberculosis is a potentially serious infectious disease. In otorhinolaryngology practice, lymph node infection is the most common site of predilection followed by the larynx. Laryngeal tuberculosis (LTB) typically presents with dysphagia, odynophagia and hoarseness. We reported a case of primary LTB presenting with acute upper airway obstruction and respiratory distress mimicking acute supraglottitis which requires emergency tracheostomy. Therefore, in acute upper airway obstruction, the appropriate initial investigation should be done to rule out TB to make sure early treatment can be given and it may prevent complications of disease to the patient. .

Usefulness of interferon-γrelease assay for the diagnosis of sputum smear-negative pulmonary and extra-pulmonary TB in Zhejiang Province,China

Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay(IGRA)for the diagnosis of smear-negative pulmonary and extra-pulmonary TB.Methods:We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients(including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients),113 extra-pulmonary TB patients,81 patients with other pulmonary diseases and 100 healthy controls.Blood samples for the TB-Ab test and the TB-IGRA were collected,processed,and interpreted according to the manufacturer’s protocol.Results:The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8%(109 of 120)and 89.6%(241 of 269),respectively.There was no statistically significant difference of its performance between these two sample sets(P>0.05).The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0%(350 of 389)and 87.6%(99 of 113),respectively,which was not significantly different(P>0.05).Conclusions:In this work,the total detection ratio using TB-IGRA was 89.4%,therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.

Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases:case reports and literature review

The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy(22.86%,16/70).The peritoneum(31.42%,22/70),bone(21.42%,15/70),and lymph node(20%,14/70) were the most frequently infected.Single organ infection was common(90%,63/70).Fever(58.57%,41/70),pain(35.71%,25/70),and enlarged lymph node(20%,14/70) were the most common symptoms.Biopsy(67.14%,47/70) and culture(40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol(44.29%,31/70) was the most common therapy.The majority of patients improved(82.86%,58/70);however,12 cases got worse(17.14%),with 10 of them dying(14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.

Tuberculosis in pregnancy—Diagnostic dilemma

The worldwide incidence of tuberculosis (TB) is rising and is linked to immigration patterns and the rise in incidence of HIV. Extra-pulmonary disease, in particular, can lead to diagnostic dilemmas. Because the total number of cases of TB in pregnancy in developed countries is small and often concentrated in specific urban areas with large immigrant populations, clinicians may rarely encounter the problem. This paper provides actual clinical experience of one recent case.

Thoracic hydatid disease:A radiologic review of unusual cases

Hydatid disease or echinococcosis is a zoonotic parasitic disease.The lung is the second most commonly affected organ after the liver.Intra-thoracic and extrapulmonary hydatid disease is uncommon and may involve the pleura,mediastinum,heart,diaphragm,and chest wall.Unusual locations or complications of thoracic hydatid disease may pose a diagnostic challenge.We present imaging findings of cases with unusual location and presentations of thoracic hydatid disease with emphasis on their clinical implications.

Prospective study of SEVA TB peroxidase assay for cocktail antigen and antibody in the diagnosis of Tuberculosis in suspected patients attending a tertiary care hospital located in rural area

Objective:To evaluate inhouse developed SEVA TB peroxidase enzyme immunoassay using cocktail of mycobacterial excretory-secretory antigens(ES-31,ES-43 & EST-6) for antibody detection and their affinity purified antibodies for antigen detection in tuberculosis suspected patients.Methods:Inhouse developed SEVA TB peroxidase enzyme immunoassay was evaluated prospectively in 73 suspected pulmonary and 46 extra-pulmonary tuberculosis patients during November 2008~March 2009 in a tertiary hospital located in rural area.Results:Assay on prospective analysis showed 100% correlation of pulmonary tuberculosis(PTB) and extrapulmonary tuberculosis(EPTB) acid fast bacilli positivity and antitubercular treatment in 11 cases.Thirty nine PTB and 12 EPTB cases showed negative for EUSA test and were also not given antitubercular therapy.However 30 PTB and 27 EPTB cases showing ELISA positivity were neither acid fast bacilli positive nor antitubercular therapy treated.These cases may possibly have dormant infection and need further diagnosis.In EPTB cases ELISA was observed to be more useful than AFB smear test.Conclusions:This inhouse developed user-friendly peroxidase ELISA can be used as an adjunct test of smear microscopy or culture techniques for routine screening of patients suspected of PTB or EPTB.

Isolated gallbladder tuberculosis mimicking acute cholecystitis:A case report

BACKGROUND Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections.There are reports of gallbladder tuberculosis mimicking cholecystitis or malignancy.However,these presentations were chronic.The diagnosis of gallbladder tuberculosis warrants the need for investigation of additional sites of inoculation and contact tracing of all tuberculosis contacts.Gallbladder tuberculosis is a rare entity but should be suspected in patients from endemic regions with risk factors such as underlying immunosuppression or history of tuberculosis.CASE SUMMARY We present a case of gallbladder tuberculosis presenting as acute cholecystitis.A 44-year-old Filipino lady presented with a 11-d history of right hypochondrium and epigastric pain which worsened after meals with no significant past medical history.She underwent laparoscopic cholecystectomy on the presumptive diagnosis of acute cholecystitis and diagnosed as gallbladder tuberculosis after histopathological examination.The patient did not have features of pulmonary or systemic tuberculosis nor was she immunocompromised.She recovered uneventfully.She was subsequently discharged and followed-up at a hospital in her home country due to financial and social reasons.CONCLUSION Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis.

Primary Breast Tuberculosis Mimicking Carcinomatous Mastitis: A Case Report

The breast is a rare localization of extra-pulmonary tuberculosis, even in highly endemic countries. It is most often primitive. The clinical and radiological features are sometimes misleading. It poses diagnostic problems especially with cancer. We report a case of breast tuberculosis having clinical and radiological presentations as a breast carcinoma. Through this observation and a review of the literature, we provide an update on the epidemiological characteristics and the means of diagnosis of this lesion. It was a 52-year-old woman with inflammatory lump of the left breast, adherent to the skin. Ultrasonography and mammography revealed a homogeneous, poorly demarcated nodule of approximately 4 cm of diameter, classified ACR4. Surgical excision was performed. The histological diagnosis was breast tuberculosis. The diagnosis of tuberculous mastitis is made on bacteriological and pathological examinations. Histological examination helps for diagnostic confirmation while excluding a malignant lesion of the breast.