Diagnosis and Treatment Outcomes of Tuberculosis in Relation to Gender and HIV STATUS in South Benin

Background: In Benin, little is known about the influence of both gender and HIV-status on diagnostic patterns and treatment outcomes of Tuber-culosis (TB) patients. Objective: To assess whether differences in gender and HIV status affect diagnostic patterns and treatment outcomes of TB patients. Methods: Retrospective cohort study of patients registered in 2013 and 2014 in the three largest TB Basic Management Units in south Benin. Results: Of 2694 registered TB patients, 1700 (63.1%) were male. Case notification rates were higher in males compared with females (96 vs 53/100,000 inhabitants). The male to female ratio was 1:1 in HIV positive patients, but was 2:1 among HIV negative cases. In HIV-positive patients, there were no differences in TB types between men and women. In HIV-negative patients, there were significantly higher proportions of females with clinically diagnosed pulmonary TB (p = 0.04) and extrapulmonary TB (p < 0.001). Retreatment TB was 4.65 times higher amongst males compared with females. For New bacteriologically confirmed pulmonary TB, no differences were observed in treatment outcomes between genders in the HIV positive group;but significantly more unfavorable outcomes were reported among HIV negative males, with higher rates of failure (p < 0.001) and loss-to-follow up (p = 0.02). Conclusion: The study has shown that overall TB notification rates were higher in males than in females in south Benin, with more females co-infected with HIV. Unfavorable outcomes were more common in HIV-negative males.

Treatment Initiation among Patients with Multidrug Resistant Tuberculosis in Bhopal District, India

Revised national tuberculosis control programme in India has limited co-hort-wise information about what happens to patients diagnosed with multidrug resistant TB (MDR-TB). We determined the pre-treatment loss to follow-up (non-initiation of treatment by programme within 6 months of diagnosis) and time from diagnosis to treatment initiation in Bhopal district, central India (2014). Pre-treatment loss to follow-up was 13% (0.95 CI: 7%, 23%), not significantly different from the national estimates (18%) and median time to initiate treatment was seven days, lower than that reported elsewhere in the country. Bhopal was performing well with reference to time to treatment initiation in programmatic settings.

Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination:A case report

BACKGROUND Primary duodenal tuberculosis is very rare.Due to a lack of specificity for its presenting symptoms,it is easily misdiagnosed clinically.Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain.Initial imaging examination revealed a duodenal space-occupying lesion;subsequent upper abdominal contrastenhanced computed tomography indicated duodenal malignant tumor.Physical and laboratory examinations showed no obvious abnormalities.In order to confirm further the diagnosis,electronic endoscopy was performed and tissue biopsies were taken.Duodenal histopathology showed granuloma and necrosis.In-depth tuberculosis-related examination did not rule out tuberculosis,so we initiated treatment with anti-tuberculosis drugs.At 6 mo after the antituberculosis drug course,there were no signs of new development of primary lesions by upper abdominal computed tomography,and no complications had manifested.CONCLUSION This case emphasizes the importance of differential diagnosis for gastrointestinal diseases.Duodenal tuberculosis requires a systematic examination and physician awareness.

Retrospective analysis of diagnosis and treatment of tuberculosis in designated medical institutions in China from 2017 to 2022

Objective To understand the status of tuberculosis diagnosis and treatment capacity and the development and changes of tuberculosis diagnosis and treatment in provincial and municipal designated medical institutions in China from 2017 to 2022,so as to provide a basis for the formulation of relevant policies for the improvement and development of designated medical institutions for tuberculosis and the tuberculosis prevention and treatment service system,and to provide reasonable support for further strengthening the capacity of designated medical institutions for tuberculosis.

Primary hepatic tuberculosis:A rare but fatal clinical entity if undiagnosed

Hepatic tuberculosis particularly in the absence of military tuberculosis is rare.It can occur as a primary case or due to reactivation of an old tubercular focus.We report case of a 24 year old married female who died of primary hepatic tuberculosis.She had no evidence of tuberculosis elsewhere.Appropriale treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.

Coexistence of tuberculosis and squamous cell carcinoma in the right main bronchus:A case report

BACKGROUND Lung cancer with pulmonary tuberculosis(TB)refers to the occurrence of lesions simultaneously or sequentially in the lung(s)of the same patient,and the pathological examination and sputum TB examination diagnose them as lung cancer and TB,respectively.The occurrence of endobronchial TB(EBTB)with endobronchial tumor sequentially in the same bronchus lesion of the same patient is relatively rare.CASE SUMMARY A 62-year-old female patient was admitted to a local hospital on June 18,2019 after a 3-mo history of dyspnea.She was a farmer and had no history of smoking and alcohol misuse.The patient had neither family nor work contact indicating exposure to TB.Emergency chest computed tomography(CT)examination showed that the right main bronchus was occupied and malignant tumor was possible.Histopathologic examination of a bronchial biopsy showed granulomatous inflammation with caseification and the presence of acid fast bacilli(AFB).However,after 6 mo of antitubercular treatment,repeat bronchoscopy and biopsy histological examination showed squamous cell carcinoma.The patient has started on systemic chemotherapy with carboplatin.After another two cycles of therapy,chest CT showed complete resolution of the lesions.Bronchoalveolar lavage and bronchial aspirate were negative for AFB and cancer cells.CONCLUSION It is not only more likely that a patient presenting with what appears to be TB will concurrently have a pulmonary malignancy than someone who does not have a TB infection,but also that it is of greater urgency to make an expedited diagnosis of the malignancy.

Hepatobiliary tuberculosis in the developing world

BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies.Delayed diagnosis may lead to inadequate treatment,thus necessitating an urgent need for accurate diagnosis and appropriate management.AIM To systematically review case reports on hepatobiliary tuberculosis,focusing on symptomatology,diagnostic procedures,management,and outcomes to provide patient safety and ensure an uneventful recovery.METHODS A systematic search was conducted on PubMed from 1992 to 2022,using keywords such as hepatobiliary,liver,tuberculosis cholangitis,cholangiopathy,and mycobacterium.Only case reports or case series in English were included in the study,and research papers published as abstracts were excluded.The search yielded a total of 132 cases,which were further narrowed down to 17 case studies,consisting of 24 cases of hepatobiliary tuberculosis.RESULTS The 10 most common symptoms observed in these cases were fever,abdominal pain,weight loss,jaundice,anorexia,generalized weakness,pruritus,chills,fatigue,and chest pains.Objective findings in these cases included hepatomegaly,hepatic nodules,elevated liver enzymes,and elevated bilirubin.Computed tomography scan and ultrasound of the abdomen were the most useful diagnostic tools reported.Histologic demonstration of Mycobacterium tuberculosis confirmed the cases of hepatobiliary tuberculosis.Treatment regimens commonly used included Rifampicin,Isoniazid,Pyrazinamide,and Ethambutol.Out of the 24 cases,18 presented improvements while 4 had completely recovered.CONCLUSION Hepatobiliary tuberculosis is a disease that requires accurate diagnosis and appropriate management to avoid complications.

Hepato Splenic Tuberculosis in Acute Cholecystitis

Background: The tuberculosis is an endemic disease in our country;it remains a major public health problem. Liver and splenic tuberculosis is a classic disease which represents 1.5% of all gastrointestinal tuberculosis. Patients and Methods: We reported the case of a fifty-six years old patient admitted in the department of surgery for acute cholecystitis, and the biological balance showed a hyperleukocytosis at 16,000 elements/mm3 and a CRP at 25 with a light cholestasis. The abdominal scanner showed a micronodular splenomegaly with coelio mesenteric ganglions. We discovered a tuberculosis location in the liver and the spleen and we realized a cholecystectomy with a hepatic biopsy and a splenectomy. Results: A gallbladder ablation associated with an enlarged spleen and liver biopsy was diagnosed with liver and splenic tuberculosis. The patient was put under anti tubercular treatment with the good clinical and radiological evolution. Conclusion: The diagnosis of tuberculosis should always be considered especially in endemic countries.

Vertebral Localization of Multifocal Skeletal Tuberculosis: Case Report and Literature Review

Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar spine pain for several weeks, associated with progressive weight loss without fever. Neurological examination was normal. CT scanning demonstrated hypodense multifocal lesions of the spine and the hip. Vertebroplasty was performed successfully. But a pathological examination of the biopsy of spinal lesions was not conclusive. One month later, the patient developed an acute spinal cord compression syndrome. Emergency decompression surgery was performed, which demonstrated the purulent epidural abscess and osteolysis. The pathological examination was in favor of tuberculosis. Despite surgical stabilization and cementoplasty, anti-TB therapy and kinesitherapy, the patient was still significantly limited a few months later with a flaccid paraplegia. TB infection was cleared at the end of the two-phase regimen. Atypical tuberculosis ormultifocal TB poses diagnostic problems especially with metastases, malignant lymphoma, and multiple myeloma. We report this rare case of mutifocal skeletal tuberculosis to show the place of vertebroplasty in the management of spinal tuberculosisor if there is indeed a potential role that vertebroplasty could have played in spreading spinal lesions. The patient was informed that non identifying information from the case would be submitted for publication, and he provided consent.

Proteomic progress in studying tuberculosis from 2010 to 2011

It is well accepted that rapid and early detection of Mycobacterium tuberculosis infection and understanding the mechanism of microbiologyhost interaction. Herein, we review the recently published papers related to TB proteomics from 2010 to 2011, including new technologies used in TB proteome research, diagnosis biomarkers of TB-associated diseases, disease pathogenesis and antigens for drug development. Through this review, we wish to offer some help for TB diagnosis and treatment.

Access to quality diagnosis and rational treatment for tuberculosis: real-world evidenee from China-Gates Tuberculosis Control Project Phase Ⅲ

Background:China has successfully reduced tuberculosis(TB)incidence rate over the past three decades,however,challenges remain in improving the quality ofTB diagnosis and treatment.I n this paper,we assess the effects of the implementation of"China National Health Commission(NHC)and Gates Foundation TB Preventi on and Control Pro-jectwon the quality ofTB care in the three provinces.

Clinical diagnosis,treatment,and medical identification of specific pulmonary infection in naval pilots:Four case reports

BACKGROUND Specific pulmonary infection could seriously threaten the health of pilots and their companions.The consequences are serious.We investigated the clinical diagnosis,treatment,and medical identification of specific pulmonary infections in naval pilots.CASE SUMMARY We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections,who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021,including three cases of tuberculosis and one of cryptococcal pneumonia.All cases underwent a series of comprehensive treatment courses.Three cases successfully obtained medical waiver for flight after being cured,while one was grounded after reaching the maximum flight life after being cured.CONCLUSION Chest computed tomography scanning should be used instead of chest radiography in pilots’physical examination.Most pilots with specific pulmonary infection can be cured and return to flight.

Views of health service providers on obstacles to tuberculosis control in Ghana

Background:Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis(TB),the disease does present considerable economic and health limitations to individuals infected with,and affected by,the disease,as well as to the health system in general.Despite this fact,insufficient studies have been done on the key barriers to controlling the disease.This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.Methods:In-depth interviews were conducted with frontline health workers involved in TB control in the country.Participants were purposively selected from a pool of national and regional,and district and facility level coordinators of the National Tuberculosis Control Programme(NTP).One key informant was also selected from an international non-governmental organisation(NGO)involved in TB-related activities in Ghana.Observations were utilised to complement the study.Data were analysed inductively.Results:Respondents identified the following as being constraints to TB control:clinical complication,bottlenecks in funding administration,quality of physical infrastructure,competition for attention and funding,unsatisfactory coordination between TB and HIV control programmes,a poor public-private partnership,and weak monitoring and evaluation of interventions.Conclusions:This paper provides evidence of some key barriers to TB control.The barriers,as reported,were generally health system-based.Although this list of barriers is not exhaustive,it would be useful to take them into account when planning for TB control,thus adopting a more rounded approach to TB management in the country.As well as that,further studies should be done to explore patients’views on health service-related barriers to TB control.

儿童肺外结核病473例临床特征分析

目的了解儿童肺外结核病的临床特点,诊治方法以及预后相关因素,以提高对该病的诊治水平。方法回顾性分析2011年1月至2020年12月北京儿童医院收治住院的确诊和临床诊断肺外结核病患儿的临床资料。结果共收治住院肺外结核病473例,占结核病患儿36.3%(473/1303),男269例(56.9%),农村378例(79.9%)。发病中位年龄为4.1(1.2~9.9)岁,≤5岁250例(52.9%)。经病原学或病理学检查确诊110例(23.3%),临床诊断363例(76.7%),其中结核性脑膜炎占比居首位(202例,42.7%)。307例患儿肺外标本中,抗酸染色涂片、Xpert MTB/RIF、结核杆菌培养、病理学检查4种检验方法的阳性率差异有统计学意义(P<0.01),病理学检查和Xpert MTB/RIF阳性率较高。313例胸部影像提示存在活动或陈旧性结核病。截至2022年6月18日,共随访336例,预后好211例,预后差125例(其中死亡23例)。多因素logistic回归分析发现,年龄≤5岁是影响预后的独立危险因素(P<0.05),腹腔结核病、骨及关节结核病(以结核性脑膜炎为参考)是影响预后的独立保护因素(P<0.05)。结论住院结核病患儿中约三分之一为肺外结核病,最常见为结核性脑膜炎,大多为临床诊断,分子诊断技术Xpert MTB/RIF在肺外结核标本中敏感度较高。≤5岁患儿和结核性脑膜炎相对预后较差。

结核后慢性肺曲霉菌病的研究进展

结核病和慢性肺曲霉菌病同属于慢性感染性疾病,严重危害人们的身体健康,且两者关系密切。近年来结核病新发人数仍在上升,虽然经有效治疗大部分肺结核可治愈,但结核后肺疾病不容忽视。慢性肺曲霉菌病是结核后肺疾病中一种重要疾病类型。因对该疾病的认识不够,诊断不及时,治疗效果不佳,严重危害人类健康,尤其在结核病高负担地区。本文重点综述慢性肺曲霉菌病的流行病学、发病机制、临床分型、临床特征、诊断和治疗新研究,以提高对结核后慢性肺曲霉菌病的认识,为临床诊治提供参考依据。

非结核分枝杆菌肺病的诊疗研究进展

非结核分枝杆菌(non-tuberculosis mycobacteria,NTM)肺病为临床多发病,其发病率呈现逐渐上升态势,其诊疗问题备受关注。本文通过搜集国内外相关研究资料,综述NTM诊断、治疗研究现状,总结研究成果,分析现有研究不足,希望为NTM临床诊疗提供参考,并为今后研究的进一步开展提供参考依据。

女性生殖器结核对生育的影响及对策

女性生殖器结核(FGTB)是常见的肺外结核,可导致不孕、不良妊娠结局、卵巢储备功能下降,以及影响辅助生殖的成功率。漏诊的FGTB不仅容易导致助孕失败,还会导致严重的母婴并发症。然而,FGTB症状不典型,误诊率高达60%,因此,对FGTB高危人群的及时筛查有着重要的临床意义。目前诊断FGTB的措施包括微生物学检测、聚合酶链式反应、环介导等温扩增、Xpert结核分枝杆菌(MTB)/利福平(RIF)耐药性检测和线性探针检测等分子检测。对FGTB的有效筛查和及时抗结核治疗,有利于改善生育结局、减少结核的垂直传播。本文将从FGTB对生育和辅助生育的影响、FGTB的诊断和治疗等方面进行综述,为FGTB的临床诊疗提供参考。

加速创新型技术应用,实现终止结核病目标

结核病是一种古老的传染性疾病,至今仍对全球人口构成严重威胁,其普遍性和影响力给社会带来了沉重的经济负担。为实现2035年全球“终止结核病”的宏伟目标,持续的技术创新和研发势在必行。本文综合梳理了21世纪以来结核病诊治的最新动态,涵盖了实验室诊断技术的进步、药物治疗策略的更新,以及疫苗研发的前沿进展,旨在为全面理解结核病的现状及未来走向提供参考。

结核潜伏感染诊断治疗的研究进展

全球大约有25%的人口遭受结核分枝杆菌的感染,其中5%~10%的潜伏感染者可能发展为活动性结核病,故准确地识别、早期治疗结核潜伏感染对遏制结核病的传播至关重要。目前对于潜伏性结核的诊断多采用结核菌素测试、干扰素释放试验及胸片检查,但特异性差,无法区分潜伏感染与活动性感染,新型的特异性生物标志物有待进一步研究。目前针对艾滋病病毒感染者、免疫抑制剂使用者、器官移植接受者等,在接受治疗过程中需要定期筛查结核分枝杆菌潜伏感染。对于这些个体合并结核潜伏感染是否预防抗结核治疗取决于是否有活动性结核病的风险。潜伏感染的预防策略通常包括异烟肼单独治疗、利福平单独治疗、异烟肼加利福平的方案,在治疗的同时需警惕药物不良反应的发生。对于多重耐药的结核潜伏感染者,预防性治疗策略包括新型抗结核药物如贝达喹啉、德拉马尼和氟喹诺酮等及其联合疗法,仍在持续研究中。本文综合了近年来的国内外指南和研究进展,概述了当前结核潜伏感染的诊断和治疗研究进展。

艾滋病合并结核相关免疫重建炎症反应综合征的研究进展

20世纪80年代以来,艾滋病(AIDS)在全球范围内蔓延,严重危害人类健康。结核病(TB)是艾滋病病人常见的一种机会性感染,同时也是导致病人死亡的重要原因之一。当病人同时感染人类免疫缺陷病毒(HIV)及结核分枝杆菌(MTB),两者可相互促进,使艾滋病病人病情变得更加复杂,并最终可能发展为艾滋病(AIDS)合并结核相关免疫重建炎症反应综合征(TB-IRIS)。目前针对这类疾病的研究不多,主要依赖临床医师的经验进行诊断和治疗。该文对AIDS合并TB-IRIS的发病机制及其疾病发生进展的关系进行分析,探讨如何更好地防治并发症,以期为临床诊断、治疗和研究提供参考性意见。