A study of clinical profile and treatment outcomes in CNS tuberculoma

Worldwide, around 10 million people fall sick every year because of Tuberculosis (TB). In India, the incidence is 2.69 million cases. Central nervous system Tuberculosis (CNS TB), which is one of the most deadly forms of tuberculosis (TB) mainly manifests as TB Meningitis followed by Tuberculoma, Tubercular abscess and other forms. CNS TB is seen in 5 to 10% of extra-pulmonary TB cases, and accounts for 1% of all TB cases and has the highest mortality. They usually present with symptoms such as headache and seizures. They may have other signs and symptoms based on the size and the location of the lesions. The advent of modern technology such as CT, MRI scans helped to diagnose early. Diagnosis is established by CT/MRI Brain, where a granulomatous lesion with/without perilesional edema is seen. MR Spectroscopy brain is indicated when the diagnosis is doubtful. Presence of lipid peak on MR Spectroscopy is diagnostic of CNS Tuberculomas. Medical management is adequate and there is no role for surgery. A course of ATT for 6 months along with corticosteroids is adequate. Addition of corticosteroids is necessary to reduce the paradoxical response; it also reduces the size of the lesion and perilesional edema. Anti epileptic drugs are not necessary. CNS Tuberculoma is curable if treated properly.

Baseline HBV Load Increases the Risk of Anti-tuberculous Drug-induced Hepatitis Flares in Patients with Tuberculosis / 华中科技大学学报（医学）（英德文版）

Hepatitis associated anti-tuberculous treatment (HATT) has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus (HBV).Therefore,we evaluated the factors related to the severity of adverse effects during HATT,especially those associated with liver failure.A retrospective study was carried out at Tongji Hospital from 2007 to 2012.Increases in serum transaminase levels of＞3,5,and 10 times the upper limit of normal (ULN) were used to define liver damage as mild,moderate,and severe,respectively.Patients with elevated total bilirubin (TBil) levels that were more than 10 times the ULN (＞171 μrnol/L) with or without decreased (＜40％) prothrombin activity (PTA) were diagnosed with liver failure.A cohort of 87 patients was analyzed.The incidence of liver damage and liver failure was 59.8％ (n=52) and 25.3％ (n=22),respectively.The following variables were correlated with the severity of hepatotoxicity:albumin (ALB) levels,PTA,platelet counts (PLT),and the use of antiretroviral therapies (P＜0.05).Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure,and high viral loads were a significant risk factor with an odds ratio (OR) of 2.066.Judicious follow-up of clinical conditions,liver function tests,and coagulation function,especially in patients with high HBV loads and hypoalbuminemia is recommended.It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.

Primary Nasopharyngeal Tuberculosis.

Tuberculous infection of the upper respiratory tract is an uncommon clinical condition and in that nasopharyngeal involvement is struck with rarity per se. This condition is often prevalent in people of low socioeconomic strata living in endemic areas, especially in developing countries. It has a silent and indolent course and most commonly mimicks nasopharyngeal carcinoma in its clinical presentation. In absence of concurrent pulmonary involvement, it is often misdiagnosed or diagnosed only after the biopsy has been taken. Nevertheless, high index of suspicion is required on part of the clinician to diagnose this comparatively rare entity.

Rapidly Progressing Foveal Atrophy with Tuberculous Serpiginous-Like Choroiditis Despite Combined Anti-Tuberculosis and Steroid Treatment

PURPOSE: To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis. CASE SUMMARY: A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and magnetic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiography showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy combined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-corrected visual acuity and foveal atrophy were no interval change. CONCLUSIONS: Tuberculous serpiginous-like choroiditis with foveal involvement can show rapidly progressive foveal atrophy and poor visual prognosis.

Tuberculous Otitis Media.

Considerable variation exists between the clinical presentation of tuberculous otitis media (TOM) seen nowadays and what was described earlier. Confusing clinical picture and subsequent delay in diagnosis of TOM permits it to progress unhindered and results in permanent disabling conditions like facial paralysis and profound hearing loss. Hence an early diagnosis of TOM and timely commencement of appropriate therapy remains a challenging task. A high index of suspicion is required on part of the clinician to diagnose this fabled entity.

Causality assessment of suspected adverse drug reaction with anti-tubercular therapy by WHO probability scale.

The objectives of the study is to monitor and causality assessment of suspected ADRs by WHO Probability Scale in patients of tuberculosis undergoing treatment with anti-tuberculous drugs. An Open, Non- Comparative Study was carried out in the Medicine Department of Majeedia Hospital, Jamia Hamdard, over a period of 6 months. A total of 139 patients, satisfying Inclusion and Exclusion Criteria of the Study were enrolled. Potential study subjects were thoroughly interrogated for history in local dialect along with thorough clinical examination for both Pulmonary and Extra-pulmonary tuberculosis. The patients were followed upon a weekly basis during the period of treatment. Assessment of ADRs was done by formal methods; Timing, Pattern Recognition, Background Frequency and Re-challenge and the same was recorded in ADR Reporting and Documentation Form. All the categorical data was analysed by chi-square test on 120 patients. Causality assessment of ADRs was found to be statistically significant by WHO probability scale. 46.7% of patients reported ADRs to anti-tuberculous drugs. The severity of ADR’s was graded on 3- point scale (Mild-34.2%, Moderate-9.2%, Severe-3.3%). Close clinical monitoring in all tuberculosis patients for ADRs is important. ADRs remain one of the key factors for non-compliance of treatment, a reason for multi-drug resistance tuberculosis.

Treatment of latent tuberculous infection in children and adolescent / 소아과

Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Therefore, it is very important to understand the significance, diagnosis and treatment of latent tuberculous infection to decrease a future disease burden of tuberculosis. Unfortunately, these concept still have not fully implicated in Korean National Tuberculosis Control Program, it should be engaged and enforced as soon as possible.

Treatment of latent tuberculous infection in children and adolescent / 소아과

Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Therefore, it is very important to understand the significance, diagnosis and treatment of latent tuberculous infection to decrease a future disease burden of tuberculosis. Unfortunately, these concept still have not fully implicated in Korean National Tuberculosis Control Program, it should be engaged and enforced as soon as possible.

Tuberculosis of the Breast

Tuberculosis of the breast is an extremely rare disease. That needs to be differentiated from inflammatory breast cancer, acute or subacute breast abscess and actinomycosis of the breast in order for it to be treated effectively. However, tuberculosis of the breast is difficult to diagnose because of the diagnostic methods used. In addition, significant time is needed to identify tuberculosis by culture. We experienced a case of tuberculosis of the breast that developed during the anti-tuberculous medication. The patient was diagnosed quickly using tuberculosis PCR and treated with a combination of a surgical excision and anti-tuberculous medication.

Effect of Anti-tuberculous Chemotherapy in Renal Tuberculosis / 대한비뇨기과학회지

Unnecessary extirpative surgical procedure should be avoided for renal tuberculosis but patients refractory to or intolerant of chemotherapy and patients unable to stay on long-term chemotherapy for any reason may still require nephrectomy. Cure of patients is more important than cure of the disease in terms of rehabilitation. The author divided therapeutic principles of the renal tuberculosis into six categories as follows and representing case of each was evaluated. Category 1: anti-tuberculous chemotherapy only Category 2: anti-tuberculous chemotherapy and renal surgery Category 3: anti-tuberculous chemotherapy and permanent urinary tract diversion such as cutaneous ureterostomy Category 4: anti-tuberculous chemotherapy and restoration of urinary tract patency following urinary diversion Category 5: anti-tuberculous chemotherapy and enlargement of contracted bladder Category 6: anti-tuberculous chemotherapy and removal of clinically healed kidney because of failure of rehabilitation.

Detection of Tubercle Bacilli in Urine and in Removed Kidney Lesion in Renal Tuberculosis / 대한비뇨기과학회지

Fifty-four cases of renal tuberculosis who had anti-tuberculous treatment were studied for effect of anti-tuberculous agents on tubercle bacilli in urine and in kidney lesion. Urinary examinations were performed for tubercle bacilli every week by means of smear and culture and caseous substance from the cavity of kidney lesion was also smeared for the bacilli. The patients were divided into five groups as follows Group 1: Treated with anti-tuberculous agents for less than one month, 26 cases.Group 2: Treated with anti-tuberculous agents for one to three months, 15 cases.Group 3: Treated with the agents for three to six months, 6 cases.Group 4: Treated with the agents for six to twelve months, 5 cases.Group 5: Treated with the agents for longer than twelve months, 2 cases.Thirty-four instances (62.9%) of 51 cases revealed positive tubercle bacilli in urine and in the kidney lesion and 13 instances(24.0%) revealed negative bacilli in urine but positive in the kidney lesion while 6 instances(11.1%) revealed negative both in the urine and in the kidney lesion. Three instances of 7 cases treated for longer than six months showed positive smear for the bacilli in the kidney lesion.

Influences of Anti-tuberculous Agents and Cortisone on Renal Tuberculosis Induced in Rabbit / 대한비뇨기과학회지

Effect of cortisone on renal tuberculosis induced experimentally in rabbit and influence of the hormone on the effect of anti-tuberculous agents have been studied. Tubercle bacilli, bovine 123 strain. was inoculated into the rabbit kidneys to induce renal tuberculosis. In one group (A) bacilli were inoculated into the left kidney and into the both kidneys in another group (B). Treatments were started on the 10th post-inoculation day in the former group and on the 50th day in the latter group. Rabbits were divided into four experimental groupsas follows and treatments were continued for one month. After one week of observation animals were sacrificed and kidneys. lunge, livers, spleens and lymphnodes were studied on their tuberculous changes.1. Control. no treatment.2. Injection with cortisone acetate 10mg3. Injection with streptomycin 100mg. and INAH 23.6 mg.4. Injection with streptomycin 100mg. INAH 23.6 mg. and cortisone acetate 10mg.The animals were weighed and tubercle bacilli in the urine were studied every week during the experiment. The following results were obtained: 1) Body weight. Comparing with the control, animals receiving cortisone revealed marked decrease in body weight, while animals receiving anti-tuberculous agents increased their body weights. The animals receiving both cortisone and anti-tuberculous agents showed a decrease in body weight. 2) Urinary tubercle bacilli. After 4 weeks of inoculation, the bacilli were positive in urine. The control and the cortisone receiving animals in both groups A and B manifestated positive bacilli in urine and animals in group A receiving anti-tuberculous agents and both cortisone plus anti-tuberculous agents showed no bacilli in urine. In group B, bacilli were positive in animals receiving anti-tuberculous agents or both cortisone plus anti-tuberculous agents after 30 days of treatment. 3) Tuberculin test. Tuberculin test was weakened or negative after administering cortisone in tuberculous animals 4) Pathological histology. In group A, there was no significant changes between the control and the animals with cortisone. All showed wide-spread tuberculous lesions. Very slight changes were observed in animals receiving anti-tuberculous agents or both anti-tuberculous agents and cortisone, and the lesion showed improvement. Microscopically, animals receiving both anti-tuberculous agents and cortisone revealed cloudy swelling and simple necrosis throughout but no cellular infiltration in the kidney tissue. The affect of treatment was more apparent than in the animals receiving only anti-tuberculous agents. In the group B, lesions in the animals receiving cortisone was more marked than in the control animals. Macroscopically, no significant changes were observed both in the animals receiving cortisone and anti-tuberculous agents, and ones receiving only anti-tuberculous agents. However, microscopically, the former animals showed less fibrosis and calcification than the latters. Dissemination of tuberculous lesion to other organs was not influenced by administration of cortisone but prohibited by anti-tuberculous agents.