Guía colombiana de tuberculosis genitourinaria / Colombian clinical practice guideline for urogenital tuberculosis

Objetivo: Brindar recomendaciones actualizadas en el diagnóstico, así como en el tratamiento médico y quirúrgico, para urólogos y profesionales de la salud atendiendo pacientes con tuberculosis genitourinaria. Método: Revisión sistemática de la literatura sobre tuberculosis urogenital definiendo preguntas de trabajo con esquema PICO para temas como epidemiología, fisiopatología, diagnóstico, manejo médico y quirúrgico de la enfermedad, y secuelas. Resultados: La tuberculosis genitourinaria presenta una incidencia aproximada del 20%, aunque se estima que hay subregistro importante. En Colombia, la tuberculosis es endémica, pero no hay guías para el diagnóstico y el manejo de este compromiso urogenital, por lo que son una necesidad. La tuberculosis genitourinaria debe sospecharse en pacientes con cuadros inflamatorios o infecciosos urinarios recurrentes, con o sin alteración estructural del tracto genitourinario, sin respuesta al tratamiento farmacológico convencional, sin causa clara o con nexo y factor de riesgo epidemiológico identificado. Puede diagnosticarse por medio de pruebas bacteriológicas, serológicas, moleculares o histopatológicas. En cada caso se requiere una evaluación imagenológica adecuada para determinar el compromiso orgánico o las secuelas, así como la estrategia para el manejo quirúrgico. Conclusiones: La tuberculosis genitourinaria es una condición infectocontagiosa, problema de salud pública, que concierne con gran interés a Colombia. Puede afectar cualquier órgano del tracto genitourinario femenino y masculino. El tratamiento médico oportuno tiene los mejores resultados y las menores tasas de necesidad quirúrgica y de secuelas. El abordaje diagnóstico y terapéutico estandarizado busca mejorar los resultados clínicos, la calidad de vida y la oportunidad del paciente con sospecha de esta enfermedad.

Objective: To provide updated recommendations in diagnosis, as well as for medical and surgical treatment focused on urologists and health-care professionals participating actively in care for urogenital tuberculosis. Method: Systematic review of literature on urogenital tuberculosis, previously defining working clinical questions with PICO scheme for topics such as epidemiology, pathophysiology, diagnosis, medical and surgical therapeutics for the disease. Results: Genitourinary tuberculosis has an incidence of approximately 20%, although a significant underreporting is estimated. In Colombia, tuberculosis infection is endemic, but there are no guidelines focused on this urogenital involvement, so there is a necessity. Urogenital tuberculosis should be suspected in patients with recurrent urinary inflammatory or infectious conditions, with or without structural alterations of genitourinary tract, who do not respond to conventional pharmacological treatment, with no apparent cause or have identified epidemiological link and risk factors. Diagnosis can be made by serological, bacteriological, molecular tests or histopathology. In each case, adequate imaging evaluation is mandatory to determine organ involvement, sequelae, and as strategy for surgical treatment. Conclusions: Genitourinary tuberculosis is an infectious disease, a public health issue, which concerns Colombia. It can affects any female and male urogenital tract organic tissue. Timely pharmacological management offers and has the best clinical results and lowest rates of surgical need or sequelae. The standardized diagnostic and therapeutic approach seeks to improve clinical outcomes, quality of life and opportunity for patients with suspected disease.

La Tuberculosis Urogenital en Cochabamba, Bolivia: incidencia, seguimiento microbiológico y del tratamiento antituberculoso / Urogenital Tuberculosis in Cochabamba-Bolivia: incidence, microbiological follow-up and monitoring of anti-TB treatment

Objetivo: describir la incidencia de tuberculosis urogenital (TBUG) en los dos centros de referencia diagnóstica del sistema de salud público del departamento de Cochabamba. Métodos: estudio transversal retrospectivo desde enero de 2013 a marzo de 2020; población de estudio: pacientes con sospecha de TBUG con solicitud de cultivo para BK. Recolección de datos: base de datos de los laboratorios y revisión de los expedientes clínicos. Resultados: se identificó a 2266 pacientes con sospecha clínica de TBUG a los que se les realizó cultivos de orina para TB; de los cuales 133 (5,87%) pacientes resultaron con cultivo positivo: 87 de sexo masculino (65,4%) y 46 de sexo femenino (34,6%); De estos, 115 pacientes no cuentan con un seguimiento completo clínico ni microbiológico, de los cuales el 83,3% tenía TB renal, 11,1% genital y 5,6% vesical; el 77,8 % presentaron síntomas del tracto urinario inferior, 33,3 % tenía algún tipo de comorbilidad y 1 requirió cirugía urológica. El tratamiento antituberculoso fue el estándar en el 100%, 1 presentó reacción adversa, pero ninguna resistencia ni defunciones asociadas al tratamiento. Discusión: la incidencia del 5,87% no es despreciable, debido a que se requiere un alto índice de sospecha y contar con el cultivo para el diagnóstico, seguimiento y finalización de la terapia y de este modo disminuir el daño irreversible que afectan la funcionalidad.

Objective: to determine the incidence of urogenital tuberculosis (UGTB) in the 2 diagnostic reference centers of Cochabamba. Methods: retrospective cross-sectional study from January 2013 to March 2020; Study population: patients with suspected UGTB with culture request for BK. Data collection: Laboratory database and review of clinical records. Results: 2266 patients with clinical suspicion of UGTB who had urine cultures for TB were identified; of which 133 (5.87%) patients were culture positive: 87 male (65.4%) and 46 female (34.6%); Of these, 115 patients do not have complete follow-up and only 18 patients were evaluated, of which 83.3% had renal TB, 11.1% genital and 5.6% bladder; 77.8% had lower urinary tract symptoms, 33.3% had some type of comorbidity and 1 required urological surgery. Antituberculosis treatment was standard in 100%, 1 presented adverse reaction, but no resistance or deaths associated with the treatment. Discussion: the incidence of 5.87% is not negligible, due to the fact that a high index of suspicion is required and to have the culture for diagnosis, follow-up and termination of therapy and thus reduce irreversible damage affecting functionality.

Tuberculosis urogenital en un paciente con falla renal, estado del arte / Urogenital tuberculosis in a patient with kidney failure, state of the art

RESUMEN La tuberculosis es una enfermedad infecciosa y frecuente en países en vía de desarrollo. Esta puede causar una amplia variedad de complicaciones y presentaciones atípicas con alta morbimortalidad. De la forma genitourinaria se sospechada muy poco, razón por la cual su diagnóstico se hace, usualmente, de forma tardía o no se realiza. Esto conlleva a consecuencias muy graves en los pacientes, por ejemplo, la enfermedad renal crónica terminal. A continuación, se presenta un reporte de caso de una paciente con la anterior enfermedad, secundaria a una tuberculosis renal bilateral diagnosticada tardíamente y se realiza una revisión de la literatura sobre este tema.

SUMMARY Tuberculosis is a common infectious disease in developing countries, which can cause a variety of complications and atypical manifestations with high morbidity and mortality. The urogenital form is rarely suspected, resulting in delayed diagnosis or even no diagnosis, which can have serious consequences for the patients, such as chronic end-stage renal disease. We report on a patient with chronic end-stage renal failure caused by a delayed diagnosis of bilateral renal tuberculosis and a literature review on this topic.

Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar / Hydrocele as initial manifestation of genitourinary and miliary tuberculosis / Hidrocele como manifestação inicial da tuberculose geniturinária e miliar

Introducción. La tuberculosis es una enfermedad infectocontagiosa que puede afectar cualquier órgano del cuerpo, incluyendo el sistema genitourinario, representando el 33.7-45.5 % de las tuberculosis extrapulmonares. El objetivo de este trabajo es reportar el caso de un paciente con hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar, enfermedad que no se sospechaba. Presentación del caso. Paciente masculino previamente sano, que consulta a urgencias por orquialgia e hidrocele bilateral, con secreción purulenta por escroto, requiriendo manejo antibiótico intravenoso e hidrocelectomía derecha, con hallazgos intraoperatorios de engrosamiento del epidídimo derecho, y drenaje de material caseoso y purulento. Se realizó epididimectomía ipsilateral, se solicitaron pruebas de detección de bacilos tuberculosos en espécimen y derivado proteico purificado, que fueron positivas. En el postoperatorio presentó sintomatología respiratoria; paraclínicos evidenciaron compromiso pulmonar, pleural y de la vía urinaria por bacilos tuberculosos. Se inicia manejo antituberculoso con evolución satisfactoria. Discusión. El genitourinario es considerado el segundo sistema con mayor afectación de tuberculosis extrapulmonar. El órgano más afectado es el riñón (en un 80 % con respecto a los demás) y el órgano genital es el epidídimo (22 - 55 %). Debe sospecharse en pacientes con síntomas urinarios crónicos sin causa aparente. Se asocia a una alta tasa de morbimortalidad por infertilidad y falla renal. Conclusiones. A pesar de su sintomatología inespecífica y de tratarse de una entidad poco sospechada, la tuberculosis genitourinaria debe descartarse al existir tuberculosis pulmonar. Su diagnóstico y tratamiento oportuno serán de gran importancia para evitar complicaciones secundarias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introduction. Tuberculosis is an infectious disease that can affect any organ in the body, including the genitourinary system, which accounts for 33.7 - 45.5 % of non-pulmonary tuberculosis cases. The purpose of this paper is to report a case of hydrocele as initial manifestation of genitourinary and miliary tuberculosis, which was an unsuspected disease. Case Presentation. Previously healthy male patient is admitted to emergencies due to orchialgia and bilateral hydrocele, with purulent secretion from the scrotum. Was managed with intravenous antibiotic and right hydrocelectomy. Intraoperative findings of thickening of right epididymis and drainage of caseous and purulent material. Ipsilateral epididymectomy was performed; testing for detection of tubercle bacillus in specimen and purified protein derivative was requested, and was found positive. In the postoperative period, respiratory symptoms arose; paraclinical tests found compromised lungs, pleura and urinary tract by tubercle bacillus. Antituberculous treatment was initiated with satisfactory evolution. Discussion. The genitourinary system is the second-most affected system by nonpulmonary tuberculosis. The most affected organ is the kidney (by 80 % compared to the others) and the most affected genital organ is the epididymis (22 - 55 %). It should be suspected in patients with chronic urinary symptoms with no apparent cause. It is associated with a high rate of morbidity and mortality due to infertility and kidney failure. Conclusions. Despite the non-specific symptoms and because it is not normally a suspected entity, genitourinary tuberculosis should be ruled out when pulmonary tuberculosis exists. Timely diagnosis and treatment are very important in order to prevent secondary complications. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introdução. A tuberculose é uma doença infecciosa que pode afetar qualquer órgão do corpo, incluindo o sistema geniturinário, representando 33.7 a 45.5 % da tuberculose extrapulmonar. O objetivo deste trabalho é relatar o caso de um paciente com hidrocele como uma manifestação inicial de tuberculose geniturinária e miliar, uma doença que não se suspeitava. Apresentação do caso. Paciente do sexo masculino previamente saudável, que consultou a emergência para orquialgia e hidrocele bilateral, com secreção purulenta do escroto, necessitando de tratamento antibiótico endovenoso e hidrocelectomia direita, com achados intraoperatórios de espessamento do epidídimo direito e drenagem de material purulento e caseoso. Foi realizada uma epididimectomia ipsilateral e foram solicitados exames de bacilos tuberculosos em espécime e derivado proteico purificado, que foram positivos. No pós-operatório, apresentou sintomas respiratórios; testes para-clínicos mostraram comprometimento pulmonar, pleural e do trato urinário devido a bacilos da tuberculose. Começa-se o tratamento antituberculose com evolução satisfatória. Discussão. O sistema geniturinário é considerado o segundo com maior comprometimento da tuberculose extrapulmonar. O órgão mais afetado é o rim (80 % em relação aos demais) e o órgão genital é o epidídimo (22 a 55 %). Deve-se suspeitar em pacientes com sintomas urinários crônicos sem causa aparente. Está associada a uma alta taxa de morbimortalidade devido à infertilidade e insuficiência renal. Conclusões. Apesar de sua sintomatologia inespecífica e de ser uma entidade pouco suspeitada, a tuberculose geniturinária deve ser descartada quando existir tuberculose pulmonar. Seu diagnóstico e tratamento oportuno serão de grande importância para evitar complicações secundárias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Genitourinary tuberculosis - a rare presentation of a still frequent infection in renal transplant recipients / Tuberculose genitourinária - uma apresentação rara de uma infeção ainda frequente nos doentes transplantados renais

Abstract Mycobacterium tuberculosis infection in renal transplant recipients is associated with significant morbidity and mortality. Genitourinary tuberculosis is a less frequent presentation and a high level of suspicion is needed to avoid treatment delay. Management is challenging due to the interaction of calcineurin inhibitors with antituberculous medications and the known side effects of these drugs, with higher prevalence in this population. The authors present a case of a renal transplant recipient with urinary and constitutional symptoms whom is diagnosed with tuberculosis after a prostatic biopsy in an already disseminated stage and develops hepatotoxicity to antituberculous therapy.

Resumo A infeção por Mycobacterion tuberculosis nos doentes transplantados renais está associada a morbilidade e mortalidade significativas. A tuberculose genitourinária é uma apresentação menos frequente desta infeção e é necessário um elevado índice de suspeição para evitar atraso no diagnóstico e tratamento. A abordagem terapeutica é desafiante dada a interação dos inibidores da calcineurina com os tuberculostáticos e os vários efeitos secundários destes fármacos, mais prevalentes nesta população. Os autores apresentam um caso de um doente transplantado renal com sintomas urínários e constitucionais que é diagnosticado com tuberculose após biópsia prostática e que desenvolve hepatotoxicidade à terapeutica.

Manifestações clínicas da tuberculose pleural, ganglionar geniturinária e do sistema nervoso central / Clinical Manifestations of Tuberculosis in the Pleura, Lymph Nodes,Urogenital System, and Central Nervous System

A tuberculose persiste como uma importante causa de morbidade e mortalidade mundial. Apesar de a forma pulmonar ser a apresentação mais importante e frequente, o acometimento extrapulmonar ocorre em aproximadamente 10-20% dos casos e em até 60% nos imunocomprometidos. Revisamos as principais manifestações clínicas dos mais importantes acometimentos extrapulmonares da tuberculose em nosso meio. O comprometimento pleural, ganglionar e urogenital são os mais comuns em nosso meio, além da importância do comprometimento do sistema nervoso central. A tuberculose costuma manifestar-se clinicamente como enfermidade subaguda a crônica, com sinais sistêmicos clássicos de febre baixa vespertina, emagrecimento e astenia, além daqueles que são dependentes do órgão afetado. Algumas dessas manifestações são revistas e descritas, lembrando, porém, que não existe quadro clínico patognomônico da enfermidade e que essa deve ser sempre lembrada no diagnóstico diferencial em nosso meio

Tuberculosis persists as a major cause of morbidity and mortality worldwide. Although the pulmonary form is more common and severe, the extrapulmonary form occurs in 10-20% of all cases and in up to 60% of cases in which the host is immunocompromised. This paper reviews the principal clinical manifestations of the most common types of extrapulmonary tuberculosis. Extrapulmonary tuberculosis most often afects the pleura, lymph nodes, urogenital system, and central nervous system, the last being the most common. In most cases, extrapulmonary tuberculosis is a clinically subacute or chronic disease, with symptoms speciic to the afected organ, as well as systemic signs, including a low fever, weight loss, and asthenia. Although some of these manifestations have been described, there is no pathognomonic clinical proile of the disease, which should always be included in the diferential diagnosis

Clinical Characteristics of Genitourinary Tuberculosis during a Recent 10-Year Period in One Center

PURPOSE: This study was conducted to analyze the clinical characteristics and treatments of patients with genitourinary tuberculosis (GUTB) over the past 10 years. MATERIALS AND METHODS: The study population comprised 101 patients who were diagnosed with GUTB and hospitalized from January 2000 to December 2009. Acid-fast bacilli (AFB) smear, urine tuberculosis culture, urine tuberculosis polymerase chain reaction (PCR), intravenous urography, cystoscopy, and histopathologic findings were used for patient selection. Yearly proportion, gender, patient distribution according to age, history of tuberculosis, and presence of other organ tuberculosis were analyzed. RESULTS: The patients hospitalized with GUTB counted for 0.9% of all patients admitted to the department of urology. The sex ratio was 1:1.53 (male:female), and the patients' mean age was 45.57+/-12.55 years (range, 19-81 years). Among the patients, there was one immunocompromised patient. A total of 22 patients (21.8%) had a medical history of tuberculosis, mostly pulmonary tuberculosis (90.9%). The sensitivity of AFB stain, tuberculosis culture, and PCR was 41.6%, 55.4%, 33.7%, respectively. A total of 54 patients required additional surgical treatment: 30 cases of nephrectomy, 8 cases of epididymectomy, 8 cases of ureteral stent, 5 cases of nephrostomy, 1 case of ureterectomy, 1 case of augmentation cystoplasty, and 1 case of transurethral resection of prostate. CONCLUSIONS: The frequency of GUTB tended to decrease progressively. However, GUTB is still a threat to public health. There was no previous history of tuberculosis in two-thirds of the cases of GUTB and more than half of them required further surgical treatment.

Tuberculosis genitourinaria: reporte de 11 casos en el Hospital Universitario de Santander, Colombia, 2003-2008 / Genitourinary tuberculosis: a report of 11 cases in Santander University Hospital, Colombia, 2003-2008

Introducción: La tuberculosis constituye aún un problema de salud pública en el mundo, el cual se agrava por la pandemia del SIDA. La tuberculosis extrapulmonar puede comprometer cualquier órgano, siendo el sistema genitourinario uno de los más afectados, por lo cual es importante conocer su magnitud en cada institución. Objetivos: Caracterizar la tuberculosis genitourinaria desde el punto de vista epidemiológico, clínico y paraclínico de los pacientes en los cuales la enfermedad constituyó la causa básica de muerte y su compromiso genitourinario fue un hallazgo principal de autopsia. Metodología: Estudio descriptivo retrospectivo realizado entre el 2003 y el 2008 mediante revisión de los protocolos de autopsias efectuadas en el Departamento de Patología de la Universidad Industrial de Santander, de los pacientes que fallecieron a causa de tuberculosis en el Hospital Universitario de Santander, Colombia. Resultados: Se encontraron 11 casos, con rango de edad entre 20 y 66 años, de los cuales 8 correspondían a hombres y 5 se asociaron con síndrome de inmunodeficiencia adquirida. Las manifestaciones clínicas más frecuentes fueron los síntomas constitucionales, seguido de los respiratorios, los urinarios, el dolor lumbar y los testiculares. El diagnóstico se realizó a través de los hallazgos anatomopatológicos durante la autopsia. Conclusiones: La tuberculosis genitourinaria es una forma severa de tuberculosis extra pulmonar, que por la poca especificidad del cuadro clínico, tiene un índice de sospecha bajo, lo que resulta inconveniente, ya que no permite diagnóstico oportuno, ni tratamiento adecuado para prevenir daños severos irreversibles.

Introduction: Tuberculosis continues to be a serious public health problem worldwide, which increases with AIDS pandemic. Extra-pulmonary tuberculosis can compromise any organ, genitourinary system being one of the most affected therefore it is important to assess the magnitude at institutional level. Objective: Summarize the epidemiologic, clinical, and laboratory data, along patients with tuberculosis as cause of death and genitourinary tuberculosis as autopsy main finding. Methodology: A retrospective- descriptive study based on the autopsy records of the Department of Pathology of the University Industrial of Santander of 11 patients deceased from tuberculosis in the University Hospital of Santander between 2003 and 2008. Results: The range patient age was between 20 and 66 years, 8 were men and 5 had AIDS. The most common clinical manifestations were the constitutional symptoms, followed by respiratory, urinary, lumbar pain, and testicular symptoms. The anatomo-pathological and histo-pathological findings at the time of the autopsy made the diagnosis. Conclusions: Genitourinary tuberculosis is a severe form of extra-pulmonary tuberculosis, which due to its unspecific clinical picture, has a low suspicious index, resulting inconveninet, since it does not allow a timely diagnosis, or treatment to prevent irreversible severe damages.

Prostatic tuberculosis: case report / Tuberculosis prostática: informe del caso

CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.

CONTEXTO: La tuberculosis prostática ha sido principalmente descrita en pacientes inmunodeprimidos. Sin embargo, es excepcional como lesión aislada en pacientes inmunocompetentes. CASO CLINICO: Describimos el caso de un varón sano e inmunocompetente con tuberculosis prostática y hallazgos irrelevantes en la urografía de eliminación realizada. La tomografía computerizada (TC) mostró un absceso en próstata, aislándose en el urocultivo Mycobacterium tuberculosis. El tratamiento con isoniazida, rifampicina y pirazinamida fue exitoso.

Patrones morfológicos de la tuberculosis: serie de casos en necropsias del Hospital Universitario de Santander entre enero de 2003 y diciembre de 2006 / Morphological patterns of tuberculosis: series of fatal cases at Hospital Universitario of Santander between January 2003 and December 2006

La Tuberculosis es una enfermedad que hace 25 años se encontraba controlada, con parámetros clínicos y paraclínicos muy bien definidos para diagnóstico y manejo. Con el advenimiento de la infección por el VIH y el aumento de la desnutrición, se ha presentado un cambio en el espectro de presentación de la tuberculosis. Objetivo: describir los hallazgos morfológicos de la tuberculosis en pacientes fallecidos en un hospital público de tercer nivel, con especial interés en aquellos pacientes con coinfección por VIH-SIDA. Materiales y Métodos: se revisaron 738 protocolos de necropsias realizadas en la morgue del Hospital Universitario de Santander del departamento de patología de la Universidad Industrial de Santander de los años 2003 al 2006, los cuales correspondieron a 17 casos fatales de tuberculosis, se realiza una búsqueda de la literatura en Medline, Scielo y Lilacs en búsqueda de series similares, las cuales se comparan con la presentada en este estudio. Resultados: los 17 casos de tuberculosis fatal, presentan cuatro patrones morfológicos: siete casos (41,2%) son de tuberculosis miliar diseminada, cuatro casos (23,5%) de tuberculosis miliar pulmonar, cuatro casos (23,5%) de tuberculosis de órgano aislado y dos casos (11,7%) de tuberculosis pulmonar cavitada. En pacientes con coinfección VIH-SIDA el patrón morfológico más usual es la tuberculosis miliar generalizada (29 %), en aquellos sin coinfección con VIH-SIDA el patrón morfológico más común es la tuberculosis de órgano aislado (23 %). Conclusión: se nota un cambio en la forma de presentación morfológica de la tuberculosis, con un predominio de las formas miliar pulmonar y miliar generalizada en especial esta última asociada a infección por VIH...

Twenty five years ago, Tuberculosis (TB) was a well-controlled illness, with very well-defined clinical and paraclinical diagnosis and handling parameters. The outbreak of Human Immunodeficiency Virus (HIV) infection, together with raised malnutrition levels, has resulted in a changed clinical manifestation of TB. Objective: To conduct fatal TB necropsy case series along last four years. Materials and Methods: 738 necropsy protocols conducted at the morgue of Hospital Universitario of Santander by the Pathology Department at the Universidad Industrial of Santander between January 1st 2003 and December 31st 2006 were reviewed of which 17 protocols corresponded to fatal TB cases. Additionally, MedLine Literature was analyzed including a comparison of result to series similar to that of this study. Results: 17 fatal TB cases are included, presented in four morphological patterns: seven cases (41,2%) of Disseminated TB, four cases (23,5%) of pulmonary miliary TB, four cases (23,5%) isolated organ TB, and two cases (11,7%) of cavitary pulmonary TB. Conclusion: TB changed its most frequent cavitary pulmonary TB manifestation into disseminated miliary form affecting predominantly lung, lymph node, spleen, liver, kidney and adrenal gland of HIV-infected patients or extreme malnutrition cases. Increased central nervous system compromise is evident not only as meningitis with outstanding vasculitis but also as abscess and Tuberculoma. The series also shows slight compromise of organs such as prostate, testes, uterus and small intestine...