Effect of cold vibrator device on pain perception of children aged 6-12 years old undergoing Mantoux Test at Philippine Children's Medical Center out-patient department

@#<p><strong>BACKGROUND:</strong> Painful procedures intensify hospital-related stress and anxiety leading to unpleasant experience that can adversely affect procedure outcomes and health seeking behaviors.</p><p><strong>OBJECTIVE:</strong> To determine the effect of a cold vibrator device on pain perception of children aged 6-12 years old during Mantoux Test at the Out-Patient Department of the Philippine Children's Medical Center.</p><p><strong>METHODOLOGY:</strong> This is a single blinded, randomized control trial where one-hundred four (104) subjects were randomly assigned to experimental (54 subjects) and control group (50 subjects) through fishbowl method. The experimental group received the cold vibrator prior to Mantoux test while the control group received the Mantoux test alone. Pre and post procedural heart rate, respiratory rate and oxygen saturation were obtained. The responses were evaluated using the Wong-Baker Faces Pain Scale.</p><p><strong>RESULTS:</strong> Pain score was higher in the control group. Wilcoxon Rank-Sum Test showed mean rank of 67.5 with aggregated pain rank of 3645.00 compared to experimental group (with cold vibrator) of 36.3 with aggregated pain rank of 1815.00 with a p value 0.0000000046. There was no significant difference between the physiologic parameters (heart rate, respiratory rate, and oxygen saturation) before and after procedure between the two groups.</p><p><strong> CONCLUSION AND RECOMMENDATION:</strong> The use of the cold vibrator was effective in reducing pain perception. It can be used as an adjunct to mitigate pain for needle-related procedures. Demographic data could also be correlated to the pain scores of the subjects. </p>

Potencial do teste IGRA (Interferon Gama Release Assay) para o diagnóstico de tuberculose ocular. Revisão e análise comparativa com o teste tuberculínico cutâneo (PPD) / The potential of the IGRA (Interferon Gamma Release Assay) test for the diagnosis of ocular tuberculosis. Review and comparative analysis with the tuberculosis skin test

Resumo A detecção precisa da infecção latente por tuberculose está se tornando cada vez mais importante devido ao aumento do uso de medicamentos imunossupressores e da epidemia do vírus da imunodeficiência humana, o que aumentou o risco de reativação à tuberculose ativa (TB). O Teste IGRA QuantiFERON® TB Gold apresenta vantagens frente ao teste de PPD como por exemplo, requer somente uma coleta de amostra sanguínea ; não há necessidade que o paciente retorne ao laboratório para leitura e interpretação dos resultados; Os resultados são objetivos, não requerem interpretação do leitor ou interferência de critérios subjetivos; trata-se de um teste in vitro, portanto não há "efeito booster" (potenciação da reação tuberculínica); o teste não é afetado por vacinação prévia por BCG ou infecção por outras espécies de micobactérias. Limitações são descritas, apesar de raras, como reações cruzadas deste método com infecções por algumas espécies de micobactérias não-tuberculosis (incluindo Mycobacterium kansasii, Mycobacterium szulgai e Mycobacterium marinum). Ainda há poucos dados sobre o teste IGRA em certas populações, como por exemplo, em crianças, pacientes imunocomprometidos e mulheres grávidas. Nestes grupos, a interpretação do teste pode ser difícil e mais estudos se fazem necessários.

Abstract Precise detection of latent tuberculosis infection is becoming increasingly important due to increased use of immunosuppressive drugs and the human immunodeficiency virus epidemic , which increased the risk of reactivation to active tuberculosis (TB).The QuantiFERON® TB Gold IGRA Test has advantages over the skin test for TB, otherwise known as a Mantoux tuberculin test, for example, requires only a blood sample collection; there is no need for the patient to return to the laboratory for reading and interpretation of the results; The results are objective, do not require interpretation of the reader or interference of subjective criteria; it is an in vitro test, so there is no "booster effect" (potentiation of the tuberculin reaction); the test is not affected by prior BCG vaccination or infection with other species of mycobacteria. Limitations are described, although rare, as cross-reactions of this method with infections by some species of non-tuberculosis mycobacteria (including Mycobacterium kansasii, Mycobacterium szulgai and Mycobacterium marinum). There is still little data on the IGRA test in certain populations, such as in children, immunocompromised patients and pregnant women. In these groups, the interpretation of the test can be difficult and more studies are needed.

​Interpretation And Clinical Correlation Of Tuberculin Skin Test Results Among Clinically Diagnosed Childhood Tuberculosis

Background: Diagnosing tuberculosis (TB) was still a worldwide big challenge in cases with negative reports of Xpert MTB/RIF, smear, and culture test of acid-fast bacilli (AFB). A single, direct Xpert MTB/RIF test identified 98.2% of the sputum smearpositive TB cases and 72.5% of those with sputum smear-negative TB. Such a diagnosis was often made based on the clinicalcriteria and other supportive findings like tuberculin skin test (TST).Objective: Hence, this study was to help in the diagnosis and treatment of clinically diagnosed childhood TB, especially in thelimited resource rural areas and developing countries.Materials and Methods: Based on the WHO revised criteria of TB diagnosis, to include clinically diagnosed TB instead ofsmear-negative TB disease, an operational definition of clinically diagnosed TB for the selection of participants for TST wasestablished for this study. Based on the recommendation of the CDC team at the Saskatchewan Lung Association, 2007-03-21at the Wayback Machine, the TST results of the study were interpreted.Results: Hence, in our study, the sensitivity of TST was 82.35% (≥10 mm) in the age group of 1–4 years and 60.16% (≥15 mm)in the age group of >4–12 years. However, this study shows that the positivity rate of TST was increased from 60.16% (≥15 mm)to 86.15% (≥10 mm), if the TST results≥10 mm were interpreted as positive even in this age group of >4 years–12 years.Conclusion: In such very difficult situations of clinically diagnosed TB, this study observed that empiric anti-TB treatment may bestarted without microbiological confirmation to clinically diagnosed childhood TB patient with negative reports of Xpert MTB/RIF,smear, and culture test of AFB, presented with one or more of the following symptoms and signs of clinically diagnosed childhoodTB: (1) Chronic anorexia, (2) ill health and fatigue, (3) weight loss of >5% during the past 3 months or documented failure to striveduring the preceding 3 months, (4) night sweating and persistent fever >2 weeks, and (5) non-remitting cough >2 weeks but cannot bediagnosed clinically by any possible causes than TB, and positive TST report, in resource-limited rural areas anddeveloping countries.

Clinical study and management of genitourinary tuberculosis

Background: Tuberculosis can affect any organ system of the body, including the genitourinary tract. Genitourinary TB is the most common form of extra pulmonary TB accounting for 27% (14- 41%) worldwide. Aim and objectives: To study distribution of GU TB in relation to age, sex, anatomical site, signs and symptoms and to study various diagnostic modalities, treatment and role of surgery in GU TB. Materials and methods: This study was a cross sectional study done at department of Urology, King George hospital, Visakhapatnam. The study was done over a period of 30 months, which was from September 2014 to February 2017. All the patients reporting to the hospital with proven genitourinary tuberculosis or diagnosed after coming to the hospital were included in the study. Total number of cases was 35. 10 were males and 25 were females. History, physical examination, laboratory and radiological investigations were done on the patients and the primary focus of the disease and organs involved are determined. All the patients received treatment as indicated. Results: Most of the patients (33 out of 35) belonged to low socio-economic status and came from rural settings. Of them 10(28.57%) were males and 25(71.43%) were females. The mean age of patients was 36 years (range 16-60years). 2 patients were <20 years, 11 patients were between 21-30 years, 11 patients were between 31-40 years, 8 patients were between 41-50 years and 3 were above 50 years. In this study, kidney was involved in 19 cases and was the most common organ involved, followed by bladder (14 cases) and ureter(10 cases). Irritative voiding symptoms were the most common symptom seen in 23 cases. Flank pain was noted in 20 cases, sterile pyuria in 22 cases and hematuria in 7 cases. Six(17.14%) out of thirty five patients had renal failure at the time of presentation and diagnosis. Nephrectomy was done in 12 cases. Nephrectomy with augmentation Immadi Chandrasekhar, Pasalapudi Anurag Jose. Clinical study and management of genitourinary tuberculosis. IAIM, 2019; 6(1): 48-57. Page 49 cystoplasty and ureteric reimplantation was done in another 6 cases. Ileal conduit was done in 6 cases. Ureteric reimplantation with psoas hitch was done in 3 cases. Conclusion: Genitourinary tuberculosis is often silent and has nonspecific clinical features. Irritative voiding symptoms are the common presentation. Kidney is the most commonly affected organ in GU TB. GU TB is a disease of young adults, with majority affected in the 3rd and 4th decades. CT scan is replacing IVU as an imaging modality of choice in GU TB. Diagnosis of GU TB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens and the difficulty to isolate or grow TB bacilli. Hence a strong clinical suspicion is necessary for correct diagnosis. Anti-tubercular therapy is the mainstay of treatment. Genitourinary tuberculosis results in sequel which may require major organ removing and reconstructive surgeries

High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India

BACKGROUND/AIMS: The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed. METHODS: This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated). RESULTS: Of 69 patients (22 ulcerative colitis/47 Crohn’s disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5–48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0–84.5 weeks) of IFX. Of these 8 patients’ none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn’s disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation. CONCLUSIONS: There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.

Latent tuberculosis infection screening in juvenile idiopathic arthritis patients preceding anti-TNF therapy in a tuberculosis high-risk country / Rastreamento da infecção latente por tuberculose em pacientes com artrite idiopática juvenil previamente à terapia anti-TNF em um país de alto risco para tuberculose

Abstract Objectives: To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers. Methods: This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals. Results: Sixty-nine JIA patients with current age of 17.4 ± 5.8 years, mean disease duration of 5.0 ± 4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years). Conclusion: Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients.

Resumo Objetivo: Avaliar, em um país endêmico, a eficácia em longo prazo do rastreamento à procura de infecção latente por tuberculose (ILTB) e profilaxia primária em pacientes com AIJ em uso de bloqueadores do TNF. Métodos: Trata-se de uma coorte retrospectiva que incluiu pacientes com AIJ elegíveis para a terapia anti-TNF. Os pacientes foram rastreados à procura de ILTB previamente ao uso de anti-TNF por meio do teste tuberculínico (TT), radiografia de tórax e história de exposição à TB. Os indivíduos foram acompanhados regularmente em intervalos de dois meses. Resultados: Incluíram-se 69 pacientes com AIJ com idade atual de 17,4 ± 5,8 anos, com média de duração da doença de 5 ± 4,9 anos; 47 pacientes receberam um único anti-TNF, enquanto 22 foram transferidos para outro anti-TNF uma ou duas vezes: 57 foram tratados com etanercepte, 33 com adalimumabe e três com infliximabe. O rastreamento à procura de ILTB foi positivo em três pacientes: um era TT positivo e tinha história de exposição à TB e dois apenas eram TT positivo. Não foi diagnosticado caso de TB ativa durante o período de estudo (mediana de seguimento de 3,8 anos). Conclusão: A avaliação em longo prazo revelou que o rastreamento à procura de ILTB e a profilaxia primária antes do tratamento com anti-TNF foram eficazes em um país de alto risco para TB e o TT foi o parâmetro mais sensível para identificar esses pacientes.

Escrófula, forma frecuente de tuberculosis extrapulmonar. Presentación de un caso / Scrofula, a frequent form of extrapulmonary tuberculosis. Case presentation

Introducción: Las formas de presentación de la tuberculosis (Tb) incluyen: la tuberculosis pulmonar, la miliar y la extrapulmonar. Fuera del pulmón, los sitios donde con mayor frecuencia se localiza la tuberculosis son, por orden de frecuencia: ganglios linfáticos, pleura, aparato genitourinario, huesos y articulaciones, meninges, peritoneo y pericardio. Objetivo: Presentar un caso interesante en la clínica de Tuberculosis extrapulmonar y Tuberculosis pulmonar. Presentación del caso: Paciente masculino de 65 años de edad, alcohólico crónico y fumador, empezó a presentar un aumento de volumen en la región lateral derecha del cuello que fue creciendo progresivamente; además de tos húmeda con expectoración blanquecina, disfagia a los alimentos sólidos, astenia, anorexia y pérdida de peso. Al examen físico se evidencian múltiples adenopatías cervicales supurativas, la mayor de 6cm y estertores crepitantes en tercio superior de hemitórax derecho. La prueba de Mantoux fue positiva y la radiografía de tórax sugestiva de TB pulmonar. El paciente fue egresado por alta a petición con tratamiento antituberculoso y antibiótico ambulatorio, los cuales fueron abandonados por parte del paciente. Es ingresado en segunda ocasión en el Servicio de Geriatría por ulceración de la lesión mayor del cuello donde fallece al tercer día por una sepsis generalizada. Conclusiones: La tuberculosis de los ganglios linfáticos es la presentación más común de la tuberculosis extrapulmonar. Esta enfermedad ataca principalmente a personas inmunodeprimidas y en el caso presentado el paciente tenia factores que podrían haber deprimido su sistema inmune como la edad, el alcoholismo crónico y el tabaquismo(AU)

Introduction: The forms of presentation of the tuberculosis (Tb) include: the pulmonary, miliaria and extrapulmonary tuberculosis. Outside of the lung, the where places with major frequency localizes tuberculosis are, by order of frequency: lymphatic ganglions, pleura, genitourinary system, bones and joints, meninges, peritoneum and pericardium. Objective: To present an interesting case in the clinic of extrapulmonary Tb and lung Tb. Case presentation: Masculine 65-years patient of age, chronic alcoholic and smoker. That began to present an increase of volume in the lateral right region of the neck that went growing progressively; besides humid cough with whitish expectoration, dysphagia to the solid foods, asthenia, anorexia and loss of weight. The physical examination made evident multiple cervical suppurative adenopathias, the major of 6cm and crepitating rasps at the superior third of the right hemi-thorax. The Mantoux proof was positive and the thorax X-ray suggested a pulmonary TB. The patient was discharged with a treatment against tuberculosis and ambulatory antibiotic, which were abandoned by the patient. He was entered in second occasion in the service of geriatrics for ulceration of the major injury of the neck and dies at the third day for a generalized sepsis. Conclusions: The tuberculosis of the lymphatic ganglions is the more common presentation of the extrapulmonary tuberculosis. Illness attacks principally to the persons with low defenses and in the presented case the patient had factors that could have depressed his immune system as the age, the chronic alcoholism and the smoking(AU)

Neumonía como forma de presentación de la tuberculosis pulmonar / Pneumonia as a form of presentation of pulmonary tuberculosis

INTRODUCCIÓN: la tuberculosis pulmonar es un flagelo que continúa afectando a la población en general, y con gran repercusión en la población infantil a nivel mundial y regional. Considerada desde hace varias décadas como una enfermedad en reemergencia, debe ser reconocida -lo más tempranamente posible- por los trabajadores de la salud, y sobre todo, por el personal médico. PRESENTACIÓN DEL CASO: se presenta el caso de un paciente de 14 años de edad, del sexo masculino, que presentaba sintomatología respiratoria de más de dos meses de evolución, e ingresó en un servicio de enfermedades respiratorias con el diagnóstico de neumonía complicada. En el interrogatorio se recogen datos de interés, se supieron las condiciones socioambientales del paciente, y que un familiar conviviente con el niño había evadido el control ambulatorio al haber sido diagnosticado de tuberculosis pulmonar, por lo que no concluyó tratamiento. Se exponen los principales resultados de los complementarios (incluyendo prueba de Mantoux positiva), evolución de las radiografías de tórax y tratamiento antituberculoso aprobado con el servicio de Infectología y el Centro Nacional de Referencia de Tuberculosis Infantil. CONCLUSIONES: es importante una historia clínica epidemiológica detallada en todo paciente con neumonía adquirida en la comunidad.

INTRODUCTION: pulmonary tuberculosis is a scourge that keeps affecting the general population, with a great impact on the infant population in the region and worldwide. Since many years ago, it is considered a re-emergent disease and should be identified -as early as possible- by the health workers, and mainly the medical staff. CASE PRESENTATION: a 14 years-old male patient who presented with respiratory symptoms for more than 2 months and was admitted to a respiratory disease service under diagnosis of complicated pneumonia. During the interview, interesting data were collected about his/her social and environmental conditions and it was found out that a relative, who live in the same house, did evade the outpatient control after he being diagnosed as a pulmonary tuberculosis case, thus he did not finish the treatment. The main results of the supplementary tests (including positive Mantoux test), progress of chest x-rays and the antituberculosis treatment approved by the Infectology service and the National Center of Reference for Child Tuberculosis were all described. CONCLUSIONS: it is essential to have a detailed epidemiological clinical record of every patient with community-acquired pneumonia.

Interpretation of Mantoux test in children

Tuberculosis is the most common infectious cause of death worldwide. Young children especially infants usually are more susceptible to tuberculous infection. Disease usually develops within 1 year of infection. The present study has been conducted upon 41 children in whom Mantoux test was positive (n=41). These children were coming to our outpatient department, in a Teaching Hospital, Nizamabad, Telangana State with mild fever, cough, night sweats, anorexia, and loss of weight. The age group selected for this study was 1 to 12 year, and the period of study was from August, 2013 to December, 2015. Among the 41 children under study 13 children were 1 to 4 year and 28 were 5 to 12 year. Among the total 41 cases of Mantoux positive, 16 (39%) were found to be suffering from tuberculous disease and anti tuberculous drugs were started. In these cases 7 were 1 to 4 year (n=13), and 9 were 5 to 12 year (n=28). After 3 months follow up, all the children who were on ATT became free from their symptoms. It shows association between mantoux positivity and tuberculosis is more in children between 1 and 4 year than children between the age of 5 and 12 year. Most of the other children needed antipyretics, other symptomatic drugs and antibiotics only. But in 3 cases symptoms were not relieved either with antibiotics or with trial ATT. The factors for deciding tuberculosis are history of contact, clinical picture, CBP, ESR, chest- x- ray, Mantoux test, sputum for AFB, antibiotic trial, follow up, trial ATT. All these factors are put together and then only we will decide whether to start ATT or not.

An unusual presentation of lupus vulgaris in pediatric patient: A clinico-histopathological diagnosis.

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 12 years old boy who was diagnosed as lupus vulgaris clinically as well as histopathologically simultaneously. He had well demarcated, irregularly bordered, pink, infiltrated plaques on the nose showing apple-jelly appearance on diascopy with multiple lymphadenopathy on bilateral submandibular and cervical group of lymph nodes. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux test showed positive reaction (20 mm) and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed significant improvement on anti-tuberculosis treatment. The main purpose of this case report was to emphasize that histopathological examination has diagnostic value in clinical suspicion of LV on face, when direct analysis or culture is negative.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

Mycobacterium tuberculosis epitope-specific interferon-g production in healthy Brazilians reactive and non-reactive to tuberculin skin test

The interferon (IFN)-γ response to peptides can be a useful diagnostic marker of Mycobacterium tuberculosis (MTB) latent infection. We identified promiscuous and potentially protective CD4+ T-cell epitopes from the most conserved regions of MTB antigenic proteins by scanning the MTB antigenic proteins GroEL2, phosphate-binding protein 1 precursor and 19 kDa antigen with the TEPITOPE algorithm. Seven peptide sequences predicted to bind to multiple human leukocyte antigen (HLA)-DR molecules were synthesised and tested with IFN-γ enzyme-linked immunospot (ELISPOT) assays using peripheral blood mononuclear cells (PBMCs) from 16 Mantoux tuberculin skin test (TST)-positive and 16 TST-negative healthy donors. Eighty-eight percent of TST-positive donors responded to at least one of the peptides, compared to 25% of TST-negative donors. Each individual peptide induced IFN-γ production by PBMCs from at least 31% of the TST-positive donors. The magnitude of the response against all peptides was 182 ± 230 x 106 IFN-γ spot forming cells (SFC) among TST-positive donors and 36 ± 62 x 106 SFC among TST-negative donors (p = 0.007). The response to GroEL2 (463-477) was only observed in the TST-positive group. This combination of novel MTB CD4 T-cell epitopes should be tested in a larger cohort of individuals with latent tuberculosis (TB) to evaluate its potential to diagnose latent TB and it may be included in ELISPOT-based IFN-γ assays to identify individuals with this condition.

Profile of serpiginous choroiditis in a tertiary eye care centre in eastern India.

Purpose: To study the clinical profile of serpiginous choroiditis in eastern India. Materials and Methods: Ninety‑one eyes of 54 patients with serpiginous choroiditis presenting to a tertiary care centre in eastern India between January 2006 and December 2010 were included in the study. Clinical presentation, treatment given, and visual outcome of the eyes were studied. Results: Thirty‑five (64.8%) patients were male and 19 (35.2%) were female in the age group of 13‑62 years (mean age: 34.1 ± 18.7 years). Blurring of vision (71; 78%) and floaters (36; 39.5%) were commonest symptoms. In 75 (82.4%) eyes, choroiditis started from optic nerve head and spreading centrifugally. Overall, 38 (41.75%) eyes had macular involvement at first visit. Mantoux test reading was 10 mm or more (Group A) in 12 (22.22%) patients and less than 10 mm (Group B) in 42 (77.77%) patients. Difference between Groups A and B in macular involvement at first visit (10; 50% vs. 28; 39.4%) and rate of recurrence (3; 15% vs. 14; 19.7%) was not statistically significant (P = 0.37 and 0.68). Oral steroid (51; 94.4%) was the commonest mode of treatment. Fifty‑one (56%) eyes had two lines or more improvement in vision. Conclusions: The present study details the clinical presentation, treatment, and visual outcome of serpiginous choroiditis. Mantoux test reading does not affect the clinical presentation or the treatment outcome in these eyes.

Exaggerated mantoux reaction in a case of LTBI.

Summary: A 42-year-old female presented with a history of receiving PPD on right forearm intradermally before two days. Patient started having itching and irritation within a few hours and pain, oedema and vesicles formation by next day at the injection site. On examination, the whole right forearm was oedematous with induration of size 50mm x 50mm around the site of injection. Tubercular infection was suspected and the patient was subjected to further investigation but nothing, including physical examination, hemogram, fundus examination, chest X-ray, USG abdomen and CT thorax, was found suggestive of tuberculosis, leading to a diagnosis of LTBI.

Sarcoidosis in north indian population: A retrospective study.

Background. Sarcoidosis is a systemic granulomatous disease of unknown origin most commonly involving the lungs. Sarcoidosis is frequently misdiagnosed due to its clinico-radiological resemblance to tuberculosis (TB). Hence, the present study was undertaken with the aim of studying the clinico-radiological profile of sarcoidosis in the Indian context. Methods. We retrospectively studied 146 patients diagnosed to have sarcoidosis during the period 2001-2010 at one of the respiratory units at Vallabhbhai Patel Chest Institute. Results. Majority of them (70%) were more than 40 years of age; females comprised 58.2% of the patients. Before coming to our clinic, 30% patients had been misdiagnosed to have TB. Cough (89.7%) was the most common presenting symptom; joint symptoms (28.8%) and end inspiratory crepitations at lung bases (49.3%) were other salient manifestations. Cutaneous involvement and digital clubbing were rarely seen. Pulmonary function testing showed restriction with impaired diffusion in 72.7% patients. The most common radiological feature was bilaterally symmetrical hilar lymphadenopathy. Transbronchial lung biopsy (TBLB) had a very high diagnostic yield (90.8%). Conclusions. Sarcoidosis is often misdiagnosed as TB in India. Transbronchial lung biopsy has high diagnostic yield in sarcoidosis.

Características clínicas y sociodemográficas de niños menores de 13 años con diagnóstico confirmado de tuberculosis pulmonar o sin él, en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007-2008 / Clinical and sociodemographic characteristics of children, younger than13 years, with or without a confirmed diagnosis of pulmonary tuberculosis, at Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007-2008

Introducción: la tuberculosis (TB) es una de las enfermedades infectocontagiosas más importantes en el mundo debido a que se asocia con altas tasas de morbilidad y mortalidad. En niños puede afectar cualquier órgano o sistema, a cualquier edad, pero con mayor frecuencia es pulmonar. Tiene graves consecuencias si no se la diagnostica y trata de forma oportuna y adecuada. Los síntomas y signos son variados e inespecíficos lo que, sumado a la dificultad en el aislamiento del Mycobacterium tuberculosis a partir de muestras de niños disminuye la probabilidad de hacer el diagnóstico. Objetivo: puntualizar las características clínicas y sociodemográficas de un grupo de niños con sospecha o diagnóstico final de tuberculosis pulmonar. Metodología: la población en estudio correspondió a 56 niños menores de 13 años atendidos en los servicios pediátricos de urgencias y hospitalización del Hospital Universitario San Vicente de Paúl, en Medellín, a quienes se les sospechó o confirmó TB pulmonar, según los criterios de la OMS, entre julio de 2007 y diciembre de 2008. Se aplicó un formulario para la recolección de los datos, que se obtuvieron directamente de los pacientes o sus acudientes, y se completaron con las historias clínicas en el archivo del hospital. Resultados: en 38 de los 56 niños (67,9%) se confirmó el diagnóstico de tuberculosis pulmonar. El 87,5% pertenecían a los estratos socioeconómicos más bajos (1 y 2); 55% provenían del área urbana de Medellín, 70% eran mestizos y 28,6%, indígenas. La tos y la fiebre fueron las manifestaciones más comunes en el grupo con diagnóstico definitivo de TB; el criterio epidemiológico fue positivo en 53,6% de los casos, el radiológico en 51,8% y el tuberculínico, en 41,1%. Conclusión: la TB pulmonar sigue presente en la población infantil y se debe tener un alto índice de sospecha clínica para detectarla, pues las manifestaciones son variadas e inespecíficas...

Introduction: Worldwide, tuberculosis is one of the most important infectious and contagious diseases. It is associated with high morbidity and mortality rates. In children, tuberculosis is most frequently pulmonary but it may affect every organ and system. Its consequences, if inadequately treated, may be severe. Symptoms and signs are diverse and nonspecific, and the bacteriological confirmation is difficult in children. For these reasons, making the diagnosis in the pediatric population may be a really difficult challenge.Objective: To determine the sociodemographic and clinical characteristics of a group of children with suspicion or confirmed diagnosis of pulmonary tuberculosis.Methodology: Fifty six children were studied at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, between July 2007 and December 2008. Pulmonarytuberculosis was confirmed according to the WHO criteria. Information was obtained from the patients themselves, their parents, and the hospital files. Results: In 38 of the 56 children (67.9%) pulmonary tuberculosis was confirmed. Their socioeconomic situation was poor in 87.5% of the cases; 55% came from the urban area of the city; 70% were mestizo, and 26.8%, Indians. Cough and fever were the predominant clinical manifestations. The positivity rate of diagnostic criteria was as follows: 53.6% for the epidemiological, 51.6% for the radiological, and 41.1% for the tuberculin test. Conclusion: Pulmonary tuberculosis continues to be of great importance in the pediatric population...

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)

The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3), patients with CD4 counts ² 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ² 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.

Interpretación de la prueba tuberculínica en adultos vacunados con BCG / Tuberculin skin test interpretation in adults vaccinated with BCG

La prueba de tuberculina o de Mantoux, es el único método probado en nuestro medio para la identificación de las personas infectadas por M. tuberculosis que no presentan la enfermedad. La prueba de tuberculina dirigida es un componente estratégico para el control de la tuberculosis (TB), ya que permite identificar a los sujetos de alto riesgo para el desarrollo de la enfermedad. Se incluyeron 80 estudiantes de la Escuela de Enfermería, para detectar los casos de tuberculosis latente y los sujetos PPD negativos. Se realizó historia clínica y administración de PPD siguiendo la metodología estándar. De los sujetos estudiados, el 85% eran del género femenino y 15% masculino. El grupo etario predominante (71%) estuvo entre 15 y 24 años. Los resultados de lectura fueron los siguientes: 36% de estudiantes presentó induración entre 0 y 4 mm; el 34% entre 5 y 9 mm, el 16% entre 10 y 14 mm y el 14% entre 15 y 20 mm. La prueba de tuberculina es el mejor método diagnóstico para la tuberculosis latente y la vacunación BCG no resta valor a esta prueba diagnóstica.

The Mantoux test is the only proven diagnostic method for latent tuberculosis in our country. The targeted tuberculin test is an strategic component for TB control, as it permits identifying high risk subjects for developing the disease and once detected can be treated. We included 80 students from our Nursing School. Clinical examination and case history was performed and the Mantoux test was applied following the standard techniques. From the subjects included 85% were females and 15% males. The age group predominant was between 15 and 24 years old. The Mantoux results were as follows: induration values between 0 and 4 mm 36%; 5 to 9 mm 34%; 10 to 14 mm 16% and 15 to 20 mm 14%. The Mantoux test is the best method for diagnosing latent TB and previous vaccination with BCG does not invalidate the test for this purpose.

The Significance of Mantoux Test and Antitubercular Therapy in the Patients with Inflammatory Nodules on the Legs / 대한피부과학회지

BACKGROUND: The inflammatory nodules on the legs are often difficult to distinguish because of clinical variations and similarity of histopathologic features. Both erythema nodosum and erythema induratum are known to be associated with various conditions, especially tuberculosis. In Korea where tuberculosis is still a major health problem, it may be a cause for the inflammatory nodules on the legs. OBJECTIVE: The purpose of this study was to establish the correlation with Mantoux test and inflammatory nodule and evaluate the efficacy of antitubercular therapy in Korea. METHODS: We performed the prospective study of 26 patients with inflammatory nodules on the legs. All patients preformed Mantoux test and skin biopsy. The patients who had strongly positive Mantoux reaction were treated with antitubercular therapy. RESULTS: The ages of the 26 patients (Male 4:Female 22) ranged from 12 to 76 years. All patients had recurrent painful, tender subcutaneous nodules on the legs. Fourteen patients of total 26 patients had a strongly postive Mantoux reaction (induration > or = 20 mm). They were treated with combination antitubercular therapy. After antitubercular therapy, skin lesions subsided in 12 patients within 2 months and in the remaining 2 patients, subsided within 4 months. The therapy was well tolerated except for flu-like symptom in one patient and drug induced hepatitis in the other patient. CONCLUSION: We suggest that antitubercular therapy is effective in the management of patients with a strongly positive Mantoux reaction with chronic recurrent inflammatory nodules on the legs in Korea.