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Mem. Inst. Oswaldo Cruz ; 116: e200517, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154877


Molecular-typing can help in unraveling epidemiological scenarios and improvement for disease control strategies. A literature review of Mycobacterium tuberculosis transmission in Brazil through genotyping on 56 studies published from 1996-2019 was performed. The clustering rate for mycobacterial interspersed repetitive units - variable tandem repeats (MIRU-VNTR) of 1,613 isolates were: 73%, 33% and 28% based on 12, 15 and 24-loci, respectively; while for RFLP-IS6110 were: 84% among prison population in Rio de Janeiro, 69% among multidrug-resistant isolates in Rio Grande do Sul, and 56.2% in general population in São Paulo. These findings could improve tuberculosis (TB) surveillance and set up a solid basis to build a database of Mycobacterium genomes.

Humans , Polymorphism, Restriction Fragment Length/genetics , Minisatellite Repeats/genetics , Mycobacterium tuberculosis/genetics , Brazil/epidemiology , Bacterial Typing Techniques , Molecular Epidemiology , Whole Genome Sequencing , Genotype , Mycobacterium tuberculosis/isolation & purification
Braz. arch. biol. technol ; 64(spe): e21210127, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285571


Abstract The rapid and accurate diagnosis of tuberculosis (TB), especially considering limited resources, is still a challenge. Development of new methodologies and tests are needed to overcome several disadvantages of the available standard tests. We evaluated the diagnostic potential of two antigens specific for Mycobacterium tuberculosis, the CFP10 and ESAT6 recombinant proteins, and developed stable formulations thereof. Sensitivity and specificity of the delayed-type hypersensitivity (DTH) skin testing and the induction of gamma interferon production (IFN-γ) by lymphocytes, as a non-invasive test, were evaluated using the CFP10 and ESAT6 protein formulations. The recombinant proteins produced by our group presented a high DTH response and the ability to differentiate between tuberculosis infection, BCG vaccination, and the contact with non-tuberculous mycobacteria (NTM). The production of IFN-γ by stimulation with individual and combined proteins was detected in a panel of 40 individuals and showed a specificity of 100% and a sensitivity of 90% when the two proteins were used together. Lyophilized formulations were stable under all conditions, while soluble formulations were stable under freezing at -20 ºC and -80 ºC. The proposed formulations containing the ESAT6 and CFP10 recombinant antigens constitute satisfactory tools for TB testing, suitable to be developed and implemented in a large-scale trial.

Tuberculosis/diagnosis , Interferon-gamma , Mycobacterium tuberculosis/isolation & purification , Antigens/chemistry
Article in English | WPRIM | ID: wpr-887737


Objective@#To evaluate multidrug resistant loop-mediated isothermal amplification (MDR-LAMP) assay for the early diagnosis of multidrug-resistant tuberculosis and to compare the mutation patterns associated with the @*Methods@#MDR-LAMP assay was evaluated using 100 @*Results@#The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDR-LAMP were 85.5%, 93.6%, 96.7%, and 74.4% for the detection of resistance to isoniazid and rifampicin, respectively, and 80.5%, 92.3%, 98.6%, and 41.4% for the detection of @*Conclusion@#MDR-LAMP is a rapid and accessible assay for the laboratory identification of rifampicin and isoniazid resistance of

Antitubercular Agents , Bacterial Proteins/genetics , Catalase/genetics , DNA, Bacterial/analysis , DNA-Directed RNA Polymerases/genetics , Drug Resistance, Multiple, Bacterial/genetics , Isoniazid , Molecular Diagnostic Techniques/methods , Mutation , Mycobacterium tuberculosis/isolation & purification , Nucleic Acid Amplification Techniques/methods , Oxidoreductases/genetics , Phenotype , Rifampin , Whole Genome Sequencing
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 366-370, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138633


INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.

INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.

Humans , Female , Aged , Tuberculosis, Female Genital/complications , Tuberculosis, Female Genital/diagnosis , Endometritis/etiology , Tuberculosis, Female Genital/microbiology , Tuberculosis, Female Genital/pathology , Tuberculosis, Female Genital/drug therapy , Postmenopause , Pelvic Pain/etiology , Granuloma/etiology , Infertility, Female , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
An. bras. dermatol ; 95(3): 343-346, May-June 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130895


Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

Humans , Male , Young Adult , Tuberculosis, Cutaneous/immunology , Tuberculosis, Cutaneous/pathology , Immunocompromised Host , Arthritis, Reactive/immunology , Immunocompetence , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Skin Ulcer/immunology , Skin Ulcer/pathology , Skin Ulcer/drug therapy , Tuberculosis, Cutaneous/drug therapy , Treatment Outcome , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
Mem. Inst. Oswaldo Cruz ; 115: e200520, 2020. tab, graf
Article in English | LILACS | ID: biblio-1154871


BACKGROUND The evaluation of procedures for drug susceptibility prediction of Mycobacterium tuberculosis based on genomic data against the conventional reference method test based on culture is realistic considering the scenario of growing number of tools proposals based on whole-genome sequences (WGS). OBJECTIVES This study aimed to evaluate drug susceptibility testing (DST) outcome based on WGS tools and the phenotypic methods performed on isolates of M. tuberculosis Lineage 1 from the state of Pará, Brazil, generally associated with low levels of drug resistance. METHODOLOGY Culture based DST was performed using the Proportion Method in Löwenstein-Jensen medium on 71 isolates that had been submitted to WGS. We analysed the seven main genome sequence-based tools for resistance and lineage prediction applied to M. tuberculosis and for comparison evaluation we have used the Kappa concordance test. FINDINGS When comparing the WGS-based tools against the DST, we observed the highest level of agreement using TB-profiler. Among the tools, TB-profiler, KvarQ and Mykrobe were those which identified the largest number of TB-MDR cases. Comparing the four most sensitive tools regarding resistance prediction, agreement was observed for 43 genomes. MAIN CONCLUSIONS Drug resistance profiling using next-generation sequencing offers rapid assessment of resistance-associated mutations, therefore facilitating rapid access to effective treatment.

Humans , Tuberculosis, Multidrug-Resistant/genetics , Drug Resistance, Multiple, Bacterial/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Brazil , Pharmaceutical Preparations , Microbial Sensitivity Tests , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Whole Genome Sequencing , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
Einstein (Säo Paulo) ; 18: eAO4620, 2020. tab
Article in English | LILACS | ID: biblio-1039737


ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Referral and Consultation/statistics & numerical data , Tuberculosis, Multidrug-Resistant/epidemiology , Brazil/epidemiology , Microbial Sensitivity Tests , Demography , Prevalence , Cross-Sectional Studies , Tuberculosis, Multidrug-Resistant/microbiology , Sex Distribution , Age Distribution , Middle Aged , Mycobacterium tuberculosis/isolation & purification
Braz. arch. biol. technol ; 63: e20190179, 2020. tab, graf
Article in English | LILACS | ID: biblio-1132181


Abstract (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.

Humans , Tuberculosis, Multidrug-Resistant/microbiology , Antibiotics, Antitubercular/pharmacology , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/drug effects , Microbial Sensitivity Tests , Multicenter Studies as Topic , Sensitivity and Specificity , Tuberculosis, Multidrug-Resistant/drug therapy , Antibiotics, Antitubercular/classification
Rev. Soc. Bras. Med. Trop ; 53: e20190175, 2020. tab
Article in English | LILACS | ID: biblio-1057267


Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.

Humans , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/economics , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/economics , Costs and Cost Analysis/statistics & numerical data , Mycobacterium tuberculosis/genetics , Brazil , Sensitivity and Specificity , Tertiary Care Centers , Genotype , Mycobacterium tuberculosis/isolation & purification
Rev. Soc. Bras. Med. Trop ; 53: e20200205, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136899


Abstract INTRODUCTION: The diagnostic accuracy of Xpert MTB/RIF (Xpert) in pulmonary tuberculosis (PTB) in children is lower than in adults. In Brazil, the diagnosis of PTB is based on a diagnostic score system (DSS). This study aims to study the role of Xpert in children and adolescents with PTB symptoms. METHODS: A cross-sectional study was conducted in 3 referral centers to TB. Children and adolescents (0-19 years old) whose respiratory samples were submitted to Xpert were included. Statistical analysis (bivariate and logistic regression) to assess the simultaneous influence of TB-related variables on the occurrence of Xpert detectable in TB cases was done. To evaluate the agreement or disagreement between Xpert results with acid-fast bacillus (AFB) and cultures, κ method was used (significancy level of 5%). RESULTS: Eighty-eight patients were included in the study and PTB occurred in 43 patients (49%) and Xpert was detectable in 21 patients (24%). Adolescents and positive culture results were independent predictive variables of Xpert positivity. DSS sensitivity compared with the final diagnosis of TB was 100% (95% CI, 88.1-100%), specificity was 97.2% (95% CI, 85.5-99.9%). The accuracy of the method was 98.5% (95% CI, 91.7-99.9%). CONCLUSIONS: Xpert contributed to diagnosis in 9% of patients with AFB and in culture negative cases. DSS indicated relevance for this diagnostic approach of intrathoracic TB (ITB) in reference centers for presenting data both with high sensitivity and specificity.

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Mycobacterium tuberculosis/isolation & purification , Referral and Consultation , Tuberculosis, Pulmonary/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Mycobacterium tuberculosis/genetics
Rev. Soc. Bras. Med. Trop ; 53: e20200051, 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136823


Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Tuberculosis, Pulmonary/diagnosis , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/urine , Tuberculosis, Pulmonary/blood , Brazil , Case-Control Studies , Polymerase Chain Reaction , Prospective Studies , Diagnostic Tests, Routine , Mycobacterium tuberculosis/genetics
Mem. Inst. Oswaldo Cruz ; 115: e200055, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1135234


BACKGROUND Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, and the number of new cases of multidrug resistant TB (MDR-TB), pre extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) has increased considerably worldwide. OBJECTIVES Herein, using 156 M. tuberculosis isolates from 106 patients previously classified as MDR or pre-XDR or XDR isolates, we investigated the genetic mutation profiles associated with phenotypic resistances in patients with MDR-TB, pre-XDR-TB and XDR-TB, treatment outcomes and resistance evolution. METHODS Molecular analyses were performed by partial sequencing of the rpoB, katG, gyrA, gyrB, rrs genes and analysis of the fabG-inhA promoter region. Clinical, epidemiologic and demographic data were obtained from the TB Notification database system of São Paulo (TB-WEB) and the Information System for Special Tuberculosis Treatments (SITE-TB). FINDINGS Drug resistance was attributed to previously known mutations and a novel Asp449Val mutation in gyrB was observed in four isolates from the same patient. Ten patients had more than one isolate evaluated and eight of these patients displayed resistance progression. MAIN CONCLUSIONS The present study is the first to report the frequency of mutations related to second-line drug resistance in MDR-TB, pre-XDR-TB and XDR-TB isolates. The results could lead to the improvement of available technologies for the rapid detection of drug resistant TB.

Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis, Multidrug-Resistant/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Mutation/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Socioeconomic Factors , Brazil , Microbial Sensitivity Tests , Extensively Drug-Resistant Tuberculosis/microbiology , Middle Aged , Mycobacterium tuberculosis/isolation & purification
Rev. bras. oftalmol ; 78(3): 202-209, May-June 2019. tab
Article in Portuguese | LILACS | ID: biblio-1013668


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.

Humans , Uveitis/diagnosis , Tuberculin Test , Tuberculosis, Ocular/diagnosis , Interferon-gamma Release Tests/methods , Tuberculin/analysis , Comparative Study , Interferon-gamma/analysis , Mycobacterium tuberculosis/isolation & purification
Rev. bras. ginecol. obstet ; 41(6): 409-411, June 2019. graf
Article in English | LILACS | ID: biblio-1013623


Abstract Endometrial tuberculosis is a rare diagnosis in the postmenopausal period, and it can mimic a carcinoma. The present article describes the case of a 54-year-old female patient with weight loss, abdominal pain, and ascites. An ultrasonography showed endometrial thickening, and a video hysteroscopy revealed a uterine cavity with formations with cotton aspect covering the entire endometrial surface and the tubal ostia. An anatomopathological evaluation diagnosed endometrial tuberculosis. The treatment was with a standardized therapeutic scheme (ethambutol, isoniazid, pyrazinamide and rifampicin), and the patient evolved with clinical improvement and normal uterine cavity at hysteroscopy. Considering the lack of pathognomonic hysteroscopic findings of the disorder, it is important to disclose the images of the case.

Resumo A tuberculose endometrial é um diagnóstico raro na pós-menopausa e podemimetizar um carcinoma. O presente artigo descreve o caso de uma paciente de 54 anos com perda de peso, dor abdominal e ascite. A ultrassonografia mostrou espessamento endometrial, e a histeroscopia por vídeo revelou uma cavidade uterina com formações que apresentavam aspecto de algodão cobrindo toda a superfície endometrial e os óstios tubários. Uma avaliação anatomopatológica diagnosticou tuberculose endometrial. O tratamento foi com esquema terapêutico padronizado (etambutol, isoniazida, pirazinamida e rifampicina), e a paciente evoluiu com melhora clínica e cavidade uterina normal na histeroscopia. Considerando a falta de achados histeroscópicos patognomônicos do distúrbio, é importante divulgar as imagens do caso.

Humans , Male , Tuberculosis, Female Genital/drug therapy , Endometrium/pathology , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use , Ascites/microbiology , Tuberculosis, Female Genital/diagnosis , Uterus/abnormalities , Uterus/diagnostic imaging , Weight Loss , Abdominal Pain/microbiology , Hysteroscopy , Ultrasonography , Treatment Outcome , Endometrium/microbiology , Endometrium/diagnostic imaging , Middle Aged
Rev. otorrinolaringol. cir. cabeza cuello ; 79(2): 173-178, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1014434


RESUMEN La otomastoiditis tuberculosa es una presentación extremadamente rara de la forma extrapulmonar de la enfermedad y puede ser difícil llegar a su diagnóstico. Presentamos el caso de una paciente de 35 años con otomastoiditis tuberculosa bilateral acompañado de vértigo, hipoacusia mixta bilateral y paresia del nervio facial bilateral, como debut de una tuberculosis. Cultivos de Mycobacterium tuberculosis (MTB) y prueba de reacción en cadena de la polimerasa (PCR) de otorrea fueron inicialmente negativos. La tomografía computarizada de oídos y resonancia magnética mostraron cambios inflamatorios otomastoídeos bilaterales sin evidencia de erosión ósea ni extensión a partes blandas. Se realizó una mastoidotomía, las muestras del tejido obtenido evidenciaron osteomielitis crónica, bacterias ácido-alcohol resistentes y PCR positiva para MTB. La paciente recibió tratamiento con drogas antituberculosas durante 12 meses logrando una recuperación completa de la otalgia y vértigo, y mejoría parcial de audición y paresia facial. En resumen, los hallazgos clínicos e imagenológicos de la otomastoiditis tuberculosa son inespecíficos por lo cual se requiere de un alto índice de sospecha clínica para lograr el diagnóstico adecuado e iniciar el tratamiento de la infección subyacente.

ABSTRACT Tuberculous otomastoiditis is an extremely rare form of extrapulmonary disease that can be easily misdiagnosed. We hereby report the case of a previously healthy 35-yearold female with bilateral tuberculous otomastoiditis associated with vertigo, bilateral mixed hearing loss, and bilateral facial nerve palsy as the initial clinical presentation. Repeated Mycobacterium tuberculosis (MTB) culture and molecular testing of otorrhea aspirates were initially negative. High-resolution temporal bone computed tomography and magnetic resonance imaging showed partial opacification of the mastoid air cells without signs of bone erosion. A mastoidotomy was performed with mastoid tissue showing chronic osteomyelitis, positivity in acid-fast staining and MTB PCR. The patient was treated with a 12 month antituberculous treatment, with complete recovery of otalgia and vertigo, and improvement in hearing levels and facial nerve palsy. In summary, clinical and imaging findings for tuberculous otomastoiditis are non-specific, hence a high degree of suspicion is required in order to diagnose and promptly treat the underlying infection.

Humans , Female , Adult , Tuberculosis/diagnosis , Mastoiditis/diagnosis , Otitis Media/etiology , Tuberculosis/drug therapy , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Polymerase Chain Reaction , Mastoiditis/drug therapy , Anti-Bacterial Agents/therapeutic use , Mycobacterium tuberculosis/isolation & purification
Rev. chil. infectol ; 36(3): 387-391, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1013798


Resumen La tuberculosis duodenal primaria es muy infrecuente, incluso en regiones endémicas. El diagnóstico plantea un gran reto, y requiere un alto índice de sospecha, apoyado en estudios de imágenes, microbiología, e histopatología obtenida por biopsia endoscópica o quirúrgica. Presentamos el caso de un varón de 31 años, sin infección por VIH ni antecedente de tuberculosis, que debutó con una obstrucción duodenal. Posterior a una laparatomía exploradora presentó una estenosis duodenal y una hemorragia digestiva alta. Luego de varias biopsias no concluyentes, sólo la última, realizada con la técnica "biopsia sobre biopsia", demostró la presencia de granulomas con bacilos ácido-alcohol resistentes. El diagnóstico de tuberculosis fue confirmado por reacción de polimerasa en cadena de tejido duodenal. No se evidenció compromiso de otros órganos. La respuesta terapéutica fue excelente.

Primary duodenal tuberculosis is rare, even in endemic regions. The diagnosis poses a major challenge and requires a high index of suspicion, supported by imaging studies, microbiology, and histopatology obtained by endoscopic or surgical biopsy. We report the case of a 31-year-old man, without HIV infection or any previous history of tuberculosis, who presented with duodenal obstruction. After exploratory laparotomy, he presented a duodenal stenosis and upper gastrointestinal bleeding. A total of four diagnostic procedures (one laparotomy and three endoscopies) were performed, all of which included biopsies. Only the last endoscopy made with the technique "biopsy upon biopsy" showed the presence of acid fast bacilli and granulomas. The diagnosis of tuberculosis was confirmed by polymerase chain reaction in duodenal tissue. There was no evidence of involvement of other organs by tuberculosis. The patient had an excellent therapeutic response.

Humans , Male , Adult , Tuberculosis, Gastrointestinal/diagnosis , Duodenal Obstruction/diagnosis , Gastrointestinal Hemorrhage/diagnosis , Tuberculosis, Gastrointestinal/microbiology , Tuberculosis, Gastrointestinal/pathology , Biopsy , Duodenal Obstruction , Granuloma/pathology , Gastrointestinal Hemorrhage/pathology , Mycobacterium tuberculosis/isolation & purification