[Pancreatic tuberculosis]. / Tuberculosis pancreática.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is currently considered a public health problem due to the socioeconomic conditions of the world population and the increase in other infections such as that due to Human Immunodeficiency Virus (HIV). Pulmonary involvement is the most common form of clinical presentation, although in recent decades extrapulmonary involvement has increased. Among these, digestive disorders represent less than 10%. We present a case of exclusive pancreatic tuberculosis, in the context of an immunocompromised patient. A 43-year-old man with a history of HIV with a low CD4 count and high viral load, without antiretroviral treatment, with one-month history of symptoms characterized by low-grade fever associated with weight loss and nonspecific abdominal pain. An abdominal tomography was performed which showed a collection in the tail of the pancreas; the puncture revealed material with positive culture for M. tuberculosis. Antifimic and antiretroviral treatment was started with a good response. Primary pancreatic tuberculosis is an uncommon extrapulmonary form, given that it is a gland that would be biologically protected by the enzymes it produces. We highlight the rarity of the case and although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The high index of suspicion of pancreatic tuberculosis by the physician and the performance of fine needle aspiration puncture to obtain histopathological evidence are important for a correct diagnosis, especially in HIV patients.

La tuberculosis es una enfermedad infectocontagiosa producida por el Mycobacterium tuberculosis. Actualmente se considera un problema de salud pública debido a las condiciones socioeconómicas de la población mundial y al incremento de otras infecciones causantes de inmunosupresión, como el virus de la inmunodeficiencia humana (HIV). La afección pulmonar es la forma de presentación clínica más frecuente aunque en las últimas décadas el compromiso extrapulmonar se ha visto incrementado. Dentro de este la afección digestiva representa menos del 10%. Presentamos un caso de localización exclusivamente pancreática en un paciente inmunocomprometido. Varón de 43 años HIV positivo, con bajo recuento de CD4 y alta carga viral, sin tratamiento antirretroviral, consultó por cuadro de un mes de evolución caracterizado por registros subfebriles asociado a pérdida de peso y dolor abdominal inespecífico. Se realizó tomografía de abdomen la cual arrojó colección en cola de páncreas, y posteriormente punción del material con rescate en cultivo de M. tuberculosis. Se inició tratamiento antifímico y antirretroviral con buena respuesta al mismo. La tuberculosis pancreática primaria es una forma extrapulmonar infrecuente, dado que es una glándula que estaría biológicamente protegida por las enzimas que origina. Destacamos la infrecuencia del caso y aunque el pronóstico es bueno con el tratamiento antifímico, podría ser fatal sin un diagnóstico y tratamiento correctos. El alto índice de sospecha de tuberculosis pancreática por parte del médico y la realización de punción aspiración con aguja fina (PAAF) para obtener evidencia histopatológica son importantes para un diagnóstico correcto, especialmente en pacientes HIV.

Factors Associated With Extrapulmonary Tuberculosis in Southeastern Mexico: A Case-Control Study.

INTRODUCTION: Extrapulmonary tuberculosis (EPTB) is a disease that can affect any organ or tissue. Due to its potential to cause more dangerous sequelae and the barriers to its timely diagnosis, greater clinical awareness of this disease is crucial. This study aimed to identify the factors associated with EPTB in the population of Oaxaca, Mexico. METHODS: This is an unpaired case-control study. The cases were patients with EPTB+ while the controls were patients with pulmonary tuberculosis (PTB+) registered in the Tuberculosis Epidemiological Surveillance System. Sociodemographic, clinical, and microbiological variables were recovered. Bivariate analyses were performed and logistic regression analyses were performed to calculate the odds ratio (OR). RESULTS: A total of 75 EPTB+ cases and 300 PTB+ controls were included. Of the total sample, 57.1% were men and 60.3% indigenous. The most frequent clinical presentations of EPTB+ were nodal (21.3%), miliary (21.3%), and breast (20.0%). According to logistic regression analysis, age <40 years (OR: 2.25 (95% CI: 1.13-4.49), female sex (OR: 1.92 (95% CI: 1.03-3.56)], urban residence (OR: 2.25 (95% CI: 1.11-4.55)), comorbidity with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 3.46 (95% CI: 1.31-9.10)), dyspnea (OR: 2.67 (1.22-5.82)), and adenopathy (OR: 3.38 (95% CI: 1.42-8.06)) were positively associated with EPTB+. CONCLUSION: These results can serve as a basis for screening EPTB+, thus improving the preventive and diagnostic capacity of local health services, taking as a starting point women under 40 years of age and patients with HIV/AIDS in urban areas, as well as the presence of adenopathy and dyspnea as clinical characteristics of the disease.

Tuberculosis Extrapulmonar como Linfopatía Cervical: Revisión Sistemática y Presentación de Caso Clínico

La tuberculosis es una infección bacteriana causada por Mycobacterium tuberculosis que afecta a millones de personas en todo el mundo. Aunque principalmente se manifiesta en los pulmones, también puede afectar otras partes del cuerpo, como la regiónes de la cabeza y el cuello. Aunque es poco común, se han reportado casos de tuberculosis en glándulas parótidas, tonsilas palatinas y seno piriforme. La forma más común de tuberculosis extrapulmonar en esta región es la linfadenopatía superficial, que afecta principalmente los nódulos linfáticos del territorio cervical anterior. Los linfonodos afectados por tuberculosis presentan características específicas en la ecografía, lo que puede ayudar en el diagnóstico. El diagnóstico de tuberculosis extrapulmonar se realiza mediante pruebas como la citología por aspiración con aguja fina (PAAF) o la reacción en cadena de la polimerasa (PCR). Estas pruebas permiten detectar la presencia de Mycobacterium tuberculosis en los tejidos afectados. El tratamiento de la tuberculosis implica el uso de antibióticos antituberculosos durante un periodo prolongado. Es importante seguir el tratamiento completo para asegurar la erradicación de las bacterias y prevenir la recurrencia de la enfermedad. En este artículo, se presenta una revisión sistemática de la literatura de tuberculosis extrapulmonar en la región de la cabeza y cuello y un caso de un paciente sexo masculino de 81 años de edad, que se presentó con un aumento de volumen submandibular izquierdo de 3 semanas de evolución, con hipótesis diagnóstica de submaxilitis idiopática. Presentaba múltiples adenopatías supraclaviculares, mediastínicas e hiliares, y en conjunto a scanner, biopsias, cultivos y test dio resultados positivos para tuberculosis que se manifestó de forma extrapulmonar.

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis that affects millions of people around the world. Although it manifests primarily in the lungs, it can also affect other parts of the body, such as the head and neck regions. Although rare, cases of tuberculosis in the parotid glands, palatine tonsils, and piriform sinus have been reported. The most common form of extrapulmonary tuberculosis in this region is superficial lymphadenopathy, which mainly affects the nodules of the anterior cervical area. Lymph nodes affected by tuberculosis present specific characteristics on ultrasound, which can help in diagnosis. The diagnosis of extrapulmonary tuberculosis is made through tests such as fine needle aspiration cytology (FNAC) or polymerase chain reaction (PCR), which allow the presence of Mycobacterium tuberculosis in the affected tissues to be detected. Treatment of tuberculosis involves the use of anti-tuberculosis antibiotics for long periods of time. It is important to follow the complete treatment to ensure the eradication of bacteria and prevent recurrence of the disease. In this article, we present a systematic review of the literature on extrapulmonary tuberculosis in the head and neck region and case of an 81-year-old male patient, who presented with a 3-week increase in left submandibular volume with a diagnostic hypothesis of idiopathic submaxilitis. The patient had multiple supraclavicular, mediastinal and hilar lymphadenopathy; following scan, biopsies, and cultures, the patient tested positive for tuberculosis that manifested extrapulmonarily.

Tuberculosis pulmonar y ósea multifocal en un paciente inmunocompetente: Reporte de caso / Pulmonary and bone tuberculosis in an immunocompetent host: A case report

RESUMEN La Tuberculosis (TB) extrapulmonar constituye aproximadamente el 15-20% de casos, siendo la osteoarticular el 11,3-34,5%. Describimos el caso de un varón de 28 años inmunocompetente que inició síntomas respiratorios y posteriormente cursó con una tumoración dolorosa con aumento de volumen en segundo dedo de mano derecha. Inició tratamiento específico en un centro de salud por el aislamiento de Mycobacterium tuberculosis en esputo. Cursa con persistencia de síntomas y por la necesidad de ampliación de estudios fue derivado a centro de mayor complejidad. Se realizó una biopsia de la tumoración, que resultó positivo para GeneXpert MTB/RIF y estudios anatomopatológicos con posterior diagnóstico de TB ósea del dedo y de una lesión vertebral a nivel de D9 descubierta incidentalmente. Este reporte ayudaría a considerar la tuberculosis extrapulmonar ósea en regiones corporales atípicas como un diagnóstico diferencial, especialmente en pacientes sin factores de riesgo conocidos y en áreas endémicas de tuberculosis.

SUMMARY Extrapulmonary tuberculosis accounts for 15-20% of all cases, osteoarticular accounts for 11.3-34.5%. We report here the case of a 28-year-old male immunocompetent host who started with respiratory symptoms and subsequently developed a painful tumor on the second finger of the right hand. He started treatment in a peripheral health care center after identifying Mycobacterium tuberculosis in a sputum sample. Due to the persistence of symptoms, he was transferred to our institution. A biopsy of the tumor was positive for Gene Xpert MTB/RIF, and pathological studies revealed bone involvement of the second finger of the right hand. Incidentally, a vertebral lesion at D9 was found. This report helps consider bone tuberculosis in the differential diagnosis of bone involvement in immunocompetent hosts from endemic areas.

Scrofuloderma of the chest with mediastinal TB.

Cutaneous tuberculosis is a rare manifestation of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis in most cases and rarely by Mycobacterium bovis. Diagnosis may be challenging due to a wide range of clinical findings and similarities to other chronic dermatoses, leading to delayed treatment. We present a case of scrofuloderma in a 4-year-old girl that arose from a contiguous spread from the anterior mediastinum with associated pulmonary involvement.

Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment.

Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusion: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.

Tuberculosis extrapulmonar: Presentación atípica de compromiso de la médula ósea / Extrapulmonary Tuberculosis: Unusual Presentation with Bone Marrow Involvement

RESUMEN La primera causa de muerte por enfermedad infecto-contagiosa a nivel mundial es atribuible a la infección por Mycobacterium tuberculosis. La tuberculosis extrapulmonar representa entre un 20 % y un 25 % de los casos de enfermedad tuberculosa. Frecuentemente, para arribar al diagnóstico de dichas localizaciones, se debe recurrir a pruebas diagnósticas invasivas Se presenta el caso de un paciente de 17 años de edad con compromiso extrapulmo nar de tuberculosis en médula ósea sin inmunocompromiso conocido, con síntomas de fiebre, astenia, pérdida de peso, tricitopenia y hepatoesplenomegalia, sin otros hallazgos clínicos significativos. Se arriba al diagnóstico por cultivo positivo para tuberculosis en material de punción/ biopsia de médula ósea. Luego de un mes de tratamiento con isoniacida, pirazinamida, etambutol y rifampicina evoluciona con registros febriles aún después de recibir antibióticos por infección urinaria por Klebsiella pneumoniae, por lo cual se inicia corticoterapia oral con buena respuesta. El paciente abandona el tratamiento luego de tres meses y medio por mala adherencia a este.

ABSTRACT The leading cause of death from a contagious infectious disease worldwide is attribut able to Mycobacterium tuberculosis infection. Extrapulmonary tuberculosis accounts for 20-25 % of cases of tuberculous disease. Frequently, in order to reach the diagnosis of these sites, invasive diagnostic tests have to be used. We present the case of a 17-year-old patient with extrapulmonary tuberculosis with bone marrow involvement. The patient wasn't immunocompromised, and had the following symptoms: fever, asthenia, weight loss, tricytopenia and hepatosplenomegaly, without other significant clinical findings. The diagnosis was reached by positive culture for tuberculosis in bone marrow puncture aspiration/biopsy material After one month of treatment with isoniazid, pyrazinamide, ethambutol and rifampicin, the patient evolved with fever episodes, even after having received antibiotics for urinary tract infection caused by Klebsiella pneumoniae. Thus, oral corticosteroid therapy was started, with good response. The patient discontinued treatment after three and a half months due to poor adherence.

Two cases of testicular tuberculosis in HIV patients with distinct clinical presentations.

Genito-urinary tuberculosis (TB) corresponds to the second most common cause of extrapulmonary tuberculosis EPTB worldwide. It is however rare and is often clinically indistinguishable from testicular malignancy and infarction. HIV hugely increases the risk of TB in unusual sites; we present two such cases of testicular tuberculosis. The diagnosis was based respectively on histopathological findings, acid-bacilli smear of biopsy, semen, and culture.

Perianal tuberculosis in an immunocompetent patient: exploring the uncommon manifestation

As it is an infrequent etiology, the diagnosis of perianal tuberculosis is challenging, especially in the absence of a pulmonary focus. TB should be considered in the differential diagnosis of perianal ulcers, fistulas, abscesses, mainly in non-healing and recurrent anal lesions. Treatment with anti-TB agents can provide complete recovery. Furthermore, these lesions are often diagnosed later after complete histopathological and mycobacterial results, where the benefit of avoiding morbid multiple surgeries by effective anti-TB treatment is lost. We reported a rare case of an immuno-competent patient with perianal TB, which was the first manifestation of the disease. A fit-and-well man in his 20s presented a large perianal abscess. Unexpectedly, his chest X-ray showed a rounded hyper-transparency in the left lung. The abscess was drained. Posterior investigation with culture analysis from pus swabs and sputum revealed the presence of Mycobacterium tuberculosis complex infection. After completing the 6 months of oral administration of anti-TB drugs, the patient was asymptomatic. By highlighting this unusual manifestation, we aim to improve clinicians' awareness of perianal TB, facilitating early recognition and appropriate management. (AU)

Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment

ABSTRACT Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusions: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.

Pangenome Reconstruction of Mycobacterium tuberculosis as a Guide to Reveal Genomic Features Associated with Strain Clinical Phenotype.

Tuberculosis (TB) is one of the leading causes of human deaths worldwide caused by infectious diseases. TB infection by Mycobacterium tuberculosis can occur in the lungs, causing pulmonary tuberculosis (PTB), or in any other organ of the body, resulting in extrapulmonary tuberculosis (EPTB). There is no consensus on the genetic determinants of this pathogen that may contribute to EPTB. In this study, we constructed the M. tuberculosis pangenome and used it as a tool to seek genomic signatures associated with the clinical presentation of TB based on its accessory genome differences. The analysis carried out in the present study includes the raw reads of 490 M. tuberculosis genomes (PTB n = 245, EPTB n = 245) retrieved from public databases that were assembled, as well as ten genomes from Mexican strains (PTB n = 5, EPTB n = 5) that were sequenced and assembled. All genomes were annotated and then used to construct the pangenome with Roary and Panaroo. The pangenome obtained using Roary consisted of 2231 core genes and 3729 accessory genes. On the other hand, the pangenome resulting from Panaroo consisted of 2130 core genes and 5598 accessory genes. Associations between the distribution of accessory genes and the PTB/EPTB phenotypes were examined using the Scoary and Pyseer tools. Both tools found a significant association between the hspR, plcD, Rv2550c, pe_pgrs5, pe_pgrs25, and pe_pgrs57 genes and the PTB genotype. In contrast, the deletion of the aceA, esxR, plcA, and ppe50 genes was significantly associated with the EPTB phenotype. Rv1759c and Rv3740 were found to be associated with the PTB phenotype according to Scoary; however, these associations were not observed when using Pyseer. The robustness of the constructed pangenome and the gene-phenotype associations is supported by several factors, including the analysis of a large number of genomes, the inclusion of the same number of PTB/EPTB genomes, and the reproducibility of results thanks to the different bioinformatic tools used. Such characteristics surpass most of previous M. tuberculosis pangenomes. Thus, it can be inferred that the deletion of these genes can lead to changes in the processes involved in stress response and fatty acid metabolism, conferring phenotypic advantages associated with pulmonary or extrapulmonary presentation of TB. This study represents the first attempt to use the pangenome to seek gene-phenotype associations in M. tuberculosis.

Tuberculosis extrapulmonar: un problema de salud pública.

Extrapulmonary tuberculosis is defined as that case of tuberculosis clinically diagnosed and confirmed by bacteriological studies that affects tissues and organs outside the lung parenchyma. Mexico is in third place among Latin American countries in terms of the incidence of pulmonary and extrapulmonary tuberculosis. Culture methods are still the gold standard for the diagnosis of extrapulmonary tuberculosis since they identify the species and susceptibility to drugs.

La tuberculosis extrapulmonar es aquella tuberculosis diagnosticada clínicamente y confirmada por estudios bacteriológicos que afecta a tejidos y órganos fuera del parénquima pulmonar. México es el tercer lugar en América Latina en incidencia de tuberculosis pulmonar y extrapulmonar. Los métodos de cultivo siguen siendo el método de referencia para el diagnóstico de tuberculosis extrapulmonar, ya que identifican la especie y la sensibilidad a los fármacos.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.(AU)

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.(AU)

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Multidrug-resistant tuberculous orchiepididymitis: a brief case report

ABSTRACT Tuberculosis (TB) is one of the leading causes of death by infectious diseases worldwide. Multidrug-resistant tuberculosis is a growing problem, especially in countries with high TB prevalence. Although the lungs are the organs most frequently affected by this disease, Mycobacterium tuberculosis can harm any organ, including the urogenital tract, causing extrapulmonary tuberculosis, which leads to a challenging diagnosis and consequent treatment delays. In this article, we present a case of orchiepididymitis caused by multidrug-resistant TB (MDR-TB) with a significantly delayed diagnosis, the proposed treatment according to the resistance profile, and the clinical outcomes.

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Pancreatic tuberculosis mimicking a neoplastic mass in an immunosuppressed patient who also presented adenopathy syndrome: Case report.

Introduction: Pancreatic tuberculosis is unusual, with an incidence reported to be less than 4,7 % worldwide. Case report: We report the case of a 32-year-old man recently diagnosed with HIV whose adenopathy syndrome was understudy. Lymph node cervical and bone marrow biopsies were performed without evidence of neoplastic infiltration, fungal infection, or tuberculosis. He arrived at the emergency room for acute band abdominal pain radiating to the back. Results: Contrast-enhanced abdominal computed tomography revealed a mass in the head of the pancreas which generates intra- and extrahepatic bile duct dilation. Serial sputum, PPD, Genexpert, bronchoscopy and ultrasound fine needle aspiration biopsy were negative for tuberculosis, with no evidence of microorganisms or malignancy; cultures results pending. A second biopsy was requested using a No. 19 needle reporting a necrotizing process with acid-fast bacilli, compatible with tuberculosis, and the pending cultures results were positive for the mycobacterium tuberculosis complex, confirming the diagnosis. Conclusion: Clinical awareness of pancreatic tuberculosis in immunosuppressed patients in our country, may lead to faster and accurate diagnosis study and management, using minimally invasive techniques as diagnostic tools.

Epidemiological and Cytokine Profile of Patients with Pulmonary and Extrapulmonary Tuberculosis in a Population of the Brazilian Amazon.

Several factors are associated with the development of different clinical forms of tuberculosis (TB). The present study evaluated epidemiological variables and cytokine levels in samples from 89 patients with TB (75 with pulmonary TB and 14 with extrapulmonary TB) and 45 controls. Cytokines were measured by flow cytometry (Human Th1/Th2/Th17 Cytometric Bead Array kit). The TB group had a higher frequency of individuals who were 39 years of age or older, married, with primary education or illiterate and had a lower family income (p < 0.05). All individuals with extrapulmonary TB reported that they were not working, and the main reasons were related to disease symptoms or treatment. The levels of IFN-γ (OR = 4.06) and IL-4 (OR = 2.62) were more likely to be elevated in the TB group (p = 0.05), and IFN-γ levels were lower in patients with extrapulmonary TB compared to those with pulmonary TB (OR = 0.11; p = 0.0050). The ROC curve was applied to investigate the diagnostic accuracy of IFN-γ levels between the different clinical forms of tuberculosis, resulting in high AUC (0.8661; p < 0.0001), sensitivity (93.85%) and specificity median (65.90%), suggesting that IFN-γ levels are useful to differentiate pulmonary TB from extrapulmonary TB. The dysregulation of pro- and anti-inflammatory cytokine levels represent a risk for the development of TB and contribute to the pathogenesis of the disease, especially variation in IFN-γ levels, which may determine protection or risk for extrapulmonary TB.