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   Table of Contents - Current issue
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July-September 2020
Volume 9 | Issue 3
Page Nos. 231-334

Online since Friday, August 28, 2020

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REVIEW ARTICLES  

Port-site infection due to nontuberculous mycobacteria following laparoscopic surgery p. 231
Waniganeththi Arachchige Manori Piyumal Samaranayake, Alison Margaret Kesson, Jonathan Saul Karpelowsky, Alexander Conrad Outhred, Ben Jacobus Marais
DOI:10.4103/ijmy.ijmy_32_20  PMID:32862154
Nontuberculous mycobacteria (NTM) are commonly found in soil and water and can cause nosocomial infections by contaminating equipment and disinfectants solution used in hospitals. NTM port-site infection after laparoscopic surgery is increasingly observed, but its clinical features, management, and prevention have not been reviewed adequately. We performed a comprehensive literature review of reports that described the clinical manifestation and management of NTM port-site infections following laparoscopic surgery. The perceived increase in NTM port-site infections is likely multifactorial, influenced by greater awareness, better diagnostics, changes in medical practice, increased prevalence of immunosuppression, and potential pathogen spread. Widespread resistance to common disinfectants is a major concern. Patients with NTM port-site infections typically present 1–3 months after the laparoscopic intervention with chronic local and minimal systemic symptoms. Surgical excision plays an important role in localized or refractory cases. Medical treatment should be guided by species identification and in vitro drug-susceptibility testing (DST) of the infecting NTM strain, with a combination of second-line antituberculosis agents, given for a prolonged duration. NTM port site infection is best prevented by meticulous skin preparation and infection control, using only sterilized supplies for laparoscopic surgery.
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Human genetic background in susceptibility to tuberculosis p. 239
Jalaledin Ghanavi, Poopak Farnia, Parissa Farnia, Ali Akbar Velayati
DOI:10.4103/ijmy.ijmy_118_20  PMID:32862155
Tuberculosis (TB), especially in developing countries, is a major threat to human health. The pathogenesis of TB remains poorly understood, and <5%–10% of individuals infected with Mycobacterium tuberculosis (MTB) will develop clinical disease. The human genetic factors contributing to susceptibility or resistance to TB pathogenesis have been investigated by high-throughput and low-throughput association studies. Genetic polymorphisms of several genes including TLR, IGRM, VDR, ASAP1, AGMO, FOXP1, and UBLCP1 effect on the disease phenotype and also the outcome of TB treatment. Recently, microRNAs (miRNAs), which negatively regulated gene expression at the posttranscriptionally level, have gained increasing attention due to their altered expression in various human diseases, including some infections. They are crucial posttranscriptional regulators of immune response in both innate and adaptive immunity. It has been established in recent studies that the host immune response against MTB is regulated by many miRNAs, most of which are induced by MTB infection. Moreover, differential expression of miRNAs in TB patients may help distinguish between TB patients and healthy individuals or latent TB. In this review, we summarize and discuss the literature and highlight the role of selected single nucleotide polymorphisms and miRNAs that have been associated with TB infection.
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A long journey to be diagnosed as a case of tuberculous cystitis: A Bangladeshi case report and review of literatures p. 248
Tajkera Sultana Chowdhury, Md Fazal Naser, Mainul Haque
DOI:10.4103/ijmy.ijmy_101_20  PMID:32862156
Urinary bladder tuberculosis (UB-TB) is one of the gravest public health issues of renal TB, and it is diagnosed with <50% of urogenital TB. Unsatisfactory and delayed diagnosis with imprudent medications for bladder TB frequently resulted in several urinary and complications, including contraction of the UB. The objectives of this research were to build awareness among medical professionals and subsequently minimize the sufferings of patients. This was a case report-based study regarding UB-TB. All routine tests for cystitis were conducted. In addition, 24-h urine sample for TB identification, including a polymerase chain reaction test, was performed. Twenty-four hours of urine sample revealed confirmatory findings of TB. The patient had responded well with the national TB guideline-designated medication. Recurrent cystitis had a higher possibility of tuberculous origin. Medical doctors must rethink when a patient visited multiple times for cystitis for the etiology of the disease.
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ORIGINAL ARTICLES Top

Epidemiology and clinical characteristics of tuberculosis in leon bernard tuberculosis unit in algeria p. 254
Schehrazad Selmane, Mohamed L’Hadj
DOI:10.4103/ijmy.ijmy_78_20  PMID:32862157
Background: This study aimed at highlighting some demographic and clinical features of tuberculosis (TB) at Leon Bernard TB unit, Algeria. Methods: This was a retrospective and descriptive study based on TB data extracted from TB patient records during 2009–2019 at Leon Bernard TB unit. Results: Of the total 1375 TB patients, 602 (43.8%) had extrapulmonary TB (EPTB), 482 (35.1%) had new sputum smear-positive pulmonary TB (PTB), 42 (3.1%) had sputum smear-negative with culture-positive PTB, and 97 (7%) EPTB patients had concomitant pulmonary involvement. The male-to-female ratio was 1.07. A total of 116 (8.4%) TB relapses were reported with predominance among ETPB cases (54.3%). Lymphadenitis TB was the most common manifestation of EPTB with 301 cases (39.6%), followed by pleural TB with 237 cases (31.2%). The number of bacteriologically not confirmed EPTB was 22.6% more than half (53.3%) of whom were pleural TB. Among patients with new sputum smear-positive PTB, 71.2% were males, whereas the reverse was observed among patients with EPTB where 62.3% were female. Two-third of recorded cases were between 15 and 45 years old. Nearly all children had EPTB (64/69). The results revealed that most of the patients who passed away were affected by PTB (15/18), and the most frequent cmorbidities were diabetes (9/18) and high blood pressure (6/18). Conclusion: Specific attention needs to be given to an examination of the risk factors of PTB among male population and of EPTB among female population and children and to diagnosis of pleural TB and primary PTB.
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Liposomes derived from Mycobacterium smegmatis promote immune activation of mice bone marrow-derived dendritic cells p. 261
Nur Ellene Mat Luwi, Ramlah Kadir, Rohimah Mohamud, Maria de los A Garcia-Santana, Reynaldo Acevedo, Maria E Sarmiento, Mohd Nor Norazmi, Armando Acosta
DOI:10.4103/ijmy.ijmy_82_20  PMID:32862158
Background: Tuberculosis (TB) is the leading cause of mortality due to infectious diseases. The development of new generation vaccines against TB is of paramount importance for the control of the disease. In previous studies, liposomes obtained from lipids of Mycobacterium smegmatis (LMs) demonstrated their immunogenicity and protective capacity against Mycobacterium tuberculosis in mice. To characterize the immunomodulatory capacity of this experimental vaccine candidate, in the current study, the stimulatory capacity of LMs was determined on bone marrow-derived dendritic cells (BMDCs) from mice. Methods: LMs were obtained and incubated with mature BMDCs. The internalization of LMs by BMDCs was studied by confocal microscopy, and the LMs immune-stimulatory capacity was determined by the expression of surface molecules (CD86 and MHCII) and the cytokine production (interleukin [IL]-12, interferon-Υ, tumor necrosis factor-α, and IL-10) 24 h after exposure to LMs. Results: The interaction of LMs with BMDCs and its internalization was demonstrated as well as the immune activation of BMDCs, characterized by the increased expression of CD86 and the production of IL-12. The LMs internalization and immune activation of BMDCs were blocked in the presence of cytochalasin, filipin III and chlorpromazine, which demonstrated that internalization of LMs by BMDCs is a key process for the LMs induced immune activation of BMDCs. Conclusions: The results obtained support the further evaluation of LMs as a mycobacterial vaccine, adjuvant, and in immunotherapy.
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Effect of dialyzable leukocyte extract, sodium butyrate, and valproic acid in the development of anergy in murine leprosy Highly accessed article p. 268
Oscar Rojas-Espinosa, Sandra Moreno-García, Patricia Arce-Paredes, Erique Becerril-Villanueva, Mario Juárez-Ortega
DOI:10.4103/ijmy.ijmy_31_20  PMID:32862159
Background: Murine leprosy is a chronic granulomatous disease caused by Mycobacterium lepraemurium (MLM) in mice and rats. The disease evolves with the development of cellular anergy that impedes the production of interferon gamma (IFNγ), tumor necrosis factor-alpha (TNFα), and nitric oxide (NO) required to kill the microorganism. In this study we investigated whether histone deacetylase inhibitors (HDACi) (valproic acid and sodium butyrate [NaB]) and the immunomodulator transfer factor in dialyzable leukocyte extracts (DLE) can prevent anergy in murine leprosy. Methods: Five groups of six Balb/c mice were intraperitoneally inoculated with 2 × 107 MLM. Thirty-days post inoculation, treatment was started; one group received no treatment, one was treated with rifampicin-clofazimine (R-C), one with sodium valproate (VPA), one with NaB, and one with DLE. The animals were monitored for the evidence of disease for 96 days. After euthanasia, their spleens were removed and processed for histologic, bacteriologic, and cytokine studies. Results: R-C completely controlled the ongoing disease. DLE and NaB significantly reduced the development of lesions, including granuloma size and the number of bacilli; VPA was less effective. DLE, NaB, and VPA reverted the anergic condition in diverse grades and allowed the expression of IFNγ, TNFα, and inducible NO synthase, also in diverse grades. Conclusion: Anergy in leprosy and murine leprosy allows disease progression. In this study, anergy was prevented, in significant degree, by DLE (an immunomodulator) and NaB (HDACi). VPA was less effective. These results suggest potential beneficial effects of DLE and NaB in the ancillary treatment of leprosy.
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Colorimetric methods for rapid determination of pyrazinamide resistance p. 274
Ahmet Ugur Akbal, Belma Durupinar, Ahmet Yilmaz Coban
DOI:10.4103/ijmy.ijmy_42_20  PMID:32862160
Background: Because pyrazinamide (PZA) is only effective for Mycobacterium tuberculosis at an acidic pH, susceptibility tests are more difficult to perform than those for other anti-tuberculosis (TB) drugs. The purpose of our work was to investigate the effectiveness of colorimetric methods to detect PZA susceptibility and to detect pncA gene mutations in resistant isolates by sequence analysis. Methods: In this study, 30 clinical isolates and 2 reference isolates were used, 15 of which were resistant to PZA. The PZA susceptibility of all the isolates was determined by the BACTEC MGIT 960 reference method. As colorimetric methods, Resazurin Microtiter Assay (REMA), Nitrate Reductase Assay (NRA), Malachite Green Decolorization Assay (MGDA), and Crystal Violet Decolorization Assay (CVDA) methods were included in the study. In addition, mutations in the pncA gene were investigated using sequence analysis in PZA-resistant isolates. Results: As a result of the comparison of the colorimetric methods with the reference method, agreement was determined as 93.3% in REMA and NRA, 90% in MGDA, and 93.3% in CVDA. In 13 of 15 resistant isolates, the pncA gene mutation was detected by sequence analysis. Conclusions: As a result of the work, the results from the colorimetric methods were found to be at a high level of concordance with the reference method. They are also inexpensive and easily applicable methods.
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Adverse drug reactions of anti-tuberculosis treatment among children with tuberculosis p. 281
Madeeha Laghari, Bandeh Ali Talpur, Syed Azhar Syed Sulaiman, Amer Hayat Khan, Zohra Bhatti
DOI:10.4103/ijmy.ijmy_75_20  PMID:32862161
Background: The frequency, severity, and the nature of anti-tuberculosis (TB)-induced adverse drug reactions (ADRs) have always been the matter of concern. The present study was, therefore, aimed to study the incidence, risk factors, and effect of anti-tuberculosis treatment (ATT) among TB children. Methods: A prospective longitudinal study was conducted in the Sindh province, Pakistan. A total of 508 TB children in multicenter hospitals under ATT were assessed for ADRs. Naranjo Causality Assessment and Hartwig's Severity Assessment Scale were used. Results: A total of 105 ADRs were reported in 67 (13.2%) of 508 patients. Gastrointestinal disorders were the most frequently observed ADRs (65.7%), followed by arthralgia (24.8%). Around 65 (61.9%) of ADRs were identified as probable and 78 (74.3%) as mild severe ADRs during the study. A total of four cases of mild hepatotoxicity were observed among children. On multivariate analysis, the independent variables which had statistically significant positive association with ADRs were female (OR; 2.66, P = 0.004), retreatment (OR; 22.32, P = ≤ 0.001), and absence of BCG scar (OR; 17.84, P = 0.001). Conclusions: The finding of the current study suggests that close monitoring of females, patients with previous TB treatment, and those without BCG is warranted at the study site.
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Comparison of four agar media for the enumeration of the Mycobacterium abscessus complex p. 289
John Edmund Moore, Beverley Cherie Millar
DOI:10.4103/ijmy.ijmy_110_20  PMID:32862162
Background: Traditional culture of nontuberculous mycobacteria (NTMs) has involved egg-based formulations (Lowenstein–Jensen medium) or defined media (Middlebrook formulations), which have disadvantages of composition complexity, availability, and cost. This study quantitatively compared three non-selective, non-blood based basal agars with Columbia blood agar (CBA), to enumerate Mycobacterium abscessus complex organisms in pure culture. Methods: M. abscessus subsp. massiliense, M. abscessus subsp. bolletii, and M. abscessus subsp. abscessus were employed. Inocula of each of these were counted on three basal agar media, including (i) standard plate count agar (SPCA), (ii) tryptone soya agar (TSA), and (iii) Mueller–Hinton agar (MHA) and compared to counts on CBA. Results: All NTM isolates of all subspecies grew successfully on all four media examined. The growth was most profuse on SPCA, with a mean colony diameter of 3 mm, whereas the mean colony diameter on all other media was 1 mm. Statistically, there was no significant difference in counts when comparing CBA with SPCA or MHA (P > 0.05), whereas there was a statistically significant difference between CBA and TSA (P = 0.01). There was no statistically significant difference between SPCA and MHA (P = 0.53). Conclusion: This study indicates that SPCA and MHA are equally effective as CBA, when enumerating of M. abscessus complex organisms. Employment of TSA gave significantly lower counts than CBA (P = 0.01) and therefore should not be employed when enumerating these organisms. SPCA yielded the most profuse growth of all media examined. In addition to these advantages, given that SPCA does (i) not require blood as a medium constituent, (ii) is simple to reconstitute, (iii) is relatively cheap, and (iv) is widely available commercially, this study endorses employment of SPCA for the nonselective culture of M. abscessus complex organisms, including enumeration.
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Detection of airborne bacteria from patient spaces in tuberculosis hospital p. 293
Taeuk Kang, Taeyoon Kim, Sungweon Ryoo
DOI:10.4103/ijmy.ijmy_115_20  PMID:32862163
Background: The spread of nosocomial bacterial infection greatly threatens public health and the impact of nosocomial infection worsens if highly pathogenic bacteria, Mycobacterium tuberculosis as an instance, involves. In this study, we have investigated the presence of airborne M. tuberculosis in a specialized tuberculosis hospital. Methods: The study sites selected were waiting room I, II, and ward VI patient lounge, Masan National Tuberculosis Hospital, where the modern ventilation system is on the operation for opportunistic infection prevention. The air samples were collected from the different sites three times for 1 day, and after air collection, air sampled disposable filter membrane was incubated for 4 weeks on nine Middlebrook 7H11 agar plates. Results: Our data showed that out of nine incubated 7H11 plate agars, four plates showed bacterial growth and these grown bacterial colonies were isolated and identified. Among bacterial species identified, there was a colony of Mycobacterium mageritense, one of nontuberculous Mycobacteria. Although there was no M. tuberculosis, the cause of tuberculous disease and transmitted through the nosocomial infection, all pathogens detected were known to be associated with nosocomial infection. Conclusions: Hospitals dealing with infectious diseases should always be wary that ventilation system does not guarantee safety from airborne pathogen exposure hence should continuously monitor the presence of other hospital-associated infection causing pathogenic microorganisms.
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Effect of temperature and pressure on antimycobacterial activity of Curcuma caesia extract by supercritical fluid extraction method p. 296
Monika Chaturvedi, Reena Rani, Dushyant Sharma, Jaya Parkash Yadav
DOI:10.4103/ijmy.ijmy_113_20  PMID:32862164
Background: Supercritical fluid extraction (SFE) is an advanced technique using CO2as a solvent and plant-based drug exploration is a topic of growing interest. Curcuma caesia is a medicinal herb with many medicinal potential. Hence, in the present study, the effect of temperature (40°C–60°C) and pressure (10–20 MPa) on extraction yield and antimycobacterium potential of C. caesia Roxb. dry rhizome powder using supercritical fluid extraction method were evaluated. Methods: The extract of C. caesia by SFE was accomplished using temperature range (40°C–60°C) and pressure range (10–20 MPa). The chemical profile of the extracts were investigated by Gas Chromatography Mass Spectrometry (GCMS) and the antimycobacterial activity of the extracts were analyzed against Mycobacterium smegmatis strains MTCC06 and MTCC994. Compounds found in the extract were further checked by in silico analyses with two protein target 4DRE and 3UCI. Results: Extraction yield ranged from 3.0 to 5.6 g/25g dry substrate, with the highest value being achieved at 50°C and 15 MPa. The results of GCMS analyses revealed the presence of beta-elemene, curzerenone, boldenone, and 2-cyclohexen-1-one, 4-ethynyl-4-hydroxy-3, 5, 5-trimethyl in the extracts. The extract obtained at 50°C temperature and 15 MPa pressure showed the highest zone of inhibition against M. smegmatis strains MTCC06 and MTCC994, that is, 15.6 mm and 13.6 mm, respectively. Active constituents present in the extracts showed good binding energy with 4DRE and 3UCI by in silico analysis. Conclusion: This study identified the effect of temperature and pressure on yield C. caesia extract by SFE method. Furthermore, the effect of different extracts on antimycobacterial potential and docking study validated the antimycobacterial potential.
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Identification of predictors of cerebrovascular infarcts in patients with tuberculous meningitis p. 303
Jeneesh U Selvaraj, Benin B Sujalini, Moses S Rohitson, Anu Anna George, Vanjare Harshad Arvind, Ajay Kumar Mishra
DOI:10.4103/ijmy.ijmy_107_20  PMID:32862165
Background: Tuberculous meningitis (TBM) remains common in developing countries. Cerebrovascular infarct (CI) in TBM occurs in 15%–57% of patients. Literature regarding the predictors of central nervous system (CNS) infarct in patients with TBM is scanty, and the outcome of these events is unknown. The aim of this study is to evaluate the predictors of CI among patients with TBM at a tertiary care center in South India and to compare the impact of CI on the prognosis and outcomes in terms of mortality and morbidity. Methods: All patients who were confirmed to have TBM and CNS infarcts/stroke were included in this study retrospectively. Forty-six patients had appropriate imaging, and they were enrolled in the study as cases. Patients without infarct were matched with age and sex as controls. Details of the course of the disease, the extent of CNS involvement, and treatment were compared between the two arms. Results: The mean age of patients with and without infarct was similar. The presence of basal meningeal inflammation, hydrocephalus, focal neurological deficit, and cranial nerve palsy, was higher in patients with infarct. Independent predictors of infarcts in a patient with TBM were Medical Research Council (MRC) staging of II or more, presence of focal neurological deficit, cranial nerve palsy, and presence of hydrocephalus, meningeal enhancement on neuroimaging. Presences of infarcts were independently associated with a higher odds ratio of 2.58 for poor outcome, 4.48 for a longer duration of hospital stay, and odds ratio of 8.85 for the requirement of multiple hospitalizations. Conclusion: CI involvement in TBM has higher morbidity, with longer stay, recurrent admission
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High degree of fluoroquinolone resistance among extrapulmonary tuberculosis patients at a tertiary care center in North India p. 309
Jigyasa Chaubey, Divya Shrivastava, Satyajit Pawar, Binit Kumar Singh, Rohini Sharma, Sanjeev Sinha
DOI:10.4103/ijmy.ijmy_116_20  PMID:32862166
Background: The treatment of drug-resistant tuberculosis (TB) involves various regimens. Among them, the most promising antibiotic regimens are fluoroquinolone (FQ) drugs. Drug susceptibility testing (DST) for FQs is not included as routine assessment for baseline TB diagnosis. Limited resources are available about FQ resistance among extrapulmonary TB (EPTB) cases. Methods: A total of 447 culture-positive specimens were subjected to DST for first-line anti-TB drugs (FLDs) and second-line anti-TB drugs. DST was performed using automated mycobacterium growth indicator tube-960 liquid culture techniques. The study was carried out during the period of April 2016 to March 2017. In addition, DST of FQs was also performed in FLD-sensitive strains. Results: Mycobacterium tuberculosis was isolated from 447 specimens. Of the 447 culture-positive EPTB specimens, 54 were rifampicin-resistant (RR)/multidrug-resistant TB (MDR-TB) isolates, 45 isolates were resistant to any drug, and the remaining 348 were sensitive to FLDs. Monoresistance of FQs was observed in 20.4% (11/54) among RR/MDR-TB isolates and 4.3% (15/348) among FLD-sensitive isolates. Conclusion: The high degree of FQ resistance observed in EPTB specimens among drug-sensitive and MDR-TB isolates is alarming. This study reflects the need to expand culture and DST for EPTB cases and include FQs within first-line DST in such settings. Furthermore, there should be a rational use of FQs for the treatment of other diseases.
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CASE REPORTS Top

Lichen scrofulosorum: An uncommon manifestation of a common disease p. 313
Nirmal Chand Kajal, P Prasanth, Ritu Dadra
DOI:10.4103/ijmy.ijmy_41_20  PMID:32862167
Tuberculid is a cutaneous immunologic reaction to the presence of tuberculosis (TB), which is often occult, elsewhere in the body or their fragments released from a different site of manifest or past tuberculous infection. These eruptive lesions are due to hematogenous dissemination of bacilli in a host with a high degree of immunity against Mycobacterium tuberculosis. Although rare, these specific lesions are important diagnostic markers of TB. Lichen scrofulosorum (LS) is one of the recognized tuberculids, usually seen in children and young adults. We report a female who was diagnosed with LS and was treated appropriately. This case report highlights the uncommon, easily misdiagnosed but readily treatable case of LS and emphasizes its early diagnosis, detection, and treatment of otherwise an occult systemic TB in young patients.
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Humeral artery aneurysm revealing a rare association between tuberculosis and behçet's disease p. 316
Raja Amri, Rabie Ayari, Ramy Triki, Imen Chaabane, Khaled Bouzaidi, Mohamed Ali Sbai
DOI:10.4103/ijmy.ijmy_71_20  PMID:32862168
The association of pulmonary tuberculosis and Behçet's disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet's disease associated with pulmonary and lymph node tuberculosis. Antituberculous chemotherapy followed by corticosteroids, immunosuppressants, and colchicine has been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet's disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring.
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Tuberculous otitis media with osteomyelitis of the regional craniofacial bones p. 319
Tran Minh Truong, Tran Hanh Uyen
DOI:10.4103/ijmy.ijmy_112_20  PMID:32862169
Tuberculosis is an uncommon cause of chronic suppurative otitis media. Delay in diagnosis can lead to delayed treatment, resulting in significant complications. We describe a case of tuberculous otitis media with osteomyelitis of the craniofacial bones in a 44-year-old woman with chronic painless suppurative otorrhea, not responding to antibiotics, hearing loss, and facial palsy. Chest X-ray was normal. Computed tomography of the temporal bone showed the destruction of the left zygomatic bone, clivus, and petrous part of the temporal bone. Polymerase chain reaction was positive for Mycobacterium tuberculosis (MTB), and histopathological findings showed caseous necrotizing tissues. Sputum culture was negative for MTB. The patient was successfully treated with surgery and anti-tuberculosis drugs. The polymerase chain reaction is a sensitive, rapid diagnostic tool used to diagnose TB. Surgical approaches and operative biopsy should be considered when the cause of the chronic purulent discharge is still unknown.
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Isolated testicular tuberculosis with ethambutol cutaneous toxicity: A combination of two rare entities p. 322
Flávio Godinho Pereira, Mariana da Silva Leal, Susana Cavadas, Inęs Ladeira
DOI:10.4103/ijmy.ijmy_114_20  PMID:32862170
Tuberculosis (TB) is an infection that can affect any organ, affecting mainly the lungs. Isolated testicular TB is very rare. Six months of a multiple drug scheme is the mainstay of TB treatment. Adverse reaction to anti-TB chemotherapy is frequent and affects the course of the therapy, leading sometimes to discontinuation of drugs. Ethambutol optic nerve toxicity is frequent. However, severe cutaneous and anaphylactic reactions associated to ethambutol are very rare. We present the case of an immunocompetent patient presenting with isolated testicular TB that exhibited a severe cutaneous and anaphylactic reaction to ethambutol during the consolidation treatment phase. This led to exhaustive etiologic study and treatment modification.
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A rare presentation of isolated carpal bone tuberculous osteomyelitis mimicking gouty arthritis p. 325
Mohamed Faisal Abdul Hamid, Suvindran Raj Rajandiran, Andrea Ban Yu-Lin, Jamari Sapuan
DOI:10.4103/ijmy.ijmy_97_20  PMID:32862171
Tuberculosis (TB) is the most prevalent infectious disease in Southeast Asia. It causes both pulmonary and extrapulmonary diseases. TB of the wrist is rare and presents as osteomyelitis or tenosynovitis. We report a middle-aged male with carpal bone tuberculous osteomyelitis. He presented with left wrist pain initially treated as gouty arthritis. Within 2 weeks, he developed seropurulent discharge with osteomyelitic changes on imaging. He underwent debridement, and intraoperatively, there was destruction of most carpal bones. Histopathological examination revealed chronic granulomatous inflammation with abscess formation. Anti-TB medication was initiated, and he made a complete recovery with almost full range of wrist movement after 9 months of treatment. This case serves as a reminder that TB is a great mimicker, and a high index of suspicion is required to make a diagnosis of TB of the wrist. Early initiation of anti-TB is pivotal to prevent complications and deterioration of joint functions.
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Lazarine leprosy: A unique phenomenon of leprosy p. 329
Vaishali Wankhade, Vrutika Shah, Rajesh P Singh, Dharitri Bhat
DOI:10.4103/ijmy.ijmy_104_20  PMID:32862172
Leprosy, a chronic granulomatous disease, has been known since ages but even today continues to baffle the clinicians with a wide spectrum of clinical, histopathological, and immunological characteristics. Leprosy reactions are mainly of two types, namely, Type 1 and Type 2. In Type 1 leprosy reaction, the preexisting lesions become erythematous, edematous, and rarely ulcerate. Ulcerating Type 1 reaction is called lazarine leprosy. Ulcerations may occur in borderline tuberculoid (BT) pole or borderline lepromatous pole but more common in BT pole. In this postelimination era of leprosy, we report an interesting case report of BT Hansen's disease with Type 1 lepra reaction with ulceration, namely, lazarine leprosy.
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Bilateral tuberculous dacryoadenitis p. 332
Rabie Ayari, Raja Amri, Emna Chalbi, Mohamed Ali Sbai
DOI:10.4103/ijmy.ijmy_57_20  PMID:32862173
Tuberculosis is a real public health problem in developing countries. The ophthalmic form is a rare clinical entity. Dacryoadenitis presents an exceptional manifestation. We report the case of a 45-year-old female who presented with a 1-month history of painless bilateral dacryoadenitis with a normal initial work-up. Anatomopathological examination of the lacrimal glandular tissue showed a gigantic epithelioid granuloma with caseous necrosis confirming the diagnosis of tuberculosis. The search for a primary focus was negative. Evolution was good under anti-tuberculosis chemotherapy. The objective of this work is to think of the tuberculous etiology when having dacryoadenitis in an endemic country.
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