Intraventricular tuberculosis abscess in an immunocompromised patient: clinical vignette

Tuberculosis is caused by Mycobacterium tuberculosis. Tuberculosis of the central nervous system is common and manifestations include meningeal and intraparenchymal diseases. However, intraventricular tuberculous abscess is a rare manifestation of intracranial tuberculous infection. We present a case of an immunocompromised female patient with high-grade fever and signs of meningism. The computed tomography and magnetic resonance imaging (MRI) of the brain showed hydrocephalus with rim-enhancing lesion in the right lateral ventricle. The MRI demonstrated a hypointense signal on T1-weighted imaging, hyperintense signal on T2-weighted imaging, and mild restricted diffusion in diffusion-weighted imaging. She underwent emergency external ventricular drainage and frank pus was drained. Diagnosis of tuberculosis was made via polymerase chain reaction analysis and culture. Understanding the intracranial manifestation of neurotuberculosis is imperative to arrive at the diagnosis correctly and ensure prompt treatment.

Immunodiagnostic Tests in the Assessment of Specific Sensitization to M. tuberculosis in Children under the Current Epidemical Situation

The objective: to study the degree of specific sensitization according to the results of intradermal immunodiagnostic tests in children with different manifestations of tuberculosis infection under the current epidemic situation.Subjects and Methods. The degree of tuberculin sensitization was studied in 299 children from different age groups (0-14 years old) who were registered for dispensary follow-up in 2018-2019.Based on the results of a tuberculosis recombinant allergen test (TRA), the degree of specific sensitization was studied in children with tuberculin tests conversion (n = 102) and infected with Mycobacterium tuberculosis (MTB) for 2 years or more (n = 165) exposed to tuberculous infection in their families and from healthy environment, and 145 patients under 14 years old with local respiratory tuberculosis.Results. Moderate sensitization to tuberculin predominated in children with converted tuberculin test exposed to tuberculous infection in their families and those from healthy environments. According to the results of TRA test, a high degree of sensitization was observed 4.7 times more frequently in children with tuberculin test conversion exposed to tuberculosis in their families. In children from healthy environments, negative responses to TRA test were registered 2.4 times more frequently. In 73% of children infected with MTB, results of annual Mantoux tests didn’t differ much. Hyperergic reactions to TRA test in infected children exposed to tuberculous infection were 10 times more frequent than in those from healthy environments. A direct correlation was found between the high degree of sensitization to active M. tuberculosis and exposure to a tuberculosis case with a positive result of sputum test (χ2 < 0.001, p < 0.05). In the case of converted tuberculin test and infection with M. tuberculosis for 2 years or more, pronounced and hyperergic reactions to TRA test were registered with equal frequency and did not depend on the timing and duration of infection. A high risk factor and predictor of the disease development is high sensitization of the host to active M. tuberculosis which is found in patients with tuberculosis using TRA test six times more frequently versus Mantoux test (OR 5.951, 95% CI 3.548 and 9.981). The demonstrated results are important for the identification of children facing a high risk to develop active tuberculosis and preventive treatment prescription.

Tuberculosis tenosynovitis of the wrist: a rare case report

Tuberculosis (TB) is a common disease of the Asian continent and has a varied presentation. Involvement of the musculoskeletal system is uncommon and presents in 10% of extrapulmonary tuberculosis. The atypical sites of tuberculous infection are the spine (51%) pelvis (12%), hip and femur (10%), knee and tibia (10%), and ribs (7%), but involvement of the wrist is rare. Tuberculosis tenosynovitis is a rare site of extra-articular TB. Delayed diagnosis and hence treatment is because it mimics many other disease processes and as a result, complications are common. Median nerve compression leading to carpal tunnel syndrome may also occur in these patients. Here, we present a case of tuberculous tenosynovitis involving the wrist flexors and the radial and ulnar bursae treated with surgery.

Latent Tuberculous Infection: Influence on Patient’s Quality of Life

Latent tuberculosis infection is an asymptomatic condition in which patients carry the bacteria, but do not show any sign of illness, however they are at risk of disease activation at any time in the future. Understanding of influence of latent tuberculosis infection on the physical and mental well-being of these patients is important as successful strategies to reduce the tuberculosis burden globally. Our purpose is to explore patients during diagnosis and treatment of latent tuberculosis infection, measure their quality of life. Materials and methods: during 2017–2019 was examined 100 children 4–7 years age. Children were divided in 3 groups. First group (n = 40) - a children with LTI. Group of the comparison (n = 40) has comprised preschool age children with tuberculosis. Group of the checking (n = 20) have constituted the preschool age healthy children. Estimation of children health was conducted by analysis health factors: social, genetic, biological. In addition were studied criteria of health. It was used study anamnestic data, questioning, estimation quality of life, anthropometry, data of objective examination, laboratory data and parameters of functioning, electrocardiography, vegetative nervous system spectrography (VNS-spectrography), manual ergometry. Physical development valued with the help of specialized tables. Leukocyte intoxication index is calculated on formula Shemitova V.F. Variety heart rhythm (VHR) was studied by method VNS-spectrography on vegetotester “VNS-Micro” with computer program “Polispectr” of company “Neyrosoft”. Interpretation source vegetative tone and vegetative reactivity was realized according to recommendation N.A. Belokon. Vegetative provision of activity was valued on tolerance to steady-state load by method manual ergometry (MEM) in help of manual dynamometer. Quality of life was defined with the help of questionnaire PedsQL version 4.0 (the Russian version). Results and their discussion: in children with active tuberculosis, specific process has a most negative influence upon quality of life, comparatively temporary negative influence has LTI. Revealed changes in general have brought to reduction of QL indicators both in first and second group. With provision of latency currents of infecting with mycobacteria of tuberculosis, indicators of quality of life should be considered as one of defining, reflecting psychological component adaptation of child, and can be recommended to enter in program of examination and dispensary observation of children with LTI. Conclusions: our study has shown that preschool age children with LTI have rather significant deflections of health condition, revealing by symptoms of intoxication, expressed breaches adaptation and regulation mechanisms. Results of study have logistical confirmed need of improvement of the preventive maintenance and dispensary observation at children with LTI and active participation in its base of the interdepartmental approach. All of this allows newly taking a look at problem of the latent tuberculous infection at preschool age children and role general practitioner in preventive maintenance of the development such dangerous diseases as tuberculosis.

Effectiveness of anti-epidemic measures in tuberculosis clusters in Chisinau municipality

The highest risk of the disease is observed among the contacts of the patients with tuberculosis in the clusters with a long-term contact. The aim of the research was to study the particularities of tuberculosis clusters (TC) depending on the degree of epidemiological danger and to assess the eff ectiveness of anti-epidemic measures in these TC. 384 tuberculosis clusters were analyzed in patients with sensitive evolutive tuberculosis admitted for the treatment in the Municipal Clinical Hospital of Phthisiopneumology. According to the criteria for the TB clusters classifi cation, they were divided into 3 groups: 1st group – 279 (72,7%) clusters, 2nd group – 104 (27,1%) and 3rd group – a single (0,2%) cluster. In the 1st group TC children 163 (58.4%) were established; pregnant women were identifi ed in 11 (3.9%) TC and were TB/HIV co-infected cases in 18 (6.5%) TC. Tuberculosis was confi rmed microbiologically by sputum smear in 263 (94.3%) patients. Contacts examination detected 15 children and 7 adults with tuberculosis. In the 2nd group TC the optimal living conditions predominated as a clasifi cation criteria. Positive culture for tuberculosis mycobacteria was identifi ed in 53 (51.0%) patients, and 4 contact from TC were diagnosed with tuberculosis. Conclusion: the high rate of the 1st groups TC showes an unfavorable epidemiological situation, despite the steady decreasing trend of the epidemiological indicators. Optimizing anti-epidemic measures in clusters through the enlargement of the actively investigated groups will contribute to the precocious detection and reducing the transmission of the tuberculous infection.

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Disseminated Tuberculosis of an Immunocompetent Patient

Disseminated tuberculosis (TB) is a rare disease and mainly occurs in immunodeficient patients. It is marked by hematogenous or lymphatic dissemination of Mycobacterium tuberculosis, causing tuberculous infection involving any organ system. Here, we report a case of disseminated TB involving lung, liver, spine, mediastinum, and prostate in an immunocompetent man. The present patient found a hepatic mass without any symptom during health examination. In the next 2 years, further examinations revealed multiple lesions in the lung, mediastinum, spine, and prostate. Imaging examinations, such as contrast-enhanced abdominal CT, F-18 FDG-PET/CT, and radionuclide bone scan, suggested the diagnosis of malignancy or metastatic tumor. Furthermore, histopathological results of the biopsies of the hepatic mass, mediastinal mass, and prostatic mass demonstrated granulomatous inflammation. Therefore, metagenomic next-generation sequencing (mNGS) was utilized to confirm the diagnosis. Mycobacterium tuberculosis complex was simultaneously detected in the spinal surgical resection specimens and bronchoalveolar lavage fluid (BALF), indicating the diagnosis of disseminated TB. mNGS is an emerging molecular diagnostic technology, and its application in disseminated TB has been rarely reported. We highlight that disseminated TB should be considered even in an immunocompetent patient, and mNGS can be performed when the diagnosis is difficult.

THE PECULIARITIES OF DETECTION AND DIAGNOSIS OF TUBERCULOSIS IN CHILDREN AND ADOLESCENTS

Objectives. To assess the peculiarities of diagnosis and clinical course of tuberculosis in children and adolescents. Material and methods. Retrospective analysis of outpatient records of children and adolescents with tuberculosis in Vitebsk region during the period from 2016 to 2020 was made. Results. In the tuberculous disease structure in children and adolescents, pulmonary tuberculosis (infiltrative pulmonary tuberculosis) prevails. In the majority of cases, tuberculosis was diagnosed during adolescence. Almost all of the sick had close family contact with tuberculosis patients. The medical risk group included 25% of patients. In patients with infiltrative pulmonary tuberculosis, symptoms and changes in the total blood count were observed only in the phase of disintegration and seeding. Bacteriological excreters made up 75% of cases. More than half of children and adolescents with tuberculosis had multidrug resistance of mycobacterium tuberculosis. Immunodiagnosing plays an important role in the detection of tuberculosis in children and adolescents. Among the sick children, only extrapulmonary forms of tuberculosis were recorded. Conclusions. Most often, tuberculosis in children and adolescents affects the respiratory organs and is asymptomatic or oligosymptomatic. 75% of patients were bacteria discharging persons, more than half of them having multidrug resistance. Family contact is of great importance in tuberculosis in children and adolescents. Doctors of all specialties need to have phthisiatric alertness in relation to patients with diseases of various localization resistant to nonspecific therapy, especially to persons with chronic diseases and to those who contact with patients suffering from tuberculosis. In case of ineffective antibiotic therapy, it is necessary to take the material for the study and verification of tuberculous infection and to carry out immunodiagnosing of tuberculosis.