Tuberculosis Arthritis Genu Sinistra with Drug-Induced Liver Injury, COVID 19 Confirmed

Background. Tuberculosis is still a significant health problem, especially in developing countries. Although pulmonary tuberculosis is the most common form of the disease, extrapulmonary tuberculosis also contributes significantly to morbidity and mortality. 10-15% of extrapulmonary cases are due to tuberculous arthritis. The following is a case report of a 36-year-old woman with a diagnosis of genu Sinistra tuberculosis arthritis and drug-induced hepatotoxic injury due to OAT. Case presentation. A woman, 36 years old, Muslim, addresses Banyuasin. The patient is a housewife, treated at Dr. Moh Hoesin General Hospital since October 11, 2021. The main complaint in the form of pain in the left knee has been getting worse since 1 week before being admitted to the hospital. 4 months before admission the hospital, the patient complained of left knee pain, the pain felt like being stabbed, coming and going, especially when walking. In this patient, there was a complaint of nausea that was felt in the pit of the stomach. The results of laboratory examinations showed an increase in the transaminase enzyme and hyperuricemia, so it was suspected that the patient had DILI due to OAT drugs. Hepatocyte death in DILI can occur through two processes, namely processes mediated by apoptosis or necrosis. In apoptosis, cell shrinkage and fragmentation occur into small pieces with the cell membrane intact. These fragments are cleared by phagocytosis and generally do not stimulate the host immune response. Conclusion. A patient diagnosed with arthritis tuberculosis genu Sinistra with Drug-Induced Liver Injury and Confirmed COVID 19.

Fatality Case in a Tuberculous Meningoencephalitis Patient Coinfected with COVID-19

: Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.

Tuberculose em Idade Pediátrica: Experiência de 12 Anos num Centro Terciário de Referência em Portugal

Introduction: The diagnosis of tuberculosis in children is a challenge namely because extrapulmonary tuberculosis and severe disease are more frequent in this age group. The aim of this study was to evaluate and reflect about severe tuberculosis in pediatric age, in a metropolitan area of Lisbon.Material and Methods: Descriptive study about patients under 18 years of age admitted with tuberculosis disease in a tertiary pediatric hospital, from 2008 to 2019 (12 years).Results: We report 145 patients, average of 12 cases/year, with an increase in the last three years. Median age of 12.9 years, 42.8% born in Portuguese-speaking African countries and 20% had a chronic disease. The diagnosis was pulmonary tuberculosis in 52.4% (n = 76) and extrapulmonary tuberculosis in 47.6%: lymphatic (n = 26), skeletal (n = 15), miliary (n = 8), meningeal (n = 7), peritoneal/ intestinal (n = 6), pleural (n = 4), renal (n = 1), cutaneous (n = 1), thoracic wall (n = 1) and salivary glands (n = 1). The tuberculin test was positive in 78/99 (78.8%) and Interferon Gamma Release Assay in 61/90 (67.8%). In 20.7% (n = 30) acid-fast bacilli were identified in gastric aspirate/sputum and the agent was identified in 59.3% (n = 86). Tuberculosis was resistant in 11% (n = 16). Patients with extrapulmonary tuberculosis were younger (p = 0.006) and had more prolonged therapy (p < 0.001). Therapy-related complications occurred in 11% (n = 16). One patient died (with terminal cancer).Conclusion: This study highlights the need for screening of tuberculosis in children from endemic countries, patients with immunosuppression and chronic disease.

Extrapulmonary Tuberculosis Manifests as Middle Ear Tuberculosis: A Rare Case Report from Secondary Health Care Center at Sub-Himalayan Region

Tuberculosis of ear is a rare entity. Early diagnosis and prompt treatment can prevent many serious complications. Here we report a case of 45 year old female with middle ear tuberculosis which was cured with mastoid exploration followed by anti tubercular treatment. Keywords: Tuberculosis, TB, Extrapulmonary Tuberculosis, Middle Ear Tuberculosis, Sub-Himalayan Region

Profile of Tuberculosis in Children and Adolescent at Dr. Soetomo General Hospital Surabaya

Introduction: Tuberculosis is one of ten leading causes of death worldwide, including Indonesia. Indonesia is one of seven countries that causes 64% deaths due to tuberculosis. Tuberculosis is caused by Mycobacterium tuberculosis through droplet nuclei in the air. It can occur to any group age, including children and adolescent, if there is a contact history of people with tuberculosis infection. In 2016, one million children had tuberculosis and around 250,000 children died because of tuberculosis. This study aimed to know the profile of tuberculosis in children and adolescent at Dr. Soetomo General Hospital Surabaya.Methods: This was a descriptive study using retrospective approach. Sample of this study was collected from electronic medical record provided by Dr. Soetomo General Hospital Surabaya using statistic formula of single sample for estimated population proportions of children and adolescent with tuberculosis from 2013-2017, with total samples of 149 people.Results: There were 149 samples of children and adolescent patients with tuberculosis. Most of the children were mostly 0-4 years old and 57% were female. 84% of the children had been immunized with BCG and classified as moderate, and 35% were under nutritional status. This study showed that 67% of the children in household contacts of adult tuberculosis patients also had tuberculosis. The most frequent symptoms of tuberculosis in children and adolescent were fever (72%) and cough (80%).Conclusion: Tuberculosis in children and adolescent is more likely to occur in children than adolescent, especially children within group age of 0-4 years old. The number of pulmonary tuberculosis in children and adolescent are higher than extrapulmonary tuberculosis.

Extrapulmonary tuberculosis: risk factors

Objective. To identify the main demographic and clinical risk factors for the development of extrapulmonary tuberculosis (EPTB).Materials and methods. A retrospective study of tuberculosis cases registered from 2016 to 2020 in the Gomel region was conducted (330 patients with EPTB and 2,505 patients with pulmonary tuberculosis). The odds ratios were calculated to assess the risk factors for the development of EPTB.Results. The prevalence of EPTB was studied over the course of five years. The most significant risk factors for the development of tuberculosis in extrapulmonary localizations have been identified.Conclusion. The risk factors for the development of EPTB are age (EPTB often develops in children and older persons), females, and in those who have had an episode of tuberculosis previously. Awareness of the predisposing factors may help physicians maintain a high index of suspicion regarding the development of EPTB.

Clinical Peripheral Atypical Presentation of Tuberculosis in the Head and Neck Region in Asian Population —11 Years Experience and Review of Literature

Tuberculosis TB one of the major health problem in developed countries, with extremely high prevalence in Asian countries, mainly caused by "Mycobacterium Tuberculosis". Although pulmonary tuberculosis is the most common form of the disease, it also can occur in other organ systems such as lymph nodes, central nervous system, skeletal system, hepatic system, and gastrointestinal system, including the oral cavity. Extrapulmonary tuberculosis is an uncommon form of chronic infection that does not present typical signs and symptoms of pulmonary tuberculosis. Oral tuberculosis is an uncommon form and is often overlooked as it shows no path gnomic signs. This article presents our experience of unusual atypical tuberculosis in the Head and Neck region.

Epidemiological trends in tuberculosis in Ukraine at the beginning of the COVID­-19 pandemic

Objective — to examine the tendencies of the epidemiological situation on tuberculosis in Ukraine at the beginning of the COVID-19 pandemic in 2020. Materials and methods. The analysis of the data of official statistics in 2015—2020, a survey of 157 medical experts and a telephone questionnaire survey of 69 residents of the Volyn region. Results and discussion. It was established that the disease of COVID-19 has found its imprint on the epidemiological situation of tuberculosis and on the functioning of the TB care service. In 2020, the rate of decline in the incidence of pulmonary and extrapulmonary tuberculosis was significantly more intensive than in previous years. However, the incidence of tuberculosis among contacts with bacterial excretion in tuberculosis foci increased 1.85 times in each year. The frequency of tuberculosis recurrences is steadily decreasing.The prevalence and mortality from all forms of active tuberculosis among the entire population of Ukraine has a tendency similar to a decrease in morbidity.The effectiveness of treatment of patients of all categories is proportional to the severity of the tuberculosis process, but still insufficient. Mortality in TB care institutions increased in the previous year against the decrease of this indicator in previous years. Against the background of the inaccessibility of the population to TB care, day hospitals are underused, and the sanatorium network needs to be reorganized. The surgical method of treatment of patients is extremely insufficiently realized. Conclusions. The dispensary contingent of TB care institutions is decreasing every year. There is a reduction in the infrastructure of the TB care service, and in each year, the largest reduction was in the bed stock of TB care institutions and sanatoriums, as well as a decrease in the number of TB doctors.