Multidrug-Resistant Tuberculosis-Diagnostic Procedures and Treatment of Two Beijing-like TB Cases.

The Beijing/W genotype is one of the major molecular families of Mycobacterium tuberculosis complex (MTBC), responsible for approximately 50% of tuberculosis (TB) cases in Far East Asia and at least 25% of TB cases globally. Studies have revealed that the Beijing genotype family is associated with a more severe clinical course of TB, increased ability to spread compared to other genotypes, and an unpredictable response to treatment. Based on the profile of spacers 35-43 in the Direct Repeat (DR) locus of the MTBC genome determined by spoligotyping, classical (typical) and modern (Beijing-like) clones can be identified within the Beijing family. While the modern and ancient Beijing strains appear to be closely related at the genetic level, there are marked differences in their drug resistance, as well as their ability to spread and cause disease. This paper presents two cases of drug-resistant tuberculosis caused by rare mycobacteria from the Beijing family: the Beijing 265 and Beijing 541 subtypes. The genotypes of isolated strains were linked with the clinical course of TB, and an attempt was made to initially assess whether the Beijing subtype can determine treatment outcomes in patients.

Pulmonary tuberculosis in a male with sarcoidosis.

Tuberculosis and sarcoidosis are chronic systemic diseases that have similar pulmonary and extra-pulmonary manifestations. It is likely that infection with Mycobacterium tuberculosis (MTB) is a common pathophysiologic mechanism for tuberculosis and sarcoidosis. We present a case of a patient with a primary diagnosis of sarcoidosis. The patient did not receive any immunosuppressive treatment till that time. Subsequently, smear-negative pulmonary tuberculosis was discovered, confirmed with the positive culture of bronchial washings and treated with antituberculous agents without major side effects. Both sputum smears and cultures were negative at the end of the treatment. It is worth highlighting that these two diseases share both clinical and histopathological features. Though it can be genuinely challenging to distinguish them, the precise and rapid diagnosis is crucial because the treatment is so different. Therefore MTB infection should be kept in mind in a broad differential diagnosis.

Pulmonary tuberculosis in a male with silicosis.

Silicosis, a preventable occupational lung disease, is associated with various diseases, including tuberculosis (TB). There is an increased lifelong risk for lung tuberculosis even if exposure to silica dust ceases. That association contributes in a large extent to very high rates of tuberculosis in countries with poor TB and silica exposure control. We report a case of a male with a prior diagnosis of silicosis who was diagnosed with and treated for TB. Anti-tuberculous treatment was extended due to a positive sputum smear in the six th month of treatment. However, the culture of the sputum was negative. This case report highlights the value of thorough screening for tuberculosis in silicotic patients. The clinical management of these patients may be challenging due to frequent overlapping radiological features and uncertain results of TB treatment.

[Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease]. / Krwioplucie w trakcie jednoczesnego leczenia rywaroksabanem i amiodaronem u chorego z obciazonym wywiadem plucnym.

UNLABELLED: Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein--P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor. A CASE REPORT: A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn. CONCLUSIONS: The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease.

Squamous cell lung cancer in a male with pulmonary tuberculosis.

Lung cancer and pulmonary tuberculosis (TB) are highly prevalent and representing major public health issues. They share common risk factors and clinical manifestations. It is also suggested that TB predicts raised lung cancer risk likely related to chronic inflammation in the lungs. However, it does not seem to influence the clinical course of lung cancer provided that it is properly treated. We present a case report of a 57-year old male with concurrent TB and lung cancer. He was diagnosed with positive sputum smear for acid fast bacilli (AFB) and subsequent culture of Mycobacterium tuberculosis. Besides, his comorbid conditions were chronic hepatitis C virus (HCV) infection and peripheral artery disease (PAD). Later while on anti-tuberculous treatment (ATT) squamous cell lung cancer (SCC) was confirmed with computed tomography (CT) guided biopsy. Due to poor general condition the patient was not fit for either surgery or radical chemo- and radiotherapy. He was transferred to hospice for palliative therapy. We want to emphasize that both TB and lung cancer should be actively sought for in patients with either disorder. In addition, there is no doubt that these patients with lung cancer and with good response to TB treatment should be promptly considered for appropriate anticancer therapy.

Tuberculosis and diabetes mellitus - an underappreciated association.

The current review presents up-to-date knowledge on tuberculosis (TB) in diabetic patients. On the basis of available literature, there is little doubt about the close relationship between these two conditions. Diabetes mellitus in this association may still contribute substantially to the burden of TB and negatively affect control of the latter. Chronic hyperglycemia at least to some extent may alter the clinical manifestation, radiological appearance, treatment outcome and prognosis of TB. Although the pathogenesis is not clear, diabetes may impair both innate and adaptive immune responses to Mycobacterium tuberculosis. Eventually, effective screening and dual management of the diseases have to be addressed both in low- and high-income countries in order to limit the negative effects of the forthcoming global diabetes epidemic.

Pulmonary embolism in a young male with tuberculosis and factor V Leiden.

There is no doubt that venous thromboembolism (VTE) is a complex and multicausal disease. Tuberculosis (TB) itself is found to have thrombogenic potential. There is an association between tuberculosis and VTE. We present a case of a 31-year-old male diagnosed with TB after a 2-month delay. He was treated with an anticoagulant for pulmonary embolism (PE) complicated by pulmonary infarction, and with antibiotics for presumed bacterial pneumonia. The patient did not improve despite in-hospital treatment. Finally, TB was diagnosed with positive sputum smear for acid fast bacilli and subsequent culture of Mycobacterium tuberculosis. Antituberculous therapy was uneventful and the patient was discharged home. Thrombophilia screening revealed a heterozygous factor V Leiden mutation. This case report emphasises that although there is a steady decline in active cases of TB, it should be still placed high on the list as a differential diagnosis in non-resolving lung infection or pulmonary infarction. This is especially relevant in cases with typical radiological findings located in the upper lobes. On the other hand, definitive diagnosis may be challenging in a case of concurrent TB, bacterial pneumonia and pulmonary infarction. Thromboembolic events may develop in TB patients without any clinical VTE risk factors. Therefore, thromboprophylaxis should be cautiously considered in this group of patients.

New onset diabetes in a patient with active tuberculosis.

The present report describes the coincidence of pulmonary tuberculosis (TB) and metabolic disorder such as diabetes. A patient's bronchoalveolar lavage was found to be positive for acid-fast bacilli (AFB) with following growth of Mycobacterium tuberculosis and complete sensitivity to first line anti-TB drugs. At the same time, the patient presented with typical diabetes manifestation and subsequently required insulin therapy. Combined treatment resulted in significant clinical improvement and gradual resolution of both TB and diabetes symptoms. Therefore, we would like to highlight the value of appropriate medical management of these disorders sharing at least some clinical symptoms and signs such as weight loss and fatigue. Moreover, a growing body of evidence indicates that diabetes may play a role as a risk factor for TB. Consequently, the increasing diabetes prevalence may be a danger to TB control.

C-reactive protein and chronic hepatitis C virus infection in diabetic patients.

INTRODUCTION: C-reactive protein (CRP) is one of the most widely used risk markers of cardiovascular disease in clinical practice. The contribution of hepatitis C virus (HCV) infection to low-grade inflammation in diabetic patients and its significance for cardiovascular risk scoring remain unclear. OBJECTIVES: The aim of the study was to investigate the relationship between HCV infection and CRP levels as one of the markers of cardiovascular risk in diabetic patients. PATIENTS AND METHODS: we compared patients with HCV infection and diabetes (n = 46) with HCV-negative type 1 (n = 56) or type 2 diabetic patients (n = 54), as well as HCV patients without diabetes (n = 54). RESULTS: CRP levels in diabetic HCV patients were lower than in type 2 diabetic patients (P <0.001), similar to those in the type 1 diabetic group (P = 0.747), and higher than in nondiabetic HCV subjects (P = 0.002). The median values were 1.07, 2.58, 0.91, and 0.45 mg/l, respectively. White blood cell count in diabetic HCV subjects was lower than in those with type 2 diabetes (P = 0.029) and similar to that found in type 1 diabetic (P = 0.064) and nondiabetic HCV patients (P = 0.279). There was difference in erythrocyte sedimentation rate between diabetic and nondiabetic HCV groups (P = 0.025); the respective medians were 10 and 5 mm/h. CONCLUSIONS: these findings indicate that HCV hepatitis may modulate chronic inflammatory state in diabetic patients. Moreover, these results suggest that screening for HCV should be considered prior to assessment of cardiovascular risk in diabetic patients, because the results may affect the cardiovascular risk scoring.

[Uncommon presentation of venous thromboembolism and fatal systemic emboli in a patient with nonbacterial thrombotic endocarditis due to pancreatic cancer]. / Nietypowy obraz zylnych powiklan zakrzepowo-zatorowych i zatorowosc systemowa u chorego z nieinfekcyjnym zakrzepowym zapaleniem wsierdzia w przebiegu raka trzustki.

In the presented case of a 60-year-old man, deep vein thrombosis and pulmonary embolism symptoms preceded pancreatic cancer diagnosis. An unexpected echocardiographic finding was a longitudinal mass attached to the tricuspid valve, and extending to the pulmonary artery - suggestive of a thrombus (as confirmed further autopsy), probably embolic in origin. This uncommon situation might be due to nonbacterial thrombotic endocarditis, which involved all, but mainly tricuspid and aortic valves. During heparin therapy the patient's haemodynamic status was stable until systemic emboli occurred with multifocal ischaemic stroke that was the cause of death.