Pancreatic tuberculosis: A systematic review of symptoms, diagnosis and treatment.

INTRODUCTION: Although pancreatic tuberculosis (TB) is traditionally considered to be a rare clinical entity, in recent times, an increase in the number of reports of pancreatic TB has been noted. We conducted a systematic review in order to summarise currently available data on pancreatic TB. METHODS: A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted in order to identify papers reporting cases of pancreatic TB. The eligibility criteria for inclusion in the review required that the studies reported patient(s) affected by pancreatic TB and that individual data on age, sex, clinical presentation and outcome were available. RESULTS: In total, 116 studies reporting data on 166 patients were included in the analysis. The majority of patients were males (62.1%) diagnosed at a mean age of 41.61 ± 13.95 years. Most cases were diagnosed in Asia (50.0%), followed by North America (22.9%), Europe (20.5%), Africa (4.2%) and South America (2.4%). Human immunodeficiency virus (HIV) infection was diagnosed in 25.3% of those affected. Pancreatic TB most frequently presented itself in the form of a pancreatic mass (79.5%) localised mainly in the head (59.0%) and less frequently in the body (18.2%) and tail (13.4%). Extrapancreatic TB involvement most frequently affected the peripancreatic lymph nodes (47.3%). More than half of patients (55.2%) were subjected to laparotomy, while 21.08% underwent endoscopic ultrasound fine-needle aspiration biopsy. The presence of TB was identified most frequently through histological analysis (59.6%), followed by culture (28.9%), staining (27.7%) and, in a smaller number, by polymerase chain reaction (9.6%) and cytology (6.6%). Almost all patients received anti-tubercular pharmacological therapy (98.2%), while 24.1% underwent surgery. Despite treatment, 8.7% of patients died. CONCLUSION: Increased awareness of pancreatic TB is needed, not only in endemic areas but especially in relation to HIV infection and other clinical conditions associated with immunoincompetence.

Characterization of tuberculosis in the Michoacan Local Office, period 2015-2018 / Caracterización de la tuberculosis en la Delegación Michoacán, periodo 2015-2018

Introduction: Tuberculosis (TB) is an infectious and curable disease caused by Mycobacterium tuberculosis complex; it affects both men and women at any age. Objective: To characterize cases of TB presented at the Michoacán Local Office of IMSS (Mexican Institute of Social Security), from 2015 to 2018. Material and methods: Cross-sectional, observational and analytical study. Cases with a clinical file with complete information and registered in the Epidemiological Surveillance Information System, from 2015 to 2018, at the Michoacán Local Office were included. Descriptive statistics, frequency and association measures were obtained by using XMH and chi squared. Results: 328 cases of TB were found, 56% were male; the most affected age group was the one of 65 years and above with 20%; 28% were housewives; 32% had primary education; 30% were from Lazaro Cardenas jurisdiction; 70% presented pulmonary TB; 88% got cured; 25% were associated with diabetes. The association of pulmonary TB with some risk factors was 1.24 times greater in retired: XMH = 2.02, OR = 2.74, chi squared: p = 0.03 (95% CI, 1.03 7.30); 1.15 times greater in males: XMH = 1.97, OR = 1.61, chi-squared: p = 0.04 (95% CI, 1.00 2.60), and 1.21 times greater in the age group of 65 years and above: XMH = 2.34, OR = 2. 21, chi-squared: p = 0.01 (95% CI: 1.12 4.35). Conclusion: The results of this study are a starting point to prevent, diagnose, control and follow up TB cases at the local office level at IMSS.

Introducción: la tuberculosis (TB) es una enfermedad infectocontagiosa y curable que es producida por el complejo Mycobacterium tuberculosis; afecta tanto a hombres como a mujeres de cualquier edad. Objetivo: caracterizar casos de TB presentados en la Delegación Michoacán del Instituto Mexicano del Seguro Social (IMSS), en el periodo 2015 2018. Material y métodos: estudio transversal, observacional y analítico. Se incluyeron casos con expediente clínico con información completa, registrados en el Sistema de Información de Vigilancia Epidemiológica, del 2015 al 2018, en la Delegación Michoacán. Se obtuvo estadística descriptiva, medidas de frecuencia y asociación utilizando XMH y chi cuadrada. Resultados: se encontraron 328 casos de TB, 56% eran hombres; el grupo más afectado fue el de 65 años o más con 20%; 28% fueron amas de casa; 32% tenía la primaria; 30% eran de la jurisdicción Lázaro Cárdenas; 70% tuvo TB pulmonar; 88% se curó; 25% estaban asociados a diabetes; la asociación a TB pulmonar con algunos factores de riesgo fue 1.24 veces mayor en jubilados: XMH = 2.02, RM = 2.74, chi cuadrada: p = 0.03 (IC 95%: 1.03 7.30); 1.15 veces mayor en hombres: XMH = 1.97, RM = 1.61 chi cuadrada: p = 0.04 (IC 95%: 1.00-2.60), y 1.21 veces mayor en el grupo de 65 años o más: XMH = 2.34, RM = 2.21, chi cuadrada: p = 0.01 (IC 95%: 1.12-4.35). Conclusiones: los resultados de este trabajo son un punto de partida para prevenir, diagnosticar, controlar y dar seguimiento a los casos de TB a nivel delegacional en el IMSS.

When students become patients: TB disease among medical undergraduates in Cape Town, South Africa.

BACKGROUND: Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown. METHODS: A self-administered questionnaire was distributed via email and social media to current medical students and recently graduated doctors (2010 - 2015) at two medical schools in Cape Town. Individuals who had developed TB disease as undergraduate students were eligible to participate. Quantitative and qualitative data collected from the questionnaire and semi-structured interviews were analysed with descriptive statistics and a framework approach to identify emerging themes. RESULTS: Twelve individuals (10 female) reported a diagnosis of TB: pulmonary TB (n=6), pleural TB (n=3), TB lymphadenitis (n=2) and TB spine (n=1); 2/12 (17%) had drug-resistant disease (DR-TB). Mean diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnoses being correct. Most consulted private healthcare providers (general practitioners (n=7); pulmonologists (n=4)), and nine underwent invasive procedures (bronchoscopy, pleural fluid aspiration and tissue biopsy). Substantial healthcare costs were incurred (mean ZAR25 000 for drug-sensitive TB, up to  ZAR104 000 for DR-TB). Students struggled to obtain treatment, incurred high transport costs and missed academic time. Students with DR-TB interrupted their studies and experienced severe side-effects (hepatotoxicity, depression and permanent ototoxicity). Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB. CONCLUSIONS: Undergraduate medical students in Cape Town are at high risk of occupationally acquired TB, with an unmet need for comprehensive occupational health services and support.

BCG-SSI(®) vaccine-associated lymphadenitis: Incidence and management.

BACKGROUND AND OBJECTIVE: There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI(®) vaccine and to evaluate the treatment results. MATERIAL AND METHODS: The study included 194 patients. All patients had received the BCG-SSI(®) vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment - the affected lymph node extirpation. RESULTS: The mean age of the patients was 5.12±0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11%±0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n=193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71±0.18 days. CONCLUSIONS: The incidence of BCG-SSI(®) vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.

[Epidemiological analysis of tuberculous lymphadenopathy in a District of Barcelona: proposal of a diagnostic algorithm]. / Valoración epidemiológica de la linfadenitis tuberculosa en un distrito de Barcelona: propuesta de algoritmo diagnóstico.

BACKGROUND: Barcelona (Spain) has experienced a dramatic change in its demography, which is reflected in the local epidemics of tuberculous lymphadenopathy (TL). The objective of the study is to analyze the associated risk factors to TL in a district of Barcelona with an incidence above 50 cases per 10,000 inhabitants/year, which will help to construct a diagnostic algorithm. METHODS: single-centre retrospective cohort study of all cases of TL diagnosed between 1990 and 2009. Due to the demographic changes, we analyzed 2 separate study periods (1990-1999 and 2000-2009). Socio-demographic, clinical and diagnostic features were assessed and compared between both cohorts and the algorithm was constructed with these results. Data was obtained from all the patients diagnosed with TL in Hospital del Mar (Barcelona) and was sent to the Public Health Agency of Barcelona. RESULTS: in the first study period, 152 patients had TL (73.7% Spanish-born) and in the second study period 147 (70.7% immigrants). In the first period, the percentage of male immigrants was 70.5% and 57.1% were younger than 35 years old but in the second study period, there was a 58.1% of Spanish-born female patients and 69.8% above 35 years old. The percentage of HIV co-infection decreased from 69.9% to 44.2% in the second period but use of immunosuppressive treatment increased to 9.3% in Spanish-born patients. Multivariate analysis showed intravenous drug use (OR 8.2; 95%CI: 3.4-19.8) and immigrant status (OR 4.8; 95%CI: 2.7-8.3) as risk factors associated to TL. CONCLUSION: male immigrants arriving from areas with high burden of TB, younger than 35 years old and Spanish-born women, older than 35 years old, with HIV infection (although with a lower proportion than before year 2000) or receiving immunosuppressive treatment, are the groups with an increased risk of TL in our district.

Assessment of lymph node tuberculosis in two provinces in Turkey.

The aim of this study was to evaluate lymph node tuberculosis (LNT) cases in two provinces in Turkey with different demographic and socioeconomic characteristics. A total of 109 LNT cases were reviewed retrospectively. The cases were analyzed and compared for symptoms, findings, age, vaccination status, and diagnostic procedures. Socioeconomic conditions were also assessed for the two provinces. A palpable cervical node was considered a significant predictor for all LNT. Mediastinal lymph node involvement was found to be common in cases of pulmonary manifestation of LNT. Female patients were predominantly from the Van Province, while older patients were found to be from Izmir Province. LNT should be suspected in lymphadenitis patients of all age-groups especially in young adolescents with cervical lymph node enlargements. In the presence of mediastinal lymphadenopathy, pulmonary tuberculosis should be investigated.

Assessment of lymph node tuberculosis in northern Germany: a clinical review.

AIM OF STUDY: To evaluate patient profiles, diagnostic approaches, and treatment strategies in patients with lymph node tuberculosis. METHODS: Demographic data, diagnostic findings, and therapies were retrospectively analyzed in 60 patients with lymph node tuberculosis who were hospitalized between 1992 and 1999. RESULTS: Thirty percent (n = 18) of patients were natives, and 70% were immigrants (n = 42). The cervical lymph nodes were most frequently involved (63.3%), followed by the mediastinal lymph nodes (26.7%) and the axillary lymph nodes (8.3%). All patients (except one patient who was HIV-positive) showed a positive response to tuberculin skin testing. Lymph node excision and fine-needle aspiration (FNA) were similarly effective in obtaining sufficient material for histologic and microbiological analysis. Mycobacterium tuberculosis was identified in 43.3% of patients by microbiological testing, and culture methods showed the highest sensitivity. Despite standard treatment, the initial enlargement of the lymph nodes occurred in 20% of patients and local complications occurred in 10%. CONCLUSION: Lymph node tuberculosis is still an important issue in developed countries and has to be considered in differential diagnosis. The best approach appears to be a combination of skin testing and FNA. Negative results in the identification of M tuberculosis do not exclude the diagnosis of lymph node tuberculosis.

Tuberculosis in an Indochinese refugee camp: epidemiology, management and therapeutic results.

In a 3-year period tuberculosis was diagnosed in 629 patients in Thailand's largest camp for Kampuchean refugees: 62% had pulmonary disease and 38% extrapulmonary forms. Tuberculosis of lymph nodes was the most important extrapulmonary manifestation (50%). The mean annual notification rates were 0.5% and 0.24% for all forms and smear-positive pulmonary tuberculosis respectively. There was a steep rise in the annual notification rate with increasing age. A 6-month course of fully supervised chemotherapy efficiently counteracted defaulting, early absconding and initial drug resistance. Seventy-three per cent of all patients remained on chemotherapy for the planned period; only 2% of the smear-positive patients failed bacteriologically on chemotherapy. Of the patients with the most common forms of extrapulmonary disease, 90% showed a favourable response to chemotherapy.