Bacteriologically confirmed extra pulmonary tuberculosis and treatment outcome of patients consulted and treated under program conditions in the littoral region of Cameroon.

BACKGROUND: Extra-pulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs. It is frequently a diagnostic and therapeutic challenge with paucity of data available. The aim of this study was to assess the prevalence of bacteriologically confirmed EPTB; to determine the most affected organs and to evaluate the therapeutic outcome of EPTB patients treated under program conditions in the littoral region of Cameroon. METHODS: A descriptive cross-sectional laboratory-based epidemiological survey was conducted from January 2016 to December 2017 and 109 specimens from 15 of the 39 diagnosis and treatment centers in the littoral region were obtained. Two diagnostic methods (Gene Xpert MTB and culture (LJ and MGIT) were used for EPTB diagnosis. Determine HIV1/2 and SD Biolinewere used for HIV diagnosis. Confirmed EPTB cases were treated following the national tuberculosis guide. RESULTS: The prevalence of bacteriologically confirmed EPTB was 41.3% (45). All 45 cases were sensitive to rifampicin. Males were predominately more infected [26 (57.8%)] likewise the age group 31-45 years with 15 (33.3%) cases. The overall prevalence for HIV was 33.6% (36). HIV infection was present in 28.9% (13) of patients with EPTB. The most affected sites with EPTB were: Lymph nodes (66.5%), pleural cavity (15.6%), abdominal organs (11.1%), neuromeningeal (2.2%), joints (2.2%) and heart (2.2%). Overall, 84.4% of the study participants had a therapeutic success with males responding better 57.9% (p = 0.442). Therapeutic success was better (71.7%) in HIV negative EPTB patients (p = 0.787). CONCLUSION: The prevalence of bacteriologically confirmed EPTB patients treated under program conditions in the littoral region of Cameroon is high with a therapeutic success of 84.4% and the lymph nodes is the most affected site.

Tuberculosis and the Heart.

Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET-Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.

Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases.

Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the 'young' patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.

Mycobacterial infections following heart valve replacement.

Mycobacterial infection is an uncommon but very serious complication of heart valve replacement and other forms of cardiac surgery. Tuberculosis has been a rare complication of valve replacement in the industrially developed countries owing to the low incidence of that disease in such countries. Most reported cases are associated with the insertion of human allograft valves. Valvular tuberculosis could become a more serious problem if heart valve replacement surgery is used to any extent in countries where tuberculosis is common. The majority of other mycobacterial infections occurring after heart surgery have, for unknown reasons, been due to the rapid growers M. chelonae and M. fortuitum. Porcine xenograft valves have been contaminated by M. chelonae, possibly during manufacture as this is not a natural pathogen of pigs. A minority of patients receiving valves known to be contaminated by M. chelonae subsequently developed valve disease. Mycobacterial disease following insertion of mechanical valves is a very uncommon occurrence but the prognosis is poor. There have been several outbreaks of infection of the sternotomy wound by M. chelonae and M. fortuitum and, although the prognosis is better than for mycobacterial endocarditis, treatment, especially for infections due to M. chelonae, often involves extensive debridement including removal of the entire sternum. In view of the poor response to therapy, prevention by avoidance of contamination of all surgical materials, including implanted valves, by environmental mycobacteria is of paramount importance.

Heart disease: the greatest 'risk' factor of them all.

By the turn of the last century, flying in the face of over a hundred years of research and clinical observation to the contrary, medicine abandoned the link between infection and atherogenesis; not because it was ever proven wrong, but because it did not fit in with the trends of a medical establishment convinced that chronic disease such as heart disease must be multifactorial, degenerative and non-infectious. Yet it was the very inability of 'established' risk factors such as hypercholesterolemia, hypertension and smoking to completely explain the incidence and trends in cardiovascular disease that resulted in historically repeated calls to search out an infectious cause, a search that began more than a century ago. Today, half of US heart attack victims have acceptable cholesterol levels and 25% or more have none of the "risk factors" associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection. Even the case of the traditionalist's latest 2003 JAMA assault to 'debunk' what they call the "50% risk factor myth" falls woefully short under scrutiny. In one group 30% died of heart disease with a cholesterol of at least 240 mg/dl, a condition which also existed in 21% who did not die during the same period. And the overlap was obvious throughout the so-called risk categories. Under such scrutiny, lead author Greenland conceded that if obesity, inactivity and elevated cholesteriol in the elderly are included, just about everyone has a risk factor and he likened the dilemma of people who do or do not wind up with heart disease akin to the susceptibility of people who are exposed to tuberculosis but do not get the disease. In Infections and Atherosclerosis: New Clues from an old Hypothesis? Nieto stressed the need to extend the possible role of infectious agents beyond the three infections which have in recent years been the focus of research: Cytomegalovirus (CMV) Chlamydia pneumoniae and Helicobactor pylori. Mycobacterial disease shares interesting connections to heart disease. Not only is tuberculosis the only microorganism to depend on cholesterol for its pathogenesis but CDC maps for cardiovascular disease bear a striking similarity to those of State and regional TB case rates. Ellis, Hektoen, Osler, McCallum, Swartz, Livingston and Alexander-Jackson all saw clinical and laboratory evidence of a causative relationship between the mycobacteria and heart disease. And Xu showed that proteins of mycobacterial origin actually led to experimental atherosclerosis in laboratory animals Furthermore present day markers suggested as indicators for heart disease susceptibility such as C-Reactive Protein (CRP), interleukin-6 and homocysteine are all similarly elevated in tuberculosis. It therefore behooves us to explore the link between heart disease and typical and atypical tuberculosis.

Constrictive pericarditis in Saudi Arabia.

Twenty four patients underwent pericardectomy for constrictive pericarditis. There were 2 operative deaths. Tuberculosis was the aetiological factor in 20 patients and a post surgical aetiology was found in 2 patients. The aetiology remained unclear in 2 patients.

Tuberculous endocarditis.

Mycobacterium tuberculosis (TB) is a major cause of death globally. TB is capable of infecting every organ in the body, and the heart is no exception. Tuberculous endocarditis (TBE) was first reported in 1892 and subsequently many other cases have been described, highlighting the significant morbidity and mortality associated with this manifestation of TB. TBE usually presents with miliary tuberculosis and most early cases were diagnosed on autopsy. With increasing application of prosthetic valve replacements in the treatment of infective endocarditis (IE), TB infections have begun to affect these as well as native valves. With the introduction of TB culture methods and drug therapy, the prognosis has improved. HIV and drug resistance are likely to make the management of TBE more difficult in the future. Large scale studies, both prospective and retrospective, are required to ascertain the true incidence of TBE whilst development of novel anti-TB therapy is also required to combat resistance. We present the first extensive literature review on TBE in over 75 years.

Tuberculosis de aorta ascendente con enfermedad de poncet / Aortic tuberculosis and poncet´disease

La tuberculosis cardiovascular constituye entre 1-3% de los casos de tuberculosis extrapulmonar. En países en vías de desarrollo es causante de 38-83% de los casos de pericarditis constrictiva crónica, mientras que en los países desarrollados, el porcentaje es del 1%. Es más frecuente en hombres entre 30-50 años de edad. Caso: paciente masculino de 36 años de edad quien 2 meses previos a su ingreso, refiere tos con expectoración verdosa y disnea de 15 días de evolución. Se asocia proptosis indolora, limitación para la motilidad ocular, artritis simétrica, aditiva, ascendente desde tobillos hasta rodillas, luego muñecas y codos. Durante hospitalización requiere múltiples pericardiocentesis, por lo cual, se realiza pericardiectomía anterior con hallazgo en biopsia de aorta ascendente: inflamación crónica granulomatosa, BAAR positiva. Se plantea diagnóstico de TBC extrapulmonar: TBC de aorta ascendente complicada con derrame pericárdico, TBC ocular derecha y artritis reactiva por tuberculosis (Enfermedad de Poncet). La tuberculosis cardiovascular constituye una enfermedad poco común, de difícil diagnóstico que conlleva a consecuencias graves si no se trata oportunamente(AU)

Cardiovascular tuberculosis occurs in 1-3% of cases of extrapulmonary tuberculosis. In developing countries causes 38-83% of cases of chronic constrictive pericarditis, while in developed countries it represents 1%. It is more common in men between 30-50 years of age. We present a 36 year old male patient, who two months prior admission, referred productive cough and dyspnea during 15 days. Painless proptosis, limitation of ocular motility, symmetric, additive, ascending arthritis from ankles to knees, wrists and elbows were then associated. During his hospitalization multiple pericardiocentesis were performed, requiring pericardiectomy. The findings in ascending aorta biopsy were: anulomatous chronic inflammation, positive for alcohol resistant bacillus. Final diagnosis: tuberculosis of ascending aorta complicated with pericardial effusion, right eye tuberculosis and ceactive arthritis tuberculosis (Poncet´s disease) .Cardiovascular tuberculosis is a rare disease difficult to diagnose which leads to serious consequences without timely treatment(AU)

Tuberculous pericarditis in Birmingham.

Forty-one patients with acute tuberculous pericarditis were studied retrospectively. Anti-tuberculosis chemotherapy alone was effective in thirty. Five patients died, two from unrelated causes, two due to delayed diagnosis, and one after pericardiectomy. Constrictive pericarditis developed in seven patients, six of whom had successful pericardiectomy. Corticosteroids could not be shown to have reduced the risk of developing constriction. When constriction occurred it did so within the first six months of illness in all cases in contrast to a separate series of 15 patients who presented with constrictive pericarditis. These had had no previous history of tuberculosis, and in 10 cases where pericardiectomy was done, no histological evidence of tuberculosis was found. They were European with an average age of 49 years whereas in the group with acute tuberculous pericarditis 33 were Asian and the average age was 36 years.

Tuberculous infection of the descending thoracic and abdominal aorta: case report and literature review.

We report here a case of infrarenal aortic disruption and aortoduodenal fistula secondary to tuberculous aortitis in a 77-year-old man. From a review of experience with operative management of tuberculous infection of the descending thoracic and abdominal aorta reported in the English-language literature, including the current report, we found that operative repair was attempted in 26 patients with tuberculous aortitis of the abdominal (n = 16), thoracic (n = 8), and thoracoabdominal (n = 2) aorta. Six patients had emergent operations for massive hemoptysis (n = 2), aortoduodenal fistula (n = 2), or abdominal rupture (n = 2), with an associated 30-day mortality of 50%. Elective or semi-elective repair was undertaken in 20 patients, of whom 19 (95%) survived for at least 30 days. On the basis of limited experience with this rare entity, in situ graft replacement is an appropriate treatment of tuberculous aneurysms and pseudoaneurysms of the descending thoracic and abdominal aorta.