Oral and maxillofacial tuberculosis: A systematic review.

OBJECTIVES: This study aimed to analyze the demographic, clinical, histopathological, diagnosis, treatment, and follow-up data on the occurrence of oral and maxillofacial tuberculosis (OMTB). METHODS: Electronic searches without publication date restrictions were undertaken in four databases. Case reports and case series describing the occurrence of OMTB were included. Critical evaluation of studies was done using the Joanna Briggs Institute - University of Adelaide tool for case reports or case series. RESULTS: A total of 217 studies were included in the qualitative synthesis, for a total of 301 cases of OMTB. Of these patients, 192 (63.7%) were male, with an average age of 39.6 ± 19.8 (15 months to 81 years). The tongue (n = 80/26.6%) represented the most common affected site, followed by the mandible (n = 43/14.3%). The clinical presentation consisted mainly of a painful ulcerated lesion (n = 156/56.5%). Histopathological analysis showed a granulomatous inflammation in most cases (n = 156/63.1%). The main diagnostic methods used were sputum test (n = 53/26.8%), culture (n = 49/24.7%) and purified protein derivative (PPD), or Mantoux test (n = 49/24.7%). Antituberculosis therapy was used in 244 cases (100.0%) and 5.2% of patients died. CONCLUSIONS: This systematic review provided clinical, demographic data and information about diagnostic methods of OMTB lesions and served as an important guide to assist health professionals in the early diagnosis of these lesions.

A case report of a tongue ulcer presented as the first sign of occult tuberculosis.

BACKGROUND: Tuberculosis (TB) is a serious infectious disease with considerable fatality, typically affecting the pulmonary system and, rarely, other body organs including the oral cavity. Due to the rarity of oral TB, it is frequently overlooked in differential diagnosis of oral lesions. Despite a declining trend in TB incidence in recent years, it is still a major public health problem with high contagiousness, thereby requiring the early diagnosis and prompt treatment. CASE PRESENTATION: A 57-year-old male patient presented with chief complaint of painful ulcer on tip of his tongue. He reported that the ulcer developed without any remarkable event such as mechanical trauma, vesicle formation or systemic illness. His past medical history revealed the TB over 40 years ago, which had reportedly healed after pharmacological treatments. As the ulceration persisted after topical steroid application and careful education about avoiding possible mechanical stimuli, biopsy was performed and histological finding showed typical findings of oral tuberculosis including intense granulomatous inflammatory features with small red rods of mycobacterial organisms as well as epithelioid cells and Langhans giant cells. After suitable antituberculosis treatments, oral tuberculosis ulcer was almost completely healed. We present a case of oral TB affecting tip of the tongue in a patient with a history of pulmonary TB and emphasize the understanding of intraoral manifestations for early diagnosis and prompt treatment of TB. CONCLUSIONS: The present case represented the importance of understanding oral tuberculosis manifestations for dental clinicians who might be frequently the first health care professionals to encounter various oral lesions.

Chronic non-healing ulcer of the oral cavity: tuberculosis or carcinoma?

OBJECTIVE: Tuberculosis is a chronic granulomatous lesion, which primarily has an affinity for the lungs. It can involve other sites like lymph nodes, kidney, oral cavity. Infection of the oral cavity by M. tuberculosis can be as a Primary infection or as a Secondary infection. Primary presentation of oral tuberculosis is in the form of the chronic non healing ulcer. A Primary infection or an Asymptomatic Secondary infection can impose a great diagnostic dilemma, as it may mimic neoplasia. Here we present a case of a 32-year-old asymptomatic female with secondary infection.

Tuberculosis of the oral cavity: an uncommon but still a live issue.

This paper aims at characterizing clinical features, occurrence, diagnostic process and treatment of oral tuberculosis (TB), basing on the available literature. Oral TB manifestations are uncommon and usually secondary to pulmonary changes. They predominantly appear as ulcers. Eruptions are usually single, painful and resistant to conventional treatment. Diagnosis always needs to be confirmed histopathologically. Anti-tubercular systemic therapy is required in every patient diagnosed with oral TB, while topical treatment is only adjuvant. A low incidence of oral TB together with a non-specific clinical picture might pose difficulties in its diagnosis. Oral changes in TB are likely to be overlooked what can result in further spread of Mycobacterium tuberculosis due to a delay in instituting proper treatment. Tuberculosis morbidity has risen recently and more multi-drug resistant strains of TB bacilli are found, what can result in a higher incidence of oral TB. Clinicians should be therefore aware of a possible occurrence of this entity and consider it while making a differential diagnosis of atypical oral changes.

Gingiva as the primary site of extrapulmonary tuberculosis: A rare case report with brief review of literature.

Multiple strains of Mycobacteria cause tuberculosis (TB), a chronic, specific infectious granulomatous disease. It mainly occurs with pulmonary involvement when compared to extrapulmonary involvement. Primary oral occurrence is uncommon and oral lesions are usually secondary to pulmonary involvement. When there are no active pulmonary clinical manifestations of TB, the diagnosis of the very rare entity of primary gingival TB poses a great challenge to clinicians. In this case report, we discuss a case of primary gingival TB in a 24-year-old lactating mother. This article briefs the onset and course of the lesion during pregnancy and postpartum, elaborates the pathway to diagnosis, various investigations performed and the regimen of antitubercular therapy for 6 months, followed by complete resolution of the lesion without recurrence. This report also describes the significance of considering TB as a differential diagnosis in oral lesions and the various diagnostic methods available. It also emphasizes the sole importance of histopathology in the early detection of the lesion and its management.

An Analysis of Xpert Test for Diagnosing Maxillofacial Tuberculosis.

Background: Maxillofacial tuberculosis is a diagnostic challenge for surgeons. The aim of this study was to present a detailed analysis of Xpert test in diagnosing maxillofacial tuberculosis and to analyse the accuracy of Xpert test results for various tissues of maxillofacial region. Materials and Methods: In this cross-sectional study, patients were selected randomly from outpatient department. The patients who had clinical picture and differential diagnosis highly suggestive of maxillofacial tuberculosis were included. Patients were divided into three different groups depending upon the site of involvement. The samples collected from the patients were further subdivided depending upon the type of specimen. Patients were screened first by routine tests, and the negative cases were followed by Xpert test for tuberculosis. Results: A total of 54 patients were enrolled in the study, 13 patients were found to be positive for maxillofacial tuberculosis on routine screening tests for tuberculosis, and 41 tested negative on routine test and were evaluated further through Xpert test. Specimens from bone (n12), soft tissue and skin biopsy (n15) and aspirates from lymph nodes (n14) were obtained and tested. Twenty-one samples were found to be positive, and 20 were negative upon Xpert testing. There was a statistically significant difference seen between the test groups (p < 0.01) with higher frequency of negative results in routine test. The p value for various specimens containing pus, biopsies and aspirates was 0.045, 0.023 and 0.067, respectively. Conclusion: Xpert test is more accurate when compared to routine test for diagnosing maxillofacial tuberculosis. Although accuracy of Xpert test is better for pus and biopsy samples in the specimens from bone and soft tissue, it gives poor accuracy for aspirated cells. The aspirates from lymph nodes were more susceptible for false negative test.

Some Manifestations of Tuberculosis in Otorhinolaryngology - Case Series and a Short Review of Related Data from South-Eastern Europe.

Tuberculosis is a disease of global outreach that may affect the entire human body but is most commonly located in the lungs. Otorhinolaryngological manifestations of tuberculosis are rare, mostly occurring secondary to pulmonary disease but nevertheless represent significant diagnostic challenges. Nasopharyngeal tuberculosis is rare, representing around 1% of all upper air-way localizations and the most common presentation is in the form of adenoids. Tuberculous glossitis (oral tuberculosis) is even scarcer and may present in various clinical forms, usually mimicking a malignant neoplasm, or, less often, trauma or other infectious lesions. Oropharynx tuberculosis is usually misdiagnosed as hypertrophic chronic tonsillitis. We present four rare cases of ENT tuberculosis, primary adenoiditis and tonsillitis in a 13-year-old girl, a curious case of tuberculous glossitis in a 65-year-old woman, clinically diagnosed as a lingual neoplasm and two cases of tuberculous lymphadenopathy uncommonly located in the submandibular and supraclavicular regions. A comprehensive review of literature follows the case presentations. Tuberculous manifestation in the ear, nose and throat area remains a difficult diagnosis to establish, particularly because of its rarity and non-specific clinical appearance, and should be included in the differential diagnosis of pharynx lesions. An early diagnosis is essential to avoid occurrence of complications.

ENT manifestations of tuberculosis: an important aspect of ENT practice.

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

Literature review of oral tuberculosis and report of a case with unique histological presentation.

As a consequence of the emergence of drug resistant tuberculosis (TB) and various immuno-compromised states, there is a re-emergence of many forgotten extrapulmonary manifestations of TB including oral TB, which must be taken into consideration while diagnosing oral lesions. The present article discusses the geographical burden, temporal evolution, demographic variables, clinical presentation and treatment of oral TB. The occurrence is most commonly secondary to pulmonary TB but oral symptoms may precede systemic symptoms. The most common presentation is ulceration (71%) and histopathological specimens demonstrate the characteristic epithelioid and langhans cells. In a unique case, presented here, an ulcerative tuberculous gingival lesion demonstrated dense plasma cell infiltration histologically and closely mimicked plasma cell gingivitis which made the diagnosis challenging.

Primary oral tuberculosis: A case series of a rare disease.

Tuberculosis (TB) is still one of the most life-threatening infectious diseases, resulting in high mortality in adults and is commonly found in developing countries. Lung is primarily affected while extrapulmonary TB is rarely encountered. Oral lesions, although rare, can be seen in both primary and secondary stages of TB. Primary oral TB may present a diagnostic challenge as its clinical features can be nonspecific that mimics other diseases and is usually misdiagnosed. Thus, it is very important to be aware and be highly suspicious of oral TB especially in endemic area. We share 4 such cases of primary oral TB with uncommon presentations (two on the gingiva, one on the palate and one on the tongue) The diagnosis was made by histopathological examination, polymerase chain reaction analysis and Mantoux test. They were successfully treated with antituberculous treatment. In secondary TB, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes or in any other part of the body and can be detected by a systemic examination.

Utility of fine needle aspiration cytology to diagnose intraoral tuberculosis and other oral granulomatous lesions.

OBJECTIVE: Tuberculosis (TB) is a common granulomatous disease leading to high morbidity and mortality worldwide. Though rare, oral tuberculosis (OTB) may manifest during the primary and/or secondary stages of the illness. We studied the manifestations and incidence of oral granulomatous lesions (OGL) and OTB diagnosed on fine needle aspiration cytology (FNAC). STUDY DESIGN: In this retrospective study, we present a review of 149 cases of benign and inflammatory lesions of oral mucosa diagnosed between 2008 and 2016. RESULT: Of the 280 oral FNAC performed during the 9 y study period, 149 cases were diagnosed as benign and inflammatory lesions among which 12 (4.3%) showed granulomatous lesions. Four out of 12 cases were diagnosed as OTB. One (0.011%) was a case of Primary OTB with no associated pulmonary or extrapulmonary manifestations of TB and three had associated lymphadenopathy including one with pulmonary TB. Per the clinical records, all four patients responded well to anti tubercular treatment (ATT) rendered under directly observed treatment short course (DOTS) supervision with regular visits and monitoring. CONCLUSIONS: Although oral mucosal TB is a rare presentation, clinicians and pathologists need to consider it early in the differential diagnosis of primary and secondary oral mucosal lesions. Such patients should be further evaluated for pulmonary TB and tuberculous lymphadenitis.

Oral tuberculosis - Current concepts.

Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.

Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma.

Pulmonary tuberculosis (TB) is the most common form of TB. Primary infection can also affect the pharynx, cervical lymph node, intestine, or oral mucosa. Historically, the observed incidence of concomitant infection with leprosy and TB is high. However, reports of concomitant infection in modern literature remain scarce. Most cases reported in the literature had borderline/lepromatous leprosy and pulmonary tuberculosis. Extrapulmonary tuberculosis is reported in only 3.2% of leprosy cases. To the best of our knowledge, this is the first case report of primary oral tuberculosis of the tongue in a patient with lepromatous leprosy with Type 2 lepra reaction. The patient was referred to Directly Observed Treatment, Short-Course clinic and started on Category I treatment. She received oral prednisolone for lepra reaction, which was subsequently tapered and stopped, however, she continued to receive other antileprotic drugs (thalidomide and clofazimine). The patient's general condition improved and she is on regular follow up.

Oral manifestation of tuberculosis: a case-report.

The present case-report describes tuberculosis on the oral mucosa, in a rare manifestation of the disease. The importance of appropriate diagnosis and awareness of the clinical manifestations is highlighted. Oral lesions seem to occur as chronic ulcers, nodular or granular areas, and rare, firm leukoplakia regions. Most extra-pulmonary lesions represent secondary infections of a primary lung infectious focus; therefore, early and accurate diagnosis is required for planning of the best treatment and strategies to control the disease.

Orofacial tuberculosis: Clinical manifestations, diagnosis and management.

Orofacial tuberculosis (TB) is an uncommon form of extrapulmonary TB and is nonspecific in its clinical presentation. It can be misdiagnosed especially when oral lesions are present before systemic symptoms become apparent. Doctors especially attending dentist who generally is the first among clinicians to come across such pathological entity should be aware of the orofacial lesions of TB and consider them in the differential diagnosis of suspicious oral lesions to ensure early diagnosis of TB and its treatment. In this review, we have discussed in detail the clinical presentation of various forms of orofacial TB, diagnosis, and management of patients. Also, an update is provided about recent anti-TB drug development.