Diagnosis of laryngeal tuberculosis in a high TB burden area.

PURPOSE: The larynx is the second most commonly affected site in the head and neck region in patients with extrapulmonary tuberculosis (TB). Despite this, the prevalence of laryngeal TB is largely unknown, particularly in areas with a high TB burden. The laboratory diagnosis of TB includes microscopy, culture and molecular testing. The aims of this study were to determine the prevalence of laryngeal TB in patients presenting with laryngeal pathology in a region with a high TB burden and to determine the optimal diagnostic methods for the diagnosis of laryngeal TB. METHODS: This was a prospective descriptive study of 80 adult patients undergoing direct laryngoscopy and biopsy for laryngeal pathology in the Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa over a 1 year period. Histopathological and microbiological investigations (microscopy, Xpert MTB/RIF, and TB culture) were performed on all laryngeal biopsies. RESULTS: Five (6.25%) out of 80 patients were diagnosed with laryngeal TB. In one patient, the Xpert MTB/RIF assay was positive on the laryngeal tissue and histology showed granulomas. Two patients had granulomas on histology although the microbiological tests on the tissue were negative. Two patients had only positive tissue cultures for Mycobacterium tuberculosis. None of the biopsies had positive Ziehl-Neelsen stains. CONCLUSION: The results suggest that the diagnosis of laryngeal TB required a combination of histopathology, culture and PCR and that the Xpert MTB/RIF assay is not a sensitive test for the diagnosis of laryngeal TB.

A review of the current public health practice for contact tracing in relation to laryngeal TB in England 2012-2016.

OBJECTIVES: Contact tracing following identification of tuberculosis (TB) is well established. However, evaluation of this activity, particularly for laryngeal TB, is limited. We compare contact tracing and outcomes in response to laryngeal TB with sputum-smear-positive pulmonary TB (ss + pTB) and consider the public health response in light of our findings. STUDY DESIGN: This study is a comparative secondary analysis of retrospective data, extracted from TB surveillance systems, to determine differences in contact tracing process and outcomes between two groups. METHODS: Cases of laryngeal TB (without ss + pTB) notified in England between 2012 and 2016 were selected and matched to ss + pTB controls. Number of contacts identified and screened, along with screening outcomes were gathered from local databases. RESULTS: There were 44 laryngeal TB cases who met inclusion criteria. The median number of contacts identified per case was 3 and 4 for controls (P = 0.04). Median number of contacts screened was 3 for cases and 4 for controls. The percentage of contacts with TB was 9.7 for cases and 20.3 for controls (P < 0.01). CONCLUSION: We observed a small difference, between case and control groups, in number of contacts identified but not number screened, indicative of a broadly similar approach to contact tracing. Conversely, the difference in screening outcomes between the groups was significant. These findings highlight a potential need to further understand infectivity of laryngeal TB; and consider possible implications for public health practice.

Laryngeal tuberculosis in the United States of America: a forgotten disease.

Laryngeal tuberculosis (TB) was a common manifestation of TB in the early twentieth century, but now represents only 1% of all cases. Most modern case series of laryngeal TB originate outside the USA. We report a case of laryngeal TB from our institution and review other US cases published between 1970 and 2012. One hundred twenty-seven cases were identified. The mean patient age was 49 y and 28% were female. The mean duration of symptoms was 19 weeks. Dysphonia and weight loss were the most common manifestations, seen in 96% and 47% of cases, respectively. These symptoms were usually attributed to malignancy initially. Most cases involved the vocal cords. Eighty-six percent of cases had underlying pulmonary involvement. Mortality was 3%. In the USA, laryngeal TB is rarely suspected and often confused with malignancy. This infection should be considered in patients with unexplained dysphonia and weight loss.

[Initial diagnosis of head and neck tuberculosis]. / Erstdiagnose einer Tuberkulose im HNO-Bereich.

BACKGROUND: In Germany tuberculosis has a decreasing incidence. The lung is the most common focus, whereas head and neck manifestation occurs rarely. MATERIAL AND METHODS: Between 1997 and 2010 all patients with initial diagnosis of tuberculosis of the head and neck region were retrospectively reviewed at the University Hospital of Bonn, Germany. RESULTS: 38 patients (24 female, 14 male, median age 43.5±19.7 years) were analysed. More than 60% were of foreign nationality. The majority of patients (87% ) presented with an unspecific cervical lymph node swelling. Extranodular manifestations (maxillary sinus, middle ear, larynx, tonsil) leading to organ specific symptoms rarely occurred. In only 3 cases a mycobacterial infection was suspected before surgery. CONCLUSION: Only the knowledge of different manifestation patterns as well as an accurate anamnesis of infectious diseases can lead to the tentative diagnosis of tuberculosis prior to surgery.

Tuberculosis in the Head and Neck: Changing Trends and Age-Related Patterns.

OBJECTIVE: To evaluate changing trends in patient collectives, age-related patterns of manifestation, and diagnostic pathways of patients with extrapulmonary head and neck tuberculosis (TB), and to provide strategies to fasten diagnosis in these patients. STUDY DESIGN: Case control study. METHODS: A 10-year retrospective analysis of 35 patients diagnosed with extrapulmonary TB in the head and neck at a tertiary university institution from 2009 to 2019, with special focus on the influence of the patient's age on consideration of TB and clinical patterns. RESULTS: The vast majority of patients younger than 40 years had their origin in countries with high TB burden (P = .0003), and TB was considered very early as a differential diagnosis (P = .0068), while most patients older than 40 years were domestic citizens initially suspected for a malignancy, who more often had an underlying immunosuppressive condition (0.0472). Most frequent manifestations in both groups were the lymph nodes, larynx, and oropharynx. Surprisingly, no differences in the rates of open TB or history of TB infection in the family anamnesis were found. CONCLUSION: The two groups of patients found most often are younger patients migrating from regions with high TB burden and elderly domestic patients suffering from immunosuppressive conditions, with the latter often being misdiagnosed as malignancies. TB remains an important but difficult differential diagnosis, due to the initially unspecific symptoms and the great variety in the presentation of manifestations in the head and neck. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2701-2705, 2021.

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.

Clinicopathological review of tubercular laryngitis in 32 cases of pulmonary Kochs.

PURPOSE: The aim is to study the current clinical features of tubercular laryngitis in adult patients with pulmonary involvement in the absence of other nontubercular comorbidities. MATERIALS AND METHODS: Medical records of histopathology confirmed cases with pulmonary Kochs in a tertiary medical center of a developing country from 1993 to 2007. RESULTS: Thirty-two biopsy-proven cases of laryngeal tuberculosis with pulmonary involvement were found. Patients' ages ranged from 16 to 65 years. The male-to-female ratio was 4.3:1. Hoarseness of voice was the commonest symptom. Most of them were associated with advanced fibrocavitary tuberculosis of the lungs. In the larynx, multiple, granulomatous, bilateral lesions were the commonest. Most of these lesions could be reversed with appropriate antituberculous treatment. CONCLUSION: Laryngeal tuberculosis with classic presentation continues to exist in developing countries. It can be the very first indication that the patient has tuberculosis. Hence, the otolaryngologist needs to remain vigilant to consider it in the differential diagnosis of chronic laryngeal disease.

Head and neck tuberculosis: Literature review and meta-analysis.

BACKGROUND: Head and neck tuberculosis (HNTB), including cervical lymphadenopathy, is the most common extrapulmonary manifestation of TB. The proposed study investigated the epidemiologic and clinical characteristics of HNTB. MATERIALS AND METHODS: A literature search was conducted via PubMed, Embase, Cochrane Library and Wanfang for keywords (tuberculosis, head and neck, laryngeal, pharyngeal, tongue, oropharyngeal, nasopharyngeal, and oral cavity). Scientific articles published from January 1990 through July 2017 were selected and reviewed to assess the epidemiology, presentation, diagnosis and treatment of HNTB disease. RESULTS: Results from the included 57 studies revealed that the majority of HNTB cases were age<40 years and female. The most common HNTB sites were cervical lymph nodes (87.9%), followed by larynx (8.7%). Involvement of other HN-regions was rare (3.4%). Multidrug resistant TB was not common among the majority of studies. Given the paucibacillary nature of HNTB, sputum tests did not have a good performance on HNTB diagnosis. Most of HNTB cases were diagnosed by fine-needle aspiration, cytology and excision biopsies in combination with clinical presentations. CONCLUSION: HNTB disease is an important manifestation in the diagnostic process in an otolaryngologist practice. The developments of rapid, ultrasensitive, simple and cost-effective high-throughput methods for early diagnosis of HNTB are urgently needed.

[Laryngeal Tuberculosis Diagnosed in a Pathological Laboratory in Senegal (2011-2015)]. / La tuberculose laryngée diagnostiquée dans un laboratoire d'anatomie pathologique du Sénégal (2011­2015).

Laryngeal tuberculosis (LT) is a rare disease. The therapy for LT is easy but the diagnosis remains a challenge for the pathologist and the laryngologist because of the absence of specific signs. The objective was to analyze the epidemiological and pathological profiles of LT cases in Dakar (Senegal) with a view to better understand this pathology. This study was a retrospective and descriptive of LT cases diagnosed in pathology laboratories in Senegal during five years (2011-2015). The LT was found in 9 cases. The mean age at diagnosis was 41.9 years (18/58) without sex predominance (sex-ratio = 0.8). Tobacco intoxication (3/9), tuberculosis contagion (1/9), HIV immunodepression (2/9), and diabetes (1/9) were the various risk factors found. Dysphonia was a constant symptom (9/9) associated with dysphagia (2/9) and cervical adenopathy (1/9). The macroscopic presentation was tumoral-like (7/9) and erythematosus and fibrinoid (2/9). The LT was of glottic seat in all the cases (9/9) with participation on top-glottic in two of the cases. The biopsy was performed in all patients. It reported tuberculous granuloma in four cases (4/9), tuberculoid granuloma in one case (1/9), and chronic lymphocytic laryngitis in four cases (4/9). CT-scan of the lungs was pathological in five patients (5/9). Evolution was favorable in all cases under "conventional tuberculosis treatment" over a period of six months. The diagnosis of LT requires a high collaboration between the laryngologist and the pathologist.

La tuberculose laryngée (TL) est une affection rare de diagnostic difficile à cause de l'absence de signes spécifiques. L'objectif de cette étude rétrospective était d'analyser les profils épidémiocliniques et anatomopathologiques des cas de TL diagnostiqués dans un laboratoire d'anatomie pathologique du Sénégal. Il s'agissait d'une étude rétrospective et descriptive des cas de TL sur cinq ans (2011­2015). La TL a été retrouvée dans neuf cas. L'âge moyen au diagnostic était de 41,9 ans (18/58) sans prédominance de sexe (sex-ratio = 0,8). Le tabagisme (3/9), le contage tuberculeux (1/9), l'immunodépression au VIH (2/9) et le diabète (1/9) étaient les différents facteurs de risque retrouvés. La dysphonie était un symptôme constant (9/9), accompagnée d'une dysphagie (2/9) et d'adénopathies cervicales (1/9). L'aspect macroscopique était pseudotumoral (7/9) et érythématoblanchâtre (2/9). La TL était de siège glottique dans tous les cas (9/9), avec participation sus-glottique dans deux cas. La biopsie systématique notait un granulome tuberculeux dans quatre cas (4/9), un granulome tuberculoïde dans un cas (1/9) et une laryngite chronique lymphocytaire dans quatre cas. L'évolution était favorable dans tous les cas sous traitement médical. Le diagnostic de la TL nécessite une collaboration parfaite et étroite entre l'otorhinolaryngologue et le pathologiste.

Improved program activities are associated with decreasing tuberculosis incidence in the United States.

OBJECTIVE: This study was conducted to determine whether improvements in tuberculosis (TB) program activities correlate with incident TB cases. METHODS: National TB surveillance data and program data from patients with pulmonary and laryngeal TB and their contacts were collected. These data were analyzed using regression models to assess the association between changes in incident TB cases and indicators of program performance (a time series of percent changes in program indices). RESULTS: A total of 1,361,113 contacts exposed to 150,668 TB patients were identified through contact investigations. From 1987 to 1992 (the period of TB resurgence and antedating increased funding), there was a decline in several measures used by TB programs for outcomes of contact investigations. From 1993 to 1998 (the period after increases in TB funds), there was an observable improvement in the program indices. Four program indices for contacts and two for TB cases (directly observed therapy and completion of therapy) were statistically associated (p < or = .01) with the decline in TB incident cases. CONCLUSIONS: These analyses suggest that expanded TB program activities resulted in the reduction in national TB cases and underscore the importance of treatment completion for TB disease and latent TB infection. Based on these results, we propose that further improvements in these activities will accelerate the decline of TB in the United States.

[Difference in transmissibility between bronchial and laryngeal tuberculosis--a retrospective epidemiological study of TB patients newly registered in recent 19 years in Aichi Prefecture, Japan].

OBJECTIVES: To elucidate difference in transmissibility between bronchial and laryngeal TB. SUBJECTS AND METHODS: The subjects of this retrospective study were 147 patients with bronchial TB and 28 patients with laryngeal TB registered in Aichi Prefecture between 1985 and 2003. All recorded files were reviewed to identify multiple TB patients in the same transmission group. When multiple patients with a registration interval of less than 10 years were found in the same transmission group, the first patient was considered as the index case, and the other patients were regarded as secondary cases. RESULTS: Bronchial TB patients were found in 0.17 per 100,000 population, and laryngeal TB patients in 0.032 per 100,000. Bronchial TB patients occupied 0.55% of total TB patients, and laryngeal TB patients occupied 0.10%. Significant differences were found in patients' proportion between bronchial and laryngeal TB; as to patients with non-cavitary infiltration (73.5% vs 50.0%, p<0.05), female patients (75.4% vs 39.3%, p<0.001), patients aged twenties (13.6% vs 0%, p<0.05), cavitary lesions (7.5% vs 21.4%, p<0.05), male patients (24.5% vs 60.7%, p<0.001), and patients aged thirties (6.1% vs 17.9%, p<0.05). However, no significant difference was observed in the patients' proportion between bronchial and laryngeal TB patients as to positive smear (64.7% vs 53.6%). Three patients with bronchial TB and other three patients with laryngeal TB were found to be the index patients. The proportion of the index patients among overall bronchial and laryngeal TB patients was 2.0% and 10.7% (p<0.05), while they were 2.1% and 20.0% (p< 0.05), respectively, in smear-positive patients, and 0% and 20.0% (p=0.18, not significant) in those patients with no chest pathology. CONCLUSION: These findings suggest that bronchial TB is less infectious than laryngeal TB.

[Laryngeal tuberculosis. Incidence between 1994 and 2004]. / Tuberculosis laríngea. Casos incidentes entre 1994-2004.

Tuberculosis is the chronic granulomatose most common infection of the larynx. It appears generally from pulmonary tuberculosis. It prevails in men. The most habitual symptomatology includes dysphony, odinophagy, referred otalgy and sometimes dispnea. The majority of patients use to have radiological pulmonary affectation to the diagnosis. The nodular exophitic or ulcerous lesions can be confused with carcinoma, therefore in these cases the anatomopathologic study is essential. The diagnosis is made with positive spit samples, specific characteristics of the thorax radiography and the positive biopsies of acid-alcohol resistant bacillus. We present the patients diagnosed with laryngeal tuberculosis in our hospital between 1994 and 2004. We describe the diagnostic procedures realised and the adopted therapeutic attitude in every case and results.

Tuberculosis laríngea en una gestante en un centro de salud / Laryngeal tuberculosis in a pregnant in a health center

La tuberculosis (TBC) es la enfermedad con mortalidad global más alta producida por un único agente infeccioso. La TBC durante la gestación es crítica incluso con tratamiento, que pueden tener reactivaciones y efectos adversos en el feto. Se describe un caso de TBC laríngea de un apaciente con embarazo gemelar a quien se le dio tratamiento según esquema del programa del Ministerio de Salud dando un excelente resultado materno-perinatal. (AU)

Tuberculosis (TB) is the disease with the highest overall mortality caused by a single infectious agent. TB during pregnancy is critical even with treatment, which can have reactivations and adverse effects on the fetus. A case of laryngeal TB is described from a patient with a twin pregnancy who was treated according to the scheme of the Ministry of Health program giving an excellent maternal-perinatal result. (AU)

Mycobacterium tuberculosis transmission rates in a sanatorium: implications for new preventive guidelines.

BACKGROUND: In 1990, the Centers for Disease Control and Prevention recommended substituting dust-mist particulate respirators for simple isolation masks in acid-fast bacillus isolation rooms, reasoning that air leaks around the simple masks could result in a higher rate of purified protein derivative skin-test conversion. In 1993, a Centers for Disease Control and Prevention draft guideline proposed that high-efficiency particulate air filter respirators be used instead of dust-mist particulate respirators. Epidemiologic data were not available to assess the importance of these changes or their cost-effectiveness. METHODS: The University of Virginia was affiliated with a tuberculosis hospital from 1979 until 1987. We surveyed physicians who had served as residents in internal medicine during this period regarding purified protein derivative skin-test history. duration of work at the tuberculosis sanatorium, and any history of unprotected exposures to patients with active pulmonary or laryngeal tuberculosis. Patients with active tuberculosis at the sanatorium were isolated in negative-pressure rooms with UV lights. Physicians wore simple isolation masks in these rooms. RESULTS: Responses were received from 83 former resident physicians. Fifty-two physicians had worked on the tuberculosis wards for a total of 420 weeks, with no subsequent skin-test conversions (95% CI 0 to 1 conversion/8 physician-years). CONCLUSIONS: These data document a low risk of occupational transmission of Mycobacterium tuberculosis to physicians who wear simple isolation masks in negative-pressure ventilation rooms with UV lights. This low rate predicts that the additional protective efficacy and cost-effectiveness of the more expensive high-efficiency particulate air filter respirators and the respiratory protection program will be low.

Hospital infection control practices for tuberculosis.

Although completely eliminating the risk for transmission of M. tuberculosis in all health-care facilities may not be possible, adherence to the principles outlined in the CDC guidelines should reduce the risk to persons in such settings. The guidelines are designed to help health-care facilities develop an infection-control plan tailored to the individual circumstances and risk in each facility. The key to maintaining an effective TB infection control plan is periodic evaluation of the plan, with reassessment of risk and revision of the plan accordingly.

Tuberculosis of the larynx. Today.

Forty-one cases of laryngeal tuberculosis accounting for 0.79% of the TB cases observed in 1975-85 are examined. The M/F ratio was 9.2:1; the mean age 52 years 9 months. In all cases current or earlier tubercular lesions on the pulmonary parenchyma were also noted. The laryngeal sites affected were as follows, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were treated with R/AMP, INH, EMB or SM, EMB with satisfactory results. Two cases required exeresis of laryngeal lesions and 3 tracheotomy.

[Epidemiological study of a tuberculosis case in a large manufacturing enterprise in Quebec]. / Enquête épidémiologique sur un cas de tuberculose dans une grande entreprise manufacturière québécoise.

OBJECTIVES: To determine the prevalence of tuberculosis infection related to a case of pulmonary and laryngeal tuberculosis in a workplace and to study PPD predictors. METHODS: The Mantoux skin test (PPD) was offered to all potentially infected contacts. Participants were asked to answer a questionnaire. RESULTS: Among 112 exposed employees, 92 (82.1%) were tested. At the 5 mm level, 65.2% of employees had positive tuberculin skin test (PPD). By controlling prior BCG and the degree of exposure, it showed a positive association between age and PPD (RC: 3.5; 95% CI: 1.25-10.03). When age and BCG were controlled, high exposure was statistically associated with PPD results (RC: 5.6; 95% CI: 1.25-24.68). CONCLUSION: The observed prevalence rate is probably related to the fact that the index case was very infectious and had contact in an enclosed area over a long period of time before withdrawal from work.

Tuberculosis of the larynx. A 10-year review of 14 patients.

A retrospective review of 14 patients with tuberculosis of the larynx seen at the Department of Otolaryngology, Kurume University Hospital during the 10 years from 1971 to 1980, was completed. Of these 14 patients, 11 were male and 3, female. All the patients were adults. Hoarseness was the commonest symptom. The laryngeal lesion was tumor-like in 5, granular in 7 and polyp-like in 2 patients and grayish in color in all the patients. Eight patients were admitted in our department. Chest X-rays revealed pulmonary tuberculosis and erythrocyte sedimentation rate was accelerated in all 8 patients. It should be emphasized that, even at present, there exist tuberculosis of the larynx.

Laryngeal tuberculosis in Tanzania.

The incidence of laryngeal tuberculosis in 341 patients with pulmonary tuberculosis was assessed in Dar es Salaam, Tanzania. Laryngeal involvement was present in 26.7 per cent of previously untreated cases. The clinical presentation corresponds to classical descriptions of the disease found in previous accounts. It is suggested that laryngeal tuberculosis is a common complication of pulmonary tuberculosis in developing countries. It should be the first differential diagnostic consideration in patients suffering from hoarseness, and pulmonary tuberculosis should be ruled out before a diagnostic direct laryngoscopy and biopsy are attempted.

Epidemiological considerations and clinical features of ENT tuberculosis.

Between 1 April 1996 and 30 June 1997, 1003 ear, nose and throat (ENT) outpatients and 340 inpatients diagnosed as having pulmonary tuberculosis were analysed for ENT manifestations of tuberculosis to determine the relationship to sputum positivity, whether any high risk factors exist for the ENT manifestations as compared to other pulmonary tuberculosis patients, and the response to anti-tubercular treatment. The commonest ENT manifestation was found to be laryngitis (seven cases), which was more common in pulmonary tuberculosis patients (five out of seven), all except one of whom were sputum negative. All of these patients were defaulters from anti-tuberculosis treatment or relapse cases, and vocal cords were the commonest site of involvement. One case of tuberculous tonsillitis and one case of tuberculous mastoiditis were also noted. The practical implications of an awareness of ENT tuberculosis is a benefit of anti-tubercular therapy and hence conservative management usually suffices.