[Disseminated infection caused by the bacillus Calmette-Guérin vaccine and SARS-CoV-2 coinfection in a patient with IL-12 receptor ß1 subunit deficiency]. / Infección diseminada por vacuna con bacilo de Calmette-Guérin y coinfección por SARS-CoV-2 en paciente con deficiencia de la subunidad ß1 del receptor de IL-12.

BACKGROUND: Inborn errors of immunity manifest with a greater susceptibility to infections, autoimmunity, autoinflammatory diseases, allergies, or malignancies. One of these is the mendelian susceptibility to mycobacterial disease. The most frequent etiology is the complete autosomal recessive deficiency of the ß1 subunit of the interleukin 12 receptor. CASE REPORT: A female patient who, by the age of six months, started with a nodular lesion in the right shoulder and ipsilateral axillary adenitis after the bacillus Calmette-Guérin vaccine was applied. Later, she developed a cutaneous fistula in the anterior thorax, the inframammary region, and chronic recidivant suppurative lymphadenitis. A disseminated infection caused by Mycobacterium bovis was diagnosed, therefore, individualized pharmacological treatment was required due to failure with the primary treatment. The patient was diagnosed with deficiency in the ß1 subunit of the interleukin 12 receptor at age six. During her last hospitalization, she presented fever, cough, and tachypnea, and SARS-CoV-2 was detected by quantitative polymerase chain reaction. The patient has had a favorable evolution. CONCLUSION: In patients with disseminated infections caused by bacillus Calmette-Guérin vaccination or by environmental mycobacteria, there should be suspicion of an inborn error of immunity and the patient should be referred to a third level hospital for an early immunological assessment.

Antecedentes: Los errores innatos de la inmunidad se manifiestan con una mayor susceptibilidad a infecciones, autoinmunidad, enfermedades autoinflamatorias, alergia o malignidad. Uno de estos es la susceptibilidad mendeliana a infecciones micobacterianas. La etiología más frecuente es la deficiencia completa autosómica recesiva de la subunidad ß1 del receptor de interleucina 12. Caso clínico: Paciente que comenzó a los seis meses de edad con una lesión nodular en hombro derecho y adenitis axilar ipsolateral posterior a la vacuna con bacilo de Calmette-Guérin. Posteriormente desarrolló una fistula cutánea en tórax anterior, región inframamaria y linfadenitis supurativa crónica recidivante. Se diagnosticó infección diseminada por Mycobacterium bovis, por lo que requirió tratamiento farmacológico individualizado debido al fracaso con el tratamiento primario. La paciente fue diagnosticada con deficiencia de la subunidad ß1 del receptor de interleucina 12 a los seis años. Durante su última hospitalización presentó fiebre, tos y taquipnea, detectándose SARS-CoV-2 por reacción en cadena de la polimerasa cuantitativa. La paciente evolucionó favorablemente. Conclusión: En los pacientes con infecciones diseminadas por la vacuna con bacilo de Calmette-Guérin o micobacterias ambientales, debe sospecharse un error innato de la inmunidad y derivarlos a tercer nivel de atención para la evaluación inmunológica temprana.

Mediastinal ganglionar tuberculosis postcardiac transplantation.

The diagnosis and treatment of tuberculosis (TB) in transplanted receivers presents several challenges. TB is an opportunistic infection with high morbidity and mortality in solid organs of transplanted patients, therefore, the diagnosis difficulties. A case of a 30-year-old male, heart transplanted patient, who after being submitted to mediastinoscopy, obtained a result of lymph node TB.

Mycobacterial cervicofacial lymphadenitis in human immunodeficiency virus-infected individuals after antiretroviral therapy initiation.

OBJECTIVES/HYPOTHESIS: Mycobacterial infections are the leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals worldwide. Cervical lymph nodes are the most frequently affected extrapulmonary sites. Despite the substantial reduction in complications of HIV-tuberculosis coinfection, a proportion of individuals develop immune reconstitution inflammatory syndrome (IRIS), a term used for a clinical deterioration following initiation of antiretroviral therapy (ART). The objective of this study was to describe mycobacterial-associated IRIS in cervical lymph nodes of HIV-infected individuals receiving ART. STUDY DESIGN: Retrospective cohort study, set in a tertiary referral center in Mexico City. METHODS: We included ART-naive subjects who had at least one follow-up ear, nose, and throat examination, and were diagnosed with lymph node mycobacterial infection before or during the first 3 months of ART initiation. Mycobacterial-associated IRIS in cervical lymph nodes was determined retrospectively through clinical case definition and medical chart review. RESULTS: Thirty-three subjects who initiated ART were diagnosed with cervical lymph node mycobacteriosis; 24 had Mycobacterium tuberculosis infection and nine had nontuberculous disease. CONCLUSIONS: M. tuberculosis was the most common pathogen isolated from cervical lymph nodes. The only factor associated with IRIS was infection with a nontuberculous mycobacteria. The unexpectedly high incidence of mycobacterial-associated IRIS underlines the relevance of head and neck examination before ART initiation. LEVEL OF EVIDENCE: 4.

Evaluation of the efficiency of nested q-PCR in the detection of Mycobacterium tuberculosis complex directly from tuberculosis-suspected lesions in post-mortem macroscopic inspections of bovine carcasses slaughtered in the state of Mato Grosso, Brazil.

Bovine tuberculosis (BTB) is a zoonotic disease caused by Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex (MTC). The quick and specific detection of this species is of extreme importance, since BTB may cause economic impacts, in addition to presenting imminent risks to human health. In the present study a nested real-time PCR test (nested q-PCR) was used in post-mortem evaluations to assess cattle carcasses with BTB-suspected lesions. A total of 41,193 cattle slaughtered in slaughterhouses located in the state of Mato Grosso, were examined. Of the examined animals, 198 (0.48%) showed BTB-suspected lesions. M. bovis was isolated in 1.5% (3/198) of the samples. Multiplex-PCR detected MTC in 7% (14/198) of the samples. The nested q-PCR test detected MTC in 28% (56/198) of the BTB-suspected lesions, demonstrating higher efficiency when compared to the multiplex-PCR and conventional microbiology. Nested q-PCR can therefore be used as a complementary test in the national program for control and eradication of bovine tuberculosis.

TBC ganglionar en escolar: a propósito de un caso / Ganglionar tuberculosis (TBC)in a school: a purpose of a case

Mycobacterium tuberculosis es un bacilo acido alcohol resistente. Las formas clínicas de la enfermedad pueden ser intratoraxicas 80 por ciento o extratoraxicas. El diagnóstico se confirma al aislar el Mycobacterium por cultivo, muestras de aspiración gástrica, esputo, la prueba de Tuberculina para personas asintomáticas, líquido de lavado bronquial, líquido pleural y cefalorraquídeo, o muestra de biopsia. La mejor manera de diagnósticar tuberculosis pulmonar en niños de corta edad con tos no productiva es el material de aspirado estomacal en la mañana. El Tratamiento usado son las drogas de primera línea: Izoniacida, Rifampicina, Pirazinamida. Se trata de Escolar masculino de 7 años de edad, quien es traído por presentar de 4 meses de evolución fiebre no cuantificada que cede momentáneamente con antipirético. Concomitantemente de 8 días de evolución aumento de volumen en región supraclavicular izquierda que fue aumentando progresivamente, motivo por el cual acude a este centro asistencial decidiéndose su ingreso; con antecedente de Hermano falleció de 12 años por TBC Extrapulmonar. Se le realiza RX de torax muestra ensanchamiento del mediastino superior con imagen nodular izquierda y derecha, además de PPD (+) 15 mm.Rx de tórax que muestra ensanchamiento del mediastino superior donde se evidencia imagen nodular izquierda y derecha, así mismo TAC de cuello-tórax-abdominal que reporta Adenomegalia en región supraclavicular izquierda y conglomerados adenomegalicos en mediastino, biopsia de ganglio cervical que posteriormente reporta Bacilo Acido Alcohol Resistente. Se inicia tratamiento con Izoniacida, Rifampicina, Pirazinamida, con evolución clínica satisfactoria.

Reconhecimento de antígenos por anticorpos de caprinos naturalmente infectados ou imunizados contra Corynebacterium pseudotuberculosis / Antigen recognition by antibodies against Corynebacterium pseudotuberculosisfrom naturally infected or immunized goats

Corynebacterium pseudotuberculosis é um cocobacilo gram-positivo, patógeno intracelular facultativo de macrófagos, filogeneticamente relacionado com o Mycobacterium tuberculosis. É amplamente distribuído em algumas espécies de animais, causando a linfadenite caseosa em ovinos e caprinos. A linfadenite caseosa, de ocorrência mundial, é uma doença infecciosa crônica cuja transmissão se dá principalmente através da pele. No presente experimento, foram estudados aspectos do reconhecimento antigênico, pela resposta humoral, em caprinos criados em regime extensivo, naturalmente infectados ou imunizados com uma vacina viva (cepa 1002), atenuada, desenvolvida pela Empresa Baiana de Desenvolvimento Agrícola (EBDA). As amostras de soros dos animais imunizados e de controle, coletadas mensalmente por um período de doze meses, foram analisadas pelo ensaio imunoenzimático ELISA e pelo Western blotting, utilizando-se como antígenos o extrato bacteriano contendo exotoxina e sonicado bacteriano de uma cepa selvagem e da cepa 1002. A análise através do Western blotting revelou que o padrão de antígenos reconhecidos pelos anticorpos séricos de animais imunizados, sem raça definida (SRD) ou de duas raças puras, bem como animais SRD naturalmente infectados, é semelhante, verificando-se bandas protéicas com pesos moleculares entre 20 e 94 kDa. Esta análise possibilitou observar-se que diferentes proteínas são reconhecidas ao longo da imunização.

The re-emergence of scrofula with HIV infection: a review of epidemiology, pathogenesis, diagnosis and treatment.

Scrofula has been called "The Dangerous Masquerader" because of its propensity to mimic other diseases. Scrofula has been mistaken for metastatic carcinoma, regional neoplasms, thyroglossal duct cysts, fungal disease, toxoplasmosis, lymphoma, osteosarcoma, chondrosarcoma, bacterial adenitis, and collagen vascular disease. Because of the enormous number of infectious and neoplastic diseases acquired by the HIV positive population, the diagnosis of scrofula may be further delayed in some patients. In these patients the early diagnosis of scrofula might allow the early identification of HIV infection and the early institution of anti-retroviral therapy. The recommended duration of anti-tuberculosis therapy is also different in HIV positive patients. Therefore, to ensure the patient of the most beneficial therapy, the physician must always consider scrofula in the differential diagnosis of a neck mass, and particularly because of the increases incidence of intrapulmonary tuberculosis in AIDS patients, he must consider the possibility of HIV infection.

The re-emergence of scrofula with HIV infection: a review of epidemiology, pathogenesis, diagnosis and treatment

Se presenta la escrofulosis desde una perspectiva histórica recalcando su importancia en la era de infección por el VIH. Se repasa la epidemiología de esta enfermedad micobacteriana y el rol de las micobacterias no tuberculosas y M. tuberculosis. Se discuten las alternativas diagnósticas y terapéuticas