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1.
Br J Radiol ; 93(1106): 20190768, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794241

RESUMO

Non-tuberculous mycobacterial pulmonary disease is growing in incidence and prevalence. However, it is frequently overlooked as a differential diagnosis by both clinicians and radiologists alike due to its non-specific clinical features, wide spectrum of radiological findings and difficulty in isolating the causative organism. The aim of this article is to illustrate the spectrum and follow-up of the radiological findings of non-tuberculous mycobacterial pulmonary disease and the challenges involved in making a diagnosis.


Assuntos
Infecções por Micobactéria não Tuberculosa/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Micobactérias não Tuberculosas , Guias de Prática Clínica como Assunto , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(49): e18282, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804370

RESUMO

RATIONALE: Fetal adenocarcinoma of the lung (FLAC) with fetal lung-like morphology is a rare entity of pulmonary adenocarcinoma. Well-differentiated fetal adenocarcinoma (WDFA) belongs to its the low-grade form, which possesses a relatively favorable prognosis. Tuberculosis (TB) is an aggressive infectious disease that has been ranked as one of the top 10 causes of death worldwide. There may be a connection between the 2 and attention should be paid to the differential diagnosis. PATIENT CONCERNS: A 28-year-old non-smoking female was admitted with signs of hemoptysis, and she had been coughing up phlegm for 5 years. The patient was previously diagnosed with TB in another hospital, and underwent an anti-TB regimen. DIAGNOSIS: The co-existence of WDFA and TB was confirmed via histopathological evaluation of postoperative samples. INTERVENTIONS: The patient was subjected to a right lower lobectomy together with a wedge resection of the right upper lobe using video-assisted thoracoscopic surgery, with systemic lymphadenectomy. OUTCOMES: The patient tolerated the surgical procedure well and underwent an uneventful postoperative course. LESSONS: To our knowledge, no previous reports exist of cases with WDFA accompanied by TB. The present case indicated that a prior diagnosis of TB might predispose to lung cancer regardless of smoking history. It is also essential to distinguish WDFA from TB because of the similarity in clinical features and sites of pathological changes. Patients with WDFA usually have a better prognosis and surgery is the preferred treatment.


Assuntos
Adenocarcinoma de Pulmão/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/cirurgia , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Biópsia Guiada por Imagem , Excisão de Linfonodo , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico
3.
BMC Infect Dis ; 19(1): 923, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666021

RESUMO

BACKGROUND: Pulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it. METHODS: New sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for 6 months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured. RESULTS: Among 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of 6 months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase. CONCLUSION: Viable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.


Assuntos
Antituberculosos/uso terapêutico , Etambutol/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Idoso , Carga Bacteriana , Testes Diagnósticos de Rotina , Quimioterapia Combinada , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paquistão , Rifampina/uso terapêutico , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico por imagem , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 909, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664931

RESUMO

BACKGROUND: Disseminated nontuberculous mycobacteria (NTM) infections occur mostly in immunocompromised patients. Therefore, it is difficult to diagnose disseminated NTM infections in patients without history of immunocompromised diseases or using immunosuppressant. Patients with anti-interferon-γ (IFN-γ) autoantibodies are vulnerable to intracellular infections, such as disseminated NTM. Currently, there is no widely used and efficient technique for the detection of anti-IFN-γ autoantibodies. Herein, we report a case of an apparently healthy patient with disseminated Mycobacterium avium complex (MAC) infection who tested positive for anti-IFN-γ autoantibodies. CASE PRESENTATION: A 64-year-old non-immunocompromised and apparently healthy Asian male presented to the emergency department with complaints of progressive chest pain for about 6 months and weight loss. A bulging tumour was found in the anterior chest wall. Chest computed tomography showed a lung mass over the right lower lobe and an osteolytic lesion with a soft tissue component at the sternum. Sonography-guided biopsies for the osteolytic lesion and sputum culture confirmed the presence of disseminated MAC infection. In addition, positive test result of anti-IFN-γ autoantibodies was noted. The patient was prescribed antibiotics. The lesions over the right lower lobe and sternum attenuated following the antibiotic treatment. CONCLUSION: Detection of anti-IFN-γ autoantibodies is important among previously healthy people with disseminated NTM infection. Presence of anti-IFN-γ autoantibodies may suggest a high risk of severe intracellular infection, such as disseminated NTM infection.


Assuntos
Autoanticorpos/análise , Interferon gama/imunologia , Neoplasias Pulmonares/diagnóstico , Infecções por Micobactéria não Tuberculosa/diagnóstico por imagem , Complexo Mycobacterium avium , Tuberculose Pulmonar/diagnóstico por imagem , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Biópsia/métodos , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/microbiologia , Infecções por Micobactéria não Tuberculosa/patologia , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Escarro/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia
5.
J Korean Med Sci ; 34(38): e250, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31583870

RESUMO

BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.


Assuntos
Osso e Ossos/diagnóstico por imagem , Pneumopatias/diagnóstico , Radiografia Torácica/métodos , Radiologistas/psicologia , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Análise por Conglomerados , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/diagnóstico por imagem , Curva ROC , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem
6.
BMC Med Imaging ; 19(1): 63, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395012

RESUMO

BACKGROUND: To investigate the value of predictive nomogram in optimizing computed tomography (CT)-based differential diagnosis of primary progressive pulmonary tuberculosis (TB) from community-acquired pneumonia (CAP) in children. METHODS: This retrospective study included 53 patients with clinically confirmed pulmonary TB and 62 patients with CAP. Patients were grouped at random according to a 3:1 ratio (primary cohort n = 86, validation cohort n = 29). A total of 970 radiomic features were extracted from CT images and key features were screened out to build radiomic signatures using the least absolute shrinkage and selection operator algorithm. A predictive nomogram was developed based on the signatures and clinical factors, and its performance was assessed by the receiver operating characteristic curve, calibration curve, and decision curve analysis. RESULTS: Initially, 5 and 6 key features were selected to establish a radiomic signature from the pulmonary consolidation region (RS1) and a signature from lymph node region (RS2), respectively. A predictive nomogram was built combining RS1, RS2, and a clinical factor (duration of fever). Its classification performance (AUC = 0.971, 95% confidence interval [CI]: 0.912-1) was better than the senior radiologist's clinical judgment (AUC = 0.791, 95% CI: 0.636-0.946), the clinical factor (AUC = 0.832, 95% CI: 0.677-0.987), and the combination of RS1 and RS2 (AUC = 0.957, 95% CI: 0.889-1). The calibration curves indicated a good consistency of the nomogram. Decision curve analysis demonstrated that the nomogram was useful in clinical settings. CONCLUSIONS: A CT-based predictive nomogram was proposed and could be conveniently used to differentiate pulmonary TB from CAP in children.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico por imagem , Nomogramas , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tuberculose Pulmonar/diagnóstico por imagem , Algoritmos , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Linfonodos/diagnóstico por imagem , Masculino , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 98(34): e16921, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441875

RESUMO

Pulmonary tuberculosis (PTB) continues to be one of the significant public health threats with significant morbidity and mortality. The present study was aimed to assess the clinical characteristics and chest computed tomography (CT) findings of smear-positive and smear-negative PTB in hospitalized adult patients.Hospitalized adult patients diagnosed with PTB by positive Mycobacterium tuberculosis growth on acid-fast bacilli culture from bronchial aspiration or sputum from 2015 to 2017 were reviewed. Only the patients who had chest CT within 14 days of the diagnosis of PTB were included. Medical records and CT images were analyzed.A total of 189 patients was enrolled. The median age was 62 years, and there were 118 males (62.4%). More than half of the patients had underlying chronic medical conditions (55.5%). The most common CT finding was nodular lesions (96.8%). The patients were categorized in 2 groups of smear-positive (n = 94, 49.7%) and smear-negative (n = 95, 50.3%). Between 2 groups, there was no difference in underlying medical conditions. However, there were more lesions of cavity, consolidation, bronchiectasis, upper lobe involvement, multiple lobe involvement, and lymphadenopathy in the smear-positive group. A predictive model for smear-positive tuberculosis was created based on the comparison analysis that had an area of 0.724 under the receiver operating characteristic curve. In a multivariate logistic regression analysis, CT findings of consolidation (odds ratio [OR] 2.521, 95% confidence interval [CI] 1.175-5.408, P = .02), lymphadenopathy (OR 1.947, 95% CI 1.025-3.696, P = .04), and multi-lobe involvement (OR 2.795, 95% CI 1.084-7.205, P = .03) were associated with smear-positive PTB.PTB patients who have chest CT findings of cavity, consolidation, bronchiectasis, upper lobe involvement, multiple lobe involvement, and lymphadenopathy may be at higher risk for smear-positive TB. A predictive model may be helpful for further assessment.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tomografia Computadorizada por Raios X/métodos , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/microbiologia , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
8.
BMC Infect Dis ; 19(1): 749, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455234

RESUMO

BACKGROUND: Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana. METHODS: A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality. RESULTS: Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality. CONCLUSION: The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.


Assuntos
Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose/epidemiologia , Tuberculose/mortalidade , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
9.
Medicine (Baltimore) ; 98(33): e16761, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415374

RESUMO

RATIONALE: Liver transplanted patients have excellent survival rates, but infectious complications are a major cause of morbidity and mortality. Diagnosis and treatment of tuberculosis (TB) in liver recipients are very challenging. Specific recommendations for anti-TB treatment in liver transplanted patients are lacking. PATIENT CONCERNS AND DIAGNOSIS: A 22-year-old male liver transplanted patient because of biliary atresia showed unexpected acute hemoptysis while he was on immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Computed tomography (CT) identified a pulmonary arteriovenous malformation (PAVM) successfully treated with endovascular embolization. A post-embolization thoracic CT revealed pulmonary cavitation and miliary pattern suggesting pulmonary TB causing PAVM. TB diagnosis was confirmed by microbiological assays and genetic amplification techniques. INTERVENTION: Anti-TB 4-drug regimen was started. Following the beginning of treatment, liver enzymes increased. In order to clarify if liver cytolysis was due to hepatotoxicity or hepatic rejection linked to the reduction of immunosuppression or a worsening of pre-existing graft hepatitis, a liver biopsy was performed. A mild graft rejection was found so that tacrolimus doses were increased despite the risk of tubercular dissemination. OUTCOME: The patient completed anti-TB therapy in 8 months with resolution of TB disease and stable liver disease. LESSONS: TB management in liver transplanted patients is challenging and needs to be individualized especially if chronic graft hepatitis is present.


Assuntos
Rejeição de Enxerto , Hospedeiro Imunocomprometido , Transplante de Fígado , Tuberculose Pulmonar/diagnóstico , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Feminino , Hemoptise/etiologia , Humanos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Adulto Jovem
10.
Elife ; 82019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31271354

RESUMO

Diabetes mellitus (DM) increases risk for pulmonary tuberculosis (TB) and adverse treatment outcomes. Systemic hyper-inflammation is characteristic in people with TB and concurrent DM (TBDM) at baseline, but the impact of TB treatment on this pattern has not been determined. We measured 17 plasma cytokines and growth factors in longitudinal cohorts of Indian and Brazilian pulmonary TB patients with or without DM. Principal component analysis revealed virtually complete separation of TBDM from TB individuals in both cohorts at baseline, with hyper-inflammation in TBDM that continued through treatment completion at six months. By one year after treatment completion, there was substantial convergence of mediator levels between groups within the India cohort. Non-resolving systemic inflammation in TBDM comorbidity could reflect delayed lesion sterilization or non-resolving sterile inflammation. Either mechanism portends unfavorable long-term outcomes including risk for recurrent TB and for damaging immune pathology.


Assuntos
Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Diabetes Mellitus/patologia , Inflamação/induzido quimicamente , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Biomarcadores/sangue , Brasil , Estudos de Coortes , Comorbidade , Citocinas/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Índice de Gravidade de Doença , Escarro/microbiologia , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico por imagem
11.
Arerugi ; 68(6): 691-695, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31308335

RESUMO

BACKGROUND: Paradoxical response (PR) is defined as a clinical or radiological worsening in patients receiving adequate anti-tuberculosis treatment, with the exclusion of documented relapse or of other disease presentations. Although most patients with PR show spontaneous improvement, some cases presenting with diffuse alveolar damage have also been reported. METHODS: Retrospective clinical and laboratory data were collected on 89 patients of pulmonary tuberculosis who were treated at our hospital between April 2013 and January 2019. RESULTS: PR occurred in 21 patients (24%), and the median onset time after anti-tuberculosis treatment was 22 days. The time to onset of PR was shorter in diffuse pulmonary infiltrates group than in local pulmonary infiltrates group or in pleural effusion group. Low serum albumin, elevated lactate dehydrogenase (LDH), high Creactive protein (CRP) and chest radiographic appearance exceeding one-lung area were associated with PR incidence. There was no difference in sputum smear grading and pulmonary cavitation. Six out of the ten patients died, developing PR with diffuse pulmonary infiltrates. CONCLUSION: Low albumin and chest radiographic appearance exceeding one-lung area were risk factors for developing PR. Diffuse pulmonary infiltrates in early phase of anti-tuberculosis treatment was related with Inhospital mortality.


Assuntos
Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Proteína C-Reativa/análise , Mortalidade Hospitalar , Humanos , Incidência , L-Lactato Desidrogenase/sangue , Radiografia , Radiografia Torácica , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/análise , Escarro , Resultado do Tratamento
12.
Folia Med (Plovdiv) ; 61(2): 312-316, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301651

RESUMO

BACKGROUND: Sarcoidosis and tuberculosis are chronic diseases that rarely occur concomitantly. We present the case of a 39-year-old woman with microbiological confirmation of pulmonary tuberculosis and concomitant sarcoidosis. Four weeks after corticosteroid therapy for sarcoidosis was introduced we had positive findings of mycobacterium culture from bronchial aspirate. Based on these results, corticosteroid therapy was discontinued and the patient received anti-tuberculosis therapy for six months as required by the national guidelines. During this period, new nodes on face, nose, and ear appeared and the patient was diagnosed with skin sarcoidosis. The patient received colchicine and corticosteroids as per the national guidelines. CONCLUSION: In cases of diagnostic uncertainty between sarcoidosis and tuberculosis we should administer corticosteroid therapy until we have microbiological confirmation of mycobacterium culture.


Assuntos
Sarcoidose Pulmonar/complicações , Tuberculose Pulmonar/complicações , Adulto , Antituberculosos/uso terapêutico , Desprescrições , Etambutol/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Prednisolona/uso terapêutico , Pirazinamida/uso terapêutico , Radiografia Torácica , Rifampina/uso terapêutico , Romênia , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Vitamina B 6/uso terapêutico , Complexo Vitamínico B/uso terapêutico
13.
Comput Methods Programs Biomed ; 177: 285-296, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31319957

RESUMO

BACKGROUND AND OBJECTIVE: Chest X-ray (CXR) is one of the most used imaging techniques for detection and diagnosis of pulmonary diseases. A critical component in any computer-aided system, for either detection or diagnosis in digital CXR, is the automatic segmentation of the lung field. One of the main challenges inherent to this task is to include in the segmentation the lung regions overlapped by dense abnormalities, also known as opacities, which can be caused by diseases such as tuberculosis and pneumonia. This specific task is difficult because opacities frequently reach high intensity values which can be incorrectly interpreted by an automatic method as the lung boundary, and as a consequence, this creates a challenge in the segmentation process, because the chances of incomplete segmentations are increased considerably. The purpose of this work is to propose a method for automatic segmentation of lungs in CXR that addresses this problem by reconstructing the lung regions "lost" due to pulmonary abnormalities. METHODS: The proposed method, which features two deep convolutional neural network models, consists of four steps main steps: (1) image acquisition, (2) initial segmentation, (3) reconstruction and (4) final segmentation. RESULTS: The proposed method was experimented on 138 Chest X-ray images from Montgomery County's Tuberculosis Control Program, and has achieved as best result an average sensitivity of 97.54%, an average specificity of 96.79%, an average accuracy of 96.97%, an average Dice coefficient of 94%, and an average Jaccard index of 88.07%. CONCLUSIONS: We demonstrate in our lung segmentation method that the problem of dense abnormalities in Chest X-rays can be efficiently addressed by performing a reconstruction step based on a deep convolutional neural network model.


Assuntos
Diagnóstico por Computador/métodos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/diagnóstico por imagem , Reconhecimento Automatizado de Padrão , Tuberculose Pulmonar/diagnóstico por imagem , Algoritmos , Bases de Dados Factuais , Humanos , Radiografia Torácica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
14.
Clin Nucl Med ; 44(10): 831-833, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31283603

RESUMO

Extrapulmonary tuberculosis could involve multiple organs. However, thymic tuberculosis is relatively rare. We report a 21-year-old man who was referred for an F-FDG PET/CT imaging to assess his newly detected pulmonary nodule. The images showed the pulmonary nodule had minimal activity uptake. Unexpectedly, the thymus with elevated FDG accumulation was noted. The pulmonary nodule and thymic lesion were confirmed as tuberculosis by pathology.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Timo/diagnóstico por imagem , Timo/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Transporte Biológico , Fluordesoxiglucose F18/metabolismo , Humanos , Masculino , Adulto Jovem
15.
PLoS One ; 14(7): e0218861, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31306434

RESUMO

Image segmentation applied to medical image analysis is still a critical and important task. Although there exist several segmentation algorithms that have been widely studied in literature, these are subject to segmentation problems such as over- and under-segmentation as well as non-closed edges. In this paper, a simple method that combines well-known segmentation algorithms is presented. This method is applied to detect acid-fast bacilli (AFB) in bacilloscopies used to diagnose pulmonary tuberculosis (TB). This diagnosis can be performed through different tests, and the most used worldwide is smear microscopy because of its low cost and effectiveness. This diagnosis technique is based on the analysis and counting of the bacilli in the bacilloscopy observed under an optical microscope. The proposed method is used to segment the bacilli in digital images from bacilloscopies processed using Ziehl-Neelsen (ZN) staining. The proposed method is fast, has a low computational cost and good efficiency compared to other methods. The bacilli image segmentation is performed by image processing and analysis techniques, probability concepts and classifiers. In this work, a Bayesian classifier based on a Gaussian mixture model (GMM) is used. The segmentations' results are validated by using the Jaccard index, which indicates the efficiency of the classifier.


Assuntos
Testes Diagnósticos de Rotina , Microscopia/métodos , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Algoritmos , Teorema de Bayes , Telefone Celular , Humanos , Processamento de Imagem Assistida por Computador , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Manejo de Espécimes , Escarro/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/microbiologia
16.
BMJ Case Rep ; 12(6)2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31160302

RESUMO

Although not frequent, thromboembolic events occurring in patient presenting tuberculosis may be observed. Frequency of such thromboembolic events seems correlated with the severity of tuberculosis. We herein report a case of venous thrombosis revealing an asymptomatic tuberculosis. A man aged 32 years was admitted for deep and superficial vein thrombosis of the left arm. Chest CT angiography ruled out pulmonary embolism and showed a mediastinal and pulmonary heterogeneous necrotic mass at the apical segment of the left lung. Histological study of a CT scan-guided pulmonary biopsy showed signs of caseating granuloma compatible with tuberculosis. Diagnosis of venous thrombosis due to pulmonary tuberculosis with lymph nodes involvement was made. Antituberculosis treatment was initiated and required an adjustment of anticoagulant therapy. Our observation highlights the possibility of causative effect between tuberculosis and venous thrombosis.


Assuntos
Veia Axilar , Veia Subclávia , Tuberculose Pulmonar/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Braço/irrigação sanguínea , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Masculino , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/patologia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
17.
Indian J Tuberc ; 66(2): 314-317, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31151503

RESUMO

Tuberculosis and sarcoidosis are chronic multisystem granulomatous conditions which have different aetiology and management but may mimic each other clinically, radiologically and pathologically. Both these diseases usually have a sub acute or chronic presentation and it is rather uncommon for them to coexist or present with acute respiratory failure. We report a case of a 57-year-old male who presented with pyrexia of unknown origin with chronic cough. He was initially diagnosed to have sarcoidosis based on clinico-radiological and histologic evidence and was started on corticosteroids. However, he presented within two weeks with acute respiratory distress and on further investigation was diagnosed with co-existing pulmonary tuberculosis.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Sarcoidose/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem
18.
Rev. chil. radiol ; 25(2): 47-49, jun. 2019. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1013849

RESUMO

Resumen: Introducción: El objetivo de este estudio fue desarrollar un modelo predictivo sobre la presencia de tuberculosis pulmonar activa utilizando datos clínico-epidemiológicos y hallazgos de radiografía simple (Rx) y tomografía computadorizada (TC) de tórax. Material y métodos: Se realizó un estudio observacional, retrospectivo, descriptivo y analítico, que recopiló 22 variables clínico-epidemiológicas, 11 hallazgos radiológicos en Rx de tórax y 23 en la TC, que se realizaron en pacientes con sospecha clínica de tuberculosis pulmonar durante un período de 10 años. Se aplicó un modelo de regresión logística multivariado a los predictores potenciales de cultivo positivo, obteniendo un modelo predictivo. Resultados: Se recogieron 1.540 pacientes con sospecha clínica de tuberculosis a los que se les realizó Rx y TC torácico. El cultivo fue positivo en 101 casos. Se utilizó un proceso de eliminación hacia atrás para obtener el mejor conjunto de variables predictivas. Se obtuvieron 24 variables que fueron significativas (6 clínicas, 5 de Rx y 13 de TC) y se les asignó una puntuación. A la suma de estas puntuaciones se restó la edad en años multiplicada por 0,03. El modelo sugiere el diagnóstico de tuberculosis pulmonar activa en pacientes con una puntuación superior a 1,845. Obtuvo una sensibilidad de 85,1%, especificidad de 83,6%, valor predictivo positivo de 26,6%, y valor predictivo negativo de 98,7%. El área bajo la curva ROC fue de 0,9163. Conclusión: Este sistema de puntuación basado en criterios clínico-epidemiológicos y hallazgos radiológicos puede ayudar a diagnosticar tuberculosis pulmonar activa en casos de sospecha diagnóstica.


Abstract:Introduction: The objective of this study was to develop a predictive model on the presence of active pulmonary tuberculosis using clinical-epidemiological data and findings of chest radiography and thoracic computed tomography (CT). Material and methods: An observational, retrospective, descriptive and analytical study was conducted, which collected 22 clinical and epidemiological variables, 11 radiological findings on chest x-ray and 23 on CT that were performed in patients with clinical suspicion of pulmonary tuberculosis during a period of 10 years. A multivariate logistic regression model was applied to the potential predictors of positive culture, obtaining a predictive model. Results: We collected 1,540 patients with clinical suspicion of tuberculosis who underwent radiography and thoracic CT. The culture was positive in 101 cases. A backward elimination process was used to obtain the best set of predictive variables. We obtained 24 variables that were significant (6 clinical, 5 of chest plain films and 13 of CT) and were assigned a score. The sum of these scores was subtracted from the age in years and multiplied by 0.03. The model suggests the diagnosis of active pulmonary tuberculosis in patients with a score higher than 1.845. The model obtained a sensitivity of 85.1%, specificity of 83.6%, positive predictive value of 26.6, and negative predictive value of 98.7%. The area under the ROC curve was 0.9163. Conclusion: This scoring system based on clinical-epidemiological criteria and radiological findings can help rule out active pulmonary tuberculosis in cases of diagnostic suspicion.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Tuberculose Pulmonar/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/epidemiologia , Modelos Logísticos , Epidemiologia Descritiva , Análise Multivariada , Valor Preditivo dos Testes , Estudos Retrospectivos , Curva ROC , Sensibilidade e Especificidade , Fatores Etários
19.
Intern Med ; 58(17): 2443-2449, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31118378

RESUMO

Objective Although rare, pulmonary tuberculosis occasionally develops in patients with interstitial pneumonia (IP). In this study, we aimed to evaluate the clinicoradiological features of pulmonary tuberculosis associated with IP. Methods In this retrospective, observational, single-center study, the medical charts, high-resolution computed tomography (HRCT) findings, and bacteriological test results of patients with IP who also tested positive for Mycobacterium tuberculosis were reviewed. Patients The study included 20 patients with IP out of 329 who tested positive for M. tuberculosis in sputum or bronchoalveolar lavage fluid cultures at Toranomon Hospital between January 2006 and December 2017. Results The HRCT patterns were usual interstitial pneumonia (UIP) in 11 patients and non-UIP in 9 patients. Consolidations (80%) were the most frequent HRCT findings, followed by cavities (60%) and nodules (45%), which are generally characteristic of pulmonary tuberculosis. Consolidations often developed in relation to fibrotic or emphysematous lesions. Tuberculosis lesions could not be identified in one patient. All patients were treated with anti-tuberculosis drugs according to WHO guidelines, and 13 patients achieved a WHO category of "Treatment success." No patient died of tuberculosis, and the median survival time for the 20 patients was 1,196 days. Conclusion Although the HRCT findings for pulmonary tuberculosis associated with IP are atypical, appropriate tuberculosis treatments can lead to favorable outcomes.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/epidemiologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Líquido da Lavagem Broncoalveolar , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Escarro/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/patologia
20.
J Nepal Health Res Counc ; 17(1): 125-127, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31110393

RESUMO

This case report has tried to highlight the ease and benefit of Gene-Xpert testing in difficult to diagnose patient with sputum smear negative pulmonary tuberculosis. Early treatment of tuberculosis is usually delayed by lack of rapid and accurate diagnostic modalities, especially in resource-limited settings like ours. Gene-Xpert is a rapid test based on real time PCR assay and molecular technology for the detection of Mycobacterium tuberculosis. It is highly sensitive tool and enables simultaneous detection of rifampicin resistance within short period of time i,e. <2hrs. It has distinct advantage of providing same-day diagnosis which could potentially limit loss to follow up during diagnostic evaluation of smear negative tuberculosis patients. Keywords: Gene-Xpert; pulmonary tuberculosis; sputum microscopy.


Assuntos
Mycobacterium tuberculosis/efeitos dos fármacos , Técnicas de Amplificação de Ácido Nucleico , Escarro/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/diagnóstico , Antituberculosos/uso terapêutico , Reações Falso-Negativas , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico/métodos , Radiografia Torácica , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem
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