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1.
Zhongguo Zhen Jiu ; 41(10): 1171-4, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34628753

RESUMO

Through analyzing the indication distribution of the different acupoints located at the upper limbs recorded in Science of Acupoints and Science of Meridians and Acupoints, the industry planning teaching materials of traditional Chinese medicine, it is discovered that the acupoints located at the upper arms are commonly selected for the treatment of scrofula and goiter, while the acupoints below the elbow at the hand meridians and those at the lower limbs of the foot meridians which running through the neck, do not have the similar indications. Based on a further analysis on the literature at ancient and modern times, it is believed that the acupoints located on the lateral side of the upper arms, especially those at the large intestine meridian of hand-yangming perhaps have the specific effect in treatment of scrofula and goiter.


Assuntos
Bócio , Meridianos , Tuberculose dos Linfonodos , Pontos de Acupuntura , Braço , Humanos
2.
Ethiop J Health Sci ; 31(3): 653-662, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483623

RESUMO

Background: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia. Methods: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05. Results: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007). Conclusion: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.


Assuntos
Coinfecção , Infecções por HIV , Linfadenite , Mycobacterium tuberculosis , Tuberculose dos Linfonodos , Coinfecção/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Linfadenite/epidemiologia , Linfadenite/etiologia , Tuberculose dos Linfonodos/epidemiologia
3.
Ann Palliat Med ; 10(8): 9233-9238, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34488408

RESUMO

BACKGROUND: The optimal duration of treatment for intestinal tuberculosis (TB), which remains a common disease worldwide, has not yet been established. The proposed randomized controlled study will aim to compare the efficacy of short-term six-month with nine-month anti-TB therapy for treating intestinal TB. METHODS: This multicenter, open-label, double-blinded, randomized controlled trial conducted in the Affiliated Hangzhou Chest Hospital of Zhejiang University will include a total of 80 patients. Patients who meet the inclusion criteria will be randomly assigned to either the six-month (n=40) or nine-month (n=40) treatment group. The primary outcome will be complete response, which is defined as endoscopy displaying active lesion healing at the end of treatment. Participants will be scheduled for follow-up visits once a month in the first three months, then once every three months until the end of the treatment. The last follow-up will be one year after the treatment. Recurrence will be assessed one year after the end of treatment, which is defined as endoscopy displaying recurrent lesions after complete response. DISCUSSION: In addition to the reports of tuberculous lymphadenitis and spinal TB, there are few appropriate randomized trials for the treatment of extrapulmonary TB with appropriate clinical endpoints. We believe that the proposed randomized controlled trial will provide further data on the efficacy of short-term six-month anti-TB therapy in intestinal TB patients. TRIAL REGISTRATION: This trial will be registered on ClinicalTrial.gov.


Assuntos
COVID-19 , Tuberculose dos Linfonodos , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
4.
Int J Mycobacteriol ; 10(2): 162-165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34558468

RESUMO

Background: Tubercular lymphadenitis (TBLN) remains the most frequent manifestation for extrapulmonary TB despite advancements in diagnostics and management over the years. Our study intends to explore five-year trend of TBLN in a tertiary care centre from south India, and aims to study clinico-demographic and diagnostic factors in the management of TBLN. Methods: All the adult patients (≥18 years) diagnosed and confirmed for TB lymphadenitis between January 2015 to December 2019 were retrospectively evaluated. Demographic factors, clinical manifestations, and different diagnostic approaches used in the management of TBLN were analysed using SPSS ver. 16. Results: A total of 164 patients with confirmed TBLN were included. Patients aged 18-45 years were the most affected (63.41%) with female dominancy. The most affected lymph nodes were cervical lymph nodes (84.1%) presenting with single palpable enlarged lymph node (80.5%). Majority (78.7%) of the lymph nodes were non-matted and 68.9% of enlarged lymph nodes were >3cm size. Excisional biopsy was performed for the majority of the patients 99 (60.4%) and 60.4% of the cases were managed with a combination of surgical excision and anti-tubercular treatment (ATT). Conclusions: The declining trend of TBLN observed in this study highlights the outcome of good public health policies; however, young females and high-risk groups like HIV infected or AIDS (affected more in the study) demand further attention. Overall, the advanced diagnostic tools along with surgical management and ATT can lead us to earlier diagnosis and successful treatment outcomes.


Assuntos
Linfadenite , Mycobacterium tuberculosis , Tuberculose dos Linfonodos , Adulto , Feminino , Humanos , Índia/epidemiologia , Linfonodos , Estudos Retrospectivos , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/epidemiologia
5.
Braz J Biol ; 83: e244311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34431905

RESUMO

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.


Assuntos
Mycobacterium tuberculosis , Tuberculose dos Linfonodos , Tuberculose Resistente a Múltiplos Medicamentos , Humanos , Rifampina/farmacologia , Rifampina/uso terapêutico , Tuberculose dos Linfonodos/diagnóstico
6.
Artigo em Inglês | MEDLINE | ID: mdl-34360313

RESUMO

The diagnosis of tuberculous lymphadenitis (TB-LAP) is challenging. We evaluated the role of blood CXC chemokine receptor 3 (CXCR3) ligands in its diagnosis. A total of 65 lymphadenopathy patients were enrolled and lymph node sampling was performed. We also recruited 113 control subjects, consisting of 27 with positive results and 86 with negative results, in the interferon (IFN)-γ release assay (IGRA). In all study subjects, whole-blood samples were collected using the IGRA methodology. After incubation, plasma levels of IFN-γ and two CXCR3 ligands, IFN-inducible T-cell a chemoattractant (I-TAC) and monokine induced by IFN-γ (MIG), were measured using immunoassay. Fifty-three TB-LAP patients were enrolled. TB antigen-stimulated IFN-γ, I-TAC, and MIG levels were all significantly higher in the TB-LAP patients than in the controls and non-TB-LAP patients. The levels of I-TAC and MIG, but not IFN-γ, showed significant differences between the TB-LAP patients and IGRA-positive controls. Area under the receiver operating characteristic curves (AUROCs) of IFN-γ, I-TAC, and MIG were 0.955, 0.958, and 0.959, respectively, for differentiating TB-LAP from control group, and were 0.912, 0.956, and 0.936, respectively, for differentiating TB-LAP from non-TB-LAP. In conclusion, the TB antigen-stimulated MIG and I-TAC could be useful biomarkers in the diagnosis of TB-LAP.


Assuntos
Receptores CXCR3 , Tuberculose dos Linfonodos , Humanos , Interferon gama , Ligantes , Curva ROC , Tuberculose dos Linfonodos/diagnóstico
7.
Front Cell Infect Microbiol ; 11: 680665, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34350132

RESUMO

Matrix metalloproteinases (MMPs) are crucial for tissue remodeling and repair and are expressed in diverse infections, whereas tissue inhibitors of metalloproteinases (TIMPs) are endogenous inhibitors of MMPs. However, the interaction of MMPs and TIMPs in tuberculous lymphadenitis (TBL), an extra-pulmonary form of tuberculosis (EPTB) and helminth (Hel+) coinfection is not known. Therefore, this present study investigates the levels of circulating MMPs (1, 2, 3, 7, 8, 9, 12, 13) and TIMPs (1, 2, 3, 4) in TBL individuals with helminth (Strongyloides stercoralis [Ss], hereafter Hel+) coinfection and without helminth coinfection (hereafter, Hel-). In addition, we have also carried out the regression analysis and calculated the MMP/TIMP ratios between the two study groups. We describe that the circulating levels of MMPs (except MMP-8 and MMP-12) were elevated in TBL-Hel+ coinfected individuals compared to TBL-Hel- individuals. Similarly, the systemic levels of TIMPs (1, 2, 3, 4) were increased in TBL-Hel+ compared to TBL-Hel- groups indicating that it is a feature of helminth coinfection per se. Finally, our multivariate analysis data also revealed that the changes in MMPs and TIMPs were independent of age, sex, and culture status between TBL-Hel+ and TBL-Hel- individuals. We show that the MMP-2 ratio with all TIMPs were significantly associated with TBL-helminth coinfection. Thus, our results describe how helminth infection has a profound effect on the pathogenesis of TBL and that both MMPs and TIMPs could dampen the immunity against the TBL-Hel+ coinfected individuals.


Assuntos
Coinfecção , Helmintíase , Metaloproteinases da Matriz/sangue , Inibidores Teciduais de Metaloproteinases/sangue , Tuberculose dos Linfonodos , Animais , Helmintíase/complicações , Helmintos , Humanos , Tuberculose dos Linfonodos/complicações
8.
Sci Rep ; 11(1): 15902, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34354146

RESUMO

Universal Bacillus Calmette-Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.


Assuntos
Vacina BCG/provisão & distribuição , Tuberculose dos Linfonodos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Vacina BCG/imunologia , Vacina BCG/farmacologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Tuberculose dos Linfonodos/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , Vacinação
9.
PLoS One ; 16(7): e0253480, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34252107

RESUMO

BACKGROUND: Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia. METHODS: Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis. RESULTS: From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]. CONCLUSION: Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose Pulmonar/epidemiologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Variação Genética , Humanos , Masculino , Fatores Socioeconômicos , Tuberculose dos Linfonodos/epidemiologia , Tuberculose dos Linfonodos/microbiologia , Tuberculose Pulmonar/microbiologia , População Urbana/estatística & dados numéricos
10.
PLoS One ; 16(7): e0255146, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34324565

RESUMO

BACKGROUND: The comparatively straightforward and cheaper light-emitting diode fluorescent microscope (LEDFM) was suggested by WHO to replace conventional microscope in tuberculosis (TB) laboratories. However, the comparable efficacy of each of those techniques differs from laboratory to laboratory. We investigated the efficacy of LEDFM for the diagnosis of tuberculous lymphadenitis (TBLN) patients. METHODS: A cross-sectional study was conducted on 211 samples from clinically suspected tuberculous lymphadenitis patients. Three smears were prepared from FNA on microscope slides for cytomorphology study, Auramine O (AO), and for Ziehl-Neelsen (ZN) staining. The left-over samples were inoculated onto Lowenstein-Jensen (LJ) media. Statistical analysis was done using STATA version 11. The sensitivity, specificity, positive and negative predictive values were calculated by considering the culture results as the gold standard using a 95% confidence interval. RESULTS: Among 211 samples 49.7% (105) were positive by cytomorphology, 32.7% (69) by LEDFM, 23.69% (50) by LJ culture, and 13.7% (29) by ZN. Compared to the gold standard sensitivity of ZN, LEDFM, and cytomorphology were 30% [95% CI: 17.9-44.6], 66% [95% CI: 51.2-78.8] 78% [95% CI: 64-88.5], respectively. The specificity of ZN, LEDFM, and cytomorphology was 91.3% [95% CI: 85.8-95.2], 77.6% [95% CI: 70.4-83.8], 58.8% [95% CI: 50.7-66.5], respectively. CONCLUSION: LED fluorescence microscopy gives a legitimate option in contrast to conventional ZN techniques in terms of its higher sensitivity, a bit lower specificity, time-saving, and minimal effort.


Assuntos
Fluorescência , Tuberculose dos Linfonodos , Adulto , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Escarro
11.
Am J Trop Med Hyg ; 105(3): 630-632, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34314372

RESUMO

Lichen scrofulosorum is the most common tuberculid in the Indian population and the second most common form of cutaneous tuberculosis. We discuss an uncommon presentation of lichen scrofulosorum, with psoriasiform morphology and koebnerization at tuberculin test site, associated with cervical lymphadenitis in a 17-year-old girl. Although the cutaneous lesions resolved completely after 3 months of antitubercular treatment (ATT), she developed scrofuloderma in the left cervical region at 4 months. In the absence of rifampicin resistance, ATT was continued for another 6 months, with no further evidence of disease activity. This case represents an infrequent occurrence of lichen scrofulosorum followed by scrofuloderma, which necessitated a prolonged course of first-line ATT.


Assuntos
Tuberculose Cutânea/diagnóstico , Tuberculose dos Linfonodos/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Feminino , Humanos , Mycobacterium tuberculosis , Pescoço , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/patologia , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/patologia
12.
Mymensingh Med J ; 30(3): 704-709, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34226459

RESUMO

Persistent lymphadenopathy with or without fever is often a diagnostic challenge to the physician which are usually caused by infection like tuberculosis, hematological malignancy (lymphoma, leukemia), connective tissue diseases (SLE, RA, Sjogren's syndrome etc.), sarcoidosis, storage diseases, drugs (like phenytoin) in Bangladesh. To establish the cause of lymphadenopathy, we need to do a good number of investigations including invasive tests like FNAC or histopathology of the involved lymph node. In many instances these are not possible due to unavailability or cost. But for last few years the adenosine deaminase is an enzyme involved in purine catabolism and its significance in the diagnosis of tuberculosis has been demonstrated by many studies. In addition to tuberculosis, elevated serum adenosine deaminase has also been found in lymphoma, sarcoidosis and some connective tissue diseases. The study was intended to assess if there are any significant diagnostic difference in the level of elevated adenosine deaminase between tubercular and different types of non tubercular lymphadenopathy. It included 68 patients, equally divided into two groups, tuberculous lymphadenitis and non-tuberculous lymphadenopathy. Epitheloid granuloma with caseation necrosis in biopsy or FNAC was taken as case definition of tuberculous lymphadenitis. Causes of non-tuberculous lymphadenopathy were established on the basis of clinical findings, laboratory investigations and histopathological diagnosis of biopsy or FNAc materials. This cross-sectional observational study was done in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period of one year and participants of 18 years and above of both genders were included as per consecutive sampling technique. Serum ADA concentrations were estimated by enzymatic method. Mean serum ADA concentration was 25.52±7.11 in tuberculous lymphadenitis and in non-tuberculous lymphadenopathy patients it was 27.29±15.91U/L with no significant difference (p=0.480). The non-tuberculous lymphadenopathy group consisted of Hodgkin disease (n=9), non-Hodgkin lymphoma (n=10), sarcoidosis (n=2), reactive lymphadenitis (n=9) and other lymphadenopathy group (n=4) (that consisted one case of each of follicular hyperplasia, adult Still disease, sinus histiocytosis and Castleman's disease). The mean ADA of these groups was 32.77±13.14U/L, 46.40±46.10U/L, 13.94±2.81U/L and 21.75±3.17U/L respectively. Tuberculous lymphadenitis patients had significantly higher serum ADA than persistent reactive lymphadenitis. On the other hand, there were statistically significant elevation of serum ADA in non-Hodgkin lymphoma and sarcoidosis than in tuberculous lymphadenitis.


Assuntos
Adenosina Desaminase/sangue , Linfadenopatia , Tuberculose dos Linfonodos , Adulto , Bangladesh , Estudos Transversais , Feminino , Humanos , Linfadenopatia/diagnóstico , Masculino , Tuberculose dos Linfonodos/diagnóstico
13.
Artigo em Chinês | MEDLINE | ID: mdl-34304486

RESUMO

Objective:To investigate the clinical effect of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess. Methods:A total of 10 patients with cervical lymph node tuberculosis complicated with tuberculous abscess in parapharyngeal space were treated. Surgery was performed using a transcervical approach. The operation time and blood loss were recorded. The level of ESR, C-reactive protein(CRP), VAS score and the rating of Kubota drinking test before and 2 weeks after operation were compared. The incision healing, symptoms of tuberculosis poisoning, and the CT findings of the cervical lesions were compared before operation, 2 weeks after operation and at the last follow-up. Results:The operation time ranged from 65 to 130 min with an average of (99.00±21.45) min. The intraoperative blood loss ranged from 100 to 250 mL with an average of (155.00±43.78) mL. The average pre-and post-operative level of ESR was (67.60±21.94) mm/1h and (30.30±13.76) mm/1h, respectively(U=5.500, P<0.01); The average pre-and post-operative level of CRP was (69.70±31.13) mg/L and (42.40±19.70) mg/L, respectively(U=22.500, P<0.05); The average pre-and post-operative VAS score was (5.60±1.26) points and (2.50±1.27) points, respectively(U=4.500, P<0.01). As for Kubota drinking test, the rating was between 1-2 two weeks postoperatively. After relieving the compression, there was no obvious choking and coughing in drinking water. During the follow-up period (range: 6-24 months), the surgical wound healed completely, and the symptoms of systemic tuberculosis poisoning disappeared. No obvious residual cavity or effusion was found in the parapharyngeal space by CT examination, nor was any protruding tissue in oropharynx. The edema of soft tissue surrounding the operational area disappeared, and the enlarged lymph nodes were significantly reduced. No sign of liquefaction, necrosis, suppuration or recurrence was observed. Conclusion:Surgery using transcervical approach effective in treating cervical lymph node tuberculosis with parapharyngeal space abscess.


Assuntos
Doenças Faríngeas , Tuberculose dos Linfonodos , Abscesso , Humanos , Pescoço , Espaço Parafaríngeo , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose dos Linfonodos/complicações
15.
PLoS One ; 16(6): e0253534, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34153068

RESUMO

BACKGROUND: Neutrophils are important for host innate immune defense and mediate inflammatory responses. Pulmonary tuberculosis (PTB) is associated with increased neutrophil granular protein (NGP) levels in the circulation. However, the systemic levels of neutrophil granular proteins were not examined in tuberculous lymphadenitis (TBL) disease. METHODS: We measured the systemic levels of NGP (myeloperoxidase [MPO], elastase and proteinase 3 [PRTN3]) in TBL and compared them to latent tuberculosis (LTB) and healthy control (HC) individuals. We also measured the pre-treatment (Pre-T) and post-treatment (Post-T) systemic levels of neutrophil granular proteins in TBL individuals upon anti-tuberculosis treatment (ATT) completion. In addition, we studied the correlation and discriminatory ability of NGPs using receiver operating characteristic (ROC) analysis. RESULTS: Our data suggests that systemic levels of NGPs (MPO, PRTN3, elastase) were significantly reduced in TBL individuals compared to LTB and HC individuals. Similarly, after ATT, the plasma levels of MPO and elastase but not PRTN3 were significantly elevated compared to pre-treatment levels. NGPs (except PRTN3) were positively correlated with absolute neutrophil count of TBL, LTB and HC individuals. Further, NGPs were able to significantly discriminate TBL from LTB and HC individuals. CONCLUSION: Hence, we conclude reduced neutrophil granular protein levels might be associated with disease pathogenesis in TBL.


Assuntos
Mieloblastina/sangue , Peroxidase/sangue , Tuberculose dos Linfonodos/sangue , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Tuberculose Latente/sangue , Tuberculose Latente/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Adulto Jovem
16.
Med J Malaysia ; 76(3): 419-421, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34031344

RESUMO

A 35-year-old lady presented at the Klinik Kesihatan Bandar 32 Bera, Pahang with a one-month history of multiple cervical swelling and ulcers over her neck area. The lesions began as papules and later progressively developed into nodules and pustules. She also had low grade fever associated with weight loss for one month duration. Chest xray revealed normal findings and sputum direct smear for acid fast bacilli was noted to be negative. Histopathologic finding of skin biopsy revealed central epidermal necrosis surrounded by granulomatous tissue forming an abscess and histiocyte infiltrates, confirming the diagnosis of Scrofuloderma. In view of the report of the fine needle aspiration cytology (FNAC) of the cervical lymph nodes suggestive for tuberculous lymphadenitis, the patient was given anti-tuberculosis therapy. Fortunately, six months later, the ulcers began to solve and heal gradually.


Assuntos
Tuberculose Cutânea , Tuberculose dos Linfonodos , Adulto , Biópsia por Agulha Fina , Feminino , Humanos , Linfonodos , Atenção Primária à Saúde , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico
18.
Indian J Tuberc ; 68(2): 215-220, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33845955

RESUMO

INTRODUCTION: The variable course of illness in patients of Tubercular lymphadenitis remains a therapeutic challenge to treating physicians in a significant proportion of patients. This study was aimed to explore the possible determinants which could predict the outcome of this subgroup of patients. METHODOLOGY: This was a prospective cohort study where 94 patients of TB lymphadenitis were enrolled who could be followed up till the end of treatment. They were evaluated in the beginning and monitored till the end of treatment keeping into account the clinical behaviour of lymph nodes during the course of Anti tubercular chemotherapy. RESULTS: Out of 94 patients, 60 had their lymph nodes resolved at the end of prescribed treatment duration wheras 34 were classified as partial responders. Another 26 amongst them had their nodes resolved by an extension of continuation phase by 3-6 months. Presence of bilateral and multiple lymph nodes, necrosis on Fine needle aspiration at initial diagnosis and occurrence of Paradoxical upgrading reaction were associated with the partial resolution of lymph nodes at the end of stipulated ATT duration. CONCLUSION: Treatment duration should be individualized by the treating physicians. Certain parameters mentioned above can be taken as warning signals of patients ending up as partial responders and hence the need of a prolonged extension phase.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose dos Linfonodos/tratamento farmacológico , Adulto , Antituberculosos/administração & dosagem , Biópsia por Agulha Fina , Estudos de Coortes , Esquema de Medicação , Feminino , Hospitais , Humanos , Índia , Estudos Longitudinais , Linfonodos , Masculino , Estudos Prospectivos , Fatores de Tempo , Tuberculose dos Linfonodos/patologia
19.
Ann Palliat Med ; 10(4): 4289-4298, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33832297

RESUMO

BACKGROUND: This study aimed to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) guided purulence aspiration and local isoniazid injection after lymph node puncture in the treatment of refractory mediastinal tuberculous lymphadenitis (MTLA) as compared to systemic anti-tuberculosis treatment. METHODS: This was a retrospective study. A total of 92 patients with MTLA and suppurative lymphadenitis who were treated in the Shanghai Pulmonary Hospital between January 2015 and December 2018 were included into present study and divided into systemic chemotherapy (CT) group and interventional therapy (IT) group. In the CT group, patients received systemic chemotherapy alone; in the IT group, patients received EBUS-TBNA guided lymph node aspiration and local isoniazid injection besides systemic chemotherapy. The recovery of lymphadenitis and adverse effects were observed. RESULTS: Seventy patients were included for final analysis, 35 patients in each group. In the IT group, aspiration and local injection were done 137 times; 4R (53.1%) and 7 groups of lymph nodes (30.6%) were the most common site of aspiration; the median number of local treatment was 3 times, and the median duration of local injection was 29 days. The recovery rate of lymphadenitis was 88.6% (31/35) in the IT group and 57.1% (20/35) in the CT group, showing marked difference (χ2=8.741, P<0.05). The most common symptoms of patients with MTLA were cough, fever, dyspnea and anorexia, and the time to recovery of these symptoms in the IT group was 0.83±0.32, 0.89±0.29, 1.00±0.18 and 1.07±0.15 months, respectively, which were markedly shorter than in the CT group 2.60±0.74, 2.46±0.73, 2.70±0.40 and 2.67±0.43 months (t=7.608, P<0.05; t=6.442, P<0.05; t=6.755, P<0.05; t=5.237, P<0.05). All the patients received EBUS-TBNA under local anesthesia, and evident adverse effects were not observed. They were followed up for 2 years, and recurrence was not noted. CONCLUSIONS: As compared to systemic chemotherapy, EBUS-TBNA guided lymph node aspiration and local isoniazid injection combined with systemic chemotherapy may significantly improve the therapeutic efficacy, which provides a new, safe and reliable management for the refractory MTLA.


Assuntos
Neoplasias Pulmonares , Tuberculose dos Linfonodos , China , Humanos , Isoniazida/uso terapêutico , Mediastino , Estudos Retrospectivos , Tuberculose dos Linfonodos/tratamento farmacológico
20.
Chemotherapy ; 66(3): 87-91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33784668

RESUMO

Ruxolitinib side effects include the most frequent hematological toxicity along with a more recently evidenced immunosuppressive activity, interfering both with the innate and adaptive immunity, and several cases of reactivation of latent infections by opportunistic agents in patients in treatment with ruxolitinib have been published in the last years. Several pathophysiological mechanisms may explain an association between ruxolitinib and opportunistic infections. From what we know, the only case of an isolated lymph node TBC reactivation in a ruxolitinib-treated myelofibrosis (MF) patient was reported by Patil et al. in 2016 [Int J Med Sci Public Health. 2017;6(3):1]. Other 10 cases describing TBC reactivations in MF patients assuming ruxolitinib and successfully treated with 4-drug anti-TBC therapy are available in the literature to date. The case we reported describes an isolated lymph nodal TBC reactivation in a patient with the diagnosis of post-essential thrombocythemia-MF during ruxolitinib treatment after a long course of interferon-a (IFN-α2b) assumed for the previous diagnosis of ET. The case we report teaches that lymphadenopathy with or without constitutional symptoms developing during ruxolitinib therapy should be considered as a possible manifestation of a TBC reactivation in patients with a previous positive TBC-exposure test. In these cases, Ziel-Nielsen testing on urine and sputum has to be performed to rule out infectiousness and eventually isolate the patient. Moreover, previous long-time exposition to IFN-α2b may be related with a higher risk for TBC reactivation in these subset of patients. We encourage reevaluation of the cohorts of patients treated with ruxolitinib in previous and current large prospective studies to study the possible correlation between previous exposition to IFN-α2b and TBC reactivation.


Assuntos
Mielofibrose Primária/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis/uso terapêutico , Tuberculose dos Linfonodos/etiologia , Adulto , Feminino , Humanos , Janus Quinase 2/antagonistas & inibidores , Janus Quinase 2/genética , Janus Quinase 2/metabolismo , Mielofibrose Primária/etiologia , Inibidores de Proteínas Quinases/efeitos adversos , Pirazóis/efeitos adversos , Trombocitemia Essencial/complicações , Trombocitemia Essencial/diagnóstico , Tuberculose dos Linfonodos/diagnóstico
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