Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 905
Filtrar
1.
PLoS One ; 15(1): e0224445, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978149

RESUMO

Availability of trained radiologists for fast processing of CXRs in regions burdened with tuberculosis always has been a challenge, affecting both timely diagnosis and patient monitoring. The paucity of annotated images of lungs of TB patients hampers attempts to apply data-oriented algorithms for research and clinical practices. The TB Portals Program database (TBPP, https://TBPortals.niaid.nih.gov) is a global collaboration curating a large collection of the most dangerous, hard-to-cure drug-resistant tuberculosis (DR-TB) patient cases. TBPP, with 1,179 (83%) DR-TB patient cases, is a unique collection that is well positioned as a testing ground for deep learning classifiers. As of January 2019, the TBPP database contains 1,538 CXRs, of which 346 (22.5%) are annotated by a radiologist and 104 (6.7%) by a pulmonologist-leaving 1,088 (70.7%) CXRs without annotations. The Qure.ai qXR artificial intelligence automated CXR interpretation tool, was blind-tested on the 346 radiologist-annotated CXRs from the TBPP database. Qure.ai qXR CXR predictions for cavity, nodule, pleural effusion, hilar lymphadenopathy was successfully matching human expert annotations. In addition, we tested the 12 Qure.ai classifiers to find whether they correlate with treatment success (information provided by treating physicians). Ten descriptors were found as significant: abnormal CXR (p = 0.0005), pleural effusion (p = 0.048), nodule (p = 0.0004), hilar lymphadenopathy (p = 0.0038), cavity (p = 0.0002), opacity (p = 0.0006), atelectasis (p = 0.0074), consolidation (p = 0.0004), indicator of TB disease (p = < .0001), and fibrosis (p = < .0001). We conclude that applying fully automated Qure.ai CXR analysis tool is useful for fast, accurate, uniform, large-scale CXR annotation assistance, as it performed well even for DR-TB cases that were not used for initial training. Testing artificial intelligence algorithms (encapsulating both machine learning and deep learning classifiers) on diverse data collections, such as TBPP, is critically important toward progressing to clinically adopted automatic assistants for medical data analysis.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Tuberculose/diagnóstico por imagem , Algoritmos , Inteligência Artificial , Bases de Dados Factuais , Aprendizado Profundo , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Tuberculose Extensivamente Resistente a Medicamentos/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/fisiopatologia , Radiografia Torácica/métodos , Radiologistas , Tuberculose/diagnóstico , Tuberculose/fisiopatologia
2.
Praxis (Bern 1994) ; 108(15): 1013-1018, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31771486

RESUMO

Ultrasound Course in Ifakara (Tanzania) with Case Studies Abstract. Presentation of two practical cases from the ultrasound course in Ifakara, Tanzania. Case 1 shows the diagnostic value of abdominal and thorax ultrasound in a polytraumatized patient with splenic rupture. In case 2 the sonographic signs of pulmonary and extrapulmonary tuberculosis are presented.


Assuntos
Ruptura Esplênica , Tuberculose , Humanos , Ruptura Esplênica/diagnóstico por imagem , Tanzânia , Tuberculose/diagnóstico por imagem , Ultrassonografia
3.
Cochrane Database Syst Rev ; 9: CD012777, 2019 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-31565799

RESUMO

BACKGROUND: Accurate diagnosis of tuberculosis in people living with HIV is difficult. HIV-positive individuals have higher rates of extrapulmonary tuberculosis and the diagnosis of tuberculosis is often limited to imaging results. Ultrasound is such an imaging test that is widely used as a diagnostic tool (including point-of-care) in people suspected of having abdominal tuberculosis or disseminated tuberculosis with abdominal involvement. OBJECTIVES: To determine the diagnostic accuracy of abdominal ultrasound for detecting abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals.To investigate potential sources of heterogeneity in test accuracy, including clinical setting, ultrasound training level, and type of reference standard. SEARCH METHODS: We searched for publications in any language up to 4 April 2019 in the following databases: MEDLINE, Embase, BIOSIS, Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Conference Proceedings Citation Index- Science (CPCI-S), and also ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform to identify ongoing trials. SELECTION CRITERIA: We included cross-sectional, cohort, and diagnostic case-control studies (prospective and retrospective) that compared the result of the index test (abdominal ultrasound) with one of the reference standards. We only included studies that allowed for extraction of numbers of true positives (TPs), true negatives (TNs), false positives (FPs), and false negatives (FNs). Participants were HIV-positive individuals aged 15 years and older. A higher-quality reference standard was the bacteriological confirmation of Mycobacterium tuberculosis from any clinical specimen, and a lower-quality reference standard was a clinical diagnosis of tuberculosis without microbiological confirmation. We excluded genitourinary tuberculosis. DATA COLLECTION AND ANALYSIS: For each study, two review authors independently extracted data using a standardized form. We assessed the quality of studies using a tailored Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We used the bivariate model to estimate pooled sensitivity and specificity. When studies were few we simplified the bivariate model to separate univariate random-effects logistic regression models for sensitivity and specificity. We explored the influence of the type of reference standard on the accuracy estimates by conducting separate analyses for each type of reference standard. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 11 studies. The risks of bias and concern about applicability were often high or unclear in all domains. We included six studies in the main analyses of any abnormal finding on abdominal ultrasound; five studies reported only individual lesions.The six studies of any abnormal finding were cross-sectional or cohort studies. Five of these (83%) were conducted in low- or middle-income countries, and one in a high-income country. The proportion of participants on antiretroviral therapy was none (1 study), fewer then 50% (4 studies), more than 50% (1 study), and not reported (5 studies). The first main analysis, studies using a higher-quality reference standard (bacteriological confirmation), had a pooled sensitivity of 63% (95% confidence interval (CI) 43% to 79%; 5 studies, 368 participants; very low-certainty evidence) and a pooled specificity of 68% (95% CI 42% to 87%; 5 studies, 511 participants; very low-certainty evidence). If the results were to be applied to a hypothetical cohort of 1000 people with HIV where 200 (20%) have tuberculosis then:- About 382 individuals would have an ultrasound result indicating tuberculosis; of these, 256 (67%) would be incorrectly classified as having tuberculosis (false positives).- Of the 618 individuals with a result indicating that tuberculosis is not present, 74 (12%) would be incorrectly classified as not having tuberculosis (false negatives).In the second main analysis involving studies using a lower-quality reference standard (clinical diagnosis), the pooled sensitivity was 68% (95% CI 45% to 85%; 4 studies, 195 participants; very low-certainty evidence) and the pooled specificity was 73% (95% CI 41% to 91%; 4 studies, 202 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: In HIV-positive individuals thought to have abdominal tuberculosis or disseminated tuberculosis with abdominal involvement, abdominal ultrasound appears to have 63% sensitivity and 68% specificity when tuberculosis was bacteriologically confirmed. These estimates are based on data that is limited, varied, and low-certainty.The low sensitivity of abdominal ultrasound means clinicians should not use a negative test result to rule out the disease, but rather consider the result in combination with other diagnostic strategies (including clinical signs, chest x-ray, lateral flow urine lipoarabinomannan assay (LF-LAM), and Xpert MTB/RIF). Research incorporating the test into tuberculosis diagnostic algorithms will help in delineating more precisely its value in diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Infecções por HIV/complicações , Tuberculose/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Artigo em Chinês | MEDLINE | ID: mdl-31594134

RESUMO

Objective: To establish a CT image radiomics-based prediction model for the differential diagnosis of silicosis and tuberculosis nodules. Methods: A total of 53 patients with silicosis and 89 patients with tuberculosis who underwent routine CT scans in Suzhou Fifth People's Hospital from January to August, 2018 were enrolled in this study. AK/ITK software was used to segment the images to obtain 139 silicosis lesions and 119 tuberculosis lesions. For each lesion image, 396 features were extracted, and feature dimension reduction was applied to select the most characteristic feature subset. Support vector machine (SVM) , feedforward back propagation neural network (FNN-BP) , and random forest (RF) were implemented using R software (Rstudio V1.1.463) , and the algorithm that achieved the largest area under of the receiver operating characteristic (ROC) curve (AUC) was selected as the final prediction model. Results: RF was the best prediction model for the differential diagnosis of silicosis and tuberculosis nodules, with an accuracy of 83.1%, a sensitivity of 0.76, a specificity of 0.9, and an AUC of 0.917 (95% confidence interval: 0.8431-0.9758) . RF had a significantly larger AUC than SVM and FNN-BP (P<0.05) . Conclusion: CT image-based RF prediction model can be used to differentially diagnose silicosis and tuberculosis nodules.


Assuntos
Silicose/diagnóstico por imagem , Tuberculose/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Interpretação de Imagem Assistida por Computador , Modelos Teóricos , Curva ROC , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios X
6.
J Med Case Rep ; 13(1): 191, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31230590

RESUMO

BACKGROUND: We describe a patient copresenting with epilepsia partialis continua, tuberculosis, and hemophagocytic lymphohistiocytosis. To our knowledge, this is the first documented case of this triad. CASE PRESENTATION: A 54-year-old black South African woman presented to a hospital in Scotland with an acute history of right-sided facial twitching, breathlessness, and several months of episodic night sweats. Clinical examination revealed pyrexia and continuous, stereotyped, right-sided facial contractions. These worsened with speech and continued through sleep. A clinical diagnosis of epilepsia partialis continua was made, and we provide a video of her seizures. Computed tomographic imaging of the chest and serous fluid analyses were consistent with a diagnosis of disseminated Mycobacterium tuberculosis. An additional diagnosis of hemophagocytic lymphohistiocytosis was made following the identification of pancytopenia and hyperferritinemia in peripheral blood, with hemophagocytosis evident in bone marrow investigation. We provide images of her hematopathology. The patient was extremely unwell and was hospitalized for 6 months, including two admissions to the intensive care unit for ventilatory support. She was treated successfully with high doses of antiepileptic drugs (benzodiazepines, levetiracetam, and phenytoin) and 12 months of oral antituberculosis therapy, and she underwent chemotherapy with 8 weeks of etoposide and dexamethasone for hemophagocytic lymphohistiocytosis, followed by 12 months of cyclosporine and prednisolone. CONCLUSIONS: This combination of pathologies is unusual, and this case report helps educate clinicians on how such a patient may present and be managed. A lack of evidence surrounding the coexpression of this triad may represent absolute rarity, underdiagnosis, or incomplete case ascertainment due to early death caused by untreated tuberculosis or hemophagocytic lymphohistiocytosis. Further research is needed.


Assuntos
Epilepsia Parcial Contínua/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Tuberculose/complicações , Epilepsia Parcial Contínua/tratamento farmacológico , Feminino , Humanos , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Pessoa de Meia-Idade , Tuberculose/diagnóstico por imagem , Tuberculose/tratamento farmacológico
7.
Infection ; 47(5): 869-874, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31236899

RESUMO

PURPOSE: There were reports of the occurrence of TB during therapy for leukemia with possible complications. In patients with acute leukemia, therapy might be delayed or complicated by the presence of tuberculosis. METHOD: We present a patient who was diagnosed with acute leukemia and concomitant tuberculosis. RESULTS: The patient's therapy of leukemia had to be delayed and he had relapse of leukemia but was subsequently treated successfully for both diseases despite a prolonged culture positivity for tuberculosis. He required a prolonged course of therapy and additional secondary anti-tuberculosis therapy. CONCLUSIONS: The possibility of tuberculosis should be considered in the differential diagnosis of patients with pneumonia, persistent fever, and those with focal signs or symptoms suggestive of tuberculosis. Despite having a sensitive organism, the infection was difficult to treat, even with the addition of two second-line drugs. The standard anti-tuberculosis therapy is usually adequate, but response may be slow, and inadequate even if the organism is sensitive requiring the addition of second-line agents.


Assuntos
Antituberculosos/uso terapêutico , Leucemia Mieloide Aguda/complicações , Tuberculose/diagnóstico por imagem , Tuberculose/tratamento farmacológico , Doença Aguda , Febre , Humanos , Leucemia Mieloide Aguda/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose/complicações
8.
Int J Infect Dis ; 85: 108-110, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31163270

RESUMO

Tuberculosis of the chest wall represents less than 5% of cases of musculoskeletal tuberculosis. We present the case of a patient with a cold abscess in the pectoral region due to Mycobacterium tuberculosis. A 29-year-old male of Senegalese origin reported a progressive increase in size of the right hemi-thorax without trauma or previous effort. A liquid collection of 14cm on the major axis, between the pectoralis major muscle and the costal wall, was demonstrated on magnetic resonance imaging. Surgical debridement revealed a marked granulomatous inflammatory reaction with focal necrosis; PCR was positive for M. tuberculosis complex and culture subsequently grew M. tuberculosis complex. Specific treatment for tuberculosis achieved a good clinical outcome. The diagnosis of tuberculosis of the chest wall is always difficult, being a clinical challenge.


Assuntos
Abscesso/diagnóstico , Mycobacterium tuberculosis , Parede Torácica , Tuberculose/diagnóstico , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Adulto , Desbridamento , Humanos , Imagem por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico por imagem , Tuberculose/cirurgia
10.
J Med Imaging Radiat Oncol ; 63(3): 329-339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932343

RESUMO

Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.


Assuntos
Tuberculose/diagnóstico por imagem , Humanos , Peritonite Tuberculosa/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Esplênica/diagnóstico por imagem
11.
Nucl Med Commun ; 40(6): 639-644, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932968

RESUMO

BACKGROUND: Mycobacterium tuberculosis (TB) infection is one of the deadliest infectious diseases worldwide and is responsible for 1.7 million deaths per year. The increase in multidrug-resistant TB poses formidable challenges to the global control of tuberculosis. TB infection could easily yield false-positive results in fluorine-18-fluorodeoxyglucose ([F]FDG) PET imaging for cancer detection because of its high [F]FDG uptake. We describe the combined [F]FDG PET with fluorine-18-fluoroacetate ([F]FAC), a promising analog of carbon-11-acetate, for targeting glycolysis and de novo lipogenesis, respectively, to determine the metabolic differences between chronic TB infection and acute infection. MATERIALS AND METHODS: Six-month-old BALB/c mice were inoculated with Mycobacterium bovis to induce chronic TB infection, and Escherichia coli as well as Staphylococcus aureus to induce acute infection for an in-vivo imaging study. Eighteen days after inoculation for chronic TB infection and 5 days for acute infection, both [F]FDG and [F]FAC micro-PET were performed on the infected mice. Analysis of variance and the Tukey honest ad-hoc test were carried out to determine differences among treatment with different bacterial infections. RESULTS: TB infection showed much lower [F] FAC accumulation than acute infection. However, both TB infection and acute infection exhibited high [F]FAC accumulation. CONCLUSION: The marked metabolic differences in de novo lipogenesis and glycolysis in [F]FDG and [F]FAC uptakes in micro-PET imaging, respectively, help to differentiate chronic TB infection from acute infection.


Assuntos
Fluoracetatos , Fluordesoxiglucose F18 , Mycobacterium tuberculosis/fisiologia , Tomografia por Emissão de Pósitrons , Tuberculose/diagnóstico por imagem , Doença Aguda , Animais , Doença Crônica , Diagnóstico Diferencial , Modelos Animais de Doenças , Glicólise , Camundongos , Camundongos Endogâmicos BALB C , Tuberculose/metabolismo
12.
Clin Nucl Med ; 44(6): e406-e408, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932977

RESUMO

The present article presented a 47-year-old woman with areas of nodular swelling and discoloration involving bilateral lower limbs since 12 months. Biopsy from skin lesions revealed erythema nodosum. As erythema nodosum can be secondary to multiple etiologies, whole-body F-FDG PET/CT was performed to assess the disease distribution and guide the site of biopsy. F-FDG PET/CT revealed metabolically active mediastinal lymphadenopathy in addition to the skin lesions. Endobronchial ultrasound-guided biopsy from subcarinal lymph node revealed tuberculosis.


Assuntos
Eritema Nodoso/etiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/diagnóstico por imagem , Eritema Nodoso/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Pele/patologia , Tuberculose/complicações
14.
PLoS One ; 14(4): e0215297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995284

RESUMO

PURPOSE: To longitudinally evaluate the visual function and structure of patients taking ethambutol by various modalities and identify useful tests for detection of subclinical ethambutol-induced optic toxicity. METHODS: This retrospective study enrolled 84 patients with newly diagnosed tuberculosis treated with ethambutol. Best-corrected visual acuity (BCVA), color vision, contrast sensitivity, fundus and retinal nerve fiber layer (RNFL) photography, automated visual field (VF) test, and optical coherence tomography (OCT) were performed: prior to starting; every month during administration, and 1 month after stoppage. We longitudinally compared visual function and structure with the baseline and identified the occurrence of subclinical toxicity. RESULTS: BCVA, color vision, and contrast sensitivity showed no change from the baseline. Mean temporal RNFL thickness was significantly increased at 6 months (p = 0.014). Subclinical toxicity was found in 22 eyes of 14 patients (i.e., 13% of 168 eyes), in the forms of VFI decrease (VF index, 9 eyes of 6 patients), quadrant RNFL thickness increase (5 eyes of 4 patients), and VF pattern defect (12 eyes of 6 patients). 73% of the patients showed recovery to the baseline at 1 month post-stoppage. The risk factors for occurrence of subclinical toxicity were age, cumulative dose, and medication duration. CONCLUSION: Mean temporal RNFL thickness increased after administration. The VFI, quadrant RNFL thickness, and VF pattern defect could prove useful in assessment of subclinical toxicity. Medication duration was shown to be a strong risk factor for occurrence of subclinical toxicity.


Assuntos
Percepção de Cores/efeitos dos fármacos , Sensibilidades de Contraste/efeitos dos fármacos , Etambutol , Tomografia de Coerência Óptica , Tuberculose , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Etambutol/administração & dosagem , Etambutol/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , /patologia , Tuberculose/diagnóstico por imagem , Tuberculose/tratamento farmacológico , Tuberculose/patologia , Tuberculose/fisiopatologia , Testes de Campo Visual
15.
Int J Mycobacteriol ; 8(1): 101-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860188

RESUMO

Despite the high prevalence of tuberculosis (TB) in developing countries, primary pancreatic TB is a rare entity. We present a case of pancreatic TB in an immunocompetent patient who was found to have pancreatic mass resembling malignancy. A 40-year-old Indian male presented to the medical emergency room with complaints of abdominal pain and fever for 2 weeks' duration. He had a history of unintentional weight loss of about 20 pounds in the past 2 months. There was no significant history of exposure to TB patient. Family history was unremarkable for any malignancy. On examination, the significant finding was epigastric tenderness. He was thoroughly investigated, his purified protein derivative and QuantiFERON were negative. Chest X-ray was unremarkable. Computed tomography scan abdomen was performed that revealed large heterogenous necrotic mass in the lesser sac likely arising from pancreatic body with possible infiltration of the stomach, left lobe of the liver and encasing celiac vessels and portal vein with multiple peripancreatic and retroperitoneal necrotic lymph nodes. Endoscopic ultrasound with fine-needle aspiration of pancreatic mass was done, biopsy specimen revealed the presence of inflammation with no evidence of malignancy. TB polymerase chain reaction and culture came positive for Mycobacterium tuberculosis. He was started on antituberculosis treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol with a plan to continue for total 6 months. However, follow-up of the patient could not be done as he traveled back to his home country.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Pâncreas/patologia , Pancreatopatias/diagnóstico , Pancreatopatias/patologia , Tuberculose/diagnóstico , Tuberculose/patologia , Adulto , Antituberculosos/administração & dosagem , Biópsia , Biópsia por Agulha Fina , Quimioterapia Combinada , Endossonografia , Humanos , Linfonodos/patologia , Masculino , Pâncreas/diagnóstico por imagem , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/tratamento farmacológico , Reação em Cadeia da Polimerase , Catar , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagem , Tuberculose/tratamento farmacológico
16.
Clin Nucl Med ; 44(4): e294-e295, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30762817

RESUMO

We present a case of a 22-year-old man with history of allogenic renal transplantation on immunosuppression, who underwent F-FDG-PET/CT to characterize a lesion in the transplanted kidney on ultrasonogram and contrast-enhanced computed tomography imaging. PET/CT revealed FDG avid lesion in the transplanted kidney and mural thickening involving the distal ileum, ileocecal junction, and ileocolic lymph nodes. Subsequent histopathological examination from the renal lesion revealed renal cell carcinoma in the transplanted kidney. Additionally, endoscopic biopsy from the ileal thickening revealed granulomatous inflammation, suggesting tuberculosis, which was missed on both ultrasonogram and contrast-enhanced CT imaging.


Assuntos
Carcinoma de Células Renais/terapia , Fluordesoxiglucose F18 , Intestinos/microbiologia , Neoplasias Renais/terapia , Transplante de Rim , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/complicações , Biópsia , Carcinoma de Células Renais/complicações , Endoscopia , Humanos , Neoplasias Renais/complicações , Masculino , Tuberculose/diagnóstico por imagem , Tuberculose/patologia , Adulto Jovem
17.
PLoS One ; 14(2): e0212094, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30811445

RESUMO

Tuberculosis is an infectious disease that causes ill health and death in millions of people each year worldwide. Timely diagnosis and treatment is key to full patient recovery. The Microscopic Observed Drug Susceptibility (MODS) is a test to diagnose TB infection and drug susceptibility directly from a sputum sample in 7-10 days with a low cost and high sensitivity and specificity, based on the visual recognition of specific growth cording patterns of M. Tuberculosis in a broth culture. Despite its advantages, MODS is still limited in remote, low resource settings, because it requires permanent and trained technical staff for the image-based diagnostics. Hence, it is important to develop alternative solutions, based on reliable automated analysis and interpretation of MODS cultures. In this study, we trained and evaluated a convolutional neural network (CNN) for automatic interpretation of MODS cultures digital images. The CNN was trained on a dataset of 12,510 MODS positive and negative images obtained from three different laboratories, where it achieved 96.63 +/- 0.35% accuracy, and a sensitivity and specificity ranging from 91% to 99%, when validated across held-out laboratory datasets. The model's learned features resemble visual cues used by expert diagnosticians to interpret MODS cultures, suggesting that our model may have the ability to generalize and scale. It performed robustly when validated across held-out laboratory datasets and can be improved upon with data from new laboratories. This CNN can assist laboratory personnel, in low resource settings, and is a step towards facilitating automated diagnostics access to critical areas in developing countries.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Microscopia , Tuberculose/diagnóstico por imagem , Antituberculosos/farmacologia , Automação , Humanos , Tuberculose/tratamento farmacológico
18.
Turk Patoloji Derg ; 35(2): 128-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30632120

RESUMO

OBJECTIVE: Granulomatous mastitis is a rare inflammatory condition of the breast clinically mimicking breast carcinoma and pyogenic abscess, thereby creating a diagnostic dilemma. Tuberculous mastitis is a rare clinical entity accounting for approximately 3% of all mammary lesions. All cases of granulomatous mastitis diagnosed cytologically over a period of 3 years were evaluated to ascertain the cases with tuberculous etiology. MATERIAL AND METHOD: Fine needle aspiration cytology of the breast lump was performed and all the cytological parameters were evaluated. Wherever histopathology was available, the diagnosis was confirmed on Hematoxylin & Eosin stained sections and the Ziehl Neelsen (ZN) stain was applied. RESULTS: A total of 10 cases of granulomatous mastitis were diagnosed on cytology during the 3-year period. On cytological smears, four cases showed presence of ill-formed granulomas and one case had scattered epithelioid histiocytes; however, the rest of the cases had well-formed granulomas. Finally, four out of ten cases were labeled as tuberculous mastitis based on the ZN stain/Tuberculosis-Polymerase chain reaction (TB-PCR) and the other six cases were granulomatous mastitis. CONCLUSION: Cytology plays a significant role in the diagnosis of granulomatous mastitis. This study re-emphasizes the role of the cytopathologist in the accurate and early diagnosis of these lesions so that unnecessary surgery can be avoided, and also highlights the fact that all granulomatous mastitis cases are not tuberculous.


Assuntos
Mastite Granulomatosa/patologia , Tuberculose/patologia , Abscesso/diagnóstico por imagem , Abscesso/patologia , Adulto , Biópsia por Agulha Fina , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Fibroadenoma/diagnóstico por imagem , Fibroadenoma/patologia , Mastite Granulomatosa/diagnóstico por imagem , Mastite Granulomatosa/cirurgia , Humanos , Pessoa de Meia-Idade , Tuberculose/diagnóstico por imagem , Ultrassonografia Mamária
19.
BMC Cancer ; 19(1): 5, 2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606144

RESUMO

BACKGROUND: The present study aims to assess the performance of 18F-FDG PET-CT on mediastinal staging of non-small cell lung cancer (NSCLC) in a location with endemic granulomatous infectious disease. METHODS: Diagnostic test study including patients aged 18 years or older with operable stage I-III NSCLC and indication for a mediastinal lymph node biopsy. All patients underwent a 18F-FDG PET-scan before invasive mediastinal staging, either through mediastinoscopy or thoracotomy, which was considered the gold-standard. Surgeons and pathologists were blinded for scan results. Primary endpoint was to evaluate sensitivity, specificity and positive and negative predictive values of PET-CT with images acquired in the 1st hour of the exam protocol, using predefined cutoffs of maximal SUV, on per-patient basis. RESULTS: Overall, 85 patients with operable NSCLC underwent PET-CT scan followed by invasive mediastinal staging. Mean age was 65 years, 49 patients were male and 68 were white. One patient presented with active tuberculosis and none had HIV infection. Using any SUV_max > 0 as qualitative criteria for positivity, sensitivity and specificity were 0.87 and 0.45, respectively. Nevertheless, even when the highest SUV cut-off was used (SUV_max ≥5), specificity remained low (0.79), with an estimated positive predictive value of 54%. CONCLUSIONS: Our findings are in line with the most recent publications and guidelines, which recommend that PET-CT must not be solely used as a tool to mediastinal staging, even in a region with high burden of tuberculosis. TRIAL REGISTRATION: The LACOG 0114 study was registered at ClinicalTrials.gov , before study initiation, under identifier NCT02664792.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/diagnóstico por imagem , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/patologia , Testes Diagnósticos de Rotina/métodos , Doenças Endêmicas , Feminino , Humanos , Masculino , Mediastinoscopia , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/patologia
20.
Rheumatol Int ; 39(2): 345-351, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30607506

RESUMO

This report presents a case of co-occurrence of Takayasu arteritis (TA) and multiorgan tuberculosis (TB) in a 20-year-old female and provides a review of 18 previously reported cases of co-occurring TA and TB. All patients were between 9 and 24 years of age. Most reports describe a concomitant diagnosis of active TB and TA. TB lymphadenitis was described in 11 cases (57.9%), and microbiologically confirmed in 4 of these. All patients received antituberculous therapy and most received corticosteroids (89.5%). In our and two other cases, TA relapses necessitating additional immunosuppressive therapy were observed.


Assuntos
Arterite de Takayasu/tratamento farmacológico , Tuberculose/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Tuberculose/complicações , Tuberculose/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA