Probable cases of tuberculosis in Early Medieval pastoralists of Eastern Europe.

Two anthropological collections of the 8-9th century AD from the forest-steppe area of the southern Eastern Europe has been the subject of analysis of the osteo-articular alterations concerning tuberculosis related lesions. According to archaeological data, the Mayaki and Dmitrievka groups are from the territory of Khazar Khaganate, which is well-known by historical data. It was a traditional population with settled pastoral farming. There were studied 292 adult human remains by macroscopic morphological and radiological methods. The completeness of the skeletons could have been better due to the intentional selection of their parts for the museum funds, so there were limitations for the differential diagnosis of TB by morphological criteria. In general, 31 individuals (20 men, 11 women) were marked as possible candidates with skeletal TB. The number of skeletons with possible specific infections from the two series is comparable, but according to sex distribution, there are some significant differences. If in the Dmitrievka group, there was approximately the same distribution of the number of cases of possible infected men and women; in the Mayaki group then there was a significant difference in the prevalence of the male sample. Various reasons can explain the observed differences. Firstly, we cannot rule out an error in the diagnosis of tuberculosis only by morphological methods since the preservation of the skeletons leaves much to be desired. Secondly, as it is known, only a few percent of tuberculosis patients show skeletal alterations, so the direct quantitative comparison cannot be adequate in paleopathological studies. The ambiguity of morphological criteria, particularly for destructive lesions of bone other than vertebrae, does not allow asserting that all identified cases result from TB. However, the results of differential diagnosis can underline that at least half of the skeletons have skeletal alterations most likely related to TB. The final analysis of the remains by aDNA methods will permit more certain confirmation of the diagnosis.

Disseminated tuberculosis after anti-TNF alpha treatment: Do not blindly trust the IGRA test / Tuberculosis diseminada tras tratamiento anti-TNF alfa: no confíe ciegamente en la prueba IGRA

Introduction: Interferon gamma release assay (IGRA) is used to detect latent tuberculosis prior to biological treatments in the context of suspected inflammatory rheumatism. Methods: We report the case of a 50-year-old woman with negative IGRA test before adalimumab introduction for presumed axial spondyloarthritis. Results: The worsening of symptoms under treatment led to further investigations and the diagnostic of disseminated tuberculosis (TB) was later established with miliary and multiple bone locations such as spondylitis and sacroilitis. The patient's history revealed past exposure to tuberculosis. This observation illustrates the limitations of IGRA in such situation due to its variable performance for active TB diagnosis. Conclusion: Misdiagnosis is frequent in bone tuberculosis due to non-specific signs. We draw the attention to the importance of a global risk assessment prior to the introduction of biological treatment for suspected chronic inflammatory rheumatism and recall the risk factors for false-negative IGRA. An extended treatment course may be necessary after exposure to anti-TNF-alpha.(AU)

Introducción: El ensayo de liberación de interferón gamma (IGRA) se utiliza para detectar tuberculosis latente antes de los tratamientos biológicos en el contexto de sospecha de reumatismo inflamatorio. Métodos: Presentamos el caso de una mujer de 50 años con IGRA negativo antes de la introducción de adalimumab por presunta espondiloartritis axial. Resultados: El empeoramiento de los síntomas bajo tratamiento llevó a nuevas investigaciones y posteriormente se estableció el diagnóstico de tuberculosis (TB) diseminada con localizaciones pulmonar y óseas múltiples como espondilitis y sacroilitis. La historia de la paciente reveló una exposición pasada a la TB. Esta observación ilustra las limitaciones del IGRA en tal situación debido a su rendimiento variable para el diagnóstico de la TB activa. Conclusiones: El diagnóstico erróneo es frecuente en la TB ósea debido a signos inespecíficos. Llamamos la atención sobre la importancia de una evaluación de riesgo global antes de la introducción de un tratamiento biológico para la sospecha de reumatismo inflamatorio crónico, y recordamos los factores de riesgo para falsos negativos del IGRA. Puede ser necesario un curso de tratamiento prolongado después de la exposición al tratamiento anti-TNF-alfa.(AU)

Poncet's Disease (Reactive Arthritis Associated with Tuberculosis).

An 82-year-old man with miliary tuberculosis was admitted to our hospital. Approximately six weeks after starting anti-tuberculosis treatment, he complained of pain in the fingers, wrists, and ankles. A histopathological examination of the synovial biopsy revealed nonspecific chronic inflammation with no granulomas. Culture of the biopsy specimen yielded no acid-fast bacilli. Poncet's disease was diagnosed based on the clinical presentation, with no findings suggestive of other diseases. His joint pain rapidly improved with steroid therapy. Tuberculosis can cause arthritis through immune-mediated mechanisms without direct invasion in an entity known as Poncet's disease.

Trends in incidence of extrapulmonary tuberculosis in children in the Czech Republic in the past 35 years.

OBJECTIVE: Extrapulmonary tuberculosis (EPTB) in children globally represents a proportion of all cases of tuberculosis, reaching 20% according to published reports. Children are at a higher risk for disseminated TB and extrapulmonary forms. The most prevalent clinical presentations of EPTB in children worldwide are peripheral lymphadenitis and osteoarticular TB. Peritoneal, urogenital, or meningeal tuberculosis is less frequent, and their diagnosis is often difficult. The aim of the study was the determination of EPTB incidence in children in a low-prevalence region over 35 years. METHODS: Descriptive retrospective study of the incidence of EPTB in children and adolescents (aged 0-18 years) in the Czech Republic in the years 1987-2021 as reported in the tuberculosis register. RESULTS: Total amount of EPTB cases was 95. The most prevalent form was extrathoracic lymph node TB. The median age was 10 years. Most patients (84%) were Czechs. None of them died. The ratio of pulmonary and extrapulmonary TB was 79.8% to 20.2%. CONCLUSION: The low incidence of EPTB in Czech children is congruent with a low incidence of TB in the Czech Republic. Our study confirms that the most frequent form of EPTB is peripheral lymph node TB. Our study did not prove a significant change in the trend of EPTB after the cessation of the mandatory Bacillus Calmette-Guerin (BCG) vaccination programme.

Incidence and Mortality of Extrapulmonary Tuberculosis in Ukraine: Analysis of National Surveillance Data.

BACKGROUND: Improved understanding of the epidemiology and mortality risk factors of extrapulmonary tuberculosis (EPTB) may facilitate successful diagnosis and management. METHODS: We analyzed national surveillance data from Ukraine to characterize EPTB subtypes (ie, localized in different anatomic sites). We calculated annual reported incidence, stratified by age, sex, and human immunodeficiency virus (HIV) status. Using Cox regression, we estimated mortality risk factors. RESULTS: Between January 2015 and November 2018, 14 062 adults/adolescents (≥15 years) and 417 children (<15 years) had EPTB with or without concomitant pulmonary TB. The most commonly reported EPTB subtypes were pleural, peripheral lymph node, and osteoarticular. Most EPTB subtype notifications peaked at age 30-39 years and were higher in males. In adults/adolescents, most peripheral TB lymphadenitis, central nervous system (CNS) TB, and abdominal TB occurred in those with untreated HIV. CNS TB notifications in people without HIV peaked before age 5 years. Adults/adolescents with CNS TB (adjusted hazard ratio [aHR]: 3.22; 95% CI: 2.89-3.60) and abdominal TB (aHR: 1.83; 95% CI: 1.59-2.11) were more likely to die than those with pulmonary TB. Children with CNS TB were more likely to die (aHR: 88.25; 95% CI: 43.49-179.10) than those with non-CNS TB. Among adults/adolescents, older age and HIV were associated with death. Rifampicin resistance was associated with mortality in pleural, peripheral lymph node, and CNS TB. CONCLUSIONS: We identified the most common EPTB subtypes by age and sex, patterns of EPTB disease by HIV status, and mortality risk factors. These findings can inform diagnosis and care for people with EPTB.

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis.

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in pastoral communities. It is difficult to differentially diagnose and usually leads to irreversible neurologic deficits and spinal deformities. The initial diagnosis of BS is based on clinical findings and radiographic assessments, and the confirmed diagnosis should be established by the isolation of Brucella species from the blood and/or the standard tube agglutination test. Differential diagnosis of multifocal BS from either degenerative disc diseases or tuberculosis is especially highlighted. The surgical approach, either endoscopic or open, is demonstrated in detail, accompanied by radiographic evidence of structural compression or severe instability. Further, the crucial surgical steps, including single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation, are explained. Moreover, perioperative care and postoperative rehabilitation are also addressed. Taken together, this clinical algorithm presents a practical guide that has yielded substantially satisfactory outcomes in the past decades, which can also be introduced for large-scale application to manage human BS, especially in endemic regions.

Multifocal skeletal tuberculosis with mycobacteremia after kidney transplantation: A case report.

Solid organ transplant recipients have a higher risk of active Mycobacterium tuberculosis infection (TB) compared to the general population. Recognized risk factors are immunosuppressant use, graft dysfunction, diabetes mellitus, liver disease caused by the hepatitis C virus, and co-infections by other opportunists. Most of the active TB cases reported in solid organ transplant recipients occur in kidney transplant patients, especially if they come from M tuberculosis-endemic areas. Extrapulmonary and disseminated TB are among the wide spectrum of clinical presentations found, but the lungs are the most common organ affected. Disseminated disease occurs in up to a third of the affected population, however, multifocal osteoarticular TB with mycobacteremia is unusual. We report the case of a kidney transplant patient with disseminated M tuberculosis infection, who presented with multifocal skeletal TB.

Tuberculosis musculoesquelética que imita neoplasia de tejidos blandos: A propósito de dos casos / Musculoskeletal Tuberculosis mimicking soft tissue neoplasms: report of two cases

Resumen La tuberculosis (TB) es una de las enfermedades infecciosas con mayor carga de morbimortalidad a nivel mundial,la presentación pulmonar es la forma más común, sin embargo, las manifestaciones extrapulmonares, especialmente las osteoarticulares, pueden ser difíciles de diagnosticar debido a sus síntomas inespecíficos sugestivos de otras entidades como neoplasias o enfermedades infiltrativas, lo que hace de su diagnóstico un reto clínico. Está enfermedad esta asociada a múltiples factores de riesgo como inmunosupresión, contacto cercano con pacientes con tuberculosis, hacinamiento, residir en zona endémica, entre otros. A continuación, se presentan dos casos de pacientes pediátricos sin compromiso inmune que cursaron con cuadros sugestivos de neoplasias musculoesqueleticas, con hallazgos imagenológicos congruentes, pero con estudios microbiológicos positivos para TB.

Abstract Tuberculosis (TB) is one of the infectious diseases with the highest burden of morbidity and mortality worldwide. Pulmonary presentation is the most common, however, extrapulmonary manifestations, especially osteoarticular, can be difficult to diagnose due to their nonspecific symptoms suggestive of other entities such as neoplasms or infiltrative diseases. Tuberculosis is also associated with multiple risk factors, especially immunosuppression, and among others, household contact with patients with tuberculosis or residing in an endemic area. We present two pediatric patients without immunecompromise, with clinical history suggestive of musculoskeletal neoplasms, with congruent imaging findings, but with positive microbiological studies for TB.

Tuberculosis en húmero proximal. Un diagnóstico infrecuente en infecciones articulares / Tuberculosis in the proximal humerus. A rare diagnosis in joint infections

Resumen La incidencia de Tb osteoarticular es mucho menor que la pulmonar, representando 1-2% de los casos de Tuberculosis (Tb) y el 10% de los casos de Tb extrapulmonar, por lo que usualmente no es considerada para el diagnóstico diferencial de pacientes con enfermedad articular. Su diagnóstico es difícil y se basa en hallazgos clínicos, radiológicos, bacteriológicos e histológicos. Las lesiones extrapulmonares son paucibacilares y las muestras, en la mayoría de los casos, difíciles de obtener, por lo que el diagnóstico a menudo es simplemente presuntivo. La tuberculosis articular en etapas tempranas, presenta manifestaciones clínicas e imagenológicas inespecíficas. Esto puede facilitar la progresión de la enfermedad local, generando lesiones osteoarticulares graves y, finalmente, la destrucción articular. Se presenta el caso de una paciente de 60 años, intervenida quirúrgicamente por presentar manifestaciones clínicas e imagenológicas compatibles con una ruptura del manguito rotador, y cuya evolución tórpida posoperatoria, llevó al diagnóstico bacteriológico de tuberculosis de húmero proximal.

Abstract The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspecific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.

[Tuberculosis in the proximal humerus. A rare diagnosis in joint infections]. / Tuberculosis en húmero proximal. Un diagnóstico infrecuente en infecciones articulares.

The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiologica l, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspe cific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.

La incidencia de Tb osteoarticular es mucho menor que la pulmonar, representando 1-2% de los casos de Tuberculosis (Tb) y el 10% de los casos de Tb extrapulmonar, por lo que usualmente no es considerada para el diagnóstico diferencial de pacientes con enfermedad articular. Su diagnóstico es difícil y se basa en hallazgos clínicos, radiológicos, bacteriológicos e histológicos. Las lesiones extrapulmonares son paucibacilares y las muestras, en la mayoría de los casos, difíciles de obtener, por lo que el diagnóstico a menudo es simplemente presuntivo. La tuberculosis articular en etapas tempranas, presenta manifestaciones clínicas e imagenológicas inespecíficas. Esto puede facilitar la progresión de la enfermedad local, generando lesiones osteoarticulares graves y, finalmente, la destrucción articular. Se presenta el caso de una paciente de 60 años, intervenida quirúrgicamente por presentar manifestaciones clínicas e imagenológicas compatibles con una ruptura del manguito rotador, y cuya evolución tórpida posoperatoria, llevó al diagnóstico bacteriológico de tuberculosis de húmero proximal.

Tuberculosis vertebral con afectación pleural: reporte de un caso / Spinal tuberculosis with pleural involvement: a case report

Resumen La tuberculosis extrapulmonar representa hasta el 25% de todos los casos de tuberculosis. Los órganos más frecuentemente afectados son los ganglios linfáticos y la pleura. Alrededor del 10-11% de casos de tuberculosis extrapulmonar tienen afectación osteoarticular y de ellos la mitad con compromiso vertebral. La infección es causada por la diseminación hematógena del bacilo desde un foco primario al hueso esponjoso de los cuerpos vertebrales torácicos o lumbares principalmente. El síntoma característico es el dolor crónico de la columna vertebral, generalmente en el sitio afectado, sin otros síntomas o signos concomitantes. La asociación de tuberculosis vertebral con afectación pleural sin un foco pulmonar establecido es infrecuente, se ha descrito en 2.5% de pacientes e intriga acerca de su fisiopatología. En Colombia, no se encontraron reportes similares. Se describe el caso de una paciente joven con historia de dolor lumbar crónico que debutó con síntomas respiratorios persistentes asociado a síntomas constitucionales; en quien se comprobó la infección por Mycobacterium tuberculosis en vértebras toracolumbares y pleura. Este caso evidencia una historia natural atípica de la enfermedad, en la cual el mecanismo fisiopatológico parece haber sido la diseminación directa por contigüidad, y resalta la importancia de la sospecha clínica para garantizar un diagnóstico y tratamiento oportuno. MÉD.UIS.2020;33(3): 67-73

Abstract Extrapulmonary tuberculosis represents up to 25% of all cases of tuberculosis. The most frequently affected organs are lymph nodes, pleura and bone. Around 10-11% of cases of extrapulmonary tuberculosis have osteoarticular involvement and a half of them present vertebral involvement. The infection is caused by hematogenous spread of the bacillus from a primary focus to the cancellous bone of the thoracic or lumbar vertebral bodies mainly. The characteristic symptom is the chronic pain in the spine, usually in the affected site, without other concomitant symptoms or signs. The association between vertebral tuberculosis and pleural involvement without an established pulmonary focus is infrequent, it has been described in 2.5% of patients, an intrigue about its pathophysiology. Similar cases in Colombia have not been reported. This article describes a case of a young patient with a history of chronic low back pain that debuts with persistent respiratory symptoms associated with constitutional symptoms; whose Mycobacterium tuberculosis infection was proven in thoracolumbar vertebrae and pleura. This case shows an atypical natural history of the disease, in which the pathophysiological mechanism of the disease would seem to have been the direct dissemination by contiguity, and emphasizes the importance of clinical suspicion to ensure timely diagnosis and treatment. MÉD.UIS.2020;33(3): 67-73

Tuberculous Osteomyelitis Mimicking a Lytic Bone Tumor: Report of Two Cases and Literature Review / Osteomielite tuberculosa imitando um tumor ósseo lítico: Relato de dois casos e revisão da literatura

Abstract Tuberculous osteomyelitis is an uncommon form of tuberculosis (TB); the isolated involvement of the wrist joint is particularly rare. The symptoms and clinical manifestation mimic other conditions; hence, careful diagnosis is required. The authors present two cases of patients presenting with soft tissue mass and a lytic bone lesion. The biopsy revealed granulomatous osteomyelitis. Lesion culture identified Mycobacterium tuberculosis. The authors urge clinicians to include TB as a differential diagnosis when investigating the primary cause of lytic bone lesions, even in the absence of pulmonary symptoms or risk factors of TB infection. The inclusion of mycobacterial cultures when analyzing biopsies of lytic bone lesions is also advised.

Resumo A osteomielite tuberculosa é uma forma incomum de tuberculose (TB) e o acometimento isolado da articulação do punho pelo TB é particularmente raro. Os sintomas e a manifestação clínica imitam outras doenças; portanto, um diagnóstico cuidadoso é necessário. Os autores apresentam dois casos de pacientes com massa nas partes moles e lesão óssea lítica. A biópsia revelou osteomielite granulomatosa. A cultura da lesão identificou Mycobacterium tuberculosis. Os autores recomendam que médicos clínicos incluam a TB como um diagnóstico diferencial da causa primária das lesões ósseas líticas, mesmo na ausência de sintomas pulmonares ou fatores de risco de infecção por TB. A inclusão de culturas micobacterianas na análise de biópsias de lesões ósseas líticas também é recomendada.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Bacteriologically confirmed extra pulmonary tuberculosis and treatment outcome of patients consulted and treated under program conditions in the littoral region of Cameroon.

BACKGROUND: Extra-pulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs. It is frequently a diagnostic and therapeutic challenge with paucity of data available. The aim of this study was to assess the prevalence of bacteriologically confirmed EPTB; to determine the most affected organs and to evaluate the therapeutic outcome of EPTB patients treated under program conditions in the littoral region of Cameroon. METHODS: A descriptive cross-sectional laboratory-based epidemiological survey was conducted from January 2016 to December 2017 and 109 specimens from 15 of the 39 diagnosis and treatment centers in the littoral region were obtained. Two diagnostic methods (Gene Xpert MTB and culture (LJ and MGIT) were used for EPTB diagnosis. Determine HIV1/2 and SD Biolinewere used for HIV diagnosis. Confirmed EPTB cases were treated following the national tuberculosis guide. RESULTS: The prevalence of bacteriologically confirmed EPTB was 41.3% (45). All 45 cases were sensitive to rifampicin. Males were predominately more infected [26 (57.8%)] likewise the age group 31-45 years with 15 (33.3%) cases. The overall prevalence for HIV was 33.6% (36). HIV infection was present in 28.9% (13) of patients with EPTB. The most affected sites with EPTB were: Lymph nodes (66.5%), pleural cavity (15.6%), abdominal organs (11.1%), neuromeningeal (2.2%), joints (2.2%) and heart (2.2%). Overall, 84.4% of the study participants had a therapeutic success with males responding better 57.9% (p = 0.442). Therapeutic success was better (71.7%) in HIV negative EPTB patients (p = 0.787). CONCLUSION: The prevalence of bacteriologically confirmed EPTB patients treated under program conditions in the littoral region of Cameroon is high with a therapeutic success of 84.4% and the lymph nodes is the most affected site.

Tuberculosis of radius diaphysis: Case report and review of literature.

Diaphyseal tuberculosis (TB) is a rare case of the skeletal TB. The following report documents the case of a 52-year-old Moroccan woman with a swelling over the right forearm followed by pulmonary TB under treatment for 3 months. The radiographs of the forearm show a lytic image located at the radius mid-diaphysis. The histopathology confirmed the diagnosis. The patient received surgical drainage with trepanation of the bone. The antibacillary chemotherapy was administered for 6 months. It is, therefore, indispensable to bear in mind the possibility of such atypical presentations of TB when making a rapid and pertinent diagnosis and prescribing the appropriate treatment.

Mycobacterium Tuberculosis Monoarthritis of the Knee in Children: A Case Report.

Mycobacterium tuberculosis monoarthritis is a rare form of TB, occurring in 1-2% of cases in the United States. Delays in definitive diagnosis and subsequent treatment are common. While case reports of tuberculous arthritis have been presented in international literature, there is a relative paucity of literature from within the United States. Given the difficulty in diagnosis and adverse outcomes of delayed diagnosis, we present the case of an 11-year-old otherwise healthy male with isolated monoarticular TB septic arthritis of the right knee. A discussion, including review of current literature, regarding presentation, diagnosis, and treatment of tuberculous monoarthritis follows. The emerging role of arthroscopy as a diagnostic and treatment modality for tuberculous monoarthritis of the knee is discussed. LEVEL OF EVIDENCE: VI.

Evaluation of 257 extra pulmonary tuberculosis cases at the Tuberculosis Control Dispensary, Van, Turkey.

OBJECTIVE: To determine whether there were any changes in demographic and clinical features of extrapulmonary tuberculosis cases. METHODS: This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised records of extrapulmonary tuberculosis patients treated between January 2009 and July 2014 at the tuberculosis control dispensary. Descriptive and clinical data, including age, gender, site of involvement, diagnostic method and coexisting systemic diseases, were noted. Any changes in terms of these parameters were investigated on a year-on-year basis. SPSS 20 was used for data analysis. RESULTS: There were 257 cases detected. Of them, 50(19.45%) related to 2009, 61(23.75%) to 2010, 24(9.33%) to 2011, 50(19.45%) to 2012, 47(18.28%) to 2013 and 25(9.72%) to 2014. Although lymph nodes were by far most frequently affected in 2009, 2010, 2011 and 2013; pleura was most commonly involved in 2012 and 2014. Age and gender distribution displayed no changes between 2009 and 2014 (p>0.05). However, diagnostic method of choice and frequency of co-existent systemic disorders displayed remarkable alterations in this period (p<0.05). CONCLUSIONS: Improved insight of clinicians for atypical demographic and clinical features at presentation may provide reduction of rates of morbidity and mortality due to extrapulmonary tuberculosis.

Manifestaciones tomográficas extrapulmonares de TBCy algunas de sus complicaciones asociadas / Extrapulmonary TB Tomography and some Associated Complications

La Tuberculosis (TBC) es una patología infecto-contagiosa de alta morbimortalidad en Chile y en el mundo, siendo la segunda causa de muerte por cuestión infecciosa y es considerada una patología de alta relevancia a nivel de salud pública. Es causada por una bacteria de alta virulencia y contagio llamada mycobacterium tuberculosis. En la actualidad contamos con protocolos de detección y tratamiento muy eficaces, que la convierten en una enfermedad prevenible y curable. El diagnóstico se realiza con estudios bacteriológicos específicos frente a una sospecha clínica-epidemiológica sugerente. Sin embargo, el uso de imágenes forma parte casi obligatoria de su estudio y control. Debido a que el órgano diana de la TBC es el pulmón, es habitual utilizar como apoyo diagnóstico una radiografía de tórax, la cual es útil, en caso de TBC pulmonar, al presentar hallazgos característicos y orientadores para su diagnóstico. Es importante destacar que el mycobacterium tuberculosis tiene alto potencial de diseminación por contigüidad, vía linfática y/o hematógena, siendo esa última vía la causante de la mayoría de las TBC extrapulmonares, las cuales se presentan en un 20% de pacientes inmunocompetentes y hasta en un 60% de inmunocomprometidos. La principal localización de una TBC extrapulmonar es a nivel pleural, seguida del compromiso ganglionar, urogenital y osteoarticular, siendo el resto de las localizaciones muy infrecuentes. Para esos casos la tomografía computada (TC) es el estudio por imágenes de elección para el diagnóstico y control, además de ser una herramienta muy útil para la detección de complicaciones.

Tuberculosis (TB) is an infectious disease of high morbility and mortality in Chile and in the world. It is the second cause of death due to infectious causes in the world, and is considered of high relevance to public health. TB is caused by a highly pathogenic and virulent bacterium denominated mycobacterium tuberculosis. Nowadays, there are effective protocols for detection and treatment of this disease, which make it preventable and curable. Diagnosis is reached by specific bacteriological studies in the presence of a clinical epidemiological suspicion. Nevertheless, imagining methods are almost an obligatory part of tuberculosis study and control. Since the lung is the target organ of TB, chest X-ray is commonly used as a support for diagnosis, which is very useful in case of pulmonary TB because it provides characteristic findings to guide diagnosis. It is important to highlight that the mycobacterium tuberculosis has a high potential for dissemination by contiguity, via lymphatic and/or haematogenous, the latter being the cause of the majority of extrapulmonary TB, which are presented in 20% of immunocompetent patients and by up to 60% of immunocompromised. The main site of extrapulmonary TB is into the pleural space, followed by the lymph node, urogenital and osteoarticular involvement, the remainder being infrequent localizations. In these cases, a computed tomography (CT) study based on the selection of images, is the tool used for diagnosis and control, which is also useful for the detection of complications.